DEPARTMENT OF FORENSIC MEDICINE - Hillsborough ...

DEPARTMENT OF FORENSIC MEDICINE 

GUY'S HOSPITAL 

(UNIVERSITY OF LONDON) 

Dr. I.E. WEST. M.B.. CTxB.. F R C.I'ith.. D M J. 

Dr, R T. SHEPHERD B.Sc.. M £.. B S.. M R C.P«h.. D M.i. 

Direct Tekphanc Line 071 -107 0378 j 071 -403 11 IS) 

(F*x: 071-403 7292) 

UNITED MEDICAL AND DENTAL SCHOOLS 

GUY’S AND ST. THOMAS'S HOSPITAL 

LONDON BRIDGE. SEl 9RT 

TELEPHONE: 071-955 5000 Ext: 3118/3119 

SCO:21/92/IEW 20th August 1992 

I have studied the papers that you have submitted to me regarding the 

tragic deaths of these young people. They include the post mortem 

reports on Paul Carlisle, Gary Church, Ian Glover, Richard Jones, Michael 

David Kelly, Peter Tootle, Kevin Daniel Williams and Philip Hammond. I 

have also studied the relevant extract from the inquest, the overview 

prepared by Professor Usher, the report prepared by Dr. Burns and the 

grounds on which applications are to be made to set aside the original 

inquest. 

I have experience of a substantial number of deaths from traumatic 

asphyxia, including victims of the claphaK Rail distaster and explosion 

at the Grand Hotel, Brighton. 

It is clear from post mortem appearances that we. are dealing with two 

different patterns of injury, namely a number of victims who shewed the 

classic appearances of traumatic aspjhyxia. and other where ths’ classic 

signs of traumatic asphyxia were absent or slight. The difference is, 

I think, relevant in respect of the precise.mechanism by vhich ench 

individual died. It may v/eli be that soiae confusion has developed over 

the use of the terra traumatic asphyxia.. 

In the classic sense traumatic asphyxia is taken to imply injuries caused 

^ A by the application of mechanical pressure to the chest and, in sowe 

.— ' instances, the abdomen, so that death results from asphyxiation- The 

f mechanism of asphyxiation in the classic case is thought to be twofold. 

V^First there is a mechanical impedence of the movement of the chest wall 

and diaphragm, thereby severely restricting inspiratory respix.at.ory 

movements. The second mechanism and one which accounts for the most 

rising findings found in cases of traumatic asphyxiqa is cotnpr^ssion 

fP*. the chest, and: abdomen resulting in direct compression over the 

superior vena cava thereby causing a sudden and dramatic rise \v. the 

treasure within the superior vena cava resulting in engorgement o f the 

blood vessels in the head and neck. it is this displacement, of blood 

into the superior vena cava and the failure to drain blood from the 

superior vena cava which accounts for the swelling of the facial features 

and the gross petechial haemorrhages so regularly seen in the face, neck 

and chest above the level of constriction. 

[Where no obstruction to the venous circulation occurs then the usual 

s:y?ns asphyxia are present but not those of the classic traumatic 

asphyxia1 death. The face may be suffused &na cyanosed and there may be 

fine petechial haemorrhages, m some instances scanty or even absent. The 

-facial features do not appear strikingly sw o llen and the coarse petechial 

haemorrhages are not apparent.

. w 

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O, i e . WEST. M.B., CUJB.. F.R.C.Pith., D.MJ. 

Dr- R.T. SHEPHERD B-Sc,. M-8.. B.S_ MR.C.P«h.. D M X 

D if act Telephone tine 07M 0? 037g /0 7 l-i0 3 1118) 

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TELEPHONE. 011-955 5000 Ext: 3118/3119 

Unfortunately it has become a habit for pathologists to call all such 

deaths traumatic asphyxia and it may well be correct in one sense in as 

much as trauma to the chest has resulted in the mechanical obstruction 

of respiration- In pathological terms there is probably little relevance 

in distinguishing between the two mechanisms as the term merely implies 

that death has resulted from a mechanical obstruction to respiration 

resulting from pressure being applied to the torso. 

