Injury Line: Western Lane Ambulance District
| Inspection Nr | 105308266 |
| Investigation Nr | 170088389 |
| Line Nr | 3 |
| Age | |
| Sex |   |
| Nature of Injury | Burn/Scald(Heat) |
| Part of Body | Bodysystem |
| Source of Injury | Aircraft |
| Event Type | Struck Against |
| Environmental Factor | Weather, Earthquake, Etc. |
| Human Factor | Insuff/Lack/Writn Wrk Prac Prog. |
| Occupation | Motor transportation occuputions n.e.c. |
| Degree of Injury | Fatality |
| Task Assigned | Task not regularly assigned |
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