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South Korea. A 53-year-old man was found dead on the roof of a freight elevator car installed on an outer surface of a four-story building in the autumn. The decedent was a thread reseller. The factory in the building asked him to take back several boxes of defective thread he had supplied. And he went to the building to get back those on the previous evening.

At the death scene, the elevator car was on the ground level. The elevator system lacked doors and structures to separate the freight car from the building wall. Five boxes of defective thread were inside on the floor of the elevator car. He was lying on the roof of the elevator car near the building wall (Figs.1-2). Police assumed the cause of death to be a fall from the building.

Fig.1 The freight elevator system is facilitated on the outside of the factory building. The elevator car is seen on the ground floor.

Fig.2 The deceased is seen on the roof of the elevator and several boxes of the goods are loaded inside of the elevator car which has no door with just iron bar frame.

The deceased showed multiple curvilinear facial lacerations. They were located between the left ear lobe and the right side of the chin. The left lower quadrant of facial skin was flayed (Fig.3). Disruption of masseter muscles and crushed fracture of mental protuberance was noted. A fragment of black rubbery material was found within the crushed surface (Fig.4). Two narrow parallel lines of abrasion (width: 0.5 cm and 1.0 cm (0.19” and 0.39”)) connecting the chin and the medial end of the right clavicle were noted accompanying smaller linear abrasions scattered parallel (Fig.5). These parallel marks matched up with bricks on the building wall (Fig.6).

Additionally, several fragments of dried soft tissue were found on the lower horizontal frame of the third-floor window. Two horizontal lines of contusion (distance: 6.5 cm (2.56”)) were present at the back of the neck (Fig.7). It was thought these horizontal lines matched up with width between a frame bar of the roof of the elevator car and the building wall (Fig.8). Several bracket-shaped abrasions were on the left shoulder and both thighs. The posterolateral aspect of the left thigh showed three linear abrasions coursing the whole length of the thigh. Each of the ankles and dorsal surfaces of feet showed a linear laceration.

Fig.3 Flayed and crushed pattern of lacerations are developed on the orofacial area.

Fig.4 A black silicon rubber fragment is seen in the mandibular fracture site.

On internal examination, diffuse hemorrhage and rupture of deep neck muscle were found. Along with fracture and separation of atlas and axis, fractures of facial bones (mandible, maxillae, nasal bone, left zygoma) were noted but scalp and calvarium were intact. The brain showed generalized severe cerebral edema and subarachnoid hemorrhage of the right temporal area. Multifocal atherosclerosis was found in the basal arteries of the cerebrum.

Coronary arteries showed atherosclerosis (which obstructs about 50% of the cross-sectional area in the proximal portion of the left anterior descending artery, about 10% in the left circumflex artery). Mild congestion of abdominal organs, mild fatty liver, and chronic inflammation and fibrosis of both kidneys were noted. About 160 g (5.6 oz) of barely digested gastric contents and foci of gastric mucosal ecchymoses were found. Both thighs showed subcutaneous hemorrhage under the previously mentioned abrasions.

Fig.5 Linear abrasions from the chin to the clavicular area are formed parallel to the neck. Theses parallel marks are thought to match up with bricks on the building’s wall.

Fig.6 Bricks on the building’s wall, and black silicon rubber material.

Toxicology analysis was negative. Infrared spectroscopy analysis showed materialistic characteristics were identical between the black rubbery material from the mandible fracture site and silicone adhesive from the outer surface of the building.

Not uncommonly, assumption or interpretation based on death scene investigation by police could be wrong, which is frequently corrected by appropriate forensic scene investigation and autopsy. The presenting case, too, was initially informed as a ‘fall’ on police death scene investigation but was found to be a ‘caught in/between’ accident after reasonable interpretation through scene investigation and autopsy by medical examiners.

The height of the building and the characteristics of injuries were considered in deciding the cause of the death. The silicone fragment found from the face and the adipose tissue on the building’s wall lead to the conclusion that he was caught between the elevator car frame and the building’s wall. The posterior neck of the decedent might have impinged between a frame bar of the roof of the elevator car and the building’s wall somehow when the elevator was descending.

Fig.7 The parallel linear contusions on the posterior neck are a form of patterned injury, compatible with the iron frame bars of the roof of the elevator car.

Fig.8 The iron frame bars of the roof of the elevator car.

The body might have been dragged down along the wall making the linear abrasions and lacerations all over the body lengthwise. The shearing force could have caused the facial and spinal injuries with a traction pattern. As the elevator came down, the gap between the elevator roof and the building wall must have been widened enough to allow the head to pass through by the windows. After the head and neck were freed from the gap, the body might have been moved toward the roof of the elevator car as found on the death scene by gravitational force.

The death could have been prevented with proper safety measurements done before the accident. The elevator in this case violated Korean government regulations regarding elevators in several aspects (i.e. not installing doors). Elevator accidents cause about 30 deaths and 17,000 serious injuries annually in the United States alone. In the Republic of Korea, the number of elevator accidents is increasing as more elevators are installed every year. About 10~20 fatalities involving elevators are reported each year in the Republic of Korea.

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