J Forensic Sci, 2019

doi: 10.1111/1556-4029.14235
PAPER Available online at: onlinelibrary.wiley.com

PATHOLOGY/BIOLOGY

Joseph A. Prahlow,1 M.D.; Zuhha Ashraf,2 M.D.; Natalie Plaza,2 M.D.; Christopher Rogers,2 M.D.;
Pamela Ferreira,3 M.D.; David R. Fowler,3 M.D.; Melissa M. Blessing,4 D.O.; Dwayne A. Wolf,4 M.D.,
Ph.D.; Michael A. Graham,5 M.D.; Kelly Sandberg,6 M.S.; Theodore T. Brown,1 M.D.; and
Patrick E. Lantz,7 M.D.

Elevator-Related Deaths*

ABSTRACT: Elevators are mechanical transportation devices used to move vertically between different levels of a building. When first
developed, elevators lacked the safety features. When safety mechanisms were developed, elevators became a common feature of multistory
buildings. Despite their well-regarded safety record, elevators are not without the potential for danger of injury or death. Persons at-risk for ele-
vator-related death include maintenance and construction workers, other employees, and those who are prone to risky behavior. Deaths may be
related to asphyxia, blunt force, avulsion injuries, and various forms of environmental trauma. In this review, we report on 48 elevator-related
deaths that occurred in nine different medicolegal death investigation jurisdictions within the United States over an approximately 30-year per-
iod. The data represents a cross-section of the different types of elevator-related deaths that may be encountered. The review also presents an
overview of preventive strategies for the purpose of avoiding future elevator-related fatalities.

KEYWORDS: forensic science, forensic pathology, death, death investigation, elevator, injury prevention

Injuries and deaths caused by elevators are rare, but cases have
been reported in the medical literature (1–5), as well as in various
media outlets. A variety of mechanisms of injury/death may occur
in such incidents, including asphyxia, blunt force (such as crush-
ing injuries or fall-related trauma), avulsion injuries, and environ-
mental trauma. Decedents include maintenance workers,
construction personnel, elevator passengers, and persons partici-
pating in risky behavior. Occasionally, other types of deaths occur
on elevators, including those related to nonelevator-associated
trauma and those related to natural disease. This report presents 48
elevator-related deaths, which occurred in nine separate United
States jurisdictions over the last approximately 30 years.
Materials and Methods
Data regarding nonrandomly selected cases of elevator-re-
lated deaths were collected from nine different medicolegal
1
Western Michigan University Homer Stryker MD School of Medicine,
300 Portage St., Kalamazoo, MI 49007.
2
Los Angeles County Department of the Medical Examiner-Coroner, 1104
N. Mission Rd., Los Angeles, CA 90033.
3
Office of the Chief Medical Examiner, State of Maryland, 900 West Bal-
timore St., Baltimore, MD 21223.
4
Harris County Institute of Forensic Sciences, 1861 Old Spanish Trail,
Houston, TX 77025.
5
Division of Forensic Pathology, Saint Louis University School of Medi-
cine, 1402 South Grand Ave., St. Louis, MO 63104.
6
Franklin County Coroner’s Office, 520 King Avel, Columbus, OH 43201.
7
Department of Pathology, Wake Forest University School of Medicine,
Medical Center Blvd., Winston-Salem, NC 27157.
Corresponding author: Joseph A. Prahlow, M.D. E-mail: joseph.prahlow@
med.wmich.edu
*Presented at the 70th Annual Scientific Meeting of the American Acad-
emy of Forensic Sciences, February 18-23, 2019, in Baltimore, MD.
Received 15 Aug. 2019; and in revised form 15 Oct. 2019; accepted 16
Oct. 2019.
death investigation jurisdictions within the United States. The
jurisdiction sizes ranged from small cities to large metropolitan
regions. Medicolegal death investigation office type included
medical examiner and coroner systems. The study period
encompassed over 30 years (1987-2018); however, it should be
noted that the series does not include every elevator-associated
case occurring in each jurisdiction during the time frame. Con-
sequently, frequency data should not be calculated based on
study results. The collection of cases represents an attempt by
the authors to gather a wide variety of case examples for the
purpose of furthering the understanding of how elevator-related
deaths occur, and how elevator-associated injuries and deaths
can be avoided.
Results
Demographics
Of the 48 cases included in this review, 44 involved men,
while just four involved women. The age range of the decedents
was from 10 to 82 years. The most common decedent type was
an on-the-job, nonconstruction, nonelevator mechanic, employee
working within a building that had an elevator; 19 of the 48
decedents were in this category. An additional 12 decedents
were elevator maintenance workers, and there were three con-
struction workers involved in elevator-related deaths. Three pas-
sengers were killed in public elevator-related mishaps, while an
additional three persons died in relation to a home elevator. Five
deaths could be categorized as occurring as a result of various
forms of risk-taking behavior. In one case, death was unrelated
to the elevator. Table 1 provides details regarding each of the 48
cases.

© 2019 American Academy of Forensic Sciences 1

 2
TABLE 1––Case synopsis—48 cases of elevator-associated deaths.

No. Dec. Circumstances COD MOD Mechanism Tox Risk Factor(s)

1 32 y/o WM Laborer at manufacturing facility on second floor yelled for freight elevator (no Cervicospinal blunt A BFI of head/neck NEG Freight elevator
bell). Elevator operator on 5th floor started down to pick him up. Operator trauma
looked down and saw him with head extending into shaft watching for
elevator. He was struck by descending elevator.
2 58 y/o WM Worker at candy factory. Planned on cleaning elevator shaft pit. Told coworker Thoracic crush injury A Traumatic asphyxia NEG Failed to shut down
to take elevator to second floor and then back to first floor. Decedent found
sitting on ledge, doubled over, being compressed by several thousand pounds
of elevator counterweight.
3 10 y/o LM Unwitnessed fall down elevator shaft in apartment building; fell 3 stories; Craniocerebral trauma A BFI/fall NEG Horseplay
children in complex were known to open the outer elevator doors while
elevator was in motion.
4 45 y/o WM Performing maintenance on elevator at work; became wedged in shaft when Multiple traumatic A Traumatic asphyxia NEG Failed to shut down
elevator moved. injuries
JOURNAL OF FORENSIC SCIENCES

