Animal-related fatalities--part I: characteristic autopsy findings and variable causes of death associated with blunt and sharp trauma

Identifying and documenting osseous trauma from shark attacks by post mortem CT examination and autopsy

A 15-year-old male was attacked by a large white shark while surfing. CT examination revealed an above-knee amputation of the right lower extremity with stripping of soft tissues from the groin distally. 3-dimensional volume rendering did not show any fragments of shark teeth but did reveal linear gouges, areas of shaving of cortical bone and an inverted 'V'-shaped defect at the distal margin of the femoral shaft. At autopsy these injuries were confirmed in addition to areas with fine parallel cross-striations matching the marginal serrations of the teeth of a white shark. Thus, while post mortem CT with 3-dimensional reconstruction at high resolution can show the nature and number of the bony injuries following shark attack, it is complimented by pathological examination which may find fine parallel grooves from teeth serrations. Post mortem 3-dimensional volume rendering may also help to find or exclude fragments of teeth, and silicone casting may provide a permanent record of bone lesions.

"Fighting the Minotaur" a Complex Blunt Chest Trauma Due to a Bull Attack: A Case Report

Bull-related injury continues to contribute to an unacceptable number of serious injuries and deaths, and bullfighting continues to be a popular, deeply traditional celebration of the culture of many Iberic-American countries. Most accidents due to bull attacks are horn-related penetrating traumas. Blunt chest trauma can cause a wide range of clinical presentations and injuries, making the diagnostics and therapies extremely challenging. Consequently, it is vital to quickly identify major life-threatening chest wall and intrathoracic injuries. In this case report, we aimed to describe the complexity of the management and the treatment of a blunt trauma patient hit by a bull.

Forensic odontology: Assessing bite wounds to determine the role of teeth in piscivorous fishes

Teeth facilitate the acquisition and processing of food in most vertebrates. However, relatively little is known about the functions of the diverse tooth morphologies observed in fishes. Piscivorous fishes (fish-eating fish) are crucial in shaping community structure and rely on their oral teeth to capture and/or process prey. However, how teeth are utilized in capturing and/or processing prey remains unclear. Most studies have determined the function of teeth by assessing morphological traits. The behavior during feeding, however, is seldom quantified. Here, we describe the function of teeth within piscivorous fishes by considering how morphological and behavioral traits interact during prey capture and processing. This was achieved through aquarium-based performance experiments, where prey fish were fed to 12 species of piscivorous fishes. Building on techniques in forensic odontology, we incorporate a novel approach to quantify and categorize bite damage on prey fish that were extracted from the piscivore’s stomachs immediately after being ingested. We then assess the significance of morphological and behavioral traits in determining the extent and severity of damage inflicted on prey fish. Results show that engulfing piscivores capture their prey whole and head-first. Grabbing piscivores capture prey tail-first using their teeth, process them using multiple headshakes and bites, before spitting them out, and then re-capturing prey head-first for ingestion. Prey from engulfers sustained minimal damage, whereas prey from grabbers sustained significant damage to the epaxial musculature. Within grabbers, headshakes were significantly associated with more severe damage categories. Headshaking behavior damages the locomotive muscles of prey, presumably to prevent escape. Compared to non-pharyngognaths, pharyngognath piscivores inflict significantly greater damage to prey. Overall, when present, oral jaw teeth appear to be crucial for both prey capture and processing (immobilization) in piscivorous fishes.

Vitale anale Tierfraßverletzung durch einen Dackel

Hundebissverletzungen weisen bei Lebenden in der Regel eine charakteristische Morphologie auf, anhand derer sich die Entstehung gut nachvollziehen lässt. Haben Hunde Zugang zu einer Leiche, so kann es zu postmortalen Tierfraßverletzungen kommen, und das Verletzungsbild kann u. U. auf den ersten Blick auch als Fremdbeibringung durch Dritte missinterpretiert werden.

Vorgestellt wird ein seltener Fall einer Tierfraßverletzung an einer lebenden Person. Eine Mischintoxikation mit Zopiclon und Alkohol im häuslichen Umfeld führte zur Bewusstlosigkeit, die einen ausgedehnten Gewebsdefekt im Analbereich durch Bissverletzungen des eigenen Dackels ermöglichte. Außergewöhnlich ist hierbei neben der vitalen Entstehung auch die Lokalisation der Verletzung.

