Forensic Science, Medicine and Pathology (2021) 17:437–448

https://doi.org/10.1007/s12024-021-00383-z

REVIEW

Explosion‑related deaths: An overview on forensic evaluation

and implications
Nicola Galante1 · Lorenzo Franceschetti1 · Sara Del Sordo1 · Michelangelo Bruno Casali1 · Umberto Genovese1

Accepted: 12 April 2021 / Published online: 1 July 2021

© The Author(s) 2021

Abstract
Purpose Explosion-related deaths are uncommon events which require expertise and confidence so that an appropriate death
investigation can be performed. The present study aims to provide a detailed forensic analysis of the issues and implications
arising in the event of an explosion.
Methods A retrospective review of casualty data was conducted on electronic literature databases. Cases concerning deadly
explosions registered at the Milan Institute of Legal Medicine were examined and analyzed altogether.
Results Explosions may involve closed or open systems. A security assessment of the site is always necessary. Alterations
of the site due to rescue procedures can occur; thus, on-site forensic investigation should be adapted to the environment.
Then, a study protocol based on autopsy procedures is presented. Application of the postmortem radiology enforces forensic
procedures both for the analysis of blast injuries and skeleton fractures, and for identification purposes. Blast injuries typi-
cally cause lacerations of the lungs, intestine and major vessels; moreover, hyoid fractures can be documented. Histopathol-
ogy may help to define blast injuries effectively. Forensic chemistry, toxicology and ballistics provide useful investigative
evidence as well as anthropology and genetics. Different forensic topics regarding explosions are discussed through five
possible scenarios that forensic pathologists may come across. Scenarios include self-inflicted explosion deaths, domestic
explosions, work-related explosions, terrorist events, and explosions caused by accidents involving heavy vehicles.
Conclusion The scenarios presented offer a useful instrument to avoid misinterpretations and evaluation errors. Procedural
notes and technical aspects are provided to the readers, with an insight on collaboration with other forensic experts.

Keywords Explosion-related death · Blast injury · Terrorism · Mass disaster · Forensic anthropology · Suicide

Introduction speed of detonation: the first ones include black powder and
smokeless powder, while the second ones are mainly repre-
An explosion is defined as a violent and sudden fluid expan- sented by dynamite, cyclonite, trinitrotoluene, cyclotrimeth-
sion, which determines a huge and rapid rise of pressure ylene trinitramine, ammonium nitrate-fuel oil and plastic
in the existing space (air or water) [1]. The main disrup- explosives (e.g. C4, PE4, Semtex) [1, 5–7].
tive effects are caused by the movement of great air (or Factors such as the amount and composition of explo-
water) masses which provoke a rapid succession of com- sive material, environment, delivery methods or the dis-
pressive and decompressive waves [2]. Explosions can be tance between the victim and the explosive device are all
triggered by airplane crashes, domestic gas leaks, fireworks important elements in defining the pattern, as well as the
and bombs [3, 4]. Chemical devices (bombs) are divided extent of injuries caused by an explosion [2, 8]. Barotrauma
into low-order and high-order explosives on the basis of the damages configure the major mechanism of wounding and
mortality, as the shock waves, coming into contact with the
gases of the lungs and the viscera, cause fatal blast injuries
* Nicola Galante [3, 9]. Furthermore, blast waves can lead to the collapse of
[email protected]
buildings and the combination of thermal energy and toxic
1
Dipartimento Di Scienze Biomediche Per La Salute, Sezione substances released during the deflagration can result in
Di Medicina Legale E Delle Assicurazioni, Università Degli a widespread multitude of very challenging scenarios for
Studi Di Milano, Via Luigi Mangiagalli 37, 20133 Milano, the forensic pathologist [1, 4, 10]. The pathophysiology of
MI, Italy

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438 Forensic Science, Medicine and Pathology (2021) 17:437–448

