Blunt trauma is most commonly due to motor vehicle accidents and is a major cause of morbidity and mortality in all age groups. The most common signs of significant abdominal trauma are pain, gastrointestinal hemorrhage, hypovolemia, and peritoneal irritation. The patterns of chest injury are highly dependent on the intensity of the trauma and may vary from harmless contusions to possible life-threatening injuries of the heart and/or the aorta. Management is initially focused on the ABCs (airway, breathing, circulation). FAST and CT imaging are used to detect intraabdominal bleeding and organ damage, while chest x-ray is the most important initial diagnostic tool in the assessment of blunt chest trauma. Treatment depends on the specific injury, as well as the hemodynamic status of the patient. Conservative management with close monitoring is indicated for hemodynamically stable patients. However, emergency surgery is often necessary. This learning card provides a brief overview of the clinical features and management of blunt trauma to the abdomen and chest.
29 March 2019
INQUEST | National Forensic Medicine Institute director Dr Mohd Shah Mahmood said that Muhammad Adib Mohd Kassim could only have sustained his injuries within a narrow 13-second window on the night of the Seafield Sri Maha Mariamman Temple riot last year.
Testifying today at the inquest into the firefighter’s death, he said that this was based on the results of Adib’s clinical examination and autopsy, and a 46-second video of the riot which took place on Nov 27.
The 59-year-old medical director, who is the 27th witness to testify at the inquest, was answering a question from inquest conducting officer Hamdan Hamzah.
Hamdan had asked Mohd Shah to pinpoint when Adib had most likely been injured in the video, which was shown in court today.
The video had shown the Fire Rescue Tender (FRT) lorry and Emergency Medical Rescue Services (EMRS) van reversing when approached by an angry mob, and ended with the van having turned around to drive away, with its rear end facing the lorry’s own rear.
Hamdan: At which second is the incident (Adib being hit on his left backside by the EMRS van’s open front passenger side door) most likely to have happened?
Mohd Shah: The 26th second.
Hamdan: Do you think the incident happened to the victim before or after the (EMRS) van turned around?
Mohd Shah: Before the van turned around.
Hamdan: At which specific second?
Mohd Shah: Based on the seven (left rear) fractured ribs which were upright, the probability was that (Adib’s left backside) was hit by the edge of the (van’s) door.
Based on the video, he would have come down from the vehicle between the 26th second and 39th second, within a 13-second time frame.
This time frame is very narrow and it takes into account the pattern of injury on the left waist and the right chest. If taking into account the phase (of time), the fastest is a few seconds.
(When Adib) Came down (from the van’s passenger side) and sustained calar (abrasions from being hit in the left backside) and fell, it would be two seconds for every phase (of the three phases where Adib got hurt).
That 13-second (timeframe of events) is not visible in the video. It takes a maximum of 6 seconds (out of the 13-second time frame) for the victim to sustain the pattern (of injuries) on his body (from being specifically hit on the back by the van’s door).
The video supports the possibility of the injury being sustained by Adib within 13 seconds before the ambulance (EMRS van) turned around.
In previous testimony, Hospital Kuala Lumpur (HKL) forensic medicine specialist Dr Ahmad Hafizam Hasmi testified before the Coroner’s Court that the results of the autopsy among others point to Adib, 24, more likely being hit by the van’s passenger door, which sent him hurling against a hard object.
Hafizam had said the evidence does not support the allegation that the firefighter had been dragged out of the EMRS van during the riot.
Today, Mohd Shah backed Hafizam’s previous testimony saying that it was unlikely that Adib was forcibly pulled out of the EMRS van based on the pattern of injury on the left side of his back.
Hamdan: Is there a possibility of the victim being pulled out and got stuck at the EMRS (van) door, which injured his back (among other body parts)?
Mohd Shah: If we take into account the narrow 13-second window for a third party to act in, in my view that this is unlikely as the one seeking to pull (Adib) out would need to run alongside the van which was reversing.
