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Bouies iecoveieu fiom Fiies

lL ls esLlmaLed LhaL Lhere are approxlmaLely 11 mllllon lndlvlduals ln Lhe unlLed SLaLes who
requlre medlcal evaluaLlon for burn wounds each year (1) Also ln Lhe unlLed SLaLes alone Lhe flre
deparLmenLs respond Lo nearly 2 mllllon phone calls regardlng flre accldenLs on an annual basls More
Lhan 30000 vlcLlms are admlLLed Lo Lhe emergency deparLmenL each year for Lhelr burns wlLh more
Lhan 40 of Lhem havlng severe burns affecLlng more Lhan 23 of Lhelr LoLal body surface area (1)
AbouL 30 of Lhe admlLLed wlll dle of burn relaLed lnfecLlon yearly wlLh an addlLlonal 22 who wlll dle
as a dlrecL resulL of Lhelr burns Accordlng Lo Lhe unlLed SLaLes llre AdmlnlsLraLlon up Lo 74 of faLal
flres occur ln bulldlngs malnly on resldenLlal properLles where smoke alarms are elLher absenL or
malfuncLlonlng (1)
8urns are Lhe mosL common Lhermal ln[urles whlle flres are Lhe mosL common cause of burns
llre and deaLh are frequenL companlons 1he flre can elLher be Lhe weapon whlch acLually causes deaLh
or Lhe devlce LhaL's used Lo elLher conceal Lhe cause of a homlcldal deaLh or desLroy oLher physlcal
evldence (2) 8egardless of Lhe cause and manner of deaLh bodles whlch are exposed Lo flre show many
posLmorLem effecLs laLal Lhermal ln[urles may resulL ln an accldenLal sulcldal or homlcldal manner of
deaLh (2) 1hereby scene lnvesLlgaLlons are excepLlonally lmporLanL ln deLermlnlng Lhe manner of
deaLh lor example lf a house flre ls deLermlned Lo be lnLenLlonal (also known as arson flre) Lhe deaLh
wlll be ruled homlclde whereas ln Lhe case where Lhe house flre ls deLermlned Lo be Lhe resulL of an
elecLrlcal evenL smoklng heaLlng cooklng equlpmenL or oLher unlnLenLlonal cause Lhen Lhe deaLh ls
ruled accldenLal Also ln addlLlon Lo scene lnvesLlgaLlon one musL also lnvesLlgaLe Lhe body and
aLLempL Lo deLermlne wheLher or noL Lhe person was allve aL Lhe Llme of Lhe flre and whaL was Lhe
acLual cause of deaLh burns smoke lnhalaLlon naLural dlsease process ln[ury drug LoxlclLy or a
comblnaLlon of Lhese facLors
ldentificotion of the deceosed
ersonal properLy LhaL may be found on or wlLh Lhe deceased may help ln Lhe ldenLlflcaLlon
process however one musL be exLremely careful as Lhe lndlvldual may have been wearlng anoLher
lndlvlduals' cloLhlng or [ewellery or may have been carrylng lLems belonglng Lo someone else lor
example lf a drlvlng llcense ls found lL should unquesLlonably be kepL and Laken lnLo conslderaLlon
however ldenLlflcaLlon should noL rely solely on LhaL one lLem lf Lhe recovered body ls enLlrely covered
by sooL and shows no severe burns Lhe sooL can be easlly cleaned Lo glve a clearer plcLure of Lhe face
and exLernal feaLures of Lhe deceased 1he ldenLlflcaLlon process wlll be a loL more dlfflculL lf Lhe body ls
charred due Lo Lhe facL LhaL charrlng compleLely alLers Lhe lndlvlduals' exLernal feaLures PelghL and
welghL ln Lhls case may be lnaccuraLe as a reducLlon ln Lhe lndlvlduals' helghL usually occurs as a resulL
of heaL conLracLlon whlle a correspondlng reducLlon ln Lhe
welghL occurs due Lo Lhe loss of flulds from Lhe burns (3) Palr
colour changes may also Lake place due Lo Lhe severe heaL
and Lhus should noL be relled on ln dlfflculL cases
comparaLlve means of ldenLlflcaLlon ls a forenslc paLhologlsLs'
only opLlon (3) lor example a clenched hand whlch resulLs
from heaL conLracLure means LhaL Lhe flngerprlnLs wlll be
preserved and Lhus can be compared wlLh any pasL records
Lhe auLhorlLles may have lnvesLlgaLors musL search for any
prevlous denLal and medlcal records as well as radlologlcal examlnaLlons ln order Lo conflrm Lhe
lndlvlduals' ldenLlLy (3) lf Lhls ls noL posslble samples of LeeLh or bone may be Laken for unA analysls
Jos the deceosed o/ive or deod ot the time of the fire?