In clinical terms however there does seem to be a difference in the two 

different types of traumatic asphyxia with a much graver prognosis being 

• 

present in those where there has been evidence of a sudden and acute 

severe rise in the venous pressure in the upper part of the body. In fact 

most of the individuals who suffer from this classic form of traumatic 

asphyxia do not survive if they are severely affected and not rescued 

rapidly. 

R . G> -•» 

where the individual suffers primarily an obstruction to his movements 

of respiration death will occur as the result of hypoxic damage to the 

brain. This may take a much longer time than in individuals who have J, 

}?een crushed so impedence of the venous return to the heart occurred, yi 

Indeed some individuals will survive but remain permanently r 

neurologically damaged as a result of suffering severe anoxic cerebral 

injury. 

It is probable that a period of at least some 10 minutes or so would be 

necessary before one would be able to state categorically that absent .# 

respiratory movement would lead to death- Consciousness may be lost quite LJ 

rapidly but where the obstruction has not been complete consciousness may /» 

take a considerable time to be lost. I have experience of cases where 

individuals have died through anaesthetic accidents whereby no oxygen was 

zin g supplied to the lungs whilst they were paralysed during surgery, 

two of the cases in e x c e s s of 10 minutes elapsed before the surgeon 

noticed that the heart action was in the terminal stages of failure. 

It is also known that individuals who have suffered severe hypcxic damage 

may not die immediately. They may be recovered unconscious with an 

active circulation but the circulation rapidly fails despite all attempts 

at x’esuscitation. This roav well represent concomitant damage to the heart 

muscle leading to what is in effect a heart attack (anoxic myocardial 

infarction). severe hypoxia of several minutes duration would be 

necessary for this tc occur- It is therefore possible that a young man 

who had been asphyxiated by being crushed, would be capable, after being 

removed from danger, of some conscious activity but could still die as 

a result of hypoxia in the ensuing minutes.

w e ^ r - i ± I f- 1 bL JUS 




Dr. I.E. WEST, MJB-. OuB.. F R.C.Path.. DJvlJ. 

Dr. R.T, SHEPHERD B.Sc.. MJ9-. B-S., M.R.Ci>»ih, D.MJ. 

Direct Telephone Law 071 -107 0378 / 071 -403 1118) 

(Fax; 071-403 7292) 

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LONDON BRIDGE. SE3 9RT 

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Anoxic brain damage could also be aggravated by the failure to maintain 

a patent airway in individuals who were unconscious but still capable of 

respiration when retrieved from the crowd. The failure to place the 

individual in the recovery position, for instance, could lead to 

subsequent ’respiratory obstruction. 

Experience from a number of instances where individuals have died from 

traumatic asphyxia has also demonstrated that not all individuals appear 

to have been effected at the same time. Some could have been effected by 

movement of the crowd in the minutes after the disaster occurred, others 

could have had only partial or incomplete respiratory obstruction 

initially and then either suffered complete mechanical obstruction of 

respiration or died as the result of prolonged incomplete respiratory 

obstruction. This could take many minutes to cause death and it is 

entirely possible that death would occur more than 15 minutes after the 

incident began- 

I have not seen the post mortem photographs and therefore am having to 

rely solely on the description provided in the post mortem reports: I 

will deal with each case individually. 

1. Paul Carlisle - He was examined by Professor Usher who describes 

suffusion of the upper body and petechial haemorrhages on the 

forehead, eyelids and within the conjunctivae. These would be 

consistent with the classic traumatic asphyxia whereby there has 

been a mechanical obstruction and mechanical interference with the. 

circulation. 

2- Richard Jones - He was examined by Professor usher w h o again found 

signs which would be consistent with the classic features o f 

traumatic asphyxia. The petechial h a e m o r r h a g e s noted in his loins 

are probably the result of pressure causing local obstruction to the 

circulation m that area. 

