bution of the sample, age groups of five-year
periods were made, with those under age 25
lumped at one end, and those age 65 or older at
the other extreme (Figure 1). The table shows
good distribution with a slight increase in cases
with each subsequent age group. Only 10 cases
occurred (5 female/5 male) under age 25, but
25 individuals (22 males/3 females) were over
age 64. Except for the late 30's male and female
distribution was similar up to age 50, after which
all age groups were predominately male. There
was a high predominance of male suicides at the
older age levels.

Body weights for each sex are tabulated in
Table I. There appears to be a relatively normal
spread considering the ages involved and the
fact that some of the older males were in ill
health.

Taste I, Bopy Werents or Farau Impact Cases

Weight (in lbs.) Female Male
> 200 - 5
190-199 1 6
180-189 - 15
170-179 2 15
160-169 3 14
150-159 8 16
140-149 4 13
180-189 16 WwW
120-129 4 6
<120 11 3

A. Heart and Great Vessels. Of the 169 au-
topsies, 87 (50.9 percent) displayed significant
cardiovascular trauma ranging from contusive
injuries to frank disruption of major vessel or
chamber. Only 5 of the 87 failed to display
multiple fractures of the bony thorax. Such
fractures are generally described as penetrating
the pleural and/or pericardial cavities and, in
most instances, one or both lings are lacerated
at sites corresponding to the parietal disruption.
It is therefore probable that the majority of the
injuries sustained by the heart and great vessels
are also due to penetration by broken skeletal
elements rather than to rupture from within the
vessel due to sudden increase in pressure.

Forty-two cases were reported in which one or
more chambers of the heart were ruptured.
Twenty-seven individuals showed damage to only
a single chamber, the remainder suttered ruptures

of two or more chambers. The left atrium ap-
pears to be the chamber most vulnerable to
damage (Table II). In addition to the 42 cases
with frank rupture of the heart, and additional
10 were encountered which showed moderate to
severe cardiac contusions, bringing the total
number with damage to the heart to 52.

Tasiy II, An Anatysis or 42 Cases or Heart
Ruprure

One Chamber Ruptured: No. of Cases:

RA 6
LA 15
RV 2
LV 4

Two Chambers Ruptured:

RA +LA
RA + RV
RA + LV
LA + RV
LA + LV
RV + LV

Orworne

Three Chambers Ruptured:

RA +LA +RV
RA +LA +LV
RA +RV +LV
LA + RV +LV

cone

All Chambers Ruptured:
RA +LA +RV +LV 3

Tora, CuamMBers RupTruRED

RA: 15 LA: 26 RV: 13 LV: iL

Traumatic rupture or laceration of one or more
of the great vessels was found in 45 cases, 12 of
which were associated with cardiac rupture.
Within the series of 45 cases, 11 displayed
rupture of two or more vessels to give a total of
67 lesions observed. In severity, these cases range
from a small tear in a single vessel to an instance
where all major vessels were severed from the
base of the heart and the heart itself avulsed
through the pericardium to lie free in the body
cavity. In terms of frequency, aortic ruptures
were the most common, a total of 38 such lesions





The force of impact, particularly in transverse
or lateral body orientations, caused extensive
fractures to the rib cage, usually bilateral and
multiple fractures involving every rib. These
were of particular importance as the primary
causation, through multiple invasion of the
thoracic area, of penetration type lacerations to
the heart, great vessels, lungs, and liver. Usually
these were in both the mid-clavicular and poster-
jor axillary line, and compound through the
pleural space.

Tasie IV, Incipence or SkeveraL FRacrures

Gross Location No. of Cases

Skull 40
Cervical Vertebra 1B
Thoracic Vertebra 8

Lumbar Vertebra 1] 25
Sacral/Coccygeal Vertebra 3
Pelvis 20
Ribs 144
Upper Extremities 25
Lower Extremities 24
Scapula and Clavicle 18
Total 296

Skull fractures occurred in 40 cases, or nearly
one-fourth of these impacts. In 14 cases of skull
fracture, microscopic examination revealed no
clinical evidence of brain trauma, thus indicating
that skull fracture is not necessarily a critical
measurement of irreversible CNS trauma. Con-
versely, 35 cases, or 56.4 percent of brain damage
occurred without skull fracture.

