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alcohol and drugs, an opportunity exists to study effectively the
specific causes and mechanisms of injury of all magnitudes and
to establish base lines against which to measure the efficacy of
control measures.
RECOMMENDATIONS
1. Judicial application of the principle of seeking impartial medical
advice in the determination of disability.
2. Replacement, on a national scale, of lay coroners by medical
examiners who are not only physicians but also qualified pathologists
experienced in medicolegal problems.
AUTOPSY OF THE VICTIM
The exact cause of death in many of the injured can be learned
only from complete autopsy examination. Especially in multiple
injuries, priority of treatment may have been directed toward
obvious, or overt, injuries, but covert injuries, such as laceration
of major vessels, retroperitoneal hemorrhage, or fat embolism
may have been the primary cause of death. Although it is the
responsibility of the coroner to direct autopsy examination, this is
not routinely performed. If this opportunity to ascertain the spe-
cific cause of death is to be grasped, complete autopsies must be
performed routinely on those who have died as the result of injury.
Furthermore, the findings in large numbers of autopsies must be
critically analyzed in order to point the way to necessary changes
in treatment. One such study, of 950 consecutive autopsies of
accident cases, revealed an unexpected finding: in 38 percent of
those who died in the hospital or after returning home following
fracture of the hip, the primary cause was pulmonary embolism.
Yet in a large number of similar patients who had not been autop-
sied, pulmonary embolism was the recorded cause of death in only
2 percent. This is but one example of the value of careful
autopsy examination. Such findings are important to alert emer-
gency department staffs to the incidence of covert injuries that
might well dictate first priority care, as well as the care and pro-
phylactic measures that must be observed during definitive care
and rehabilitation.
RECOMMENDATION
Routine performance and analysis of complete autopsies of accident
. . .
victims.
27
Representative terms from entire chapter:
covert injuries