3 . Ian Glover - Again examined b y Professor Usher. The examination 

revealed changes of asphyxia/ ie the c y a n o s i s and visceral 

haemorrhages. The signs of venous obstruction were relatively 

slight and in the form of small petechial haemorrhages in the upper 

eyelids and conjunctiva of the left eye. There were scanty 

petechiae also found in the larynx. in ray opinion he has died 

primarily as the result of impedence of respiration and any 

interference with his venous circulation was minimal. 

4. Peter Tootle - Was examined by Dr. Slater- Dr. Slater described 

changes in Mr. Tootle which are consistent with a degree of classic 

traumatic asphyxia but I suspect that the main reason for death has 

been compression of the chest resulting in impudence of respiratory




Dr. I.E. WEST, M-B.. OvB.. FR.C.PaUi.. D.MJ. 

Dr. R.T. SHEPHERD B.Sc., MJ8.. B.S.. M.R.C.Pa(h.. D.MJ. 

Direct Telephone Lme 071 -107 0378 / 071 -,103 1118) 

(fix: 071 -103 7292) 

UNITED MEDICAL ANT) DENTAL SCHOOLS 

GUYS AND ST. THOMAS S HOSPITAL, 


TELEPHONE: 071-955 5000 Ext: 3118/3119 

movement. Without the post mortem photographs I am not clear as to 

why Dr. Slater feels that there has been intensive blunt compression 

of the right side of his face. 

5. Kevin Williams - Was examined by Dr. Slater who describes the 

external features of classic traumatic asphyxia with cyanosis of the 

face extending onto the chest with numerous petechial and larger 

haemorrhages on the face and neck. He found bilateral fractures of 

the hyoid bone and of the superior horns of the thyroid cartilage 

on both sides of the larynx. These appear related to a number of 

linear abrasions over the front of his neck and on the undersurfac® 

of the chin. There appears to have been local pressure to his neck. 

It was possible that when he was crushed in the crowd, the front of 

his neck, vas pushed against some rigid structure. It is also 

possible that, for instance, he could have been trodden an during 

the panic subsequent to the incident occurring. 

P . 0 6 

*1 do not believe it is possible to say how long consciousness would 

" have been retained but he^ certainly would noc have become 

unconscious between 3 and 5 seconds of being crushed. Again I would j 

not agree with Dr. Slater in estimating how long the deceased would yj 

have survived. Although he-has suffered injuiies to the neck these 

are by no means invariably fatal and can be seen in those surviving 

strangulation and quite striking signs of classic traumatic asphyxia 

can be seen in individuals who survive crush incidents because they j/< 

are removed frow danger in tiiae to prevent death- As I have already VIJI 

indicated he could veil have survived for a considerable period,/tI 

well beyond 3.15 pm. 

He suffered convulsions as the result of anoxic brain damage. 

Whether Mr. Brooder saw convulsions or twitching is irrelevant. 

A dead body neither convulses or twitches. Dr. Gompert’s point that 

bodies may twitch after brain stem death has taken place is, of 

course, correct and to some degree reflects the dilemma over 

precisely defining death. One sees it in individuals who are 

maintained on a respirator but whose heart is still functioning. 

One also may see it during the process of dying as the heart is 

stopping and for a very short period after the heart stops. This 

phenomenon only occurs for a very short, period after death unless 

muscles are electrically stimulated. Twitching movements, however, 

suggest that one is much inore likely to be dealing with a live body 

than with a dead one. 

The evidence of Special Constable Martin is difficult to refute in 

some respects. Whilst it is possible for an individual examining a 

dead body to mistakenly feel an apparent pulse it is usually 

difficult to be mistaken over whether somebody is making breathing




Dr-f-S-WEST. M.B.. Ch.B.. F.R.C.Paih_ D.MJ. 

Df. R.T. SHEPHERD B.-Sc. M J , B.S., M.R.C.PsiK D.MJ. 

