An Unusual Accidental Death From Positional Asphyxia

Abstract

Death from postural or positional asphyxia takes place in circumstances when the victim's body assumes an abnormal position compromising the process of respiration. The diagnosis is usually based on circumstantial evidence in conjunction with excluding other significant underlying causes of death. This case report is about a 37-year-old man who had been drinking the previous night and was found dead in the morning in a knee-chest position. The forensic medical examiner had the opportunity to examine and photograph the scene of death while the body was still in its original position. Apart from a blood alcohol level of 290 mg/100 mL, marked congestion of the face, and petechial hemorrhages on the conjunctivae, autopsy findings were unremarkable. There were no injuries or pathological findings to account for his death. Death was certified as due to postural asphyxia secondary to intoxication by alcohol.

The medico-legal scene in Dubai: 2002–2007

“…a case of fatal accidental inhalation of sulfuric acid 6 , a few cases of accidental fatal asphyxiation by sand inhalation 7 and one unusual accidental death from positional asphyxia. 8 The predominant method of suicide was hanging (80%), followed by fall from height (5.7%), drowning (2.8%), extensive body burns (2.6%), ingestion of corrosive liquids (1.4%) and ingestion of insecticides (1.4%). Many cases of suicidal hangings accompanied by masking and bondage have been encountered.…”

Fatal accidental asphyxia in a jack-knife position

“…It is essentially based on the following criteria: the body must be in such position that normal respiratory movements were impaired, accidental nature must be ascertained by scene investigation or historical evidence, it must be impossible to move to another position, and other significant underlying causes of death natural or violent nature must be excluded. 4,6 Death from positional asphyxia was reported in a variety of circumstances such as reverse suspension, 7,8 Hyper-flexed head or head-down position 3,4,9 and 'jack-knife position'. 1 In most of the reported cases the victim was intoxicated or incapacitated to a degree that it was impossible to move out of that abnormal position.…”

“…2,3 It is not necessary that the whole body is inverted to cause death from positional asphyxia, as partial inversion of the torso, hyper-flexion of the neck or face down position during inebriation can also be fatal. 4,9 Fatal positional asphyxia is usually accidental and associated with drunkenness or other intoxicants or disabilities. It may also be a factor in a proportion of the rare cases of sudden deaths occurring during restraint by police, prison officers and health care staff.…”

An analysis and report of custodial deaths in Nebraska, USA: Part II

“…Cases of positional and postural asphyxia and excited delirium in the setting of restraints are established in the literature. 4,11,12 Sudden and unexplained death has been shown to occur in the setting of altered behavior, restraints, and stimulants. 13 This case resulted from restraints in the setting of a 'spit mask,' made of fabric.…”