Crocodile Attack Injuries: A Failed Attempt to Conceal Homicide

Crocodile attacks are not uncommon in this region. There have been 92 cases reported since 2015 and 50 cases alone reported in Sarawak. Every year death has been attributed to a crocodile attack. An estimate of 71% of the total cases of crocodile attack ended up dead. However, there are instances where a crocodile attack happened after the death of a person. This is a case of an adult male who was reported missing. His body was found by two local anglers, being mauled by crocodiles. Only partial trunk and lower limbs were found, and the major organs were absent. The postmortem features of the crocodile attacks have been described.

Death caused by a domestic pig attack

The primary medico-legal investigation goal in deaths due to animal attacks is distinguishing between animal-related injuries and potential homicidal wounds. We report the case of a 49-year-old male found dead in his farm's pigsty, where a sow and her piglets were present. At the postmortem examination, numerous, severe blunt force injuries were observed on the body, with special regard to the upper extremities where massive injuries involving soft tissues, bones, and regional vessels, tendons, and nerves were present. The death resulted from severe bleeding from massive upper extremities injuries due to a domestic pig attack. Domestic pigs are usually placid but they can become aggressive if disturbed and attack humans producing severe injuries due to trampling, kicking and biting. Knowing the relevant anatomy, pattern of attack, and morphologies of wounds produced by particular animals can distinguish animal attacks from homicides, as well as attempt to identify the type of animal involved in an unwitnessed attack.

Camel-Related Deaths-A Forensic Overview

ABSTRACT

Camels are ungulates of the genus Camelus and have been used for centuries in parts of Asia and Africa for transport and sustenance. Handling of camels is not without its dangers, and 4 cases from South Australia are reported with a review of lethal camel-related issues. Case 1 is a 56-year-old man who died of multiple blunt force injuries after he had attempted to move a 7-year-old female dromedary (Camelus dromedarius). Case 2 is a 65-year-old woman who was crushed by 1 or more camels that she had been training. Case 3 is a 1-year-old girl who died of blunt craniocerebral trauma after the car in which she was traveling rolled when the driver swerved to avoid a herd of camels that had strayed onto the road. Case 4 is a 66-year-old woman who died of ischemic and hypertensive cardiac disease exacerbated by physical activity while rounding up camels. Deaths associated with camels involve kicking, stomping, kneeling or sitting on a victim, or biting and shaking and throwing. Lethal mechanisms include hemorrhage from vascular injuries and internal organ disruption, crush asphyxia, and blunt craniospinal injuries. Death may also follow falls from camels or vehicle collisions. Camels also carry a wide range of zoonotic diseases, the most significant of which is Middle Eastern respiratory syndrome. Handling of camels may also exacerbate underlying organic illnesses such as cardiac disease. Those working with camels should be aware that the size, strength, and temperament of these animals may make them dangerous and that they also carry potentially lethal zoonotic diseases.

A Recreational Fishing Death Due to a Jumping Spanish Mackerel (Scomberomorus commerson)

Commercial or recreational fishing may be associated with a wide range of potentially lethal events. We report the case of a 56-year-old man who died of blunt force chest and abdominal trauma after impact with a large Spanish mackerel (Scomberomorus commerson) that had jumped into his recreational fishing boat. Injuries at autopsy included soft tissue bruising with fractured ribs, a ruptured diaphragm, intestinal and mesenteric contusions, contusion and disruption of the pancreas, and hilar splenic lacerations with a left-sided hemothorax and a hematoperitoneum. The clear temporal association of pain and progressive deterioration leading to cardiac arrest after the impact indicated that lethal injuries had been sustained. A variety of fish and cetacean species are known to jump out of the water sometimes to escape predators. It was reported that a large number of jumping fish being pursued by sharks were observed in the harbor on the day of the reported incident. This case demonstrates that lethal blunt abdominothoracic trauma may be caused by impact with Spanish mackerel, increasing the range of potentially dangerous situations that may be encountered while fishing.

Injuries and deaths caused by non-human primate attacks: Paediatric vulnerability

A six-month-old girl was taken from her mother's lap by a macaque monkey (Macaca) that had entered the room through an open door. The monkey escaped with the infant but subsequently dropped her from a rooftop terrace. Death occurred soon after impact with the ground, and was found at autopsy to be due to blunt cranio-cerebral trauma with skull fractures and intracranial haemorrhage. Monkeys and apes may cause a variety of serious and potentially life-threatening injuries and may manifest quite unpredictable and aggressive behaviour around humans. The very young are particularly vulnerable to primate attacks, and 'baby theft' by apes and monkeys is an event that has now been reported, albeit rarely, in a number of different countries around the world. The fatally injured infants have died from bites, falls and drowning. Chimpanzees in the wild may also specifically hunt human infants for food.