Dircct Telephone Lm c07U 07 0378 / 071-) 03 1118) 

(Fax: 071-403 7292) 


C V YS AND ST. THOMAS'S HOSPITAL 


TELEPHONE: 071-955 5000 Ext: 3U 8 /3119 

^ movemen,t!S,J3jt-aQJ5!.- I am, of course, making the assumption here that 

^ when the term breathing is used that we are referring to movements 

of respiration and not merely sounds. Sounds frequently emanate 

from the air passages of a recently dead body when it is being 

moved. v 

S 

6. Gary Church - He was examined by Dr. Slater who found changes 

which would be consistent with classic traumatic asphyxia. He had 

a dislocated right sternoclavicular joint. T h i s type of injury is 

H most likely to occur as the result of falling. It would require 

very severe crush injuries to dislocate the sternoclavicular joint 

and the post mortem findings do not appear to reflect severe local 

pressure on the chest or shoulder area. It is possible that he 

received this injury as the result of falling over in an attempt to 

escape and has suffered pain and discomfort consequent upon this 

injury. 

7. Michael David Kelly - He was examined by Dr. John Clark who found 

non specific signs of asphyxia; the external appearances do not shew 

evidence of classic traumatic asphyxia. The petechial haemorrhages 

on his right arm I am sure reflect a obstruction to the circulation 

in the ara caused by local pressure. The internal examination 

revealed no other explanation for death other than it. having 

resulted from anoxia and it is probable here that we are dealing 

with a case where there is no evidence whatsoever of obstruction to 

the large veins in the body tut where death has occurred as the 

result cf progressive cerebral anoxia resulting from prolonged and 

severe compression of the chest. 

If Mr Kelly was treated as described by PC Mauahan and apparently 

successfully resuscitated then it is possible that he has died as 

the result of hypoxic damage affecting his heart or as the result 

of seme other forTi o f respiratory obstruction. He appears not to 

have been placed in the recovery position and this may well be 

material. There is nothing to indicate that this man was definitely 

dead by 2,i5pn; indeed the evidence available to me suggests 

otherwise. 

8. Philip Hammond - this young boy does not bear the classic signs 

of tramnatic asphyxia although there are generalised asphyxial signs 

and evidence of anoxic damage to che brain. Dr. Slater who 

performed the post raortem found extensive haemorrhage in both lungs 

and a laceration of the right lung associated with a fracture of the 

right 2nd rib. 1 think the death of this young man is rather more 

complicated than some of the other cases. There is certainly 

evidence that he has suffered from asphyxia and there is evidence 

in his brain of anoxic damage. However, the primary pathology 

R - © T

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»■« i i i. i r jl tz. I— -A-* 




Dr. I.E. -WEST. MB.. FR.C.Pwix.. D.M.J. 

Dr. R.T. SHEPHERD B.Sc., M 3., J3.S, M-R.C.Piih-. D.M.J. 

Direct Telephone Line 071-107 03?g /071-103 1118) 

(Fa*: 071-J03 7292) 

P - 0 8 

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LONDON BRIDGE, SE1 9RT 

TELEPHONE: 071 -955 5000 Ext: 3118 / 3119 

appears to be in his lungs which were bruised with a laceration of 

the right lung associated with a rib injury. The rib injury and 

bruising of the adjacent intercostal spaces suggests a localised 

pressure or impact, in that region of the right chest. It is likely 

to have Been due to localised pressure, probably on the young man’s 

back, forcing the right side of his chest against an object causing 

the right s i d e d ribs to be forced inwards towards the spine. If 

this pressure were maintained then death would undoubtedly occur 

very rapidly but I would have expected to have found sorae-evidence 

^ of the more classic changes associated with traumatic asphyxia. If, 

however, the pressure is relieved then death from injuries of this 

type may take considerable time to supervene. Unconsciousness is 

likely to be fairly rapid but death could have taken a substantial 

number of minutes and it would be impossible, from a medical point 

of view, to state that this boy was dead at 3,15 pm. 