5 36 y/o WM Elevator mechanic working on elevator (appropriately shut down); compressed Traumatic (pressure) A Traumatic asphyxia NEG Failed to shut down
between adjacent elevator (not shut down) and I-beam asphyxia
6 24 y/o LM Likely fell from roof; found at bottom of elevator shaft; probably drinking prior Multiple traumatic A BFI/fall EtOH—0.10% Unknown; possible
to falling; fell 65-70 feet injuries horseplay; EtOH
7 41 y/o WM Maintenance worker opened doors of elevator to show that work had been Multiple traumatic A BFI/fall None Forced doors open
completed and fell into elevator shaft. Fell 17 feet, 4 inches. injuries
8 34 y/o LM Ran a sweatshop in apartment building; fell down service elevator; lost footing Traumatic injuries A BFI/fall NEG Freight elevator
while attempting to grab canvas strap to close heavy doors, in order to “call”
elevator. Fell 45-50 feet.
9 42 y/o WM Pinned between counterweight and spreader beam while repairing elevator shaft Multiple traumatic A BFI/crush asphyxia NEG Failed to shut down
while at work. injuries
10 25 y/o WM Fell into water-filled elevator shaft and drowned; struck head, with laceration of Drowning; A Drowning POS for EtOH, Unsecured access to shaft;
forehead; recent cocaine use (body discovered after tenants of apartment contributing factors: cocaine, EtOH; Drugs
building smelled foul odor). Apparently entered shaft through unsecured door blunt trauma; recent and BE
near bottom of shaft. cocaine use
11 78 y/o WM At his place of employment. Fell down elevator shaft. Fell at least one floor. Blunt force trauma to A BFI/fall POS for Rx drug Improperly functioning
Found at bottom of shaft; doors ajar on lobby level. Elevator stuck on 4-5th head elevator; Doors forced open
floor.
12 52 y/o WM Paraplegic in electric wheelchair, inspecting his house under construction, got Multiple trauma A BFI/fall None Open shaft under
too close to open elevator shaft on 4th floor and fell down elevator shaft 30 construction; Failed to
feet employ fall-prevention
strategies; Home elevator
13 13 y/o AAM Became caught by elevator as it ascended, via a pen with string around his neck. Craniocervical trauma A BFI NEG Horseplay/ Vandalism
Likely attempting to undo a cover on the top of the elevator when elevator was
called up.
14 31 y/o AAM While in jail, fell down elevator shaft 50 feet, approx. 11 years before death. Sequelae of blunt A BFI/fall None Unknown
Sustained massive head trauma. head trauma
15 30 y/o LM Employee crushed by elevator counterweight in elevator shaft when he entered Multiple blunt force A BFI/crush NEG Failed to shut down
the freight elevator shaft via basement access to attempt to recover a injuries
customer’s keys.
16 32 y/o WM Elevator worker fell down elevator shaft while at work. Fell 70 feet Multiple blunt force A BFI/fall NEG Failed to employ fall-
injuries prevention strategies
17 43 y/o AM Mail courier found at bottom of elevator shaft; Elevator became stuck between Multiple blunt force A BFI/fall NEG Improperly functioning
9th and 10th floors. He pressed emergency call button, but when responders injuries elevator; apparently forced
came, no one was in elevator. He was found at bottom of shaft. Fell approx. doors open
100 feet.
18 24 y/o LM Cement mason at work when he fell down elevator shaft; fell 30-40 feet Multiple blunt A BFI/fall NEG Unknown circumstances;
traumatic injuries failed to employ fall-
prevention strategies
 TABLE 1—Continued.

No. Dec. Circumstances COD MOD Mechanism Tox Risk Factor(s)