Bull horn injury causing traumatic tooth intrusion - ultrasound and CT imaging

Introduction

Traumatic injury to upper alveolus may result in apical displacement of the affected tooth/teeth into the underlying alveolar bone. The tooth while being driven into the socket under the upwardly directed impact force usually causes a crushing fracture of the alveolar socket bone. The tooth may also be displaced through the labial plate of bone or may even impinge upon the bud of the permanent tooth.

Case report

We present a case of tooth intrusion due to bull horn injury and its imaging features on ultrasound and CT scan.

Discussion

Most common teeth involved in dental trauma in children of 6 to 12 year age group, are the maxillary anteriors, and this age group also constitutes the most common group in whom tooth intrusion is seen. Tooth intrusion usually involves a single dental element. Common etiologic causes are injuries, falls, sports accidents, violence and traffic accidents. Traumatic intrusion due to injury by animals is rarely described and is more commonly seen in less developed areas that too in rural set-up where man-animal encounters are frequent.

Conclusion

In such cases, whenever the conventional imaging modalities like the X-rays such as intra oral peri-apical views and orthopantomograms are unavailable, or where use of ionizing radiation is a grave concern (especially in children and pregnant patients), ultrasonography offers a non-invasive diagnostic imaging method which helps in diagnosis of the condition and also helps in supplementing the clinical information, thereby helping in better understanding of the underlying condition.

Fatal mauling by tigers

Lethal injuries due to large animal attack are uncommon in routine forensic practice in Europe. Specifically, few incidents are reported concerning tiger/lion attacks that usually involve captive circus or zoo animals. We present the case of a 61-year old animal tamer who was mauled to death by four tigers while he was training them for a circus performance. Careful investigation of the circumstances surrounding the fatality revealed that the tamer had most likely been struck with a tiger paw and then mauled by additional tigers resulting in serious and fatal injuries. Although a full medico-legal autopsy was not authorized, total body CT scan coupled with post-mortem external examination allowed a reconstruction of events.

Fatal rooster attack

A 76-year-old woman was attacked by a domestic rooster on her rural property while collecting eggs. The bird pecked her lower left leg causing significant hemorrhage with collapse and death. The decedent's past medical history included treated hypertension, hyperlipidemia, non-insulin dependent diabetes mellitus and varicose veins. At autopsy the major findings were limited to the lower left leg which was covered with adherent dried blood. Two small bleeding lacerations were present, one of which was located immediately over a perforated large varix. Death was therefore due to exsanguination from bleeding varicose veins following an attack by a rooster. This case demonstrates that even relatively small domestic animals may be able to inflict lethal injuries in individuals if there are specific vascular vulnerabilities present.

Who is the killer? Barking up the wrong tree

In recent years, several cases of predation on hunting dogs have been reported in Italy. These cases caused uproar among owners and the wolf was singled out as the culprit. The remains of a dog allegedly killed by wolves were submitted for forensic analysis. Wolf predation was ruled out based on gross findings and wild boar aggression was suspected instead. Genetic analysis of salivary swab samples confirmed that wild boars fed on the dog. As poaching is one of the main threats to wolf conservation, it is essential to identify correctly the predator in cases of attacks on domestic animals.

Fatal deer attack in a rutting season

Animal inflicted fatal or near fatal injuries are well described in the forensic literature, with the most frequently described cases involving dogs, large cats and bears. To our knowledge, a deer inflicted fatality has not been described in the forensic literature previously. This article reports a case of a 64-year-old male, who was found lying in a pool of blood near an enclosure for stags and hinds at the end of October. There were mechanical defects on his jacket and trousers, which appeared to be torn or penetrated, as well as multiple lacerations and stab wounds in different parts of his body. The type and location of the injuries the man had sustained strongly suggested that another person had been involved in the incident that had led to his death. The cause of death was deemed as external exsanguination due to multiple stab wounds to large vessels. After evaluating all of the information regarding the circumstances around the death, the case was classified as a deer attack related fatality, and the manner of death was determined to be accidental. The man was most probably attacked by one of the deer while he was refilling the animal feeder. A substantial increase in the levels of selected hormones, especially testosterone, during the rutting season explains the increased levels of aggression shown by the deer that led to a fatal outcome for the decedent.

