Week 8

Deaths Due to Fire

When a fire results in a fatality, there should be a low threshold for treating the death as
suspicious, in view of the frequency with which attempts are made to conceal a homicide by
“burning the evidence” - about 5% of fire deaths are due to homicide.

Course Learning Outcomes

CLO1: Determination of the time, cause, mechanism and manner of death.

CLO2: Identification of the different types of wounds.
CLO3: Proficiency in the methods by which a detailed external examination of the deceased should be carried out, to include
methods of assessing the “postmortem interval”.
CLO4: Medical examination and detailed description and assessment of injuries and their sequelae on both the living and
deceased persons throughout the age spectrum, including cases of abuse that would enable a full evaluation of such
aspects of direct legal interest as their method of infliction, possible causation, consequences and complications.
CLO5: Compilation of authoritative medico-legal reports to the relevant authorities, describing in detail the findings and
results of any examinations carried out and including a full and pertinent commentary which provides balanced scientific
opinion and conclusions.
CLO6: Determine age and personal identification applying the procedures in Forensic Odontology and Anthropology.
CLO7: Know the concept of Forensic Pathology.

The aims of the pathological investigation of fire deaths are:

1. To confirm the identity of the deceased

2. To determine whether the deceased was alive or dead at some time during the fire
3. To determine why the deceased was in the fire ( and why they could not get out)
4. To determine the cause of death was fire related
5. To determine (or give opinion as to) the manner of death.

Identification of the Deceased

Personal property found on or with the deceased may be of assistance in supporting a

presumptive identification, although it should be remembered that people may be wearing
clothing or jewelry belonging to someone else. Similarly, documents, such as driver’s licence
etc. (that have survived the fire) may not belong to the deceased.

If there is only limited fire damage to the body, it may be possible to obtain visual
identification of the deceased; facial features may become distorted by heat/fire, and such
identification may not be reliable or desirable.

Other personal characteristics include:

 1. height/weight - although there may be heat related shortening and weight loss
(evaporation0
2. hair color/length
3. eye color
4. skin color/tattoos
5. scars
6. surgical implants
7. fingerprints
8. DNA

When there is marked fire damage to the face, dental identification may be most
appropriate; although tooth enamel can survive extremes of heat, it may become friable and in
such cases, the pathologist can preserve the teeth prior to odontological examination by
spraying them with hair lacquer/spray. If the jaws have not survived the fire, the X-ray
appearances of the frontal sinuses may be used for comparison with antemortem skull X-rays.

Determine if the deceased was alive or dead at the time of the fire.

A Blood sample (from anywhere in the body) must be taken for estimating the
carboxyhemoglobin (CO-Hb) level; this can be submitted to the hospital biochemistry
department for an urgent CO-Hb level.

Smokers may have a CO-Hb level of up to 10% (although this could be as high as 20% in
heavy cigar smokers), but a level of over 50% is good evidence that the deceased was alive at
the time the fire started, and was able to breath in the smoke and fumes generated by the fire.
The level of CO-Hb may be lower in those individuals more at risk of dying due to the effects of
fire and smoke, such as the elderly, or those with chronic lung disease.

A low CO-Hb level does not necessarily imply that the deceased was dead at the time
the fire started; deaths due to a “flash-over” fire are of ten associated with a “zero” or “normal”
CO-Hb level.

A careful external examination is required in order to identify any evidence of injury.

Patterns of injury most in keeping with self harm (such as incised wounds of the wrists, or old
scars at the elective sites of self harm, etc.), or assault (scalp lacerations, etc) may point to an
alternative cause of death, but an assessment of antemortem injury may be complicated by the
effects of fire, creating artifactual injury.

Fire-related artifacts include:

 1. The pugilist attitude - differential heat related contraction of the limbs result in a
characteristic position of the limbs; the arms are flexed at the elbows and wrists.
2. Fractures - brittle fire damaged bone may be fractured, particularly when such bone is
crushed by collapsing building structures or damaged during the fire-fighting or recovery
phases of the investigation.
3. Extradural hemorrhage - heat-related extravasation of blood may collect in the extradural
space, mimicking an extradural hemorrhage. The assessment of such an artefact may
be complicated by the co-existence of a heat-related skull fracture in the same vicinity; if
in doubt stop the post mortem and seek advise/help.
4. Pseudo-ligature - due to the effects of tight clothing/jewelry and postmortem neck
swelling.
5. Anal diltation

Possibilities when the deceased cannot escape the fire:

a. they were already dead

b. they were intoxicated due to alcohol +/-drugs
c. they were old +/- infirm
d. they were immobile for some some reason
e. they were rapidly overwhelmed by fumes/smoke due to poor physiological reserve (e.g.,
coronary artery disease or chronic obstructive pulmonary disease;
f. there was insufficient time to escape the fire due to the nature of the fire itself e.g. a flash
fire or explosion
g. there was a panic/confusion
h. escape routes were obstructed, (deliberately or accidentally)
i. the deceased was in unfamiliar environment (and did not know where the escape route
was)

Cause of Deaths in Fire

Deaths occurring during the Fire

Death may be due to the effects of breathing the products of fire/burning, principally carbon
monoxide, but also cyanide and many other toxic by-products of combustion. Alternatively,
death may be due to the effects of heat ( i.e., heat shock) or the inhalation of hot air/gases,
possibly related to the initiation of vagally mediated reflex cardiac arrest following the stimulation
of nerve endings on the pharynx/larynx.

Deaths occurring After Fire - such deaths may be due to:

a. the effect of burns - fluid loss, electrolyte imbalance, hypovolemic shock. A rough ‘rule of
thumb‘ is that the prognosis is poor if the sum of the % of body surface area burned and
the age is greater than 100
b. infection (reduced skin ‘barrier protection’ of burned skin
c. adult respiratory distress syndrome (ARDS)
d. renal failure
e. abnormal clotting