19 35 y/o AM At work in hospital when he attempted to enter an elevator which had stopped Multiple blunt force A Decapitation EtOH POS Improperly functioning
between floors; he was attempting to climb up into the elevator when the doors injuries elevator; attempted to enter
closed, pinning his shoulders; decapitated when elevator moved upwards. stalled elevator; EtOH
20 49 y/o LM Lift operator at construction site who climbed into shaft of elevator that was Blunt head and chest A BFI NEG Failed to shut down
malfunctioning (landing too low) to attempt to repair it. Elevator went up, trauma
counterweight descended and dropped onto him.
21 80 y/o WM Wheelchair-bound man entered elevator in his private residence and failed to Traumatic head and A Traumatic asphyxia None Failure to use safety
close the safety gate before ascending to 2nd floor. Wife heard loud noise and neck injuries with BFI/crush features; Home elevator
found him wedged in elevator shaft
22 46 y/o AAM Elevator maintenance supervisor who dropped keys down elevator shaft while Thoracic blunt trauma A BFI Delta-9 Failed to shut down
working in building. Went to basement and was lying down using a hook to THC - 6.6 ng/mL
try to retrieve them from shaft floor. He had crawled up to his waist into shaft.
Elevator came down and struck him.
23 75 y/o WM Trapped in elevator on 12th floor with 2 young children; able to help children Multiple blunt force A BFI/fall EtOH POS Improperly functioning
out after prying door open with a person outside of elevator. Lost balance as injuries elevator; attempted to exit
he was following, falling 12 floors to his death. stalled elevator; EtOH
24 40 y/o AM Working at a shipyard, painting a ship. Harnessed into I-beam above. Next to an Multiple blunt force A BFI/crush NEG Unsafe set-up while
elevator on a guide roller. Harness became caught in the guide roller as injuries working adjacent to
elevator traveled upward. Crushed between elevator and ship. elevator
25 43 y/o LM General maintenance worker on a ladder cleaning the glass on the outdoor Blunt trauma A BFI/crush NEG Unsafe set-up while working
elevators, leaning into shaft when an elevator cab came down and crushed him. around elevators
26 18 y/o WM On elevator with total number of passengers of 15-20 people; elevator became Cardiopulmonary A Traumatic asphyxia EtOH, 0.22% Malfunctioning or possibly
stuck between two floors; doors were still open and decedent attempted to exit collapse due to overloaded elevator;
through open doors when the elevator began to move again, crushing the mechanical attempted to exit stalled
decedent. asphyxiation elevator; EtOH
27 32 y/o AAM Decedent and another broke into empty building and fell into elevator shaft; fell Blunt head trauma A BFI/fall EtOH, 0.22% Suspected robbery/
20 feet. Decedent broke partner’s fall and he survived. vandalism; EtOH
28 64 y/o WM Construction worker fell down elevator shaft while at work; approximately 35 Multiple blunt force A BFI/fall NEG Failed to employ fall-
feet. injuries prevention strategies
29 64 y/o LF Objects fell off elevator hoist at work/factory, blocking it; Decedent, and Multiple traumatic A BFI/crush NEG Failed to shut down
employee, climbed under elevator hoist to retrieve objects; machine started injuries
working again and crushed decedent.
30 22 y/o WM Manager of apartment building; Created hole in drywall in order to access shaft Asphyxia A Traumatic asphyxia NEG Failed to shut down
so that he could retrieve a set of keys he accidently dropped down shaft.
Compression of chest by elevator weight in shaft.
31 51 y/o WM Elevator company employee working on elevator renovation, working on Mechanical A Traumatic asphyxia POS for Failed to shut down
cosmetic work with coworker. Became compressed between wall and elevator asphyxiation caffeine and
while working in elevator shaft. gabapentin
32 52 y/o WM Building manager at work. Waiting for freight elevator. Stuck head through Severe craniocerebral A CCT NEG Freight elevator
window of elevator door, struck by elevator on way down. trauma
33 47 y/o LM Freight elevator accident while making delivery at work; was messing around Traumatic/avulsion A Traumatic/ NEG Freight elevator; Horseplay
with others when leg became entrapped between elevator and building; injuries avulsion injuries
PRAHLOW ET AL.

traumatic injuries of the legs; left leg with 13-inch laceration and tissue
.

avulsion; not amputated.

34 48 y/o LF At place of employment, on elevator, when it stopped 1-2 feet short of 3rd Traumatic asphyxia A Traumatic asphyxia NEG Malfunctioning elevator;
floor; Tried to climb up and out of the car, but elevator began to move down, Attempted to exit stalled
crushing her. elevator
35 35 y/o WM Maintenance technician for an apartment complex that had a parking garage. He Multiple injuries A BFI/fall Low levels of Freight elevator;
was manually overriding the self-parking car elevator when he fell 30 feet to hydro-codone Malfunctioning automobile
concrete floor. Found at the bottom of car elevator shaft. Elevator had been and acetamino-phen elevator
malfunctioning.
ELEVATOR DEATHS
3
 4
TABLE 1—Continued.

No. Dec. Circumstances COD MOD Mechanism Tox Risk Factor(s)

36 69 y/o WM Elevator repairman fell down elevator shaft while doing elevator repair work; Multiple blunt trauma A BFI/fall NEG Failed to employ fall-
unwitnessed; fell 22 feet prevention strategies
37 61 y/o WM Elevator mechanic working on elevator found at bottom of elevator shaft; struck Head injuries A BFI POS for Failed to shut down
in head by moving elevator; survived in hospital for approximately 1 day. therapeutic drugs
38 31 y/o LM Construction worker pouring concrete into structural shells/forms of elevator Multiple blunt force A BFI/fall NEG Failed to employ fall-
shaft on the 10th floor; no safety harness; standing on improperly fastened injuries prevention strategies
platform. Lost footing and fell approx. 120 feet to bottom of elevator shaft.
39 48 y/o AAF Malfunction of elevator at work in 9 years earlier which resulted in injury of the Pulmonary A BFI (spine) None Malfunctioning elevator
spine and paraplegia. Elevator reportedly slid down 2 floors while she was on thromboembolism d/
it. Developed UTI ? aspiration ?long hospital stay ? PE. t paraplegia; part II
JOURNAL OF FORENSIC SCIENCES

—DM, HTN,
decubitus ulcers
40 31 y/o WM Elevator mechanic; Electrocuted while working in an apartment elevator shaft Electrocution A Electrocution NEG Failed to disconnect
electrical power
41 46 y/o WM Volunteer at a church, attempting to repair sump-pump at base of elevator shaft. Multiple injuries A Traumatic asphyxia NEG Failed to shut down; Failed
Another person on the second floor called for him, and he responded, telling and BFI to recognize shaft as
them not to push the elevator button. They heard him wrong, thinking that he confined space
said to push the button. It caused the elevator to go to the ground floor,
crushing the decedent.
42 38 y/o M Electrocuted while at work, which encompassed painting and polishing the Electrocution A Electrocution NEG Failed to disconnect
windings of elevator motors electrical power
43 46 y/o LM Elevator mechanic at work to repair faulty door. Found by a coworker wedged Traumatic asphyxia A Traumatic asphyxia NEG Failed to shut down
between elevator and elevator door
44 82 y/o WM Reported missing; found 3 ½ weeks later, decomposing in little-used parking Unknown U Natural disease None Death unrelated to
garage elevator. History of extensive natural disease, but decomposition versus other elevator.Elevator was the
precluded determination of a definite COD. location of death
45 31 y/o WM Elevator mechanic was inside shaft on ground level. Coworker on 5th floor hit Compressional A Traumatic asphyxia NEG Failed to shut down
button to take elevator down and heard the mechanic shout “stop!” Found asphyxia
crushed between counterweights and wall. Counterweights weigh an estimated
8000 pounds
46 48 y/o WF Hotel employee entered the hotel basement via a freight elevator during a Drowning A Drowning Low levels Freight elevator; dangerous
tropical storm; became trapped in basement; made phone call to other of EtOH & environment
employees saying she was trapped; decomposed body found 11 days later, in acetone
ceiling of elevator lobby; freight elevator doors open
47 61 y/o WM Intentionally sat atop home elevator cab and pushed the “up” button in order to Traumatic/ S Traumatic asphyxia Tramadol – Home elevator
kill himself; recent suicidal ideation; elevated tramadol levels compressive 1341 ng/mL;
asphyxia with blunt low levels
head trauma of other drugs
48 45 y/o WM Construction worker at hospital, working under the platform of an elevator, Mechanical asphyxia A Traumatic asphyxia/ POS for cotinine Failed to recognize shaft
along with 2 others; he was removing bolts from the hydraulic system, when due to crushing be crushing injuries as a confined space
hydraulic system failed and elevator descended onto decedent. elevator platform
and hydraulic
mechanism failure
Key: y/o, year-old; A, Asian; AA African–American; L, Latino; W, white; F, female; M, male; COD, cause of death; MOD, manner of death; A, accident; U, undetermined; S, suicide; BFI, blunt force injuries;
CCT, craniocerebral trauma; NEG, negative; POS, positive; EtOH, ethanol; BE benzoylecgonine; THC, tetrahydrocannabinol; ng/mL, nanograms per millilitre.