Mudslide and/or animal attack are more plausible causes and circumstances of death for AL 288 ('Lucy'): A forensic anthropology analysis

Following a global morphological and micro-CT scan examination of the original and cast of the skeleton of Australopithecus afarensis AL 288 ('Lucy'), Kappelman et al. have recently proposed a diagnosis of a fall from a significant height (a tree) as a cause of her death. According to topographical data from the discovery site, complete re-examination of a high-quality resin cast of the whole skeleton and forensic experience, we propose that the physical process of a vertical deceleration cannot be the only cause for her observed injuries. Two different factors were involved: rolling and multiple impacts in the context of a mudslide and an animal attack with bite marks, multi-focal fractures and violent movement of the body. It is important to consider a differential diagnosis of the observed fossil lesions because environmental factors should not be excluded in this ancient archaeological context as with any modern forensic anthropological case.

Autopsy Features of Fatal Donkey Attack

Lethal donkey attacks have very rarely been described. The case of a 65-year-old man who was found deceased on a country road with 2 domestic donkeys nearby is, therefore, reported. Examination of the body revealed contusions and lacerations of the face and scalp, a comminuted fracture of the left maxilla, comminuted fracturing of the right radius and ulna and of the left anterior superior iliac spine, a flail chest, and pulmonary contusions. In addition, there were bite marks on the left thigh, right buttock, right axilla/upper arm, and left cheek which corresponded to the dental arcades of the donkeys. Death had resulted from blunt chest trauma due to an attack by 1 or 2 donkeys. Deaths and serious injuries are much more commonly caused by horses; however, this case shows that even domesticated donkeys may also rarely be capable of inflicting significant trauma and so should be approached with circumspection.

Large batoid fishes frequently consume stingrays despite skeletal damage

The shapes of vertebrate teeth are often used as hallmarks of diet. Here, however, we demonstrate evidence of frequent piscivory by cartilaginous fishes with pebble-like teeth that are typically associated with durophagy, the eating of hard-shelled prey. High-resolution micro-computed tomography observation of a jaw specimen from one batoid species and visual investigation of those of two additional species reveal large numbers of embedded stingray spines, arguing that stingray predation of a scale rivalling that of the largest carnivorous sharks may not be uncommon for large, predatory batoids with rounded, non-cutting dentition. Our observations demonstrate that tooth morphology is not always a reliable indicator of diet and that stingray spines are not as potent a deterrent to predation as normally believed. In addition, we show that several spines in close contact with the jaw skeleton of a wedgefish (Rhynchobatus) have become encased in a disorganized mineralized tissue with a distinctive ultrastructure, the first natural and unequivocal evidence of a callus-building response in the tessellated cartilage unique to elasmobranch skeletons. Our findings reveal sampling and analysis biases in vertebrate ecology, especially with regard to the role of large, predatory species, while also illustrating that large body size may provide an escape from anatomical constraints on diet (e.g. gape size, specialist dentition). Our observations inform our concepts of skeletal biology and evolution in showing that tessellated cartilage-an ancient alternative to bone-is incapable of foreign tissue resorption or of restoring damaged skeletal tissue to its original state, and attest to the value of museum and skeletal specimens as records of important aspects of animal life history.

Blunt injuries related to equestrian sports: results from an international prospective trauma database analysis

INTRODUCTION

The objective of this study was to investigate the nature, management, and outcome of major injuries related to equestrian sports and to define the at-risk groups for serious and life-threatening injuries.

METHODS

We analyzed demographic, pre-hospital, clinical, and outcome data from an international population-based prospective trauma database (TraumaRegister DGU®). Patients with major injuries (Injury Severity Score [ISS] ≥9 points) related to equestrian sports activities were included (January 1, 1993, to December 31, 2012). Clinical and outcome parameters were stratified for four different types of injury mechanisms: fall from horse (FFH), horse-kick (HK), horse crush (HC), and carriage-related accidents (CRA). Participating countries included Germany, Austria, Switzerland, Finland, Slovenia, Belgium, Luxembourg, and The Netherlands. Statistical analyses were performed with SPSS (Version 22, IBM Inc., Armonk, NY).