The injury (on Adib) that would arise from this scenario would be different but the pattern (of injury) seen on Adib (during his medical examination and autopsy among others) showed it was from a hard object.
Geseran (scraping) or being hit by an upright object would lead to (a different type of) abrasion or tear.
But the fracture of the front right ribs does not match (the attacker scenario) as the third and fourth ribs were fractured in several parts. It is hard to get that kind of fracture in that scenario.
Hamdan: So what did you conclude from the victim’s injuries?
Mohd Shah: Taking into account the type, location and position of the injury, pattern of injury and matching them to the objects that may have caused them, all said injuries match the objects (the EMRS van door and road curb, among others).
This is a unique injury as this is the first time I have seen a straight line injury on the back (of Adib). I have never seen it before
Mohd Shah further testified that the sequence of events on the night of the incident could be broken down into three phases based on the pattern of injuries on Adib’s body and testimony from the driver of the EMRS van.
The expert said the fractured left rear ribs and upright abrasion on Adib’s back matched the shape of the edge of the van’s front passenger door thus the probability the fireman exited the passenger side of the van in a hurry.
“(Adib) had alighted in a hurry as the van was moving (reversing) with momentum. When he came down from the van, Adib may have lost some balance.
“The open left (front passenger) door was narrow (at the edge). The increased momentum caused Adib to be thrown and he fell and hit his right chest) on the surface of a hard and protruding object.
“This impact affected his right chest this being the third phase. Based on the injury, we can arrange the sequence from the first to third (phase) as to how the vehicle would move in that very brief moment in time.
(The witness did not specify the first and second phases).
“Before this (prior to a clinical examination of Adib, inspection of the two vehicles and the autopsy), we did not hold any concrete view (on how Adib got injured) and we were open to (the notion of Adib having been) attacked physically or being hit by a part of a vehicle or being squeezed between two vehicles.
“But after the reconstruction (of the sequence of events), we found that two of the possibilities (Adib being pulled out or being sandwiched between two vehicles) could not have happened,” Mohd Shah told Coroner Rofiah Mohamad.
He noted that the fractures on Adib’s left rear ribs were only discovered after an autopsy being conducted on Dec 18 and they were not previously informed about it.
He said the injury, not detected by doctors when Adib was alive, showed that Adib’s first to seventh rear left ribs were fractured in a unique pattern being straight and upright.
He added this type of injury coincided with it being hit by a blunt, narrow and upright object such as the edge of the EMRS van front passenger door.
The inquest resumes on Monday next week with a police investigating officer expected to be one of two witnesses.
22 March 2019
SHAH ALAM: A forensic medical specialist told the Coroner’s Court here today that two broken rib bones of firefighter Muhammad Adib Mohd Kassim had pierced his right lung.
Dr Ahmad Hafizam Hasmi, 40, of the Kuala Lumpur Hospital said he established this of the fourth and fifth rib bones, during an internal examination of Adib’s body at 1am on Dec 18 last year.
Adib, 24, died at the National Heart Institute on Dec 17, twenty-one days after he was severely injured in a riot at the Seafield Sri Maha Mariamman Temple in USJ 25, Subang Jaya, on Nov 27 last year. He had gone there with a team to put out a car fire.
The inquest is to determine the cause of his death. There have been allegations that his injuries were due to an attack by the rioters and there are claims that he was injured after a fire truck reversed into him.
Dr Ahmad Hafizam, the 24th witness, testified: “The sternum (breast bone) was not broken. The second to fifth right rib bones were broken in the front and the side. The third rib bone was broken in three places and the fourth rib bone, in two.”
The inquest, being conducted by Hamdan Hamzah before coroner Rofiah Mohamad, resumes this afternoon. — Bernama
SHAH ALAM: The postmortem on fireman Muhammad Adib Mohd Kassim indicate that his injuries did not come from any assault and were more likely caused by impact with a vehicle, says a forensics expert.