Elevator Types
Of the 48 cases reported, a majority (39) involved elevators,
which would be considered “regular” passenger elevators. There
were six deaths involving some sort of freight elevator, and three
deaths involved home elevators.
Circumstances
It should be noted that the details of the circumstances of
death in this review vary considerably from case to case. Also,
the categories listed are not necessarily mutually exclusive. As
such, some of the cases are included in multiple categories.
Table 2 provides a list of some of the circumstances, situations,
and risk factors at play in the reported deaths.
Failure to Follow Safety Guidelines
A vast majority of elevator-related deaths occurred, at least in
part, because of failure to follow safety guidelines. Thirty-three
of the 48 cases resulted from failure to follow safety guidelines.
In many of these cases, workers failed to shut down the elevator
during maintenance or repair, or failed to use other safety fea-
tures. Numerous examples exist within the case series where
workers were struck by moving elevators or counterweights,
apparently not realizing the inherent danger of these heavy, mov-
ing structures. Several other cases occurred in employees or
others who were attempting to access an elevator shaft and were
unaware of the inherent dangers of doing so. For example, an
apartment building manager accidently dropped a set of keys
down an elevator shaft. He subsequently cut a hole in the dry
wall to access the base of the shaft, and while leaning through
the hole to retrieve the keys, was crushed by the elevator coun-
terweight. In numerous cases, unsafe activity around an elevator
shaft resulted in a fall. These occurred in workers, employees,
and others. Occasional decedents died after attempting to force
TABLE 2––Circumstances, situations, and risk factors associated with eleva-
tor-associated deaths. (note: the listed items are not necessarily mutually
exclusive).
Circumstances/Situations/Risk Factors Number of Cases
Structure or elevator under construction
Elevator maintenance/repair
Malfunctioning of stalled elevator
Elevator maintenance worker
Employee/volunteer at place of employment/work
Failure to shut down elevator for service work or
when entering shaft
Unauthorized access to elevator shaft
Unsafe activity around elevator shaft, resulting in a fall
Failure to consider hazards related to “confined space”
of elevator shaft
Failure to employ fall-prevention strategies
Failure to utilize other safety devices/protocols
Failure to de-energize electric power
Unsafe environmental dangers
Freight elevator
Home elevator
Risky behavior (drugs/ethanol, horseplay, vandalism,
felonious behavior)
Attempting to force doors open
Attempting to enter or exit stalled elevator
Attempting to retrieve objects that fell into shaft or
under elevator
Overloading an elevator
PRAHLOW ET AL. . ELEVATOR DEATHS 5
open closed elevator doors, or while attempting to enter or exit a
stalled elevator, including one case where the elevator was over-
loaded with passengers. Two deaths occurred via electrocution
when workers failed to turn electrical power off and made con-
tact with electrical components of the elevators.
Malfunctioning or Stalled Elevators
Several cases occurred as a result of elevators that were either
malfunctioning or stalled and appeared to be malfunctioning. It
should be noted that stalled elevators are not necessarily mal-
functioning. Instead, their safety mechanisms may be activated,
with subsequent stalling to prevent further mishap. This is likely
what occurred in one case referred to above, where an elevator
was overloaded with passengers and subsequently stalled
between two floors, with the decedent being crushed as he
attempted to exit the cab through open doors. One case of true
malfunction involved a woman who suffered a spinal injury
when a malfunctioning elevator suddenly dropped two floors;
she died nine years later as a complication of paraplegia sus-
tained in the elevator incident.
Risk-taking Behavior (Horseplay, Drunkenness, Vandalism, and
Felonious Behavior)
As indicated above, five cases were related to horseplay,
drunkenness, vandalism, or felonious behavior. A 10-year-old
boy was playing in the elevator shaft of an apartment building
when he fell three floors to his death. A 24-year-old drunk man
fell down an elevator shaft after drinking on a roof. A 13-year-
old was attempting to open a panel on the elevator cab ceiling
during an act of vandalism when his cloth necklace became
caught in the elevator, and he died from craniocervical trauma.
A 32-year-old male robber and his accomplice broke into an
unoccupied building and fell into an elevator shaft. The accom-
plice survived the fall. A 47-year-old man was messing around
with others on a freight elevator when his leg became entrapped
between the elevator and the adjacent wall; he died of traumatic
avulsion injuries. In a handful of other cases, ethanol was posi-
tive on toxicology.
Freight Elevators
4 An additional five cases occurred on or around freight eleva-
12 tors, for a total of six freight-elevator-related deaths. Two of
8
12 these cases involved separate incidents in which workers who
19 were awaiting the arrival of a freight elevator stuck their heads
14 through an open window to look for the elevator and were
struck in the head by the moving elevator. One case involved a
5
6
worker who lost his footing while trying to pull the elevator
2 doors closed; he fell 45-50 feet down the elevator shaft. The
final freight elevator case involved a maintenance worker who
6 was overriding a malfunctioning self-parking automobile freight
