"In examining the bodies of these children, there is nothing at the autopsy table that will distinguish an asphyxial hanging, due to an intentionally self-destructive act, suicide, from an unintentional catastrophe from playing this game," he said.
In fact, four years ago, Andrew, New Hampshire's chief medical examiner, came across this situation in his investigation into the shocking death of 11-year-old Thomas Fortin. At first glance, the death of the healthy, active boy appeared to be suicide.
The boy's mom, Penny Fortin, remembers a scene eerily similar to the site in Chelsea Dunn's bedroom.
"The first thing I saw was it looked like Thomas was kneeling up against the wall, facing the wall. I remember running over to him and taking him down, removing the dog leash from the coat rack, removing the other part from his neck," she said.
The sixth-grader's death was yet another in a string of similar apparent childhood suicides. Suspicious, Andrew investigated further and soon discovered that some of the kids had been playing the suffocation game to get a quick high.
Andrew demonstrated how children playing the game alone have only moments to undo the choke-hold around their neck before passing out.
If the child fails to unloosen himself, the result can be deadly. "Should he not be able to reach it, and lose consciousness and fall forward, that pressure on his neck is now even tighter. It will deprive the blood flow, or it will deprive the brain of blood flow nearly completely, leading to a fatal result," he said.
That's what happened to Thomas, and most likely to Chelsea, and other pre-teen and early adolescent children around the country. Recently, a 13-year-old California boy and a 10-year-old boy in eastern Idaho were likely victims of the game.
And 14-year-old Jennifer Cernekee from Wisconsin also died under similar circumstances in 2001.
There are tip-offs parents and friends may be able to spot. Experts say severe headaches, marks on the neck, bloodshot eyes and closed doors are common signs. Most importantly, experts say, parents should talk to their children about risky behavior.
Investigators have ruled the cause of Chelsea's death undetermined, but her parents believe there's no uncertainty. They're convinced they lost their daughter to this dangerous game.
"She might have thought it was dangerous, and she might have thought it was risky. But I don't think she had any idea that it ever killed anybody," her father said.
Three months after Chelsea's death, her room is just as she left it. Her drawings still decorate the wall and her birthday money sits neatly on her dresser. Chelsea would have turned 14 the day after her funeral.
And her family is still dealing with the intense grief of losing their vibrant young girl.
Tammy Dunn wishes she would have spotted some warning signs that Chelsea was risking her life for a senseless game. "I blame myself. Maybe I should have known, maybe I should have checked in on her, but I'm angry with her. I'm angry that she made those choices that she made that took her away from us. And her brother and her sister, and everybody who loves her. She had a huge future that you know, with one decision took all that away."