Table 1  Classification of injuries caused by explosions

Classification of injury Mechanism of injury Type of injury

Primary Direct interaction of the supersonic blast wave (spalling, implo- Tympanic membrane rupture
sion, inertia) with gas-containing and hollow organs of the Hyoid bone fracture
body Blast lung, gas embolism, pneumothorax
Heart avulsion, aorta laceration
Blast intestine, intestinal perforation
Traumatic amputations
Secondary Direct trauma to the victim’s body caused by fragments or Fragmentation/penetrating injuries such as blunt or
materials which have been energized by the explosion sharp force injuries (depending on the nature of
the objects)
Comminuted fractures
Tertiary Mass movement of the body or structures/objects against a body Spiral fractures
propelled by the blast wind 3-point bending fractures
Axial loadings
Traumatic amputations
Quaternary Miscellaneous causes of injury, the remainder Burns
Crash injury
Noxious gas inhalation injuries
Traumatic asphyxia
Psychological disorders

explosion-related deaths is complicated and subordinated to The present study aims to better clarify a topic that has
many factors: direct blast injuries, injuries generated from been poorly analyzed in the forensic medicine literature.
the perforation of the body by large fragments during the Problems and forensic implications related to blast events
explosion, traumatic asphyxia in the event of a building are highlighted. A classification of the different scenarios
collapsing, and acute distress respiratory syndrome due to resulting from explosions that the forensic pathologist might
chemical pneumonia and thermal injury [1, 7, 9, 11–13]. face is provided and schematically summarized in Table 2.
Injury profiles are unique if compared to non-blast accidents
and as a consequence they have been categorized as four
distinct groups, listed in Table 1. Materials and methods
Many elements must be considered by forensic pathologists
in the event of an explosion in order to perform a proper medi- A retrospective review of casualty data was conducted, selecting
colegal death investigation. Among them, on-site investigation the titles and abstracts of articles based on their relevance. In the
is essential due to the diversity of environments where an explo- most common electronic databases (Pubmed, Scopus, Medline
sion-related death can occur [14–16]. Blasts are associated with and Web of Science) a literature research was carried out using
severe damage. In particular, a variety of skin injuries can be the following combination of free text protocols, individually
observed at the autopsy: abrasions, bruises, lacerations, various and randomly combined trough the Boolean operator “AND”:
degrees of burns, including charring, damage to the extremities “explosion”, “injury”, “bomb”, “explosive”, “lesions”, “terror-
or body disruption. Other findings are mainly represented by ism”, “suicide”, “fatality”, “burns”, “identification”, “disaster
pulmonary injuries and injuries to the upper airways. Trachea management”. Filters such as full-text, publication date and
and main bronchi might show lacerations or rupture while the English language were also activated. Preference was given to
lungs are often hyperinflated, hemorrhagic and marked by rib recently published articles, but commonly referenced and highly
contusions. Barotrauma effects can also be detected in the gas- regarded older publications were also included. Moreover, the
trointestinal system: as for the lungs, there can be hemorrhagic bibliographies of the selected articles were reviewed for other
injuries, large intestine avulsion or lacerations [10, 11, 14–18]. relevant articles. The research resulted in less than 50 articles,

Table 2  Classification of
explosion-related deaths Civilian setting Non-terrorist events Self-inflicted explosion deaths
Domestic explosions
Work-related explosions
Heavy transport-related explosions
Terrorist events
Military setting War-related explosions
Terrorist attacks

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Forensic Science, Medicine and Pathology (2021) 17:437–448 439