In conclusion there is clear evidence that some of the victims have 

suffered severe traumatic asphyxia in the classic sense in which the term 

• is employed'. Jnconscious:iess is liKely to have occurred quite rapidly, 

in probably somewhere between 15 and 45 seconds but dearh would have been 

delayed for a number cf minutes. In those who where severely crushed so 

the venous drainage from the head was impeded then it is probable that 

death would have occurred within 10 minutes of sustained pressure 

commencing. if the pressure was not continuous survival could be for 

a longer period. 

In the individuals who have scanty signs or no signs of traumatic 

asphyxia it is much more difficult to predict the survival time. To 

re|l’ce the survival time to a very short number of minutes would require 

cf^Linuous sustained severe compression of the chest. Because of the 

r ure of the incident it is impossible in many instance to know when 

mechanical compression of the chest would have commenced. I feel it is 

impossible to state purely from the medical point of view that a number 

of the young men that I have indicated above could not been alive at 3.15 

pm. Those dying as the result of anoxic damage consequent to their chests 

being crushed could well have survived for a much longer period only to 

die subsequently from the effects of irreversible anoxia. 

[ain Eric West, M.B., cn.B F. R. CTPath., D.M.J 

Consultant Forensic Pathologist, 

iirector, Department of Forensic Medicine, 

’nited Medical Schools of Guy's and St. Thomas', 

uy's Hospital, 

ondon, SEl 9RT.



Dr I.E. WEST, MJ3..ChJB., D.M J. 

Dr. R.T. SHEPHERD B.Sc.. MJ3„ B.S„ M.R.C.Path.. D.M.J. 

Direct Telephone Line 071 -407 0378 

(Fix: 071-403 7292) 


UNI FED MEDICAL AND DENTAL SCHOOLS 

GUTS AND ST. THOMAS'S HOSPITAL 

LONDON BRIDGE. SEI 9RT 

TELEPHONE: 071 -955 5000 Ext: 311S / 3119 

SCO:21/92/IEW 29th October 1993 

I have studied the photographs of Kevin Williams, Michael Kelly, Peter 

Tootle, Ian Glover, Richard Jones and Paul Carlisle. I have reviewed the 

photographs together with the original post mortem reports. 

All photographs are identified on the album covers and there are marks 

of identification on all of the bodies. Names were inscribed upon the 

right lower limbs. 

The photographs of Paul Carlisle confirm that he has died as a result of 

classic traumatic asphyxia. There are also some abrasions on the forehead 

and chin consistent with being crushed in the incident. 

The photographs of Richard Jones confirm the classic signs of tr a u m a tic 

asphyxia in the head and neck with evidence of constriction around the 

chest. They also confirm the presence of inhaled vomit in the airway. 

The photographs of Ian Glover reveal more minor changes of asphyxia with 

cyanosis of the face but no overt swelling. There were abrasions visible 

on the undersurface of the chin and on the left ankle. 

From Professor Usher's report it was clear that vomit was present in the 

deceased's air passages. inhalation of vomit may occur during life in 

a number of circumstances including compression^ of the chest and/or 

abdomen. Traces, of vomit may also enter the airway as a result of 

passive regurgitation after death, either as the result of attempts at 

resuscitation or when the body is being moved. 

The photographs of Peter Tootle are not particularly helpful^ in that 

there is no close view of his face, The photographs reveal abrasions over 

the lumbar region- of the back and over the upper chest region adjacent 

to the spine. The facial features, as reviewed in the full length 

photograph, do not suggest the classic features of traumatic asphyxia, 

nor can I see any evidence of substantial blunt trauma to the face. 

I have seen photographs which, on the cover the album are labelled 

Miohael Kelly, but the indication on the leg of the deceased is Kelly - 

A.P. with the number 17841. The photographs do not appear to be those 

of the deceased described by Dr. Clark in his post mortem report. The 

photographs of the deceased show a man, 167cm in height, showing moderate 

truncal obesity with heavy tattooing on both arms. The deceased in this 

case also showed signs of severe traumatic asphyxia. I do not believe 

that I have seen the correct photographs in this case.

FuF.El fSI I MEDIC il'to uu< -■ 




WEST, MJB., Ch.B„ F.R.C.P*th„ DW J. 