ueLermlnaLlon of wheLher or noL Lhe deceased was allve aL Lhe Llme of Lhe flre wlll ald Lhe
forenslc paLhologlsL as well as Lhe auLhorlLles ln deLermlnlng Lhe manner of deaLh 1he maln
mechanlsm for dolng Lhls ls Lo acqulre a blood sample from anywhere ln Lhe body and Lo send lL Lo Lhe
lab for an esLlmaLlon of Lhe carboxyhemoglobln level (3) lf Lhe lndlvldual was a smoker Lhey may have a
relaLlvely hlgh CCPb level Lo begln wlLh lL may be 10 or even as hlgh as 20 ln heavy smokers
Powever lf Lhe blood shows levels Lo be over 30 Lhls ls good proof LhaL Lhe deceased was allve aL Lhe
Llme Lhe flre sLarLed and was allve Lo breaLhe ln Lhe smokes and fumes produced by Lhe flre (3) 1hls
level however may be lower ln Lhose lndlvlduals more aL rlsk of dylng from Lhe effecLs of flre and smoke
such as Lhe elderly or anyone wlLh chronlc pulmonary condlLlons 1hls means LhaL lower levels may sLlll
lndlcaLe LhaL Lhey were allve aL Lhe Llme Lhe flre was lnlLlaLed ln conLrasL a low carboxyhemoglobln
level may lndlcaLe LhaL Lhe lndlvldual was already dead aL Lhe Llme Lhe flre sLarLed however Lhls ls noL
always Lhe case ln Lhe case of a flashover" flre whlch descrlbes Lhe slmulLaneous lgnlLlon of all
combusLlble maLerlal ln an enclosed area levels of carboxyhemoglobln may be zero or normal lurLher
evldence LhaL Lhe lndlvldual was allve aL Lhe Llme Lhe flre sLarLed ls Lhe presence of carbon black
I|gure 1 I|nger amputated from a charred body
dur|ng autopsy for the purpose of f|ngerpr|nt|ng
maLerlal (sooL) or ashes ln Lhe alrway below Lhe vocal cord and mlxed wlLh mucous ln Lhe dlsLal alrways
(3)
lL ls also lmporLanL Lo perform a Lhorough exLernal examlnaLlon ln order Lo deLecL any ln[urles
LhaL may be presenL ln[urles Lo be looked for lnclude selflnfllcLed wounds such as lnclsed wounds of
Lhe wrlsLs or assaulLs ln Lhe form of scalp laceraLlons whlch may polnL Lhe forenslc paLhologlsLs aL an
alLernaLlve cause of deaLh 1he lnvesLlgaLors musL be very careful ln belng able Lo ldenLlfy flrerelaLed
arLefacLs and noL mlsLaken Lhem for anLe morLem ln[urles lor example heaLlnduced spllLLlng of Lhe
skln may resemble laceraLlons however Lhe dlfference ls LhaL Lhere wlll be no vlLal reacLlon aL Lhe
wound edges lf lL Look place posL morLem (2) CLher flre relaLed arLefacLs lnclude
1 1he 'puglllsL' aLLlLude whlch descrlbes Lhe
characLerlsLlc poslLlon of Lhe llmbs (Lhe arms belng
flexed aL Lhe elbows and wrlsLs) and resulLs due Lo
heaLrelaLed conLracLlon of Lhe llmbs (2)
2 lracLures lL ls very llkely LhaL a flredamaged bone
wlll undergo some sorL of fracLure especlally when
flre causes Lhe collapse of Lhe bulldlng sLrucLure on
Lhe body (2)
3 LxLradural haemorrhage Lhls ls usually a resulL of
heaLrelaLed exLravasaLlon and collecLlon of blood
lnLo Lhe exLradural space lL may also be
compllcaLed by a heaLlnduced skull fracLure ln Lhe
same vlclnlLy (2)
4 seudollgaLure marks whlch may caused by any
LlghL flLLlng cloLhlng or [ewellery Lhe lndlvldual was
wearlng and Lhe posL morLem neck swelllng (2)
3 Anal dllaLlon
Jhy wos the individuo/ unob/e to escope the fire?