mostly case reports, which matched the following criteria of Discussion

inclusion (at least one):
On‑site forensic examination
• description of death scene investigations and forensic
implications; The on-site investigation in the event of an explosion plays
• discussion of postmortem evidence at autopsy; a twofold purpose: on one hand it allows identification of
• analysis of issues related to the interpretation of body the victims, while on the other hand it contributes to clarify
injuries. the circumstances which caused the explosion. Unfortu-
nately, the presence of the forensic pathologist is not always
Additionally, pertinent forensic pathology handbooks and requested from the very beginning of the rescue procedures:
manuals [17–21], which include chapters dedicated to the this may result in a confused and chaotic on-site examina-
description of explosion injuries, were used when appro- tion, complicating further operations of identification.
priate. The cases concerning deadly explosions registered Explosion-related deaths are characterized by widespread
at the Institute of Legal Medicine of Milan were therefore injuries; the environment in which the explosion took place
examined. Subsequently, the selected studies were analyzed represents an important element that must be carefully con-
altogether. sidered by the forensic pathologist [16, 20, 46, 47]. Firstly,
the on-site examination is divided into either a closed or
open system, as for the classification of mass disasters [8,
Results 15, 46, 47].
In a closed system the deflagration releases an amount
Thirty-four scientific articles dealing with forensic pathology of mechanical energy, also amplified by deflected and rico-
and explosions that fulfilled the inclusion criteria were included cheted pressure waves, provoking not only direct blast inju-
in the present research. Among these were 18 case reports [5, ries but even the collapse of buildings such as industrial
13, 22–37], 11 original articles [7–9, 11, 12, 14–16, 38–40], 3 factories or houses (Fig. 1) [46]. In an open system, such
reviews [41–43], and 2 case series [44, 45]. No technical notes as squares, the countryside or out-of-town rural areas, blast
or extensive reviews focused on forensic evaluation of explo- waves can project bodies or parts of them across a large
sions and implications were found. The analysis of the litera- area (Fig. 2), and weather conditions, local predators and
ture revealed that several authors had described, mainly through the natural decay of the dead bodies can destroy important
case reports, the most common alterations and modifications of elements and hinder forensic operations [16, 20]. The whole
the crime scene and also the postmortem injuries caused by dif- area may be divided into smaller subareas which should be
ferent types of explosives. As previously mentioned, the pres- numbered in order to facilitate the recovery operations of the
ence of forensic pathologists on the crime scene and the subse- victims, or parts of them, including any personal items. In
quent medicolegal evaluation in the autopsy room may provide both cases, the explosion might result in a total obliteration
useful information when dealing with blast events. Alterations of the affected area, thus preventing a thorough investigation
caused by blasts lead, if approached incorrectly, to misleading of the scene, which is simply no longer recognizable [21,
interpretations and faulty investigative reconstructions. 47]. Moreover, alterations of the crime scene can occur due
The following paragraphs discuss the problems and the to damaging effects of the area, which are usually followed
challenges posed by the crime scene, as well as of the body by rescue operations [13, 14].
effects of explosion on the body. Different situations related As usual, during on-site investigations, the security assess-
to explosion are described, starting from the on-site forensic ment of the site should be performed before entering the area and
examination and autopsy procedures. Each of the five sce- at the same time the police should seal off the scene so that it will
narios related to explosions is introduced by the description remain untouched and a proper investigation can take place [19,
of a past event that occurred in Milan. Technical procedures 47]. First, it is important to take as many pictures as possible (vid-
and scenarios are grouped in the following subsections: eos are even more preferable) of the scene and the surrounding
area. The conditions of the site may have been deeply modified
• on-site forensic examination; by the fire or adverse natural events. If an appropriate computer
• autopsy procedures; program is used, the photographs and the scanning of the scene
• deaths by self-inflicted explosion; can provide a 3D recreation of the event and thus make it possible
• domestic explosions; to accentuate important details for further forensic analyses [48].
• work-related explosions; In addition, an accurate photographic record of the victims and
• heavy transport-related explosions; their visible injuries, including the location of the bodies and
• terrorist events. their distance from the explosive device must be realized [20, 21].

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440 Forensic Science, Medicine and Pathology (2021) 17:437–448

Fig. 1  An explosion caused by

ANFO (Ammonium Nitrate
Fuel Oil), which occurred in
a closed domestic setting. In
A decapitation of the victim’s
head (red arrows), and B a
part of the scalp, which is
completely avulsed from the
face (red arrows). In C the face
of the victim shows severe
craniofacial damage, where a
part of the scalp, the orbital
cavities and the tongue can be
still recognized (white arrows).
Courtesy of Nucleo Investiga-
tivo Antincendi (NIA) Vigili del
Fuoco Lombardia, Milan

It is important, especially for those cases of supposed atypical of differentiating domestic accidents and homicidal explosion-
suicides, to give an answer to the questions asked by the local related deaths from such uncommon forms of suicide.
authorities so that the forensic investigations can be promptly Finally, the analysis of the scene analysis should be per-
organized. The forensic pathologist, supported by the police formed by a specialized team with competent training in rescue
investigators, should obtain a detailed examination of the vic- procedures and death scene investigations: photographing and
tim’s background: a socio-economical and personal profile, such collecting the victim’s clothes and personal items will be helpful
as prior medical history, is an essential documentation for a bet- for the following identification operations [14, 16, 38, 41, 42].
ter interpretation of the crime’s dynamics [15, 21, 22]. At the
scene, the presence of any suicide note should be established, Autopsy procedures
and information concerning any past suicide attempts be col-
lected, including whether the victim possessed expertise in rela- In the event of an explosion-related death, a study proto-
tion to explosives [22, 23, 44]. This investigatory approach can col based on postmortem radiology, external examina-
allow a preliminary reconstruction of the fatal event as a means tion, autopsy, forensic histopathology, toxicology and