Vertebral fractures occurred in 25 cases, with
another 20 receiving pelvic fractures or separa-
tion of the pubic symphysis. Thirteen cervical
fractures occurred, six of which were also as-
sociated with a fractured skull. Seventeen indi-
viduals received no fractures at all, probably im-
pacting in a head-first or feet-first (Gz) body
orientation. Fractures to the upper extremities
occurred in 25 cases and in 24 cases to lower ex-
tremities.

G. Reproductive System. There were no in-
juries in any of these cases to the reproductive
system, Although one woman was pregnant and
in her second trimester, there was no injury to
the uterus or fetus.

IV. Discussion

Discussion of these findings would be incom-
plete without consideration of the factor of
drowning in water impact as a cause of death or
contributing factor. In 45 cases (26.6 percent)
drowning was listed as a probable or possible
cause of death. In more closely evaluating
these cases on a basis of concomitant trauma it
is apparent that many would not have survived
the impact injuries whether or not drowning was
a factor. Of these, 22 individuals had trauma to
the heart, great vessels or spleen, 16 had brain
injuries, and 37 had lung penetrations, either
singly or in combination. It is equally evident
that eight individuals who made fatal jumps
from the Golden Gate Bridge died primarily
from drowning and not as a result of impact
trauma. Two individuals had no other injuries.
In these latter cases, the individual perhaps
couldn’t or wouldn’t swim for various reasons.
Debilitation as a result of fractures to the ex-
tremities, as may occur in attempted evacuation
during commercial airliner post-crash fires, may
be an important factor, as well as environmental
conditions of clothing, waves, tide, and exposure.

Injuries received in water impact often differ
in nature and patterns from those impacts oc-
curring on steel, soil or concrete, primarily in
the lower incidence of fractures and external
lesions. But two-major factors play an important
role in this regard, in either water or non-water
impact: duration of deceleration and body orien-
tation, Previous studies have demonstrated that
a water impact in the feet-first (+Gz) body
orientation can result in considerably less trauma
than an impact in lateral or transverse positions
due to the smaller surface area and thus longer
deceleration involved.

A previous study of water impact survival in
free-fall has demonstrated that the critical ve-
locity (corrected for aerodynamic drag) for
human survival of water impact in the feet-first
body position appears to be at slightly over 100
ft/sec (30.48 m/sec), five individuals having sur-
vived impacts of 100-116 ft/sec (380.48-35.30
m/sec) impact velocity. Since that time, three
additional water impact survivals have occurred
in that range. However, the highest impact
velocity survived in the lateral (-G,) body orien-
tation was 87 ft/sec (26.52 m/sec); 88 ft/sec
(26.82 m/sec) in the prone position (-G,); 98



being reported, 22 of which occurred in the as-
cending aorta, two in the arch, and 14 in the
descending aorta. The other 27 vessel disruptions
were distributed among the other great vessels
with tears of the vena cava most frequently
found. A more detailed analysis of the frequency
and location of injuries is given in Table ITI.

Taste IIL. Sire or Rurrure in 45 Cases or
Trauma To Great VESSELS

StneE Lustons: No. of Cases

Aorta
Ascending Aorta
Arch
Descending Aorta

Pulmonary Artery

Pulmonary Veins

Superior Vena Cava

Inferior Vena Cava

we wont

Muurrpte Lesions: No. of Cases

Ascending and Descending Aorta 4
Ascending Aorta -+ Pulmonary Artery 2
Ascending Aorta + Inferior Vena Cava 1
Aortic Arch + Pulmonary Artery 1
Descending Aorta + Pulmonary Vein 2
Pulmonary Vein + Inferior Vena