Dr Ahmad Hafizam Hasmi told the inquest into Muhammad Adib’s death that it was unlikely that the fireman was beaten up during the early morning of Nov 27 last year.
Dr Ahmad Hafizam is the 24th witness in the inquest and was the forensic doctor who conducted the postmortem.
He said that there were no injuries to indicate that the 24-year-old fireman was beaten up.
“The pattern of injuries on the deceased’s thorax was inconsistent with that of being kicked or punched.
“Apart from that, there were no injuries on the face, head, abdomen, upper limbs, and lower limbs that would match injuries sustained after being hit or while defending one’s self that could be found on the deceased,” he told the coroner’s court on Friday (March 22).
Based on the postmortem and on the information he received from a reconstruction of the incident, Dr Ahmad Hafizam said that Muhammad Adib’s injuries were most likely caused by a combination of him being hit by the door frame of the Fire and Rescue Department’s Emergency Medical Rescue Services (EMRS) van, and then hitting a hard object at the road shoulder as he fell to the ground.
“I had been informed on the day of reconstruction of the event – by the investigating officer (IO) – that (one) witness, the driver of the EMRS van who was with the deceased in the van, said that he (Muhammad Adib) was not inside the van after the fire truck suddenly reversed; which had caused the rear of the truck to hit front of the van.
“Based on that information, I am of the opinion that the most probable event that took place was that if indeed the deceased was outside of the EMRS van, the deceased was standing and facing towards the rear of the van with his back towards the fire truck.
“The back left side of the deceased’s body received the full impact of the hit from the edge of the door frame of the left front passenger seat of the EMRS van, and this led to his back ribs – ribs number one to seven – to break.
“The impact from the door frame also caused the deceased to lurch forward and fall with his limbs outstretched, facing forward and the right side of his ribs hit a hard surface that was raised – such as the road shoulder or any other hard structures that were around the area – with force, and this caused injuries on the deceased’s right thorax,” he said.
Dr Ahmad Hafizam said that the postmortem was done on Dec 18, 2018.
19 March 2019
SHAH ALAM: A witness testifying at the inquest into the death of Muhammad Adib Mohd Kassim told the Coroner’s Court here that he saw someone in fireman’s pants get hit by a reversing fire truck.
Pakistani national Mohsin Budd, the 20th witness in the inquest, said he saw this person being squeezed by an Emergency Medical Rescue Service (EMRS) van and parked cars near the Seafield temple on Nov 27, 2018.
In the morning, Mohsin did not identify the fireman who was hit by the EMRS van but during the afternoon session, he named the man as Adib.
Mohsin told coroner Rafiah Mohamad in the morning that he was visiting a friend, a security guard who worked in a residential area near the temple, and that they were able to see what was going on outside the temple from where they stood.
Sometime before 1am that morning, Mohsin said he saw two fire engines arrive along the main inner road – a fire rescue tender (FRT) truck followed by an EMRSvan which was directly behind the FRT.
“I saw a group of Indians approach and throw something at the lorry (the FRT). I saw someone from the lorry get down from the passenger’s side. He just stood outside.
“The person in the passenger’s seat got down from the van after that. Then, one other person came from where I do not know, and stood in between the lorry and the van.
“The one in the middle wore a helmet and the orange-green Bomba uniform. The one from the lorry wore a full Bomba uniform but he had an orange jacket and no helmet.
“And the one from the van, I can’t recall what coloured shirt he wore, maybe black or blue, but his pants were the same as the Bomba pants,” Mohsin, 24, said today in Punjabi.
When the group of Indians approached the FRT, Mohsin said, the fireman who was in the middle, with the helmet, as if expecting to be attacked, quickly entered the EMRS via its sliding door on the side.
As this group started to hit the FRT with bottles and wood, the one with the fireman’s pants and dark coloured shirt – the one who had been in the EMRS van’s passenger seat and who was then standing at the back of the van – wanted to run.
