| dc.description.abstract | Deaths due to accidental and intentional inhalation of chemically generated gases are not an uncommon occurrence in the field of forensic pathology and death investigations. Gases such as carbon monoxide, helium, nitrogen, nitrous oxide, and propane are the most encountered in these types of incidences (Azrael et al., 2016). And yet, an unsuspecting gas, hydrogen sulfide (H2S), has recently emerged as a significant cause of inhalation mortality in the United States, but not in an anticipated manner. Previously, hydrogen sulfide-related deaths have been associated with fatalities and accidents in industrial and occupational settings such as oil and gas operations, agricultural settings, confined spaces, power plants, and utility industries (Morii et al., 2010). Post 2007-2008, in the United States, H2S has been utilized as a means of suicide by individuals that intentionally generate the gas, usually, in small, confined spaces. The first documented H2S-mediated suicides emerged in Japan in 2007-2008, following a social media dissemination of an online "how-to" guide (Sams et al., 2013). Subsequently, H2S-related suicidal deaths have also increased in the United States, more specifically, suicides by the intentional generation of the toxic gas. Despite the increase in H2S-mediated suicides within the United States, limited research has been conducted regarding the potential hazards encountered during H2S death scene response, incident investigation, victim recovery operations, and autopsy examinations. This colorless, odorless gas can pose serious health risks to unsuspecting first responders and other medicolegal personnel attempting to save, remove, or process victims on scene and in other investigatory venues. To better elucidate the risk factors and pathology novel to H2S deaths, a survey was deployed using Survey Monkey to members of the ABMDI (American Board of Medicolegal Death Investigators). Autopsy and investigative reports were obtained via email from various Coroner and Medical Examiners' Offices across the United States. Demographic data, incident characteristics, and pathology findings were compared with a previous study wherein preliminary data (n=30 cases) were collected from the National Vital Statistics System (NVSS), NAME (National Association of Medical Examiner's), and public source document searches (Reedy et al., 2011). Our study demonstrated a definitive increase in reported H2S fatalities, post-2008, within the United States. Additionally, our data revealed an increase in suicidal deaths via intentional H2S manufacture and inhalation, as well as the presence of a preponderance of novel, greenish-discolored brain, and central nervous system tissues, unrelated to postmortem decomposition. To ensure the safe investigation and diagnosis of deaths due to H2S inhalation, it is paramount to incorporate a comprehensive, timely combination of scene information, decedent history, as well as the safe collection of appropriate anatomical and toxicological postmortem specimens. Postmortem analyses should include the quantification of thiosulfate levels in blood and/or urine, a detailed history of circumstances surrounding H2S exposure, and a central nervous system (CNS)-focused internal examination or complete autopsy. Additionally, brain and CNS tissue should be thoroughly examined to elucidate a unique and possibly pathognomonic appearance of a greenish discoloration informative to H2S toxicity. This research has implications for the enhanced understanding of personnel and environmental hazards, incident dynamics, asphyxia mechanisms, and postmortem findings associated with H2S-related fatalities. | |