RESULTS

The Database identified 122,000 documented patients, of whom 679 were equestrian incidents. Among these, the four major injury mechanisms were: FFH (n = 427), HK (n = 188), HC (n = 34), and the CRA (n = 30). Females were more likely to sustain FFH (75.5%, p < 0.001), leading to head injuries (n = 204, 47.8%) and spinal fractures (n = 109, 25.5%). HK injuries often resulted in facial fractures (29.3%, p < 0.001). Individuals sustaining HC injuries had a high risk for pelvic (32.4%, p < 0.001) and abdominal injuries (35.2%, p < 0.001). In contrast to the FFH cohort, the CRA cohort involved older males (57 ± 13 years), with chest (63.3% p = 0.001), and extremity injuries, resulting in significant injury severity (ISS 20.7 ± 10.6). In the CRA cohort, 16% were in haemorrhagic shock on scene, and also the highest in-hospital mortality (14.8%, p = 0.006) was observed.

CONCLUSIONS

Young female riders are at risk from falling, horse-kicks, and crush-injuries. Older males in carriage-related accidents sustained the highest injury severity and mortality rate, and must specifically be targeted by future prevention initiatives. Level of evidence Descriptive Epidemiologic Study, Level II.

A Unique Fatal Moose Attack Mimicking Homicide

Fatalities caused by animal attacks are rare, but have the potential to mimic homicide. We present a case in which a moose attacked and killed a woman who was walking her dog in a forest. Autopsy showed widespread blunt trauma with a large laceration on one leg in which blades of grass were embedded. Flail chest was the cause of death. The case was initially conceived as homicide by means of a riding lawn mower. A review of the case by moose experts and analyses of biological trace material that proved to originate from moose, established the true source of injury. The dog probably provoked a moose, which, in response, stomped and gored the victim to death. The injuries resembled those previously reported from attacks by cattle and water buffalo. Fatal moose attacks constitute an extremely rare threat in boreal areas, but can be considered in traumatic deaths of unknown cause.

Causes and Mechanisms of Death in Fatal Water Buffalo Attacks

Deaths due to buffalo attack have not been well described. A 72-year-old man was trampled by a water buffalo (Bubalus bubalis) while attempting to move the animal within an enclosed area at an abattoir. At autopsy, there were numerous injuries involving the chest, head, neck, and left upper arm. Blunt force injury had resulted in multiple rib fractures with a flail chest and fracture/dislocation of the mid-cervical vertebrae caused either by physical crushing by the animal against the walls of the enclosure or by stomping. There was also evidence of crush asphyxia with bilateral conjunctival hemorrhages and petechial hemorrhages. In addition, there was a deep degloving injury of the upper left arm compatible with goring by one of the buffalo horns. While large animal attacks may result in death from multiple injuries, careful dissection and examination of specific injuries at autopsy may clarify the complex interaction of lethal mechanisms.

Pathological Features of Fatal Crocodile Attacks in Northern Australia, 2005-2014

Eleven deaths from crocodile attacks in the Northern Territory, Australia were reviewed. The male:female ratio was 8:3; age range-10-62 years, average 29.4 years. Four children were included (one boy and three girls, aged 10, 11, and two at 12 years), and there were seven aboriginal victims (64%). The attacks were witnessed in eight cases with the victims swimming in freshwater N = 5, standing on a river bank N = 1, fishing in fresh water N = 1, or diving in the sea N = 1. At autopsy, several distinct patterns of injury were observed ranging from complete traumatic disruption of the body with only incomplete remains for examination (N = 5), to crushing of the head with fractures of the skull (N = 4), crushing of the chest with fractures of the ribs and sternum (N = 2), and avulsion of limbs (N = 4). In one case, there was decapitation. Autopsy evaluations were complicated by decomposition and loss of body parts.

Forensic Veterinary Pathology

Sharp-force injuries are injuries caused by a mechanical force using sharp objects against the skin. Sharp-force injuries are mainly classified as stab, incised, chop, and therapeutic wounds and are less frequent than blunt-force injuries in animals. The analysis of the edges of the wound is crucial, especially if more than one type of lesion is involved. It may be difficult to differentiate between sharp trauma and blunt trauma, because lacerations can resemble incised wounds. The accurate documentation and examination of these injuries may indicate the instrument involved, the relationship between the animal and the perpetrator, and the force of the stab. Situations in which this type of trauma occurs may involve social violence, accidents, hunting, veterinary medical management, and religious rituals. The causes of death related to this type of trauma include hypovolemic shock, pneumothorax, or asphyxiation due to aspiration of blood. Necropsy findings should provide objective and unbiased information about the cause and manner of death to aid the investigation and further judgment of a possible crime.