Fig. 2  An explosion caused by

LPG (liquefied petroleum gas),
which occurred in an open sys-
tem. The victim was working on
an LPG storage tank (8,000 L),
when a high-pressure gas leak
hit his body. A The abdominal
region is disrupted, with the
liver lying on the ground (white
arrows). B The left lower limb,
which was found a few hundred
meters away from the body.
Courtesy of Nucleo Investiga-
tivo Antincendi (NIA) Vigili del
Fuoco Lombardia, Milan

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Forensic Science, Medicine and Pathology (2021) 17:437–448 441

anthropology is mandatory. Postmortem radiology should the forensic pathologist: in lungs, standard hematoxylin–eosin
be the first forensic procedure performed on all bodies that (HE) shows alveolar ruptures, thinning of alveolar septae,
have been involved in an explosion. It thereby offers the and enlargement of alveolar spaces. Other features include
possibility to improve the observation of complex patho- circumscribed subpleural, intraalveolar, and perivascular
logical findings in the autopsy room [49]. Bone and metallic hemorrhages with a cufflike pattern. Also, Oil-Red-O (OR)
fragments or other foreign objects may be easily detected histochemical staining may reveal fat embolism [12]. Further-
at whole-body postmortem computed tomography (PMCT) more, a moderate to strong hemoglobin immunoreactivity of
[50]. Postmortem radiology may reveal small metal objects the edema fluid within the alveolar spaces can be detected,
that form part of the explosive device mechanism. These showing a homogenous staining pattern. On the other hand,
may be invaluable in allowing the ballistics experts to rec- it is very important to establish the vitality of blast injuries.
ognize the handiwork of a particular bomb-maker or ter- Thus, immunohistochemical analyses using anti-CD15, anti-
rorist group [17]. Also, threedimensional surface scanning IL-15 and anti-tryptase antibodies allow a precise assessment
(3DSS) and multi-detector computed tomography (MDCT) of the lesion that may have been involved in the determinism
are two techniques that are used in forensic medicine for of death, representing a tool of considerable utility in explo-
digitalizing a body or body parts, such as bones. Interest- sion-related deaths [59]. Toxicological samples should also
ingly, these radiological techniques allow reconstruction of be collected; analysis may reveal toxic gases or substances
severely injured skulls [51]. The instrumental approach plays inhaled or taken by the victim.
two major roles in the event of an explosion: firstly, images Finally, forensic pathologists should cooperate with foren-
of skeletal fractures can be evaluated whenever needed. Sec- sic anthropologists and odontologists to improve personal
ondly, skull and facial digital reconstructions considerably identification of the victims. A dental examination carried out
improve identification of the victims [52, 53]. Dental radio- by a forensic odontologist is also a very important and effec-
graphs are also crucial information, since they are impor- tive method of identification, if antemortem data are available
tant for dental identification, postmortem profiling, and age [38, 54–56]. Dental prosthesis records (fixed and removable
estimations [54–56]. Nevertheless, a complete radiographic prosthetic appliances as well) are one of the most common
study before the autopsy allows preservation of information records used for identification purposes. Forensic odontolo-
for subsequent evaluations; also, it provides evidence that gists may also analyze morphological features of extraoral
can guide the forensic pathologist during the autopsy. and intraoral structures such as lip print patterns and rugae
External examination is very useful in such cases, since patterns, which are important elements for recognition of vic-
features of the injury patterns can be defined, and several tims [60]. Genetic analysis on muscle or bone samples of the
different samples can be collected as well. Thus, forensic victims may confirm identity, if any relative is available.
pathologists should collect genetic swabs, if suspicious A schematic forensic assessment in the event of an
lesions are documented on the body. Homicides may indeed explosion is shown in Fig. 3.
be concealed by the explosion of the building where the
body was set. Ballistic experts may also collect bullets, pro-
jectile fragments and evidence from explosive discharge res-
idues from the body of the victim. Explosive traces should
be analyzed by a forensic chemical expert in order to define
the typology of explosive material [57]. Moreover, residual
particles may be searched through the use of Scanning Elec-
tron Microscopy/Energy Dispersive X-Ray Spectroscopy
(SEM/EDX), which allows different classes of particles to
be defined according to their composition and images [5,
58]. Upon external examination, a thorough collection of
personal items (e.g. clothes, jewels, identity cards), in asso-
ciation with the identification of personal descriptors such
as tattoos, scars or medical devices should improve recogni-
tion of the victim. Also, the collection of fingerprints, if still
available, may permit identification of the deceased.
Internal examination reveals macroscopic evidence of blast
injuries. Particularly, lungs, and intestine blast injuries, major
vessel lacerations and bone fractures are the most common
pathological findings. Also, hyoid bone and thyroid cartilage
fractures may be present. Histologic examination may help Fig. 3  A forensic assessment to explosion-related deaths