“He saw that big group approaching to where he was. And because the fireman in the middle closed the sliding door and went inside quickly, this person could not enter the van. So, he was ready to run to the Caltex station nearby.”
Then, the FRT backed into the EMRS, pushing it backwards, to get away from the rowdy crowd. The EMRS hit the fireman who was next to its back left tyre and squeezed him in between cars on the side of the road, he said.
Mohsin said: “He was facing towards the temple when the FRT reversed and hit the EMRS which squeezed the victim and the cars. Then, with his head facing the (USJ 16) Caltex, he fell down backwards, his feet facing Caltex.”
The inquest proceedings stopped at this point for lunch.
Mohsin, an air conditioner technician from USJ 11 who has lived in Malaysia for four years, named the fireman as Adib later this afternoon.
He had been giving his testimony through a Punjabi court interpreter. However, a court clerk offered to assist after difficulties in translation arose.
It was the clerk who identified the fireman who had been squeezed between cars as Adib.
He also mentioned “EMRS” and “FRT” as opposed to the “lorry” and “van” which Mohsin had been referring to so far.
Conducting officer Hamdan Hamzah later referred to Adib as the man in the fireman’s trousers as well, and continued doing so in the afternoon proceedings.
Mohsin said the person was Adib but did not make clear how he identified the fireman.
Hamdan later showed him a dark blue T-shirt bearing the fire department logo and asked if it was the shirt he had seen “Adib” wearing that day.
Mohsin said it “looked like it” but added that he was unsure about the colour.
He also said several members of the public took the fireman whom he identified as Adib to the nearby USJ 16 Caltex after he was injured, but that he did not know what happened after that.
The inquest previously heard that Adib was inside the EMRS at the time the FRT backed into it, which led the EMRS to spin 180 degrees.
Mohsin was questioned by deputy public prosecutor Hamdan, who is part of a three-member team from the Attorney-General’s Chambers.
21 February 2019
Free Malaysia Today @fmtoday
Adib’s lungs had collapsed, rib cage fractured, doctor tells inquest
SHAH ALAM: The doctor who treated Muhammad Adib Mohd Kassim told the Coroner’s Court today the fireman’s lungs were injured and several rib bones fractured when he was brought to the hospital.
Subang Jaya Medical Centre doctor Nantha Kumaren Muthu Kerishnan said he heard cracking sounds in Adib’s rib cage when he was inspecting the unconscious fireman in the emergency unit of the hospital in the early hours of Nov 27 last year.
“His blood pressure and oxygen level were very low and my job at that time was to increase the blood pressure and oxygen level in him,” he said.
Nantha Kumaren also said Adib was “gasping for air and making incomprehensible sounds” when admitted to the hospital.
The doctor then called for an X-ray on the patient because he suspected Adib’s lungs had collapsed.
“From the X-ray image, it could be seen the patient had fractures on the second, third, fourth and fifth bones of his rib cage as well as injuries on the lungs,” he said when asked by conducting officer Zhafran Hamzah.
The doctor showed Adib’s chest X-ray image to the Coroner’s Court, explaining that the “white patches all over the lungs”meant the lungs were injured.
Asked by Zhafran if he could identify the possible cause of the lung injury, Nantha Kumaren replied: “In my opinion, it was major blunt trauma”.
The witness said his two colleagues then came to assist in resuscitating Adib.
Nantha Kumaren noted that Adib’s body and face became swollen after doctors inserted a tube into his trachea.
“The lungs were already injured and we were forcing air into him. The oxygen we gave him had escaped under his skin,” he added.
Adib still in EMRS van during temple riots, inquest told
Firefighter Muhammad Adib Mohd Kassim was still in the Emergency Medical Rescue Services (EMRS) vehicle he was assigned to when chaos erupted at the Seafield Sri Mahamariamman temple grounds last November.
Ahmad Shahril Othman, the third witness in the inquest to determine Adib’s cause of death, said he was behind the wheel of the van at the time of the incident.