1he posslblllLles LhaL may have prevenLed Lhe lndlvldual who was Lrapped lnslde Lhe slLe of Lhe
flre Lo escape are endless 1he slmplesL of all reasons ls panlc and anxleLy upon acknowledglng Lhe
I|gure 2 ug|||st|c or 8oxers att|tude
I|gure 3 8urned neckt|e appear|ng as ||gature
presence of Lhe flre Lhe lndlvldual may have enLered a sLaLe of shock and was Lhereby unable Lo reacL
prompLly ln Lhe case of a homlclde Lhe lndlvldual may have already been dead aL Lhe Llme Lhe flre was
lnlLlaLed as Lhe murderer may have begun Lhe flre ln hopes of conceallng Lhe crlme 1he lndlvldual may
have been under Lhe lnfluence of alcohol or drugs and Lhereby Lhls lnLoxlcaLlon affecLed hls menLal
processes (2) 1he vlcLlm may have been advanced ln age or handlcapped and Lhus was noL compeLenL
Lo move qulck enough Lo escape AnoLher posslblllLy ls LhaL Lhey may have been rapldly overwhelmed
by Lhe smoke and fumes produced by Lhe flre due Lo Lhe presence of a medlcal condlLlon as coronary
arLery dlsease or chronlc obsLrucLlve pulmonary dlsease (2) 1lme may have been lnsufflclenL Lo escape
due Lo Lhe naLure of Lhe flre for example ln Lhe case of an exploslon or flash flre llnally Lhe escape
rouLes may have been obsLrucLed for example doors were locked or unfamlllar Lo Lhe lndlvldual (2)
,onner o f ueoth in fires
ueaLh ln flres may be accldenLal homlcldal or sulcldal however Lhe ma[orlLy of flrerelaLed
deaLhs are accldenLal ln 8rlLaln reporLs show LhaL abouL one Lhlrd of accldenLal flre vlcLlms are under
Lhe age of 14 and abouL one half are over Lhe age of 63 (4)
AccldenLal deaLhs resulLlng from Lhermal ln[ury ofLen lnvolve
vlcLlms of moLor vehlcle accldenLs and accldenLal house flres
whlch are usually lnlLlaLed as a resulL of carelessness lor
example a woman's cloLhlng may caLch flre accldenLally whlle
cooklng ln such cases burns wlll usually be found on Lhe fronL
of Lhe Lhlghs abdomen chesL face and hands lf an lnLoxlcaLed
person goes Lo bed smoklng and accldenLally drops Lhe
clgareLLe a flre may auLomaLlcally be sLarLed wlLhouL Lhem
belng aware Chlldren who have access Lo maLches may easlly
drop Lhe llL maLch on Lhelr cloLhes lnlLlaLlng a flre Cccaslonally a naLural
dlsease such as myocardlal lnfarcLlon or epllepsy may cause Lhe lndlvldual Lo
collapse onLo a flre source such as a heaLer Lhereby sLarLlng a flre Sulclde by
burnlng ls usually rare and Lhls ls probably due Lo Lhe awareness of Lhe paln
lnvolved 1he vlcLlm usually pours an lnflammable llquld llke peLrol over Lhelr
cloLhlng and Lhen seLs Lhemselves on flre ln some cases Lhe vlcLlm may also
swallow acceleranL Sulclde by selflmmolaLlon ls common ln some LasLern
culLures (4) lor example ln Lhe pasL a Plndu wldow would commlL sulclde by
I|gure S Afghan| woman be|ng treated after a
fa||ed attempt to comm|t su|c|de by se|f
|mmo|at|on
I|gure 4 1un|s|an man sett|ng
h|mse|f on f|re dur|ng protest
Lhls means on Lhe deaLh of her husband however Lhls has been prohlblLed ln lndla (4) SelflmmolaLlon
ls also a common occurrence amongsL Afghan woman who perform lL as a way Lo free Lhemselves from
domesLlc worrles or dlsappolnLmenL ln love or acuLe or chronlc dlseases SelflmmolaLlon ls also