Fatal Injury Caused by a Ram (Ovis Aries) Attack

Animal-inflicted injuries to humans are a major public health problem around the world resulting in great morbidity, money loss, and mortality. They are related to wild and domestic animals alike. Animals can cause injuries by various mechanisms--biting, stinging, crushing, goring, stomping, butting, kicking, pecking, etc. We present a case of a ram's attack with fatal consequences. A 4-year-old, 120 kg jezersko-solčava breed ram with prior history of aggressive behavior inflicted multiple injuries to his 83-year-old owner, who died in the hospital a few hours later due to severe blunt force injuries sustained in the attack. The autopsy revealed the cause of death to be multiple injuries of the thorax and the head. Sheep, even though they are not considered aggressive or large farm animals such as cattle and horses, can inflict serious injuries with devastating results.

Horse kick injury mimicking a handle bar injury or a hidden speared injury

A 16-year-old male was transported to our emergency department after he was kicked in the abdomen by a horse. He was diagnosed with injury of the liver and abdominal rectus muscle, and was cured by observational treatment. An Ichushi search was undertaken to identify articles published from 1983 to 2013 using the key words "horse" and "trauma". We found 13 cases that described horse-related injuries and summarized these cases, including our case. There were 10 males, three females and one patient of an undescribed sex. The patients ranged in age from 16 to 58 years old, with an average age of 33 years. The injured sites were predominantly the face (mandible) and upper abdomen, indicating that a projecting part of the body may be more likely to be injured. Cardiac rupture, aortic head injury, or lethality induced by a horse kick have not been reported in Japan, but such injuries have been reported in other countries. Ten of 15 cases (67%) required surgical treatment for severe injuries. Horse kick injuries tend to be severe, because the transfer of energy from the end of the hoof, with a small cross-sectional area, to a small field, leads to internal organic injuries that are more severe than predicted, similar to a handlebar injury. Accordingly, we advocate the close observation of patients with horse kick injuries, which may be regarded as being similar to blunt stab wounds or hidden speared injuries.

A 51-year-old woman crushed by an elephant trunk

Wild and exotic animal attacks are not common in the United States. Animal-related injuries in the United States are usually caused by dog bites, followed by cattle and horse injuries. Exotic animal attacks can occur when the animals are provoked, depressed, or housed improperly by owners. We report the case of a 51-year-old woman who sustained multiple systemic traumatic injuries after she was pinned to a fence by an elephant's trunk. Upon arrival in the emergency department, she was hypothermic with a temperature of 35.1ºC (95.1ºF), hypotensive to 94/60 mm Hg after 5 L crystalloid, tachycardic at 108 beats/min, and intubated with oxygen saturation of 100%. Tranexamic acid was administered in addition to starting a massive transfusion protocol. Injuries included bilateral multiple rib fractures, left abdominal wall degloving injury, right pneumothorax, right hemothorax, left chest wall puncture wound, grade IV splenic laceration, 3 grade III liver lacerations, retroperitoneal hematoma, and degloving injuries to bilateral posterior thighs requiring more than 30 operations. Why should an emergency physician be aware of this? Several factors need to be considered when evaluating animal-related injuries, including type, age, and sex of the animal. Multisystem traumatic injuries should be assumed when a large animal is involved. Prehospital care and transport time are vital to a patient's survival in both urban and rural settings. During the initial resuscitation, administering antibiotics tailored to the specific animal can greatly decrease risk of infection and morbidity. Additionally, tetanus immunoglobulin, tetanus toxoid, and rabies immunoglobulin and vaccine may be needed, unless the victim has been previously vaccinated.

Potential dangers of hay bailing

Individuals engaged in farming have higher risks of injury and death from trauma than many other workers. Fatalities most often involve tractor-related incident such as roll-overs. Although it is also recognized that farm machinery may result in serious injuries and death, little has been reported on problems associated with hay baling, transport and storage. Case 1: A 43-year-old man trying to dislodge jammed hay in a hay baler had either been pulled, or had fallen, into the baler, where he had been crushed, rotated and then cocooned within a hay bale. The body showed extensive blunt trauma to the head, neck, chest, abdomen, pelvis and limbs, with burning from a fire that subsequently started within the overheated machine. Case 2: A 58-year-old man was crushed between the moving arms of a hay shuttle and a safety fence. Death was attributed to blunt chest and abdominal trauma with crush asphyxia. Case 3: A 56-year-old man fell some distance from the top of stacked hay bales fracturing his neck and causing virtual transection of his cervical spinal cord. These cases demonstrate rare forms of farm deaths that may be associated with the creation (baling), moving (shuttling) and storage of hay bales. All forms of farm machinery should be treated circumspectly, given the possibility that serious injury or death may result from inattention or inappropriate handling. Temporary stacking of hay bales may create high work platforms that risk falls with lethal consequences.

