Entrapment in small, enclosed spaces: A case report and points to considerregarding the mechanism of death

The mechanism of death due to confinement in an enclosed space is usually a scribed to asphyxia from oxygen deprivation. We report the case of the deco mposed remains of a 23-year-old man discovered in an unused industrial size refrigerator in which the mechanism of death is heatstroke. The investigat ion of the death indicates the subject most likely voluntarily entered the refrigerator and for unknown reasons, closed the door. Injuries identified at autopsy and damage to the inside of the structure indicate he struggled to exit the cabinet. The autopsy shows no significant natural disease proce sses and toxicology studies were negative. The diagnosis of heat stroke typ ically rests on the evaluation of multiple features, including the age and size of the decedent, the ambient temperature, the medical history of the d ecedent, whole body hydration, body fat content, alcohol and drug use, medi cation history, general physical condition, and many other factors. The dia gnosis of heatstroke due to confinement in an enclosed container requires e valuation of the heat stress of the container, the heat strain experienced by the individual, autopsy findings suggesting signs of a struggle to exit the container, and other factors. In all such cases, a careful death invest igation with correlation of autopsy findings is required to accurately dete rmine the mechanism and cause of death. We suggest that for all such deaths , physiological and environmental factors promoting hyperthermia and heatst roke be considered as a possible mechanism of death, along with those assoc iated with the more obvious danger of asphyxiation.