- 學位論文
臺灣地區汽車道路交通事故致死解剖及相驗案例分析
Analysis of Fatal Car Incidents from Forensic Autopsy in Taiwan
摘要
交通事故為國人十大死因事故傷害之重要原因之一，更是法醫相驗及解剖鑑定上常遇見的死亡型態。在司法上，鑑別汽車駕駛或是乘客，對於責任歸屬具舉足輕重的角色。近年來人 口結構老化，帶病駕駛更是值得關注的領域。本研究收錄 2016 - 2020 年間台灣地區汽車事故致死且經解剖鑑定個案之完整資料，總計 146 例。再針對其人口學特性、危險因子、事故型態、損傷型態及死亡方式與原因進行分析，所有案例中男性居多，男女性別比為 5.95:1，年齡分佈自 8 個月大嬰兒至 94 歲老翁，平均年齡為 50.65±15.19 歲。所有案例中共計 110 位駕駛者，29 位乘客，其中 7 位座位無法歸類。無照駕駛比例為 6.4%，無照駕駛者均已達報考駕照之年齡，(包含未曾考照、吊銷與吊扣)。146 例中有 14 例未使用安全帶，且 2 例小於 12 歲之孩童均未使用安全座椅。在事故樣態分類中，自撞案件佔 45.5%，非自撞則為 40.9%。 最常發生事故之道路種類以市區道路的 37%最多，道路型態以直路的 53.3%最多。在所有收錄個案中，以牽涉車輛數只有 1 輛者佔所有案例的 51.0%為最多，僅包含 1 輛車之自撞事故佔所有所自撞事故的 85%，其餘為 2 兩輛以上(死者駕駛或乘坐之汽車撞擊其他靜止車輛或自撞靜止物後遭其他車輛撞擊)。不論駕駛或是副駕駛座乘客都是以胸部損傷最多，是最常見的損傷型態，後座乘客則以頭臉部損傷的 29.6% 最多，駕駛座的胸部損與撞擊方向盤相關，後座乘客的頭臉部損傷則與撞擊前方座位有關。有無使用安全帶之個案受傷型態均以胸部損傷最多，但未使用安全帶者有較高比率被拋飛車外，有使用安全帶者則有較高的脊柱損傷以及肢體骨折。所有個案中，有 74%的死亡個案於事故時至少具有一種疾病，以心、腦血管相關疾病最多，而帶病駕駛佔所有駕駛的 78.2%，且帶病駕駛自撞的比率顯著高於健康駕駛。顯示疾病有無對於影響駕駛能力或是受傷後康復能力佔有重要角色，當欲判定駕駛死亡方式時，需同時考慮死亡個案之傷勢嚴重程度、解剖鑑定發現、過往病史以及檢警外部調查資料方能判斷，自然死個案往往有傷勢較輕、解剖鑑定發現與過去病史相符等特徵，對於肇事責任歸屬、保險賠償上具有決定性關鍵。經由本研究，期待可以協助對於民、刑事之司法審判上對汽車事故發生事實的判定，提供釐清肇事責任以及真相的依據。
並列摘要
Traffic accidents are one of the leading causes of death and injury among the population, and they are commonly encountered in forensic examination and autopsy. In the field of justice, determining the responsibility of the car driver or passenger plays a crucial role. In recent years, with increasing aging population, driving with medical conditions has become an area of concern. This study includes comprehensive data from autopsy cases of fatal car accidents in Taiwan from 2016 to 2020, totaling 146 cases. The study analyzes the demographic characteristics, risk factors, accident patterns, types of injuries, and causes of death and their correlation. Among all the cases, males accounted for the majority, with a male-to-female ratio of 5.95:1. The age distribution ranged from 8-month-old infants to 94-year-old elderly, with an average age of 50.65±15.19 years. There were a total of 110 drivers and 29 passengers, with 7 cases where the seating position could not be classified. The proportion of unlicensed drivers was 6.4%, and all unlicensed drivers had reached the legal age for obtaining a driver's license (including those who had never applied, had their licenses suspended, or had their licenses revoked). Among the 146 cases, 14 cases involved individuals not wearing seat belts, and 2 cases involved children under the age of 12 who were not using child safety seats. In terms of accident patterns, self-collision cases accounted for 45.5%, while non-self-collision cases accounted for 40.9%. The most common type of road involved in accidents was urban roads, accounting for 37% of the cases, and the most common road configuration was straight roads, accounting for 53.3%. Single-vehicle accidents accounted for the highest percentage, with 51.0% of all cases involving only one vehicle. Both drivers and front-seat passengers had the highest incidence of chest injuries, which was the most common type of injury. Rear-seat passengers had the highest incidence of head and facial injuries, which were related to impacts with front seats. Cases involving individuals not wearing seat belts also had a high incidence of chest injuries, but they had a higher rate of being ejected from the vehicle. Cases involving individuals wearing seat belts had a higher incidence of spinal injuries and limb fractures. Among all the cases, 74% of the fatalities had at least one pre-existing medical condition at the time of the accident, with cardiovascular-related diseases being the most common. Drivers with medical conditions accounted for 78.2% of all drivers, and the rate of self-collision was significantly higher among drivers with medical conditions compared to healthy drivers. This indicates that the presence of medical conditions plays a significant role in affecting driving ability or post-injury recovery. When determining the cause of driver's death, the severity of injuries, findings from autopsy examinations, medical history, and external investigations conducted by the police and other agencies must be considered. Natural deaths often exhibit characteristics such as less severe injuries, consistent findings with the medical history, etc. These characteristics are crucial in determining liability in the accident and insurance compensation. Through this study, it is hoped that it can assist in the judicial determination of factual evidence in civil and criminal trials related to car accidents and provide a basis for clarifying the liability and truth behind the incidents.