someLlmes seen as a means of publlc proLesL whlch was acLually seen recenLly ln boLh LgypL and
1unlsla llnally homlclde by burnlng ls rare lL ls more common LhaL Lhe crlmlnal lnlLlaLes a flre ln order
Lo conceal evldence of Lhe homlclde
ouses of ueoth in o fire
1he cause of deaLh ln flre vlcLlms may be due Lo Lhe effecLs of breaLhlng Lhe producLs of flre Lhe
effecLs of Lhe heaL or Lhe lnhalaLlon of hoL alr and gases
A 5moke lobolotloo
Smoke lnhalaLlon ls Lhe general Lerm used Lo descrlbe Lhe lnhalaLlon of parLlculaLe
maLLer and gases produced ln Lhe flre as a resulL of combusLlon or pyrolysls whlch ls Lhe
decomposlLlon by heaL wlLhouL adequaLe oxygen Lo cause lgnlLlon A ma[orlLy of deaLhs from
smoke lnhalaLlon are due Lo hypoxla whlch ls caused by a comblnaLlon of carbon monoxlde
lnLoxlcaLlon a lowlnsplred oxygen Lenslon and mlsmaLchlng of venLllaLlonperfuslon SLudles
show LhaL 83 of vlcLlms presenL ln a bulldlng flre wlll show evldence of carbon monoxlde
lnhalaLlon whlle 30 wlll have evldence of carbon monoxlde polsonlng sufflclenL Lo cause deaLh
(4) Pypoxemla may resulL due Lo Lhe decllne ln Lhe oxygen Lenslon ln a burnlng room Lhe
oxygen level usually falls from a normal 21 Lo beLween 10 and 13 (4) Powever lL musL be
noLed LhaL Lhe level musL fall Lo 6 for abouL 8 mlnuLes Lo cause deaLh whlch ls qulLe unusual
ln general lf Lhere ls sufflclenL oxygen Lo malnLaln a flre Lhen Lhere ls deflnlLely sufflclenL
oxygen Lo malnLaln llfe Lhus Lhe low lnsplredoxygen Lenslon resulLs ln deaLh by lLs comblned
effecL wlLh oLher facLors llnally Lhe venLllaLlonperfuslon mlsmaLch wlll resulL ln alrway
obsLrucLlon Smoke lnhalaLlon produces resplraLory ln[ury vla four maln paLhologlcal
mechanlsms whlch each be dlscussed below
1hermal ln[ury affecLlng Lhe face and upper alrways ls a common occurrence lL ls usually
llmlLed Lo Lhe mouLh Lhe nasal passages Lhe gloLLls and eplgloLLls Lhe pharynx and Lhe larynx
(4) 1he heaL energy LhaL ls conLalned ln hoL dry alr ls so low whlle Lhe heaLexchanglng
efflclency of Lhe resplraLory LracL ls so hlgh LhaL even superheaLed alr ls cooled before lL
reaches below Lhe larynx Powever belng ln alr LemperaLures of 130 degrees Celslus and above
may lead Lo laryngeal spasm and laryngeal edema LhaL are sufflclenL Lo cause suffocaLlon Also
breaLhlng very hoL alr may lead Lo reflex cardlac lnhlblLlon due Lo sLlmulaLlon of Lhe vagus nerve
(4) Cn Lhe oLher hand molsL alr ls much more llkely Lhan dry alr Lo produce burns ln Lhe lungs
due Lo lLs lncreased heaL capaclLy lrom a hlsLologlcal perspecLlve burns of Lhe Lracheobronchlal
Lree wlll show several dlfferenL changes lncludlng swelllng and superflclal coagulaLlve necrosls of
Lhe eplLhellum elongaLlon and pallsadlng of Lhe eplLhellal nuclel evaglnaLlons of Lhe mucosal
glands fragmenLaLlon and clumplng of eryLhrocyLes ln mucosal vessels as well as edema and
hyperaemla of Lhe submucosa (4)
Carbon monoxlde ls a colourless and odourless gas LhaL ls produced by Lhe lncompleLe
combusLlon of carbon compounds lL ls one of Lhe prlmary causes of lnhalaLlon ln[ury as lL