4 elevator when he fell 40 feet to his death.
2
2
6 Unsafe Environmental Conditions
3
5 In addition to the two electrocution cases mentioned previ-
3
ously, two additional cases were the result of an unsafe environ-
4 ment. One of these involved a hotel employee who, during a
3 tropical storm, took the elevator to the hotel basement, only to
become trapped in the flooded basement, where she drowned. In
1 another case, a 25-year-old man’s decomposing body was found
6 JOURNAL OF FORENSIC SCIENCES
within a water-filled elevator shaft. His death was attributed to
drowning with contributing factors of blunt force injury and
recent cocaine use.
Home Elevators
A 61-year-old man committed suicide by intentionally sitting
on the top of his home elevator’s cab, pressing the “up” button
and becoming crushed between the elevator cab and the ceiling.
A 52-year-old paraplegic in an electric wheelchair was inspect-
ing his house, which was under construction, when he got too
close to the open elevator shaft and fell 30 feet. An 80-year-old
wheelchair-bound man entered his home elevator and failed to
close the safety gate before ascending; he was found wedged in
the elevator shaft.
Death Unrelated to Elevator
In one case, death was deemed unrelated to the elevator. In
this case, a man who had been missing for approximately
3.5 weeks was found decomposed in a functional, but rarely
used parking garage elevator.
Cause/Mechanism of Death
Table 3 provides a summary of the causes/mechanisms of
death in the 48 cases within this series. Sixteen decedents had
causes of death categorized as blunt force injuries (BFI) related
to falls, while 13 had nonfall-related BFIs, including some cases
with head trauma, others with neck injuries, one with avulsion
injuries of the legs, one decapitation case, and one case of com-
plications related to spine trauma. There were 14 cases of trau-
matic/crush/pressure asphyxia (with varying degrees of
associated BFI), two electrocutions, and two drownings. In one
case, a cause of death could not be determined secondary to
decomposition, but was not considered to be related to the
elevator.
Fall-Related Cases
The 16 cases of fall-related deaths had various underlying cir-
cumstances of death, including construction work, maintenance
work, horseplay, and felonious behavior, among others. The
longest recorded fall distance was 120 feet, while the shortest
recorded distance was just over 17 feet. Table 4 provides a syn-
opsis of the recorded distances in the fall-related deaths.
Traumatic/Crush Asphyxia Cases
As with the fall-related deaths, the 14 cases of death related
to traumatic/crush/pressure asphyxia occurred under various
circumstances. Common scenarios included construction/
TABLE 3––Cause/mechanism of death—48 elevator-associated deaths.
Cause/Mechanism of Death Number of Cases
Blunt force injuries - Fall 16
Blunt force injuries – Nonfall related 13
Traumatic/crush/pressure asphyxia 14
Drowning 2 fell 50 feet down an elevator shaft, sustaining massive head inju-
Electrocution 2 ries. He lived for 11 years before dying of sequelae of his inju-
Noninjury related death 1
TABLE 4––Fall-related elevator deaths—16 cases.
Fall distance Number of cases
<50 feet 9
50-100 feet 4
>100 feet 2
Unknown 1
Shortest recorded fall = 17+ feet; longest recorded fall = 120 feet.
maintenance situations, persons being within elevator shafts
without being aware of the crush hazards associated with eleva-
tor cabs or counterweights, and situations where persons
attempted to enter or exit stalled elevators. This category also
includes the previously described suicide involving a home ele-
vator.
Electrocution
Two cases of electrocution occurred in the series. One
involved a 31-year-old elevator mechanic who failed to turn the
power off while working in an elevator shaft and was electro-
cuted. The other case involved a 38-year-old maintenance
worker who was painting and polishing the motor windings of
an elevator without shutting off the electrical power.
Drowning
The two drowning cases were previously described above
under the “unsafe environmental conditions” section. They
include the hotel employee who took the elevator to the base-
ment and became trapped in the flooded basement, and the
decomposed man who was found in water at the base of an ele-
vator shaft.
Manner of Death
The manner of death in all but two cases was certified as acci-
dental. There was one suicide (the home-elevator case described
previously) and one undetermined (the decomposed case
described earlier). Manner of death interpretation is best deter-
mined when the death scene investigation, circumstances of the
death, which includes a review of the decedent’s past medical
history and reported actions/mental state prior to death, and com-
plete postmortem examination with ancillary studies (toxicology)
are reviewed altogether. In the single suicide case in this series,
the man, who was depressed, had recently expressed suicidal
behavior including witnessed self-inflicted head injuries for
which he refused medical treatment. Testing of the home eleva-
tor revealed that it functioned properly but at a relatively slow
velocity. By pressing the “up” button, the unit would travel
upward without the need for continued pressure on the button.
Time From Event to Death
A vast majority (44) of the 48 deaths occurred immediately or
shortly after the elevator-related event, while three cases had
delayed deaths. The first death occurred in the hospital approxi-
mately one day after an elevator mechanic was struck in the
head by a moving elevator. The second case involved man who
ries. The third case was previously described, wherein a woman