Cava 1
Ascending Aorta + Pulmonary Vein

+ Inferior Vena Cava 1
Ascending Aorta -+ Pulmonary Artery

+ Pulmonary Veins + Vena Cava 3
Aorta 38
Pulmonary Artery 8
Pulmonary Veins 10
Vena Cava = 1

Total Lesions 67

Comparison of the 86 significant cases of
cardiovascular trauma which was found in this
study with the 459 such cases from the files of
the Armed Forces Institute of Pathology re-
viewed by Gable and Townsend, supports their
findings concerning differences between blunt and
penetrating fatal trauma.® Aortic ruptures ap-
pear to be the most common type of injury in
both studies, with roughly one-fourth (42 cases)
of our water impact cases receiving one or more
chambers of the heart ruptured, and rupture or
laceration of one or more of the great vessels
(45 cases). While it has been demonstrated else-

where that direct nonpenetrating cardiac trauma’
seldom produces serious consequences unless the
myocardium ruptures or a fatal arrhythmia de-
velops, the consequences of penetration of the
thoracic area by numerous ragged sharp rib and
sternal fragments are obviously considerably
more traumatic.

B. Respiratory System. In 181 cases, the lungs
or trachea were injured, with penetration of at
least one lobe being due to jagged rib fractures
in 129 cases or 76 percent of these impacts. The
lungs were the most vulnerable organ due to this
high incidence of rib penetrations.

C. Digestive System. Injuries to the digestive
system occurred in nearly half of these water im-
pacts, with 91 out of 96 such injuries occurring
to the liver. Virtually all of these injuries could
be attributed to lacerations of lobes of the liver
due to rib fractures. Four ruptures of the small
intestine itself, two of the stomach, and one of
the large intestine were also found. In one case,
hemorrhage extended into the pancreatic capsules,
and in a second hemorrhage in the retroperitoneal
spaces and mesentery occurred around the pan-
creas,

Hemorrhage or laceration to the adrenal glands
was observed in only five instances,

Dz Kacretory System. In eight individuals in-
juries to the kidneys (7), ureters (1), or bladder
(1) occurred. Thirteen additional cases of retro-
peritoneal perinephric hemorrhage were noted.
Kidney trauma occurred in only 4.6 percent of
impacts. Injuries consisted of three superficial
lacerations; three cases of hemorrhage in the
renal pelvis; one laceration and rupture, and
one slight contusion.

E. Central Nervous System. Injury to the
brain was most typically subarachnoid hemor-
rhage, with occasional petechiae, focal ecchymotic
zones, perivascular, or epidural hemorrhages
present. Contusions of the lobes or lacerations
occurred in several eases. As noted in the dis-
cussion of skull fractures, brain injury occurred
in 62 cases (30.8 percent) ; however, it is inter-
esting to note that in half of these cases, there
was no skull fracture. The spinal cord was lacer-
ated or contused in six cases, in four of which
there was also brain injury.

F. Skeletal System. Only fractures which were
grossly demonstrable at autopsy were noted. As
listed in Table IV, rib fractures were by far the
most typical skeletal injury, with 144, or 85.2
percent: occurring,



38.

|. Lasky, I. 1:

REFERENCES

Armstrona, J. A., Fryer, D. I., SrewArr, W. K., and
Warrrienam, H. E.: Interpretation of Injuries in
the Comet Aircraft Disasters. Lancet 268: 1145, 1955.

. Civil Aeronautics Board: Personal communication,

1965.

Corner, J. S: Analysis of Air Resistance Effects on
the Velocity of Falling Human Bodies (unpublished
ms.) 1962.

. Earzey, J. C.: Body Terminal Velocity. Unpublished

data. 1964.

. Hartey, J, C.: Dummy Water Impact Tests, Un-

published data. 1965.

. Gaste, W. D. and Townsenp, F, M.: An analysis

of Cardiovascular Injuries Resulting from Accelera-
tive Force. Aerospace Med. 34: 929-934, 1963.
‘Traumatic Non-Penetrating Heart dis-
ease—A Review. Medical Times, 1963.