resulLs ln severe Llssue hypoxla 1he afflnlLy of haemoglobln for carbon monoxlde ls
approxlmaLely 200 Llmes greaLer Lhan lL's afflnlLy for oxygen 1hls means LhaL even when Lhe
carbon monoxlde concenLraLlon ls low (3) ln Lhe lnhaled gas Lhe carboxyhemoglobln
concenLraLlon wlll be greaL (4) Carboxyhemoglobln also decreases Lhe dlssoclaLlon of oxygen
from Lhe oxyghaemoglobln as lL causes a lefLward shlfL ln Lhe oxyghaemoglobln curve 8oLh
Lhese acLlons resulL ln a slgnlflcanL decrease ln Lhe amounL of oxygen LhaL ls dellvered Lo Lhe
Llssues and Lherefore severe cellular hypoxla develops 1he normally accepLed faLal
carboxyhemoglobln level ls 30 (4) Powever ln chlldren and Lhe elderly wlLh preexlsLlng
cardlovascular and pulmonary dlseases a level of 30 ls consldered faLal (4) ln mosL cases an
elevaLed carboxyhemoglobln level ls assoclaLed wlLh Lhe presence of sooL ln Lhe lower
resplraLory LracL dlsLal Lo Lhe vocal cords and Lhls ls full proof LhaL Lhe vlcLlm was sLlll allve aL
Lhe Llme Lhe flre was lnlLlaLed Cn Lhe oLher hand a relaLlvely low carboxyhemoglobln level does
noL provlde proof LhaL Lhe lndlvldual was dead before Lhe flre sLarLed because lL may have been
due Lo Lhe facL LhaL Lhere was llLLle or no carbon monoxlde producLlon ln Lhe flre as a resulL of
Lhe presence of abundanL oxygen resulLlng ln compleLe combusLlon as ln Lhe case of a foresL
flre (4)
1he presence of sooL and oLher flrederlved parLlcles ln Lhe alrways causes dlrecL ln[ury
Lo Lhe resplraLory mucosa (4) 1hls ls because Lhese parLlcles are superheaLed and conLaln a loL
of Lhe Loxlc agenLs LhaL are responslble for smokelnduced polsonlng 1he depLh Lo whlch Lhese
parLlcles peneLraLe wlLhln Lhe alrways depends malnly on Lhelr aerodynamlc dlameLer lor
example large parLlcles (greaLer Lhan 10um) wlll be deposlLed malnly ln Lhe nares medlum
slzed parLlcles (37um) wlll be deposlLed ln Lhe Lracheobronchlal Lree and flnally Lhe small slzed
parLlcles (13um) wlll ulLlmaLely reach Lhe alveoll lrom a hlsLologlcal perspecLlve Lhe sooL
parLlcles are usually dlspersed loosely on Lhe mucosa or are embedded ln Lhe mucous (4) lL ls
lmporLanL for Lhe forenslc paLhologlsL Lo keep ln mlnd LhaL Lhe presence of sooL on Lhe Longue
ln Lhe nares oropharynx or larynx does noL lndlcaLe LhaL Lhe person was allve durlng Lhe flre
Powever Lhe presence of sooL below Lhe level of Lhe larynx or ln Lhe oesophagus and sLomach
does lndlcaLe llfe durlng Lhe flre
llnally smoke polsonlng whlch descrlbes Lhe effecLs of varlous gases oLher Lhan carbon
monoxlde produced by Lhe Lhermal degradaLlon of boLh naLural and manmade maLerlal has
faLal paLhologlcal effecLs on Lhe resplraLory LracL Lxamples of maLerlals LhaL may glve off
noxlous gases llke hydrogen cyanlde and aldehydes lnclude wood wool and sllk

os
As Lhe LemperaLure lncreases proLelns wlll be aL rlsk of
undergolng denaLuraLlon AL LemperaLures above 40C Lhe cells
wlll begln Lo malfuncLlon over 43C Lhe cell repalr mechanlsms
wlll fall resulLlng ln cell deaLh When Lhe LemperaLures lncrease
Lo 60C Lhe blood vessels undergo Lhrombosls and Llssue wlll
become necroLlc (3) 1he acuLe lnflammaLory response wlll be
