Landslides rank among the most destructive natural disasters, frequently leading to substantial loss of life, particularly when individuals become trapped under debris. The main causes of death in these situations are traumatic injuries and mechanical asphyxiation from burial. Research examining multiple landslide events revealed that most fatalities were due to traumatic injuries, with mechanical asphyxiation also playing a major role.1

Over a span of three years, the Department of Forensic Medicine and Toxicology at VCSGGIMS & R, Srinagar Garhwal, received five cases for medico-legal autopsy. These included one case in March 2022, three in July 2023, and one in May 2024. All deceased were male, aged between 30 and 55 years, and employed at an under-construction road project in a hilly region of Uttarakhand, North India. Of the five, three were declared dead on arrival. The remaining two were found breathing spontaneously after being extricated and were transported to the emergency department with supplemental oxygen. Clinical examination showed symptoms such as cough, rapid breathing (tachypnea), and reduced breath sounds. Despite medical intervention, both individuals died within an hour of hospital admission. Detailed autopsies were conducted following the receipt of inquest documents from the police to determine the exact cause of death.

Autopsy findings revealed that all individuals were of average build on external examination. Sand and dirt particles were observed in the mouth, nostrils, external ear canals, and eyes. The face and conjunctiva appeared congested.

Internal examination showed rib fractures ranging from the 2nd to the 6th ribs on both the left and right sides along the midclavicular line in three cases. These fractures were accompanied by blood extravasation into surrounding tissues, indicating trauma due to chest compression. In the remaining two cases, rib fractures were absent, but varying-sized contusions were noted on the surface of the lungs.

The respiratory tract—including the larynx, trachea, and bronchi—contained soil particles. The lungs were congested and edematous, findings consistent with asphyxia. Soil particles were also present in the bronchioles. The stomach contained a straw-colored fluid mixed with dirt particles (see figures 4–5).

In all cases, the cause of death was determined to be traumatic asphyxia resulting from chest compression.

Table-1: Demographic profile of all five cases

Table -2: Autopsy finding all of 05 cases

Landslides can be classified based on the factors that cause them. In the case of slow erosion, elements like water, cycles of freezing and thawing, and wind gradually wear away the earth's supporting structures. Any trigger either manmade or natural usually results in rock falls, dry debris cascades down a slope. The entry of foreign substances into the respiratory system is one of the ways mechanical asphyxias can occur. Instances of fatalities due to the inhalation of gastric contents have been documented, particularly as a complication arising from acute alcohol intoxication. Instances of fatal suffocation caused by the inhalation of sand due to accidental burial are extremely uncommon. The lack of injuries in these situations is due to the soft texture of sand. Finding sand in the eyes, nostrils, mouth, and ear canals should raise concern.2 Instances of unintentional and abrupt sand burial are sometimes reported at construction sites, sandboxes, or beaches. This phenomenon typically occurs due to the collapse of sand tunnels, sandcastles, or holes dug in the beach. However, instances of sand aspiration have also been documented in cases of vehicle accidents, homicides, or when young children ingest sand themselves.3

These cases represent unfortunate accidental deaths at workplace due to burial in soil. The mechanism of death is asphyxiation by inhalation of sand inside the respiratory passages. The diagnosis was ascertained by the presence of sand and dirt particles in the respiratory passages and gastrointestinal tract. In most of the cases, autopsy findings were sufficient to suggest that the deceased had actively participated in the process of inhalation of sand while they were alive. The extent of penetration of dirt and sand, as well as severe congestion and edema in the air passages are indicators to that effect. Bonilla-Santiago noted chest radiographic findings in two patients with sand aspiration.4 there have also been documented cases of aspiration of sand and gravel following unintentional burial. In certain instances, the patients received bronchoscopy to remove aspirated fine foreign material after receiving emergency airway care. One child among them recovered with chest physiotherapy and additional oxygen. The core trachea bronchial tree in these patients had radio dense material lining it, displaying “classic” sand broncho grams on chest radiographs.5-9

Forensic autopsy plays an important role while encountering such type of cases as it is of utmost importance to rule out any foul play depending on the medical and circumstantial evidences. The presence of soil in the airways and lungs indicates that deceased inhaled soil, which can cause respiratory distress, associated inflammatory responses and presence of internal thoracic injuries also suggest that deceased experienced severe compression of chest, eventually lead to cause respiratory distress. Public health implications include the need for rapid rescue, airway protection in survivors, and education regarding burial and suffocation risks in landslide-prone regions. Forensic awareness of such presentations can improve diagnostic accuracy and inform disaster preparedness protocols including rapid rescue efforts and thorough searches for early extracting of individuals trapped under debris. Early warning systems, proper land use planning can help to rescue such incidents.