became a paraplegic following an elevator mishap and then died
nine years later.
Toxicology Results
In only a small percentage of cases were toxicology results
considered potentially significant. In the suicidal case, elevated
levels of tramadol were present. Eight cases were positive for
drugs of abuse, including ethanol. Six cases were positive for
ethanol alone, ranging from qualitatively positive to 0.22%;
however, one of the cases with low levels was also decomposed.
One case was positive for ethanol, cocaine, and benzoylecgo-
nine. One case was positive for delta-9-THC. Five cases were
positive for prescription drugs, over-the-counter drugs, caffeine,
or cotinine, but none of these had levels that can be considered
worrisome. Toxicology testing was negative in 28 of the 48
cases, and was not performed in six cases.
Discussion
History
The idea of an elevator, a mechanical device used to transport
persons vertically between different levels of a structure, is said
to have been first envisioned by the Greek mathematician Archi-
medes in 236 B.C. (6). Prior to the development of safe, modern
elevators, elevator use was reserved for select circumstances.
They were used in ancient Rome in the Colosseum (6), and a
variation of an elevator, known as the “flying chair,” existed
within Louis XV’s palace at Versailles in the 1700s (6). By the
early to mid-1800s, elevators powered by steam or water were
in existence, but the hoisting ropes were so unreliable as to
make their everyday use untenable (6). Then, in 1852, Elisha
Graves Otis invented an elevator safety brake which revolution-
ized the elevator industry; in 1857, the first commercial passen-
ger elevator was installed by Otis in a 5-story New York City
department store (6). Since then, elevators have become a promi-
nent part of the modern world. Without them, efficient personal
transportation in high-rise buildings would be nearly impossible
or at least impractical.
Elevator Basics
The following information is gleaned from several online
sources (7–13). As indicated above, an elevator is a mechanical
transportation device used to move people (or other items) verti-
cally between different levels (floors) within a building or other
structure. The compartment within which people (or objects) are
transported in an elevator is referred to as a “car” or a “cab,”
with car doors that allow access into the car. The vertical space
within which the elevator car moves up and down is referred to
as a “shaft” or “hoistway.” Two basic types of systems are used
to move the elevator car/cab up and down. Hydraulic elevators
use hydraulic cylinders/pistons attached to a hydraulic pump that
extend to “push” cars upward from below, or retract to lower
them. Hydraulic systems are limited to operating in structures
with up to three or four floors only. The second type of elevator
configuration is referred to as a traction (“pull”) elevator,
wherein a hoist motor (hoist machine) uses cables (steel ropes)
attached to the car and to counterweights to control the move-
ment of the car. The hoist motor, which is typically near the top
of the elevator shaft, often in an adjacent motor room, turns a
sheave (a grooved pulley-like cylinder), with the hoist cables
PRAHLOW ET AL. . ELEVATOR DEATHS 7
winding around the sheave. Other pulleys exist within the
sheave/car/counterweight configuration to ensure smooth and
efficient operation. There are typically multiple cables, and the
counterweights, which exist to prevent unnecessary strain on the
hoist motors, typically have a weight equivalent to the elevator
cab plus about 40% of the certified passenger capacity. Traction
elevators may be used in any situation, but must be used in mul-
ti-floored buildings having more than three to four levels. Eleva-
tor cars are guided along the inside of the hoistway/shaft via
guide rails attached to the sidewalls of the shaft and roller guides
mounted to the cab. Counterweights likewise have guide rails
and roller guides. The base of the shaft is referred to as a “pit,”
and it has “car buffers” which function to cushion the car if it
drops within the shaft. The function of the elevator motors,
hydraulic pumps, and overall movements are via electronic com-
ponents referred to as “control systems.” More modern designs
have resulted in the use of compact, gearless motors in place of
bulkier hoist motors with gears, and the use of flat, high-strength
steel belts in place of bulkier and less resilient steel cables.
Although the hydraulic and traction elevators as described repre-
sent the most common types of elevators, several other systems
exist, including various combinations of hydraulic and traction
mechanisms and those that use chains. Safety features include
governors (which use the centrifugal force created by increasing
speed to engage a ratchet-like mechanism that initiates braking
mechanisms) and other braking systems, such as electromagnetic
brakes and “safety brakes,” as well as devices such as emer-
gency lighting and communication devices, such as alarms and
telephones.
Despite the disconcerting scenarios associated with elevator
mishaps, the elevator actually represents one of the safest modes
of mechanical transportation of humans in existence today, with
only an estimated approximately 25 elevator-related deaths
occurring each year within the United States (14). Unfortunately,
as with any mechanical device, especially one that involves
extremely heavy moving parts and operates at great heights,
accidental severe injuries and deaths occasionally occur in asso-
ciation with elevators. More often, however, the mechanical
safety devices that exist within modern elevators function to pre-
vent catastrophic results. A particularly disturbing “near-miss”
scenario unfolded at the iconic 100-story building previously
known as the John Hancock Building in downtown Chicago on
November 16, 2018. Six passengers boarded an elevator on the
95th floor, and after the doors closed, they heard sudden noise
and then the elevator car fell 84 floors after one of the “hoist
ropes” (cables) broke. The emergency braking system prevented
any physical injuries, and it took emergency responders several
hours to rescue the passengers (15). Despite this horrific story
with a happy ending, Hollywood has successfully conveyed the
idea that, when elevator deaths occur, they tend to occur as a
result of elevator cars full of people suddenly plunging hundreds
or thousands of feet downward. Despite this characterization,
only one of the deaths in this report involved the sudden drop of
an elevator, and in that case, death was delayed by nine years.
While falls down elevator shafts certainly occur, the usual cir-
cumstance is that of an individual falling rather than the entire
elevator car falling.
Injury Types
A 2013 review by McCann of deaths and injuries involving
elevators and escalators was collated from data obtained from
the U.S. Bureau of Labor Statistics from 1992 to 2009 and the
8 JOURNAL OF FORENSIC SCIENCES
Consumer Product Safety Commission from 1997 to 2010 (14).
Between the years 1992 and 2009, there were a total of 263