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442 Forensic Science, Medicine and Pathology (2021) 17:437–448

Self‑inflicted explosion deaths a 2v3-year-old man who located at the right side of the
abdomen a homemade explosive device (a mixture of
In September 2006, an explosion occurred in an apartment potassium cholate, sulfur and antimony) which caused
building on the outskirts of Milan. The building collapsed the destruction of the heart, liver, diaphragm and lungs
and 4 people died. After the conclusion of the investigations, [33]. Tsokos et al. published the suicide of a 39-year-old
the cause of the explosive event was established as a gas leak man where death occurred in a combination of craniocer-
provoked by a woman with suicidal intent. ebral, abdominal and pelvic trauma with rupture of the
Suicide by using an explosive device, when not involved large vessels as a result of a homemade bomb explosion
in a terrorist attack, is quite uncommon in medicolegal prac- [44].
tice when compared with other routinely adopted methods • The third pattern involves cases which do not match
[23, 44]. The case presented is a further exception, since the two patterns previously described. Particularly, an
the possibility to mistake this suicidal event with an acci- unusual suicidal explosive death of a 55-year-old male
dent or homicide relies mainly on circumstantial findings. induced by intentional methane gas leak inside his bun-
In the literature of the last thirty years, a few case reports [7, galow was reported [34]; also, the case of 30-year-old
24–35] and one older study from Sweden [39] about self- man who was found dead in a truck cabin after the deto-
inflicted explosion deaths have been published. In the cases nation and explosion of an acetylene cylinder [35]. In
reported [7, 23–36, 39], victims were men, ranging between the first case, the cause of death was attributed to mas-
20 and 76 years-old (mean 37.7 years), and except for one sive pulmonary fat embolism, extensive gastrointestinal
case (with no risk factors described) [24], all suffered from epithelial burns, and acute respiratory distress syndrome
psychiatric diseases, alcoholism, drug addiction, financial (ARDS); while the second one resulted in charring and
or personal problems [22–36, 39, 44]. severe blast lung injuries.
In the analysis performed, three different patterns of
non-terrorist explosion-related suicides can be defined, as Since in these cases victims who committed suicide by
follows: this uncommon manner were males, great caution should be
paid by the forensic pathologist when dealing with a case
• The first pattern, which is the most frequent, shows a spe- of a woman suspected of a self-inflicted explosion death. A
cific involvement of the cephalic region due to placement suspicion of murder or accident should be kept in considera-
and detonation of fireworks or other explosive materials tion, until proven otherwise.
directly on the head or inside the oral cavity [22–31]. At Further considerations are required in the evaluations of
autopsy, the injuries typically show a regular and sym- the damage patterns related to explosions, considering that
metrical pattern, primarily consisting of severe craniofa- such injuries can easily be mistaken for shotgun wounds.
cial damages such as lacerations and blunt trauma of the Hence, the absence of a firearm and the absence of any bul-
lips, gums, palate, nose and orbits associated with exten- lets at the scene, but the presence of radiopaque fragments
sive comminuted fractures of the mandible, maxilla and within the body at the postmortem radiological examination,
base of the cranium [22, 26, 44]. In addition, trauma can should direct suspicion towards the use of explosive devices
provoke deep cortical lacerations or pulpification of brain [22, 42, 44]. Finally, an accurate assessment of the victim’s
matter, albeit decapitation or complete head destruction background must be conducted in order to determine the
have been rarely described [24, 25]. Burns and gross tis- manner of death: look for possible access to explosive mate-
sue damages to the upper limbs, and, in particular, of the rials, psychiatric disorders or any personal problems of the
hand used for triggering the explosive device, provide deceased [13, 26, 29, 61].
possible evidence for suicide [27–29]. Other findings
may include soft tissue and muscular hemorrhage of the Domestic explosions
neck, fracture and dislocation of the hyoid bone, lacera-
tions and bruises of the lungs and the avulsion of the In June 2016, a blast occurred in an apartment building
heart as a consequence of the direct effect of blast waves in the south of Milan. After the explosion, the building col-
[22–24]. lapsed, and 3 people died. Investigations identified the cause
• The second pattern is identified in victims who clutch of the explosive event as a methane gas leak caused by a
an explosive device in close proximity to the abdominal male saboteur with homicidal intentions.
region. The injury pattern depends on the blast magni- This subcategory of explosion-related deaths includes
tude of the device. Siciliano et al. described the case of a fatalities by explosion that occurred in a domestic setting.
32-year-old man whose suicide was due to deflagration Among these, accidental gas leak represents a common
of a hand grenade which divided the body into two parts event worldwide [1, 4, 6, 7, 11, 17–19, 46]. The scene is
[32]. Similarly, Varga and Csabai reported the case of characterized by building collapse, fire, debris and a cloud