T. SHEPHERD B.Sc., MJ3., B.S., M.R.C.P*th„ DMJ. 

. Telephone Line 071-407 0378 

071-403 7292) 


GUVS AND ST. THOMAS'S HOSPITAL 


TELEPHONE: 071-955 5000 Exi: 3118/3119 

e photographs of Kevin Williams appear to show the correct body. They 

.nat.indicate the classic signs of traumatic asphyxia. There^i^no 

eliing of the face although there js'll5ae1 cyanosis. The most prominent, 

.ndings that can be seen on the photographs are the injuries _ o v e r the 

idersurface of the chin and left jawline just below the prominence^of 

le larynx (Adam’s apple). The photographs indicate one long a b r a s i o n 

ider the right side of the chin and an abrasion under the left jawline 

.id two abrasions over the region of the larynx. An additional abrasion 

s visible just outside the left eye. There,also appears to be deformity 

f ^ ) neck in the region of the larynx. 

n / opinion there has been substantial damage to the front of Mr. 

illiams neck as the result of compression of the neck possibly caused 

>y his neck being crushed under the feet of individuals in the crowd or 

I caused by his neck being crushed against some rigid object. The 

Jeformity seen in the photographs and the fractures, found by Dr. Slater 

I luring his post mortem examination, strongly suggest that damage to the 

apper airway was an important contributory factor in the death of Kevin 

Williams. Damage to the airway at this level may lead to obstruction and 

swelling of the lining of the larynx which reduces the amount of air that 

can reach the deceased's lungs. As I have stated in my previous report 

I do not believe that this type of injury would lead to.unconsciousness 

within a few seconds. Whilst death may occur repdily following such 

laryngeal injuries this is not inevitably the case and death may be 

delayed for a considerable period. This type of injury is amenable to 

treatment in the form of an emergency tracheostomy or a cricothyroidotomy. 

Whilst an emergency tracheostomy is a relatively major 

p ^ f e d u r e , crico-thyroidotoray is a simpler procedure which involves the 

pBLage of a tube through the membrane between the thyroid and cricoid 

c tilages. It is possible that if one of these procedures had been 

carried out at the scene then he would not have suffered from the fatal 

asphyxia which led to his death. 

Both cricothyroidotoray and emergency tracheotomy can be performed in the 

field although, in the latter instance# with difficulties owing to an 

increased likelihood of haemorrahge at the operation site. 

I could find nothing, from the post • mortem report or from the 

photographs, to refute the realistic possibility that this young man was 

,still alive after 3.15 pm on the day. I do accept, however, that he is 

/unlikely to have spoken the word "Muiti" if he had already suffeced 

convulsions due to lack of oxygen. In my opinion, the primary cause of 

death in this instance is damage to his neck which would not have been 

inevitably rapidly fatal.

y -r—— 

FOPEH'r' 1 ■; MEDIC IKE GUT'E O'71 -*03 729-' P.p 



(UNTVERsrry o f l o n d o n ) 

x. l.Ei WEST, 

X. R.T. SHEPHERD B.Scn M 3 , B.S„ M.R.C-P*ih., J3.M J . 

)irect Telephone Line 071*407 0378 

F « : 071-403 T292) 


GUTS AND ST. THOMAS’S HOSPITAL 


TELEPHONE: 071 -955 5000 E xt 3118 / 3119 

In relation to the individuals who have died of traumatic asphyxia.; it 

is possible to say that, with sustained^ compression of the trunk# death 

could have occurred prior to 3.15 pm and that they were likely to have 

been quite rapidly rendered unconscious. There is no way, however, that 

one can state with any certainty that death occurred within that period. 

If the compression of the chest had been intermittent they could well 

have survived well beyond 3«15 pm. 

Iain Eric West, M.B., Ch.B., F.R.C.Path., D.M.J., 

Consultant Forensic Pathologist, 

Director, Department of Forensic Medicine, 

United Medical Schools of Guy's and St. Thomas', 

Guy's Hospital, 

London, SEl 9RT. 

T Y

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