Menscu, E, C.: The Golden Gate Bridge. A Techni-
cal Description in Ordinary Language, 1935.

9. Scrmewer, R. C., Papo, M,, and Atvarez, ©. 8.: The
Effects of Chronic Recurrent Spinal Trauma in High
Diving, A Study of Acapulco’s Divers. J Bone and
Joint Surg. 44: 648-656, 1962.

10. Snyper, R. G.: A Case of Survival of Extreme Verti-
cal Impact in Seated Position, CARI Report 62-19,
Office of Aviation Medicine, Federal Aviation
Agency, 1962,

11. Snyper, R. G.: Human Tolerance Limits in Water
Impact. Aerospace Med. 86: 940-947, 1965.

12. Swyper, R. G.: Unpublished data, 1986.

18, Srarp, J. P, and Tayror, E. R.: Space Cabin Landing
Impact Vector Effects on Human Physiology. Aero-
space Med. 85: 1117-1183, 1964,

14, TowNsnunn, B, W.: Safety in Over-Water Flights:
A Study of Ten Years Losses of Aircraft Over
Water. 1952-1962, R.F.D. Company, Ltd., Surrey,
England.



AM 68-19

FATAL INJURIES RESULTING FROM EXTREME WATER
IMPACT

Richard G. Snyder, Ph.D.
Clyde C. Snow, Ph.D.

Approved by Released by
‘ ier As PYS.2 A ud
J. Rosert Diniz, M.D. P. V. Sixcen, M.D.
Curer, Crvin AmRomepicaL Feperat Am Surczon
InsriruTE

September 1968

Department of Transportation

FEDERAL AVIATION ADMINISTRATION
Office of Aviation Medicine



ft/sec (28.35 m/sec) in supine (+G,); and
97 ft/see (29.52 m/sec) head-first (Gz). Since
th tal cases reported in this study impacted
at . 08-110 ft/sec (32.92-33.53 m/sec) and con-
sidering the high incidence (85.2 percent) of
penetrating rib fractures, it is believed that most
of these impacts occurred in transverse or lateral
combinations of body orientation. This is
further supported by the previous experimental
water impacts with anesthetized guinea pigs, in
an attempt to reproduce trauma in free-fall of
the two 1954 Comet airline ruptures which spilled
their occupants into the sea.’ Stunt divers at
Acapulco, Mexico, routinely dive up to 135 feet
(86 ft/sec, or 26.2 m/sec) in the —Gz orientation.®

Tests conducted with an instrumented anthro-
pometric dummy in various body orientations
produced measured G forces exceeding 500 G's at
only 9.14 m/sec impact velocities, less than one-
quarter the impact velocity of these fatal cases.®
Both the nature of the trauma and these experi-
mental tests suggest that for pure water impact,
considerably greater protection of the thoracic
cage will be required for human survival of high
velocity +Gx,- impacts.

V. Conclusions.

The necropsy reports and environmental data
were studied for 169 individuals (52 female and
117 male) who had received fatal trauma in
freefall water impacts. All were incurred in
jumps of 239 to 261 feet, or 108-110 ft/sec (82.92-
33.53 m/sec) impact velocities, from the Golden
Gate Bridge in San Francisco, thus constant en-
vironmental factors of velocity, a water impact
surface, and autopsy results were available for
each. To date, of 305 jumps from this bridge,
there have only been 2 survivors. This study is
intended to complement earlier work concerning
survival tolerances in water impact by providing
data on mechanisms and causations of fatal in-
juries.

VI. Summary.

The most common mechanism of injury was
erushing of the thoracic cage with resultant
multiple bilateral fractures of the ribs which

penetrated the vital organs. Fractured ribs oc-
curred in 85.2 percent of these fatal impacts.

In 76 percent of these cases, the lungs were
lacerated, usually by intrusion of rib fragments.

The liver was ruptured in 53.8 percent of these
impacts.