“Arwah (Adib) was (sitting) next to me. He was still communicating with me.
“We saw another officer exiting the fire truck to extinguish a fire… We said, ‘Hazim got out so quickly’,” he told the Coroner’s Court in Shah Alam.
Hazim was identified as one of the firefighters deployed from the Subang Jaya Fire and Rescue Department, who arrived on site at 1.12am to extinguish a burning car across from the temple.
“I saw that before he (Hazim) managed to take out the hose reel, he was attacked.
“After that, I did not see him anymore. I do not know where he went,” said Shahril, adding that the crowd had come from the front and both sides of the fire truck.
Fire truck driver Md Eliza Mohd Noor, the inquest’s second witness, continued his testimony after the lunch break and confirmed that Hazim had exited the fire truck and attempted to take out the hose reel to put out the burning car.
Both vehicles eventually left the scene and headed towards the USJ8 police station.
Upon arrival, Eliza said he was alerted to Shahril informing his supervising officer that Adib was no longer in the EMRS van.
“We then tried to call Adib several times, but nobody picked up.
“After about 15 to 20 minutes, we received a call (on Adib’s phone) and the person told us that Adib is being taken to SJMC (Ramsay Sime Darby Subang Jaya Medical Centre),” said Eliza, adding that their team was immediately instructed to head to the hospital.
Fire truck driver testifies he was ‘fearful’ of mob attack at temple riot
The driver of a fire truck deployed to the riots near the Seafield Sri Mahamariamman temple in Subang Jaya last November told an inquest today that he had reversed the vehicle in a state of panic after being chased away by a mob of civilians.
Md Eliza Mohd Noor, the second witness in the inquest to determine firefighter Muhammad Adib Mohd Kassim’s cause of death, said the mob chanted “Bomba pergi balik, jangan padam! (Fire Department go home, don’t put the fire out)” and subsequently hit his front mirror with bricks and helmets.
“They shouted it many times, and made the ‘shooing’ hand signal asking us to leave.
“After the windscreen cracked, I was scared. I immediately reversed the vehicle,” he to questions from the inquest coordinating officer, deputy public prosecutor Hamdan Hamzah.
Eliza told the Shah Alam Coroners Court that he saw a man breaking away from the mob of about 50 people to knock the front mirror of the truck with a white pole, before bricks, helmets, and other unidentified objects were hurled towards it seconds later.
He said his team, comprising a supervising officer and five other personnel deployed from the Subang Jaya fire station to put out a burning car, arrived on site at 1.12am on Nov 27.
They were accompanied by the Emergency Medical Rescue Services (EMRS) van that medical officer Adib was travelling in.
When reversing the fire truck, Eliza said he was aware of the EMRS van’s position at its tail, and two other vehicles, including a Proton Exora taxi.
After backing up about 30m, he said he noticed through one his functioning mirrors a crowd who appeared to be shaking an object, which he assumed was the EMRS van.
“I saw around four or five people (behind the fire truck) who seemed to be shaking something.
“I continued to reverse until I saw that the back of the EMRS on my left side was slightly further ahead than the front of my truck.”
He added that the truck was about 80m away from its initial location, and that they left the scene shortly after reaching a junction.
The inquest’s first witness, Mohd Nasir Rahman, earlier testified that his team was stationed to control traffic at a traffic light opposite the temple.
With a clear view of up to 100m, Nasir estimated that the crowd gathered at the temple grounds numbered between 3,000 and 5,000.
“At the time, together with my officer, I had instructed for the road in front of the temple to be closed, and diverted all traffic from Shah Alam to Puchong into the USJ toll.
“And from the other direction, we directed traffic to do a U-turn into the LDP,” he said.
Nasir also told the inquest that while he saw a crowd attacking the fire truck, his team was outnumbered, and due to safety considerations, he decided that they should remain on traffic control.
9 February 2019
Lawyer: Evidence of doctors, witnesses key to what caused fireman Adib’s death