deaths related to work on or near elevators; the causes of death
based on injury type, and listed from most common to least
common, were as follows: falls, caught in/between, struck by
object, collapses (of the elevator), and other (14). McCann’s
report also relates data collected from the National Institute for
Occupational Safety and Health’s (NIOSH) Fatality Assessment
and Control Evaluation (FACE) reports (http://www.cdc.gov/
niosh/face/) (14). From this source, 45 elevator-related deaths
occurred from 1982 to 2010 and included 25 falls down elevator
shafts; eight deaths involving being struck by an elevator car,
caught in an elevator mechanism, or struck by a counterweight;
four deaths from elevators collapsing with a worker in or on the
elevator; three electrocutions; and two “other” causes, including
one explosion and one related to falling material (14).
Although our study uses slightly different categories, they
more-or-less align with those presented by McCann. Our data
included 16 fall-related deaths, 13 nonfall-related blunt force
trauma deaths, 14 cases of traumatic/crush/pressure asphyxia
deaths, two drownings, and two electrocutions.
Activities at Time of Injury/death
A portion of the McCann report focuses on worker-related
deaths and describes three subcategories of activities within a
group of 263 worker-related deaths: 1) installing or repairing ele-
vators—110 of the 263 deaths; 2) working in elevator shafts/cars
—46 of the 263 deaths; and 3) working near elevator shafts/cars
—107 of the 263 deaths (14). A variety of specific activities are
described, including various maintenance activities, and mention
is also made of attempts at recovering keys or other objects from
within elevator shafts (14).
A different part of the McCann report focuses on elevator pas-
senger deaths. From the years 1992 to 2009, there were 89 per-
sons who were at work and using elevators when they died (14).
Of these 89 cases, 52 involved falls, 24 involved being caught
in/between, five involved being struck by an object, and eight
were classified as “other,” including six elevator collapses (14).
Many of the caught in/between and struck cases involved per-
sons getting caught in elevator doors or between the elevator
and door or shaft (14). Similar data were also collated for a dif-
ferent time frame (1997-2010) involving elevator passenger
deaths while not at work, with a total of 91 deaths in the times-
pan, 51 involving falls, 33 involving caught in/between scenar-
ios, and seven “other” cases (14).
Toxicology
As indicated in the results section, toxicology findings were
not considered to be significant or potentially contributory to the
circumstances of elevator-related death in a majority of cases;
however, it may be argued that intoxication may have played a
role in at least 8 cases. The most obvious case was the single
suicide case (the man who intentionally crushed himself between
the home elevator cab and ceiling), who had elevated tramadol
levels in postmortem blood samples. Six cases were positive for
ethanol alone, at varying levels. Except in the decomposed case
where ethanol was detected (and likely a product of decomposi-
tion), it may be argued that the actions of the other decedents
may have been affected by being under the influence of ethanol.
Likewise, in the case with ethanol and cocaine, and the case
with THC, the decedents’ actions may have been affected by the
intoxicating substances. Therefore, the completion and interpreta-
tion of toxicology results in context with the death scene investi-
gation and postmortem examination findings may provide
additional insight of the decedent’s actions, which may help the
forensic pathologist opine the manner of death. It should be
noted that the present study includes toxicology results from
multiple jurisdictions, with considerable variation regarding the
extent of substances tested for within various toxicology test
panels.
Preventive Strategies
The McCann report also provides recommendations regarding
preventive strategies for avoiding elevator- (and escalator-)re-
lated deaths (14). Many work-related elevator deaths are related
to failure to ensure that elevator parts cannot move during main-
tenance or repair, or a failure to de-energize elevator electrical
circuits (14). As such, adequate lockout/tagout procedures should
be implemented whenever elevator work is required (14). Failure
to implement this commonsense strategy resulted in many of the
deaths presented in the current series of cases.
Another commonsense strategy for preventing elevator-related
deaths is ensuring adequate fall protection (14). About three-
fifths of the deaths during work in or near elevators reported by
McCann resulted from falls to a lower level. Fall protection
devices, such as scaffolding, guardrails in front of open shafts,
and personal fall protection systems such as harnesses, should be
employed to prevent falls down elevator shafts (14). Our current
series of cases also contains numerous examples of cases where
such preventive strategies might have saved lives.
A third recommendation in the McCann report is that elevator
shafts should be treated as confined spaces (14). In more than a
quarter of the work-related elevator deaths reported by McCann,
death occurred when workers entered elevator shafts to repair or
maintain elevators, or to perform other activities, such as clean-
ing, welding, or retrieving fallen objects. Treating something as
“a confined space” requires workers to understand the nature of
every potential hazard involved in the space, as well as the nec-
essary precautions to be taken to avoid the hazards (14). Indeed,
this safety precaution might have prevented many of the deaths
presented in our series.
Two additional recommendations regarding preventive strate-
gies in the McCann report are: providing adequate maintenance
and inspections for all elevators, and only using qualified per-
sonnel for repairs and maintenance of elevators (14). While not
as commonly described in our series, these two preventive strate-
gies might also have prevented some of the deaths reported.
The presented case series serves to highlight several important
strategies for preventing injury and death related to elevators.
For construction and maintenance workers, as well as for mem-
bers of the general public, elevators, elevator shafts, counter-
weights, and all of the mechanical and electrical components
related to them, must always be recognized as potentially dan-
gerous. This is especially true when elevators are under con-
struction, being repaired, or when they are not functioning
normally. As such, constant vigilance and awareness of potential
dangers is absolutely essential when riding on or working on or
around elevators. Likewise, proper implementation of appropriate
safety devices and protocols is necessary to avoid potentially
life-threatening accidents.
Suggested strategies for elevator passengers to avoid injury
and death include the following: do not use malfunctioning ele-
vators; report such elevators immediately; do not pry elevator