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Forensic Science, Medicine and Pathology (2021) 17:437–448 443

Fig. 4  Bruises, abrasions, and

different degrees of burns on the
victim’s body; furthermore, dust
can be seen on the face and the
hair of the victim. The woman
was involved in a domestic
explosion, which caused the
collapse of a building

of dust, which make rescue operations protracted and very been reported such as explosions caused by coffee-making
difficult. machines, autoclave machines, or while repairing an air con-
At autopsy, external examination can reveal a diffusely ditioner compressor [45]. A common pattern can be iden-
edematous body with multiple wounds [34], mainly lacera- tified in the evidence that explosions derived from high-
tions, many abrasions along with different degrees of burns pressure appliances [7, 40, 45].
(Fig. 4). Internal examination usually shows pulmonary inju- Byard described the risk of work-related explosions in
ries and injuries to the upper airways: the trachea and main the enclosed engine room of fishing vessels if volatilized
bronchi are lacerated while the lungs are often hyperinflated fuel is not adequately removed. The flammable properties of
with severe blunt-force trauma and lacerations [1, 4]. Also, the mixture are determined by the ratio of fuel vapor to air:
traumatic asphyxia can frequently lead to death due to the the speed and magnitude of combustion can be extremely
massive amount of dust inhaled in the event of building col-
lapse or to fixation of the chest by rubble [17–19]. The abdo-
men can be heavily damaged with organs torn off from the
abdominal wall, such as the stomach, intestines and kidneys
avulsion or hepatic and splenic gross lacerations [1, 17–19].
An additional finding is the fracture of the thyroid cartilage
(Fig. 5), which is produced by the explosive barotrauma or
direct violent impact. When this evidence is found, atten-
tion must be paid to avoid misinterpretation regarding homi-
cidal strangulation [11, 17, 22]. Autopsy helps to confirm
the cause of death of the victims; also, it contributes to the
assessment of the manner of death. Hence, a close coopera-
tion between the forensic pathologists and the investigators
can differentiate sabotage from accidents in cases of domes-
tic explosive-related deaths.

Work‑related explosions

In November 2010, an explosion occurred in the industrial

area of a small town close to the metropolitan city of Milan.
The point of blast origin was the storage site for hazardous
waste due to a malfunction of safety systems. 4 workers died.
Work-related fatalities are a common phenomenon world-
wide. Hazardous work is represented by coal mines (espe-
cially in the past for firedamp leaks), chemical industrial
Fig. 5  Blast effects on the larynx resulting in a deep laceration of the
sites or firecracker factories, where explosions can typi- thyroid and cricoid cartilages. This injury was caused by a domestic
cally occur [7, 36, 39]. In the literature, a few cases have explosion related to a gas leak

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444 Forensic Science, Medicine and Pathology (2021) 17:437–448