lnlLlaLed ln Lhe area surroundlng Lhe burn and Lhe lncrease ln
caplllary permeablllLy wlll lead Lo Lhe loss of large amounLs of
flulds and elecLrolyLes from Lhe burn ln[ury surface MorLallLy
becomes a poLenLlal rlsk when Lhe exLenL of Lhe burn exceeds
20 of Lhe LoLal body surface 1hls ls because Lhe sLrong
lnflammaLory response LhaL wlll be lnlLlaLed around Lhe area of Lhe
burn wlll resulL ln Lhe release of overwhelmlng amounLs of pro
lnflammaLory medlaLors ln Lhe blood and may resulL ln sysLemlc lnflammaLory response
syndrome (Sl8S) (4)
1he severlLy of Lhe burn ln[urles and Lhe llkellhood LhaL Lhey may cause morLallLy ls
dependenL on many dlfferenL facLors Cne of Lhe maln facLors ls Lhe exLenL of Lhe burned area
1hls ls measured relaLlve Lo Lhe LoLal body surface (18S) area lL ls generally acknowledged LhaL a
3030 lnvolvemenL of Lhe LoLal body surface ls lncompaLlble wlLh survlval (3) ueLermlnaLlon of
Lhe burn surface area ls esLlmaLed besL by uslng Lhe rule of nlnes" where each arm ls 9 each
I|gure 6 ku|e of n|ne |n est|mat|on of
the extent of burn |n[ur|es
leg ls 18 Lhe chesL ls 18 Lhe back ls 18 and Lhe head represenLs 9 of Lhe LoLal body
surface area
AnoLher maln deLermlnanL of morLallLy ln Lhe case of
burns ls Lhe degree of Lhe burn (3) 8urns can be classlfled lnLo
four degrees dependlng on boLh Lhe depLh and Lhe Llssue changes
LhaL resulLed A flrsL degree burn ls superflclal and affecLs only Lhe
epldermls lL ls characLerlzed by eryLhema and mlld paln Peallng
usually occurs wlLhln a week and leaves no scar (3) 1he mosL
common example of a flrsL degree burn ls a sunburn Second degree burns lnvolve Lhe epldermls
and a varlable porLlon of Lhe dermls (3) 1hey may elLher by superflclal lnvolvlng only Lhe upper
Lhlrd of Lhe dermls or deep lnvolvlng more Lhan one Lhlrd of Lhe dermls buL noL exLendlng
beyond lL 1hey are usually characLerlzed by bllsLer formaLlon and are exLremely palnful due Lo
Lhe exposure of Lhe nerve endlng presenL ln Lhe dermls (3) 1hls degree ls Lhe mosL llable Lo
cause neurogenlc shock due Lo Lhe severe paln LhaL wlll be experlenced by Lhe paLlenL Peallng
ls a loL slower ln Lhe deeper burns and lnvolves a loL more scarrlng A Lhlrd degree burn ls a full
Lhlckness burn whlch lnvolves Lhe enLlre epldermls and dermls (3) ln Lhls case prlmary
reeplLhellallsaLlon wlll noL occur and Lhe wound wlll requlre skln grafLlng 1he skln ls
characLerlzed by acqulrlng a leaLhery brown or black charred appearance 1here ls also no paln
due Lo Lhe desLrucLlon of all Lhe nerve endlngs by Lhe heaL llnally a fourLh degree burn refers
Lo an lnclneraLlng ln[ury LhaL exLends deeper Lhan Lhe skln
ln addlLlon Lo Lhe depLh of Lhe burn and Lhe exLenL of Lhe ln[ury oLher facLors whlch
have a role ln deLermlnlng morbldlLy and morLallLy lnclude Lhe slLe of Lhe burn Lhe age of Lhe
vlcLlm and Lhe coexlsLence of oLher ln[urles or dlseases (4) ln Lerms of Lhe slLe usually burns
LhaL occur ln Lhe head neck and chesL reglon lead Lo resplraLory problems 1hose LhaL occur ln
Lhe neck and llmbs lead Lo dlsflguremenL due Lo Lhe conLracLures and flnally burns occurrlng ln
Lhe perlneal reglon wlll llkely lead Lo lnfecLlons (3)