doors open; do not forcibly enter or exit an elevator; do not
enter or exit a “stuck” or stalled elevator; do not attempt to
repair a malfunctioning elevator; never enter an elevator shaft;
do not “play” on elevators or in elevator shafts; and avoid risk-
taking behavior in and/or around elevators. Many persons have
seen elevators with glass shafts in hotels or other facilities; the
elevator cars and counterweights tend to appear incredibly
smooth and quick-moving, perhaps creating the false impression
that they are not dangerous; however, this is far from the truth.
Counterweights (and elevator cars themselves) can weigh several
tons and can cause tremendous injury in very short order.
Employees who work in buildings with elevators, or those
whose job or daily living encompasses frequent elevator use,
may develop an almost cavalier attitude toward elevator use.
Since elevators are so easy to use and typically cause no safety
concerns, they are not recognized as potentially dangerous.
Familiarity may breed carelessness, thoughtlessness, or even
ignorance regarding elevator safety.
Home/residential elevators have additional safety concerns.
A recent media article highlighted the increased risk of injury
and death of children in home/residential elevators (16). The
article claims that an estimated 300,000 to 500,000 U.S.
homes and other buildings have “residential” elevators. Many
of these have an outer swing-type door and an interior accor-
dion or gate door, with a several inch “gap” between the two-
door mechanisms that represents a major safety hazard, as the
space is large enough for a small child to become entrapped
between the two doors, with subsequent serious injury or
death possible from entrapment, crushing, or falls (16).
Although elevator codes were changed in 2017 to address this
serious safety hazard, the standard only applies to new instal-
lations; therefore, hundreds of thousands of existing elevators
represent a continued danger, something that, according to
elevator experts, could be addressed with a relatively
inexpensive space guard (16).
TABLE 5––Prevention strategies for avoiding elevator-related deaths.
At-risk population Risk factors
General (everyone) Being unaware of potential elevator dangers
Elevator in disrepair
Malfunctioning elevator
Unauthorized access to shafts and/or other areas
Home elevators
Freight elevators
Intoxication
Risk-taking behavior
Those working Untrained workers
in or around elevators Failure to shut down elevator during repair or shaft access
Risk of falls from heights
Risks inherent to being in confined space of shaft
Electrocution hazards
Passengers Malfunctioning elevator
Prying elevator doors open
Forcibly entering or exiting an elevator
Attempting to enter or exit a stalled elevator
Overloading an elevator
PRAHLOW ET AL. . ELEVATOR DEATHS 9
For maintenance and construction workers, recognizing the
potential dangers of elevators is equally important, since working
in and around elevators puts such persons at great risk of injury
and death. Those responsible to maintain elevators and buildings
with elevators should ensure that access doors to elevator shafts
and mechanical rooms are secured in order to prevent unautho-
rized access. When working on elevators, the use of appropriate
safety devices, protocols, and precautions will help to avoid
injury and death. Examples of safety strategies include the use
of fall-prevention protocols, as discussed previously; treating ele-
vator shafts as “confined spaces,” as described above; shutting
down elevator function (lockout/tagout procedures; sometimes
referred to as placing the elevator in “service” mode) while
working on, above, below, or near elevators, including in an ele-
vator shaft; de-energizing elevator electrical circuits; ensuring
adequate maintenance and inspections of elevators; ensuring that
only qualified persons work on elevators; and following all other
industry safety regulations and codes. More information is avail-
able via the National Elevator Industry, Inc. (NEII), an organiza-
tion that advocates for advanced elevator (and escalator) safety,
including the American Society of Mechanical Engineers
(ASME) Safety Code for Elevators and Escalators, AASME
A17.1/CSA B44, which is used by every jurisdiction in the Uni-
ted States and Canada (17). Table 5 provides a synopsis of pre-
ventive strategies for avoiding elevator-related deaths.
Death Investigation Issues
While elevator deaths are rare, the circumstances, thorough
death scene investigation, and external and internal postmortem
examination with ancillary studies (toxicology) are critical to
complete before determining a cause of death and opining a
manner of death. This review similarly highlights the causes,
mechanisms, and circumstances of elevator-related deaths as dis-
cussed by McCann. However, this review also briefly discusses
Preventive strategies
Education and awareness
Do not use
Elevator inspections
Do not use
Regular maintenance
Report malfunctioning elevators immediately
Do not enter shaft
Do not enter other areas
Secure all access doors
Be aware that home elevators may be more dangerous
Be aware that freight elevators tend to be more dangerous
Avoid using elevators when Intoxicated
Watch out for intoxicated persons on and around elevators
Avoid horseplay, vandalism, illegal behaviors in and around elevators
Use only qualified workers
Always put elevator in “service mode” when working on or around
elevator or in shaft
Fall-prevention strategies (harnesses, scaffolding, etc.)
Recognize all potential risks and employ strategies to avoid injury
De-energize electrical circuits prior to working on or around them
Do not use
Report immediately
Do not pry elevator doors open
Do not forcibly enter or exit an elevator
Do not enter or exit a stalled elevator
Use emergency alarm or phone to call for help
Do not overload an elevator
10 JOURNAL OF FORENSIC SCIENCES
the relevance of toxicology results and interpretation of the total-
ity of information when investigating suspected elevator-related
deaths to best opine the manner of death. Thorough death inves-
tigation requires the collection of additional information, includ-
ing the following: determine the specific type of elevator system
(passenger, freight, home, hydraulic, traction, combined) and
serial number of the elevator; document the date when the eleva-
tor last had a maintenance or inspection, if there were any issues
during that time, and who performed the maintenance or inspec-
tion; contact the elevator manufacturer to determine if there are
any recalls or reports of malfunction; request to review surveil-
lance videos that are often within or around an elevator system;
work with a qualified person to check electrical power to the
elevator system; contact an elevator expert to inspect the eleva-
tor, ideally the same day of the death, but even if the inspection
has to occur day(s) after the death; if fall-related, measure the
distance from the location of the elevator in the elevator shaft to
where the decedent was found; and if the decedent was working
on the elevator at the time of death, confirm the decedent was
appropriately credentialed to perform the elevator work. In addi-
tion, various oversight organizations may need to be contacted,
such as the Occupational Safety Organization and the Consumer
Product Safety Commission. By performing a detailed investiga-
tion and postmortem examination with ancillary studies, a better
understanding of the current death will result, and additional
information may be gleaned to prevent future elevator-related
deaths.
Acknowledgments
The authors are grateful to Drs. James Caruso and Krista
Timm for their willingness to contribute cases to this series.
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