violent, resulting in an explosion [43]. Furthermore, an unu- fire explosion was produced, resulting in 118 deaths and
sual “work-related” death occurred in Milan in 2017, when a no survivors.
thief died while attempting to break into an automated teller A variety of events can lead to explosions related to large
machine (ATM) using the explosive power of an acetylene transport vehicles. Aircraft accidents, such as the example
gas cylinder [37]. Most of the cases were accidental events; reported above, railway disasters, maritime accidents and
moreover, victims frequently died after the explosive acci- other mass disasters can be included in this category [20].
dent or within the first 24 h, reflecting the seriousness of In these cases, the explosion produces a significant kinetic
the injuries reported by the workers [40]. The injury pat- effect as a result of collisions between objects travelling at
tern showed a combination of blast effects, burns, and flying high speed [19]. Since the mechanical shock wave cannot
missile injuries which damaged internal organs. The lungs dissipate the energy of the impact itself, the accumulation
may also show subpleural patchy hemorrhages, pulmonary of heat and pressure at the contact site instantly breaks the
contusions and intrapulmonary hemorrhage (Fig. 6). The two objects, projecting their fragments in every direction and
predominant site of lethal wounding was the head, followed vaporizing or partially melting the material [7, 38]. These
by the chest or the combination of both [36, 37, 40, 43, 45]. events result in a wide number of fatalities, the remains of
In cases like the ones mentioned above, forensic exami- which, being often severely traumatized, charred and/or dis-
nation of the dead bodies revealed mainly several burn inju- membered, need to be identified and subjected to medicole-
ries: different degrees of burns are differently distributed all gal investigation [1, 2, 13, 20].
over the body, including significant charring. Charred and Two major factors complicate the recovery of human
extensively damaged bodies require a careful examination remains: body destruction and context [40]. Since explo-
for identification purposes [20, 21, 41]. Nowadays, work- sion may lead to extreme body fragmentation, care must be
place deaths represent an important social problem [40]: taken in analysis at the scene [15, 19, 47]. Forensic analysis
the reconstruction of the event allows authorities to find out of remains must include assessment of minimum number of
which responsibilities involved the employer and which ones individuals and commingling issues as well as identification
the worker. [17, 18, 54, 55, 56]. Identifications are frequently facilitated by
recovery and analysis of identification tags, dental restora-
tions and surgical materials [41]. The context is important
Heavy transport‑related explosions since in most cases human remains are located in proximity
to other materials of similar appearance [20, 21]. Ideally,
In October 2001, two aircrafts collided on the runway at forensic anthropologists should participate in the recovery
Milan city airport “Linate”. The crash occurred in weather since they are experts in recognizing fragmented human
conditions of heavy fog and was caused by nonfunctioning remains [17, 41]. In the case mentioned above, the team of
and nonconforming safety systems. After the collision, a experts guided by forensic odontologists succeed identifying

Fig. 6  Blast effects on the lung.

A The left lung is hyperinflated
with pulmonary contusions
(white arrows); B Subpleural
patchy hemorrhages on the
diaphragm surface of the lung
(white arrows); C The pulmo-
nary parenchyma is markedly
hemorrhagic (white arrows)

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Forensic Science, Medicine and Pathology (2021) 17:437–448 445

all the victims, through consultation of the victims’ dental and clothing, the burning of hair and eyebrows, and the lac-
records, a fundamental part of the entire investigation [38, eration and ignition of clothing [10, 21]. Also, the so-called
60]. “peppering” appearance of the skin caused by the small mis-
At autopsy, trauma interpretation can be difficult due to siles creating the typical triad of lesions (bruises, abrasions
the multiplicity of skeletal and visceral injuries with a preva- and lacerations) can be assessed (Fig. 7) [9, 17]. The body
lence of heat-related lesions, usually complete charring and can be totally or partially destroyed: extremities are equally
fragmentation [41]. The distinction of different injury pat- involved resulting in hands, arms, feet and legs disrupted
terns may provide important information for the investiga- or ripped out (Fig. 8). Localized injuries at the legs and the
tors, since one of the priorities is to reconstruct the dynamic abdominal region have been assessed on the body of the
of the event to differentiate accidental events from sabotage. terrorist when a premature deflagration occurs [8, 14, 42];
it can be an important element to be considered in order
Terrorist events to distinguish between bombers and suicidal attacks. The
number and distribution of fractures can help the differentia-
In December 1969, during a terrorist attack, a dynamite tion of injury mechanisms, as they are relevant criteria for
bomb exploded at the headquarters of Banca Nazionale distinguishing an explosive charge carrier from a victim [13,
dell’Agricoltura, a few hundred meters from the Duomo of 18, 42]. According to the literature, multiple injuries resulted
Milan. 17 people were killed and 88 wounded. On the same in the cause of death, followed by localized injuries at the
day, a second unexploded bomb was found. head, then the chest and the abdomen [6, 8, 14].
In cases of explosive military devices, blast effects Various ballistic and forensic experts may be involved in
uncommonly lead to death since the terrorist bomb usually terrorist events; among them, chemists and engineers will
produces low energy barotrauma in close proximity to the have the task of determining the composition and position
explosion. For more powerful bombs, flash burns can occur of the device. The forensic pathologist can be part of the
on individuals nearby [2, 3]. event reconstruction, as localized severe trauma indicates
The individual in contact with or near the seat of explo- the relative position of the bomb and the victim at the time
sion can be blown to pieces and scattered by the force of of detonation [14]. Trace evidence of explosive residues can
explosion gases [8]. Solid fragments from the device, such be found on the bodies and further analyzed [5]. In this way,
as the case or the conveyance, in which the bomb was con- investigations can receive a fundamental support in identify-
cealed (a car usually is usually the most common vehicle ing also the bomb-carrier and, thus, the precise dynamics of
used), can be projected at high speed and over a wide area, the event [17, 18, 42]. In the case mentioned above, starting
hitting the bodies of people nearby [2]. Metallic pieces can from the autopsy reports, the team of experts in charge man-
act like bullets, causing significant or fatal injuries [13, 18]. aged to develop a visual record placing each victim in the
In these cases, the autopsy shows a multiplicity of injuries most probable position at the time of the explosion, playing
such as a pigmented dust produced by the explosion on skin a pivotal role in the forensic proceedings.