Cardiovascular trauma ranged from contusive
blunt impact-type injuries to frank disruption of
a major vessel or chamber. Only five of 87 were
not associated with multiple fractures, the bony
thorax penetrating the pericardial or pleural
cavities, Forty-two cases occurred in which one
or more chambers of the heart were ruptured,
with the left atrium most vulnerable. Traumatic
rupture or laceration of one or more of the great,
vessels was found in 45 cases, with aortic ruptures
most frequent. The 12 cases of cardiac and
great vessel rupture occurred together.

Brain injury, most commonly in the form of
subarachnoid hemorrhages, occurred in 62 cases,
in half of which skull fracture did not occur.
Kidneys were not found to be as vulnerable to
injury as generally believed, only eight (or 4.6
percent) receiving contusions, laceration or rup-
ture. Retroperitoneal perinephric hemorrhage
was found in 18 cases.

Skull fractures occurred in 40 cases, or in
nearly one-fourth of these impacts. However, in
1+ of these cases histological examination revealed
no brain trauma.

Seventeen individuals received no fractures at
all, and in 45 cases (26.6) drowning was a
probable or possible cause of death. It is be-
lieved that in eight cases, impact trauma was not
sufficient to be fatal and that three individuals
drowned post-impact. These individuals ap-
peared to have impacted in the foot to head
(+Gz) orientation.

These data reinforce previous survival infor-
mation indicating that the extreme limit of hu-
man impact water survival ranges close to 116
ft/sec (35.30 m/sec), but that body position at
impact is critical. For non-fatal transverse and
lateral impact (=+G,,x) in pure water environ-
ments additional protective restraint must be con-
sidered.


25
20 + 4
A
a MALE: 4
NO. 15 19 22,
OF
CASES ‘i 3
10 4
5
5 2 FJ
5 5 5
% Y 3
%
Ve
so 8 8 & 3 a S oh
° 5 : ; . : ba
gs” 8 & $ z S 2 8

AGE

Figure. 1 Age and Sex Distribution

tion of force. However, examination of the
trauma in each case provided good indications as
to body orientation at impact, the majority of
these cases being in a combination of transverse
or lateral +Gx,, positions.

Until the recent completion of New York’s
Verrazano-Narrows Bridge, this structure was
the longest suspension span ever constructed, with
a 4200’ single center span conjoined by two 1125’
side spans at 746-ft steel towers.’ Vertical clear-
ance under the center of the bridge is 220’ at high
water level, and the roadway, resting on steel
stiffening trusses, is 25’ higher, with sidewalks
along the roadway guarded by 4-foot steel rail-
ings. At the mid-span the distance from rail to
water is 249’ and about 261’ at low tide. On
either approach the clearance is 10’ less. Some
individuals have jumped from the chord, a flat
steel support structure which extends 4’ out on
either side and 8’ below the railing level. Thus,
each of the jumps included in this study involved
distances exceeding 239’ and ranging to 261’.

Velocity in free-fall is calculated as V=\/2g8,
where g (at San Francisco) = 39.49 meters per
second, and S or distance = 37.19 to 38.04 meters
per second velocity. Utilizing the aerodynamic
dvag correction of Cotner? and Earley, these
velocities were calculated to range closely between
32.92 to 33.53 meters per second (or 73.6 to 75
mph) impact force in each case. Wind, a strong
tide, and waves add to the hazards of the jumper.
In analysis each case history was examined and
rechecked by the authors at least three times, and
statistical data reduced and correlated by means
of a Royal Keydex retrieval system.

Il. Results.

Necropsy reports were examined for 169 indi-
viduals (52 female and 117 male) who had re-
ceived fatal trauma as a result of water impact
in jumps of 32.92 to 33.53 meters per second im-
pact velocities (239-250’) from the Golden Gate
Bridge in San Francisco.

To provide information concerning age distri-


FATAL INJURIES RESULTING FROM EXTREME WATER IMPACT

I. Introduction.

Currently it is estimated that one-third of all
commercial air transportation involves flight over
a water environment. It is becoming increasingly
common for private civil aircraft to fly water
routes as aircraft range, performance, and navi-
gational and survival equipment improves. Due
in great part to the less hostile conditions of im-
pact in water as compared to terrestrial environ-
ments, all United States manned space flights to
date have re-entered in “splash-downs.”