Sheep shearing and sudden death

A 29-year-old sheep shearer collapsed after walking across a shearing shed floor, holding his hand over an incised wound to his neck. Attempted resuscitation was unsuccessful. At the death scene fine arterial blood spatter was noted and at autopsy a single incised wound to the neck was observed, the patterned edges of which corresponded to the teeth of the shears. Dissection revealed injury to the underlying jugular vein and the mid portion of the common carotid artery. Death was attributed to blood loss from an incised wound of the left side of the neck. This case demonstrates the rare event of an accidental death related to the actions of a sheep. Although a relatively small animal, review of the circumstances and interviews with those present revealed that sudden and unexpected movement of the sheep during shearing had caused the shearer to lose control of his electrical shears resulting in a lethal incised wound to the neck. The blood spatter pattern at the scene was supportive of both witness descriptions and the findings at autopsy.

Camel-related injuries: prospective study of 212 patients

BACKGROUND

Camel-related injuries have been less well studied than other animal-related injuries. We aimed to study prospectively the incidence, mechanism, distribution of injury, and outcome of patients admitted to hospital with camel-related injuries in Al-Ain, United Arab Emirates.

METHODS

All patients who were admitted to Al-Ain Hospital with a camel-related injury were prospectively studied during the period of October 2001 to January 2010. Patient's demography, time of injury, mechanism of injury, and distribution and severity of injury were studied.

RESULTS

A total of 212 patients, all male, with a median age of 28 years (5-89 years) were studied. The estimated incidence of hospitalized camel-related injured patients in Al-Ain City was 6.88 per 100,000 population per year. Camel kicks were most common (36.8 %) followed by a fall from a camel (26.4 %) and camel bites (25.0 %). Camel kicks and falling from a camel were more common during the hot month of August, and camel bites were more common during the rutting season (November to February). Patients with a kick-related injury had a significantly higher rate of maxillofacial fractures compared with other mechanisms. Spinal injuries occurred significantly more often in vehicle occupants who collided with camels compared with other mechanisms (3/7 compared with 7/205, p = 0.0022, Fisher's exact test). Twelve patients (5.7 %) were admitted to the intensive care unit. The mean hospital stay was 8.6 days (1-103 days). Two patients died (overall mortality 1 %).

CONCLUSIONS

Understanding the biomechanisms and patterns of injury and correlating them with the behavior of the camel is important for identification and prevention of camel-related injuries.

Prevention of child camel jockey injuries: a success story from the United Arab Emirates

OBJECTIVE

To study the effects of a law banning children from taking part in camel racing on child camel jockey injuries in Al-Ain City, United Arab Emirates.

DESIGN

Prospective study.

SETTING

University Teaching Hospital.

PATIENTS

All patients who were admitted to Al-Ain Hospital and were injured while riding camels were prospectively studied between January 1, 2002, and December 31, 2009.

ASSESSMENT OF RISK FACTORS

Two periods, before the law and after its introduction, were compared.

MAIN OUTCOME MEASURES

Pediatric injuries, their anatomical distribution, and severity of injury.

RESULTS

Fifty-four patients were studied, and all were males. There were 13 children and 41 adults. All children were camel jockeys except 1 child who was riding a camel for fun. None of the adult camel riders was a camel jockey. The median (range) age of patients admitted before the law was 12.5 (5-45) years, which was significantly less compared with 27.2 (20-40) years after its introduction (P = 0.001, Mann-Whitney test). All 13 children sustained their injuries before the law was implemented, whereas 12 of 41 adults sustained their injuries before the legislation was in place (P < 0.0001, Fisher exact test). The total length of hospital stay of patients was significantly reduced after the law enforcement (P < 0.01, Mann-Whitney test).

CONCLUSIONS

Our findings emphasize the important role of law enforcement in injury prevention, illustrated by the replacement of children by robot substitutes. This is possibly one of the few examples where child injury has been completely prevented by legislation.