الفهرس 
Definition, classification and EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Fall from height, defined as unimpeded DROP of a body from known point to a known impaction point, is predominantly an urban phenomenon and represent an important form of blunt trauma in society. The incidence of deaths due to fall from height is increasing day by day as many work activities require working at a considerable height.
Whether by accident or foul play virtually thousands of falls’ related fatalities occur each year. While a number of past studies addressed the relationship between falls, injury, and death, only a small fraction sought to establish an objective index geared specifically towards determining the manner particular fall.
Diagnosis of the manner of fatal fall from a height is very important issue. It is necessarily needed for the establishment of justice and chasing assailants. In certain conditions it may be needed for the protection of civil rights or compensation.
Jumping from height is frequently chosen method of suicide among adolescent and young adults, however, the final confirmation of suicide or murder requires careful and systemic medico-legal investigation. The injury pattern is influenced by many factors such as body weight, clothing, ground composition and landing position.
When establishing the mode of death, it is essential for the pathologist to reconsider autopsy findings within the framework of the subject’s individual factors, outcome of toxicology, and circumstances at the death scene.
The present study aimed at throwing light on the probability to differentiate between homicidal, suicidal, and accidental fatal falls from a height, through careful study of circumstantial evidences, scene of the crime and pattern of injury detected by autopsy.
The current study was a retrospective study, it carried was out on the records of cases of fatal fall from presented in Kafr EL Sheikh Medico legal Department over the period from 1st of January 1999 till the 31 st of December 2013. The records were examined and the following data were obtained: personal data, detailed history of the cases as mentioned in the prosecution previews, scene examination, autopsy findings and toxicological analysis reports.
The results of the present study showed that the total number of the cases over the period of the study were 21 cases. The age of the victims ranged from 8 to 69 years with the mean age 32.47 years the highest number of cases found in the age groups (> 30 up to 40) and (> 20 up to 30) years respectively and the least found in the age group of (0 up to10) years.
Males showed preponderance (61.9%), most of them of age group (>30 up to 40) years while the majority of female victims were in the age group (> 20 up to 30) years.
Data about employment was mentioned only in the records of (38.1%) of the cases. As regards the data about the circumstances around the events, they were missing and not mentioned in the most of the records. Social problems, medical illness and previous suicidal attempts were mentioned in (9.52%) of cases each, while psychiatric diseases were mentioned in (14.29%).
Accidental falls were the most prevalent manner (52.38%) mostly in the age groups of (> 20 up to 30) (19.04%) and (> 30 up to 40) years (14.29%) respectively and encountered mainly in male victims. Suicidal falls were the second prevalent manner (23.81%) encountered in females only nearly in all age groups, except (0 up to 10) and) > 20 up to 30) years age groups. This followed by homicidal falls (14. 29%) that occurred in males in the age groups of (30 up to 40) and (> 10 up to 20) years. Undetermined manner (9.52%) was the last.
Scene examination where examination of the site of fall from outside revealed that the nature of the place of fall was from buildings in majority of cases (71.44%) followed by construction sites (9.52%). Other sites were encountered in (19.04%) of the cases. The height of fall was found in majority of records to be from the 4th storey (23.81%) followed by falls from 3rd storey (19.04%). The fall from2 -3 meters and 1st storey were the least (4.76%).
Examination of the trajectory of fall was not reported in most of the cases (95.23%). The nature of impact surface was mentioned only in (38.1%) of the cases where the impact surfaces were hard.
Body orientation in relation to impact surface was mentioned in (38.1%) of the cases, (23.81%) of them were lying on their back and (14.29%) were lying on their front.
Examination of the site of fall from inside was very defective. Presence or absence of suicidal note, signs of struggle and available pre fall running area were unmentioned in all cases (100%). The presence of barrier and its height was mentioned in (33.33%) of the cases.
Autopsy findings showed the presence of extensive damage to different body regions. The head and the thorax were the most affected regions (85.71%) followed by abdomen and pelvis and extremities (80.95 %) each. The neck was the least affected regions (14.29%).
Traumatic shock with multiple organ damages, scalp injuries, skull fracture with meningeal hemorrhage and brain injuries, thoracic cage and intrathoracic injuries as well as abdominal wall and abdominal and pelvic viscera injuries were found. Fracture of pelvic girdle bone and extremities was also found.
The probable primary site of impact was detected by autopsy in (47.62%) of the cases. The front or the back was equally detected as the primary site of impact (19.05%) each. This followed by head and feet (4.76%) each. It was undetermined in ) 52.38 %( of the cases.
The cause of death was head injuries in the majority of cases either by itself (28.57%) or in conjunction with abdominal injuries (9.52%), and or spinal and thoracic injuries (9.52%) as well as abdominal and thoracic injuries (9.52%) were the causes of death. In (9.52%) of the cases, the cause of death was undetermined. Screening of the commonly used drugs through toxicological analysis was carried in (90.48%) of the cases, where it was negative in (85.72%) of cases. Blood alcohol content was performed in (61.9%) of the cases and it was negative.
It was concluded that, data about the history of the event and scene examination wither from inside or outside were deficient. Many items which of great importance in determining the manner of fall were missing. Many recommendations were suggested. Finally a protocol for investigation of cases of fatal fall from height was proposed to be applied in examination of these cases. This protocol could be of value in solving the mystery of manner of fatal fall from height.