Fatal Asphyxia in the Head-down Position: An Uncommon Case of Accidental Work-related Death

Positional asphyxia is a rare but potentially fatal condition where an individual's body assumes a position interfering with normal respiratory movements and leading to asphyxiation. We report a case of an 83-year-old farmer trapped in the tank of a vineyard spray atomizer while attempting maintenance and stuck in the opening of the tank with his upper body inside and legs outside. He was unable to extricate himself, and rescuers, who arrived 2 hours later, found the victim dead. The forensic autopsy showed patterned external injuries corresponding to the edge of the opening of the tank, internal signs of asphyxia such as pulmonary congestion and pleural petechiae, in the absence of major traumatic injuries. The cause of death was confirmed as positional asphyxia due to the head-down position and abdominal compression, which impaired breathing. The victim disregarded safety protocols, which prohibit entry into the loading tank of the sprayer, which is classified as a confined space by manufacturers. This incident highlights the importance of adhering to safety guidelines in all working routines, using appropriate personal protective equipment (PPE) and following proper maintenance procedures and adequate safety practices. Enhanced safety measures and safer equipment design are crucial to prevent similar occurrences.