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Lessons from the DeadChris Hartlove

Lessons from the Dead (continued)

Dave Fowler has pursued another avenue toward safe sleep. At the request of Joshua Sharfstein, secretary of Maryland’s Department of Health and Mental Hygiene, he reviewed pathophysiological evidence of sudden unexplained infant deaths as part of a team of experts looking into the safety of crib bumpers.

 Next June, Maryland will become the first state to ban the manufacture and sale of this padding, which is intended to cushion babies from injuring themselves on the crib slats. “Crib bumpers don’t prevent any substantial injuries. Limbs are rarely entrapped and even in those situations the worst that can happen is minor bruising,” says Fowler. “There is no benefit and there is a substantial risk.”

More than two dozen baby deaths across the nation have been attributed to bumper pads in the last 20 years, and Maryland’s records show one child who was asphyxiated.  “A brand new child is ‘shifting’ about half an ounce of air, whereas an adult shifts about two or three quarts with each breath,” Fowler points out. “As an infant, you don’t actually have to have your face up against anything. You can be close to a soft toy, a blanket, a bumper, edge of a bassinette and you can breathe out the oxygen in that area until it won’t sustain human life.”

Fowler calls pediatrics one of the most challenging areas in forensic pathology. “When you have someone who has been shot multiple times or been in a motor vehicle collision, the cause of death is usually fairly apparent. But when you’ve got a pediatric case—a young person who dies suddenly and unexpectedly, who was normally previously healthy, it is much more challenging.”

Such cases sometimes disappear in the deluge of injuries afflicting the nation. According to the CDC, more than 180,000 Americans will die this year from injuries sustained in such events as fires, vehicle crashes, intimate partner violence, drowning, drug poisonings and falls.

As medical examiners collect evidence on new threats, such as emerging infections or unsafe products, the injury prevention researchers aren’t far behind.

“I found my passion. Injury prevention combined so many elements: studying risk and protective factors, educating the public and conducting community advocacy to get [laws] on the books,” says Andrea Gielen.

“In this country, injury data often come from forensic investigation and death certification,” says Carolyn Cumpsty-Fowler. “The better your relationship with the investigators, the more likely you are to get at the real heart of the information.”

And the facts of a tragedy remain critical for finding the path toward prevention. Sue Baker remembers poring over the case of a teenager who committed suicide in the early 1980s by overdosing on anti-depressant pills brought into the house by her mother’s boyfriend. At the time the girl had just broken up with her own boyfriend and was feeling distraught.

“Today that young girl might be coded as suicide from a drug overdose—or whatever was on the death certificate—and people might miss the details of the incident,” Baker notes. “It’s gotten so easy to ‘spin the tapes,’ as we say, and just look at the [computerized] tables for the findings and analyses.”

Instead Baker read the suicide note and the investigators’ records. They pointed to another problem that demanded public attention: Teenagers were abusing adult medications. Baker began imagining another research paper.


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Death and Data (3.9MB)
Death and Lifespan (2.0MB)
Death and Learning (2.1MB)