Accompanying this increased overwater activ-
ity is an increased risk and incidence of crash
landings.* Military airerew ejections, for ex-
ample, into water are occurring with much
greater frequency under low-level, high or termi-
nal velocity conditions. In manned space flight,
the 13.7 meters per second estimated descent rate
of the Apollo capsule with a damaged parachute
would probably be injurious to occupants in a
ground landing. In civil aviation in the United
States last year alone 78 general aviation acci-
dents occurred in water.

Since little is known concerning human sur-
vival tolerances in water impacts, design of an
optimum protection and survival envelope is
largely dependent upsn rather meager knowledge
of basic human biological tolerances. The ob-
jective of this study has been to evaluate fatal
trauma and determine primary causes of death
in impact with a water surface. Information
relating to the total envelope of survivability
criteria supplements previous free-fall survival
data obtained in water impact research.’*

II. Method and Materials.

The 169 cases reported in this study involved
suicides in jumps from the Golden Gate Bridge

From the Biomechanics Department, Office of Automotive
Safety Research, Ford Motor Company, Dearborn, Michigan,
48121 and the Civil Aeromedical Institute, Federal Aviation
Administration, Oklahoma City, Oklahoma, 73125.

Presented at the International Meeting on Aerospace Medi-
cine, Sydney, Australia, November 27, 1966.

23826

in San Francisco for which autopsies were avail-
able during the 28-year period from 1937 to 1966.
This bridge provides a unique experimental situa-
tion as far as extreme impact is concerned. Since
its construction in 1935, California Highway
Patrol records officially show that 305 persons,
as of 10 August 1966, have jumped from it. How-
ever, the actual figure may be much higher since
bodies can usually be recovered only during day-
light hours. Thus, a person might jump at night
undetected and never be recovered. To prevent
this, the bridge is now closed to pedestrian traffic
during the hours of darkness. At present, the
chances for survival of a jump from this bridge
are not good: 99.3 percent of the known falls
have been fatal. To date, the only survivors have
been a 28-year-old female who jumped in 1941,
and a 16-year-old boy, who jumped in January
of this year, both impacting in water. Two
others survived for 10 hours and 10 days.®

The present series does not include survivors,
those who impacted on surfaces other than water,
or those whose bodies were unrecovered or were
recovered by other than San Francisco County.
In addition, cases were not included if injuries
were obviously caused by impact with floating
objects or the base of the pier adjacent to the
Bay.

Such free-fall data have several useful ad-
vantages over similar information obtained from
typical aircraft or automobile accidents because
environmental factors can be ascertained with
greater confidence. Accidents in which the indi-
vidual may be displaced several times during the
impact sequence are difficult to analyze. On the
other hand, in the present series, a number of
parameters are constant throughout. Each indi-
vidual impacted a water surface; the distance,
and thus velocity at impact were nearly identical;
and each case included complete CHP reports
(including witness statements). Complete gross
and microscopic necropsy was performed by the
San Francisco Coroner's Office on each case
presented here. One unknown factor was direc-



ACKNOWLEDGMENTS

The authors wish to acknowledge the generous assistance and courtesy
extended by Henry W. Turkel, M.D., Coroner, City and County of San
Francisco, who made his files available for study; Captain T. F. Parnow,
California Highway Patrol, who provided reports on each case; John Ice,
who assisted with the data reduction; and Mrs. Bonnie Branum, who assisted
with the enormous task of typing dictated case histories, organizing the data,
and making summary sheets for all the cases. It is ironical, perhaps, that in
acknowledging failure in life by these suicidal jumps, each of the individuals
involved provided, in death, information which might someday be utilized to
save a future life.

Qualified requesters may obtain Aviation Medical Reports from Defense Documentation
Center. The general public may purchase from Clearinghouse for Federal Scientific and
Technical Information U.S. Dept. of Commerce, Springfield, Va. 22151