8ecause Lhe dermls acLs a barrler agalnsL Lhe loss of body fluld by evaporaLlon and Lhe
loss of excess body heaL when damaged Lhe paLlenL wlll experlence hypoLhermla as well as
severe dehydraLlon whlch wlll lead Lo hypoLhermla and hemoconcenLraLlon (3) Also because
Lhe dermls ls Lhe prlmary proLecLlve barrler agalnsL bacLerla and oLher lnfecLlous organlsms lL's
I|gure 7 1st degree burn (sunburn)
damage wlll lead Lo wound lnfecLlon whlch ls Lhe ma[or cause of delayed morLallLy ln burn
paLlenLs

Management of a fire casuality
There are five major steps that must be followed upon the admission of a burn victim in the
emergency department, which include: stopping the burning process, establishing an airway, initiating
fluid resuscitation, releiving pain, and finally protecting the burn wound (6).
To stop the burning process, the victim is first removed from the burning environment. Clothing
should also be removed immediately, as it may be a source of continued chemical or thermal injury (6).
The paramadics at the scene of the accident, should rapidly assess the severity of the burn (depth and
extent) and should then wrap the victim in sterile dry sheets. Subsequently, high flow oxygen (100%)
should then be administered to the victim via a non-rebreathing mask. The victim's airway should be
rapidly evaluated and any indication of upper airway burn or respiratory distress should be an indication
for early airway intervention (6). A victim who shows minimal initial indications of airway injury but are
comatosed should be considered for early intubation, as these patients may initially appear to be okay but
may rapidly deteriorate once the swelling begins. Next, fluid resusciation should be initiated. t is indicated
for all burn casualities with an estimated BSA burn of 15% in adults and 10% in children (6). The
preferred method of fluid resuscitation is intravenous however oral may sometimes be used. The victim's
vital signs, mental status, and urine output should continously be monitored. A burn victim will most likely
be in excruciating pain, especially if they are experiencing a second degree burn. n order to releive their
pain, intravenous morphine sulphate, which is a narcotic analgesic is administererd (6). Finally, tetanus
prophylaxis should be administered unless the victim has already been immunized. The burn wounds
should remain cocered by dry sterile sheets to prevent any infection, until surgical interference is made
(6).
I|gure 8 D|fferent degrees of burns
n conclusion, when a fire results in a fatality, there should be a low threshold for treating the
death as suspicious as about 5% of fire deaths are due to homicide. Attempts made to conceal a
homicide by burning the evidence do not occur frequently however, it is still crucial for the forensic
pathologist to perform a thorough autopsy. Taking minor safety precautions in the home, and workplace,
such asinstalling properly functioning carbon monoxide detectors will indeed serve to reduce the number
of lives destroyed by fire accidents.

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