Fig. 7  Peppered appearance of

the skin caused by the small
missiles creating the typical
triad of bruises, abrasions and
lacerations. These injuries were
caused by an explosive device
(trinitrotoluene), which was hid-
den in a car

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446 Forensic Science, Medicine and Pathology (2021) 17:437–448

Fig. 8  Peppered appearance of

the skin with the lower extremi-
ties partially disrupted. These
injuries were caused by an
explosive device (trinitrotolu-
ene), which was hidden in a car

Conclusions • on-site forensic investigation;

• postmortem radiological examination;
Explosion-related deaths are a critical issue for forensic • external examination to gather surface evidence (genetics,
pathologists since a proper investigative reconstruction chemistry, ballistics), collect clothes and items, and note
and interpretation are based on many different pieces of personal descriptors and document traumatic injuries;
information. Hence, this review shows that death caused • internal examination to analyze both macroscopic path-
by explosions is an uncommon event, with the majority of ological findings of blast injuries and other traumatic
cases occurring in the workplace and in a domestic setting. lesions; also, the autopsy allows samples to be collected
Non-terrorist self-inflicted deaths are exceptional, especially for histopathological, toxicological, anthropological,
if they are associated with the detonation of the explosive odontological and genetic analyses.
in close proximity to the head and abdomen. Non-terrorist
homicides using explosive devices are even less common. In conclusion, a multi-disciplinary approach is highly rec-
Moreover, it is important to be aware that the integrity of ommended in death investigations. Especially, when dealing
both the scene and the victim’s body may be damaged by with explosion-related deaths, a close cooperation between
alterations due to human and environmental factors. forensic pathologists and other forensic professionals, such
Once on-site forensic examination is completed, forensic as anthropologists, radiologists, engineers, ballistic experts,
pathology investigations should therefore rely on study pro- and chemists is preferable, in order to provide a high-quality
tocols based on precise procedures for postmortem analysis. forensic investigation and consequent evaluation.
Postmortem radiology allows the preservation of informa-
tion for subsequent evaluations; also, it provides evidence
that can guide the forensic pathologist during the autopsy. Key points
This approach improves the analysis of complex pathologi-
cal findings of blast injuries. Moreover, forensic histopathol- 1. Forensic pathologists may deal with different and com-
ogy, toxicology, genetics, chemistry, and anthropology are plex explosion-related scenarios.
key elements to achieve successful outcomes. The correct 2. For blast injuries, postmortem radiology before autopsy
training for a forensic pathologist should include expertise examination is mandatory.
regarding death produced by blasts, preferably through crime 3. Identification of explosive residue particles requires
scene simulations to avoid misinterpretations and evaluation ballistic and chemistry experts.
errors. Forensic and emergency teams must know the pat- 4. Blast injuries typically involve the lungs, intestine, and
terns of the injuries caused by explosives. Ideally, a proper major vessels.
and structured postmortem assessment in explosion-related 5. Forensic anthropologists and odontologists may help
cases must observe the phases summarized as follows: the pathologist to identify victims of explosions.

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Forensic Science, Medicine and Pathology (2021) 17:437–448 447

Funding Open access funding provided by Università degli Studi di findings in human blast lung injury. Am J Respir Crit Care Med.
Milano within the CRUI-CARE Agreement. The authors received no 2003;168:549–55.
financial support for the research, authorship, and/or publication of 13. Delannoy Y, Delabarde T, Plu I, Legrand L, Taccoen M, Tracqui
this article. A, et al. Terrorist explosive belt attacks: specific patterns of bone
traumas. Int J Legal Med. 2019;133:565–9.
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est with respect to the research, authorship, and/or publication of this European Council of Legal Medicine (ECLM) principles for on-
article. Ethical approval: This study follows the guidelines provided by site forensic and medico-legal scene and corpse investigation. Int
Legislation and the National Bioethical Committee. J Legal Med. 2017;131:1119–22.
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