The management of landslides should primarily involve prevention and mitigation, including geologic surveys, engineering, land use management, and avoidance of high-risk areas. Monitoring and early warning systems are also of high importance. Responders should be properly equipped and manage the scene based on a careful assessment of the safety of the area. Medical care of casualties should be centered on management of traumatic and crush injuries and exposures, including hypothermia. Post event response should include careful evaluation of the public health situation because landslides can leave large populations homeless and in need of food, water, shelter, sanitation, security, and mental health support.

1. Pollock W, Wartman J. Human Vulnerability to Landslides. Geohealth. 2020 Oct 1;4(10):e2020GH000287. doi: 10.1029/2020GH000287. PMID: 33094206; PMCID: PMC7567151.
2. Benomran FA, Hassan AI. Accidental fatal asphyxiation by sand inhalation. Journal of Forensic and Legal Medicine. 2008 Aug 1;15(6):402-8.
3. Kiryu K, Takeichi T, Kitamura O. An autopsy report of accidental burial in a beach sand hole. Legal Medicine. 2018 Nov 1;35:88-90.
4. Bonilla-Santiago, J., and W. L. Fill. 1978. Sand aspiration in drowning and near drowning. Radiology.128:301–302
5. Mellema JD, Bratton SL, Inglis A, Morray JP. Use of cardiopulmonary bypass during bronchoscopy following sand aspiration: a case report. Chest. 1995 Oct 1;108(4):1176-7.
6. Bender EM, Kashuk JL, Moore EE, Hopeman AR. Conservative management of sand aspiration: case report. Military Medicine. 1984 Feb 1;149(2):98-9.
7. Wales, J., K. Jackimczyk, and P. Rosen. 1983. Aspiration following a cave-in. Ann. Emerg. Med. 12:99–101.
8. Bergeson PS, WA H, RF C, MJ S, DS T. Asphyxia secondary to massive dirt aspiration.
9. Van Dyke JJ, Lake KB. Survival after asphyxia secondary to gravel aspiration. Archives of internal medicine. 1976 Apr 1;136(4):471-3
10. Mechanical Asphyxial Deaths: An Autopsy Based Cross Sectional Study in a Tertiary Care Hospital. Indian Journal of Forensic Medicine & Toxicology [Internet]. 2024 Apr. 27 [cited 2025 May 29];18(2):168-73.
11. Scopetti M, Padovano M, Manetti F, Di Fazio N, Radaelli D, D'Errico S, Frati P, Fineschi V. Molecular Autopsy in Asphyxia Deaths: Diagnostic Perspectives of miRNAs in the Evaluation of Hypoxia Response. Int J Med Sci. 2023 Apr 24;20(6):749-753. doi: 10.7150/ijms.79539. PMID: 37213668; PMCID: PMC10198145.
12. Berzlanovich AM, Fazeny-Dörner B, Waldhoer T, Fasching P, Keil W. Foreign body asphyxia: a preventable cause of death in the elderly. Am J Prev Med. 2005 Jan;28(1):65-9. doi: 10.1016/j.amepre.2004.04.002. PMID: 15626557.
13. D'Ovidio C, Rosato E, Bonelli M, Carnevale A, Marsella LT. A particular case of accidental asphyxiation. Med Sci Law. 2018 Jan;58(1):55-57. doi: 10.1177/0025802417747430. Epub 2017 Dec 28. PMID: 29283003.
14. Bogdanovic M, Alempijevic D, Curcic D, Durmic T. A Fatal Outcome of Pica Syndrome: An Unusual Case of Delayed Mortality. Am J Forensic Med Pathol. 2018 Sep;39(3):261-263. doi: 10.1097/PAF.0000000000000409. PMID: 29771703.
15. Prahlow JA, Prahlow TJ, Rakow RJ, Prahlow ND. Case study: Asphyxia caused by inspissated oral and nasopharyngeal secretions. Am J Nurs. 2009 Jun;109(6):38-43; quiz 51. doi: 10.1097/01.NAJ.0000352471.63370.32. PMID: 19478604.