Accidental cut-throat injuries from the broken windshield of an auto rickshaw: Two unusual cases

Introduction

This paper presents two cases of fatal unusual cut-throat wounds caused by the broken windshield of an auto rickshaw.

Case reports

Case 2

A 35-year-old auto-rickshaw driver was brought to the emergency department of a trauma center following a road traffic accident. However, he succumbed to his injuries on the way to the emergency department. As per the history, the deceased was driving an auto rickshaw which collided sideways with a high-speed car. The auto rickshaw lost control and crashed into a brick wall. The crash compressed the driver compartment and propelled the driver forward with momentum. The driver’s head went through the windshield which broke into pieces, and one of the protruding pieces struck his neck, as in the first case.

On post-mortem examination, an incised wound 14 cm in length was present on the upper part of the neck, with a gap of 4.7 cm (Figure 1(a)). The larynx and neck vessels on both sides were cut. An imprint abrasion of a broken glass piece was present on the left cheek, extending to the nose and lips (Figure 1(b)). A flapped incised wound was present on the chin.

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Figure 1.

(a) Incised wound over neck, blood oozing from the incised vessels on left side. (b) Abrasion and incised wound over face creating the pattern of a glass piece.

The brother of the deceased gave consent for the details of the case and photograph of the deceased to be published.

Discussion

Accidental glass wounds to a person are well documented in the scientific literature. They are one of the commonest mechanisms of fatal accidental penetrating wounds.^1,2 Accidental glass wounds mainly occur in two ways: the victim strikes the glass pieces with or without a fall or flying glass pieces strike the victim. ³ These injuries mainly occur in children as a result of falling over glass pieces, ramming into glass doors or windows or playing with glass utensils or glass pieces. ⁴ Injuries to adults occur from falling over glass pieces, ramming into glass windows or doors or passing through broken glass doors or windows. ³ Injuries mainly take the form of lacerations, with others being extensive bruises, head bumps, and deep cuts. In adults, glass wounds involve the upper limb and lower limbs, the trunk and the head in that order, with the neck being the least commonly involved.^3,4

Accidental cut-throat wounds by glass pieces have been rarely documented in the literature. A case of fatal accidental glass wound to the neck was described by Fracasso and Karger. ⁵ The wound was inflicted by the broken edges of a wine glass which a woman bent over to answer a telephone call. In their series of 22 accidental sharp-force injuries, Prahlow et al. ² found one case of penetrating neck injury by glass pieces caused by a broken windshield during a motor vehicle accident. The man was an unrestrained passenger in a car, and his head went through the windshield during a head-on collision. Current case scenarios had the same mechanism as Prahlow et al.’s. The unrestrained drivers went through the front windshield pane upon sudden deceleration. The toughened glass windshield broke into large pieces, and one of the protruding pieces struck the neck, causing the driver’s death. The deceased suffered no other fatal injury.

Restraining a driver with a seat belt is important in preventing him/her from colliding with the steering wheel and from being thrown from the vehicle in the case of sudden deceleration. It can reduce the chances of the fatality up to 50% in motor-vehicle collisions. ⁶ The seat belt decreases the chances of fatality and other injuries by distributing the deceleration force over a wide area of the body, by distributing the deceleration force over the strongest part of the body, by increasing the time duration of the deceleration and by preventing the person from colliding with the interior of the vehicle. Failure to use a seat belt is one of the major risk factors for death and major injuries to the occupant of a vehicle. ⁶

As per Central Motor Vehicle Rules 1989 of the Government of India, seat-belt fitting is now mandatory for every vehicle, except motorcycles and three-wheelers (the auto-rickshaw). ⁷ Today, three-wheeler auto-rickshaws are an important means of travel within the city, as they are cheap and eco-friendly. However, they have limited crashworthiness and carry risks of serious injury to their occupants, even at lower speed. Furthermore, auto-rickshaw drivers are known for hazardous driving practices and traffic-rule violations. ⁸ The vehicles are open at the sides, making their occupants prone to ejection in case of a collision. In road traffic accidents, the windshields form a physical barrier to prevent the driver from being thrown out of the vehicle. The front windshield of the auto rickshaw is made up of lower-grade toughened glass. These glass panes are prone to shattering into large pieces during collisions, which makes the driver prone to eject through the front glass pane during sudden deceleration. Furthermore, the inclination of the windshield towards the driver and the absence of any shock-absorbing panel (Figure 2) pose additional threats for fatal and non-fatal injuries. These facts suggest that some kind of restraining device should be provided for the auto-rickshaw driver, such as the ‘seat belts’ in the four wheelers, in order to protect the driver from fatal and non-fatal injuries in case of a collision. Other safety measures could include a high-grade laminated glass front windshield and a straight windshield without inclination, which would increase the distance between the driver and the windshield.

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Figure 2.

A prototype of auto rickshaw; the distance between the windshield and the driver’s head is only 1–1.5 feet.

Cut-throat wounds from glass pieces, as seen in this report, have medicolegal significance. These injuries can be in the form of an incision or stab to the neck and create suspicion of homicide, as an accidental penetrating wound to the neck is unusual. Crime-scene analysis is important in such cases to determine the manner of the wound.⁵ In one of our cases, examination of the auto rickshaw showed glass pieces protruding from the broken front windshield. During the post-mortem examination, careful analysis of the wound can differentiate accidental wounds from a homicidal or suicidal wound, and should be correlated with the history of the incident. ⁹ A clean irregular margin of the neck wounds, as seen in these two cases, suggests a glass wound injury, ¹ and associated facial injuries correspond with the history of being ejecting through the broken glass pane.

Conclusion

Cut-throat wounds in the depicted cases were produced by broken pieces of windshield during a motor-vehicle collision. This is very unusual and is prone to create confusion about the homicidal manner of the wound. Thorough autopsy examination and crime-scene findings are essential to determine the origin and manner of such type of wounds.