Category Archives: Forensic pathology

Journal articles relating to forensic pathology including coronial autopsies and Disaster victim identification.

The pathology of lethal exposure to the riot control agents: towards a forensics-based methodology for determining misuse

Journal of Forensic and Legal Medicine Volume 29, January 2015, Pages 36–42;  doi:10.1016/j.jflm.2014.11.006

The aim of this is to review deaths associated with the use of Riot Control Agents (RCAs) and to assess how the presenting pathologies is such cases may better inform cause of death conclusions upon autopsy. We also sought to present which additional steps should be added to the Minnesota protocol and the European harmonization of medico-legal autopsy rules in suspected cases of deaths associated with the use of RCAs.

We included 10 lethal cases in our study. In three cases, RCAs were found to be the sole cause of death, in three cases RCAs were ruled a secondary cause of death due asphyxia or asthma subsequent to exposure to RCAs and in four cases RCAs were contributory factors to death. In three cases the responsible agents were identified as Chloroacetophenone (CN), Chlorobenzylidene malononitrile (CS) and Oleoresin capsicum (OC) and in the remaining 7 cases, the agent was OC alone.

As there are no specific findings in suspected cases of death associated with RCA use, establishing cause of death and whether RCAs are the sole cause or only a contributory factor will be based on the elimination of other possible causes of death. For this reason, a specifically structured autopsy is essential. This specifically structured autopsy should contain basic principles of the Minnesota Protocol and the European harmonization of medico-legal autopsy rules with the following additional steps taken: examination of clothing, eyes, and skin; examination of pharyngeal, tracheobronchial, and eusophegeal mucosas; and a thorough recording of the steps taken by the party conducting the arrest, including other possible causes of in-custody death, as well as a detailed medical history of the deceased.

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The use of 3D computed tomography reconstruction in medico-legal testimony regarding injuries in living victims – risks and benefits

Journal of Forensic and Legal Medicine Volume 30, February 2015, Pages 9–13;  doi:10.1016/j.jflm.2014.12.006

Forensic pathologists are often called upon to determine the mechanism and severity of injuries in living individuals. Such expert testimony is often based solely on hand-written clinical notes. The victims’ injuries may also be visualized via three-dimensional (3D) reconstruction of computed tomography (CT) images. This method has certain benefits but is not free from limitations. This paper presents two case reports. The first case is that of a female who was brought to the hospital with a knife thrust into her body. The prosecutor’s questions focused on the wound channel. The information obtained from the patient’s medical records was very general with many contradictory statements. A re-evaluation of the available CT scan data and a subsequent 3D reconstruction helped determine the exact course of the wound channel. The other case was that of a young male, hospitalized based on CT evidence of bilateral rib fractions, who claimed to have been assaulted by police officers. Court expert witnesses were already in possession of a 3D reconstruction showing symmetrical fractures of the patient’s lower ribs with bone fragment displacement. An expert witness in radiology definitively excluded the presence of any actual fractures, and explained their apparent visibility in the three-dimensionally reconstructed image as a motion artifact. These two cases suggest that a professionally conducted 3D CT reconstruction is a very useful tool in providing expert testimony on injuries in living victims. However, the deceptive simplicity of conducting such a reconstruction may encourage inexperienced individuals to undertake it, and thus lead to erroneous conclusions.

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Infant death scene investigation

J. Forensic Nurs. 2015;  DOI:  10.1097/JFN.0000000000000057

The sudden unexpected death of an infant is a tragedy to the family, a concern to the community, and an indicator of national health. To accurately determine the cause and manner of the infant’s death, a thorough and accurate death scene investigation by properly trained personnel is key. Funding and resources are directed based on autopsy reports, which are only as accurate as the scene investigation. The investigation should include a standardized format, body diagrams, and a photographed or videotaped scene recreation utilizing doll reenactment. Forensic nurses, with their basic nursing knowledge and additional forensic skills and abilities, are optimally suited to conduct infant death scene investigations as well as train others to properly conduct death scene investigations. Currently, 49 states have child death review teams, which is an idea avenue for a forensic nurse to become involved in death scene investigations.

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The choking game: A deadly game. Analysis of two cases of “self-strangulation” in young boys and review of the literature

Journal of Forensic and Legal Medicine Volume 30, February 2015, Pages 29–33; doi:10.1016/j.jflm.2014.12.008

The choking game is defined as a self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia. Death may occur, but forensic pathologists often classify them as suicides or accidental deaths, without focusing on the possibility that they may result from a deliberate self-temporary-asphyxiation, turned into a deadly game. Presenting two fatal cases of self-strangulation involving an 11-year-old boy and a teenager of 15 years, the authors identify victims’ characteristics and death scene’s evidence, which may help to distinguish if a death is from an asphyxial suicide or an asphyxial game.

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Gastric mucosal lacerations in drowning: resuscitation artifact or sign of death by drowning (“Sehrt’s sign”)?

Forensic Science, Medicine, and Pathology January 2015; DOI10.1007/s12024-014-9641-9

First described in the 1930s by German forensic pathologists, radial superficial ruptures of the gastric mucosa may occasionally be found in cases of drowning. According to the German physician Ernst Theodor Sehrt, these mucosal lesions may be a consequence of emesis of swallowed fluid (“Sehrt’s sign”) [1, 2]. In fact, “Sehrt’s sign” is uncommon in drowning fatalities and it is not recognized as a diagnostic finding in drowning cases described in the English medicolegal literature. To our knowledge the only available English reference to “Sehrt’s sign” is the recent paper by Nečas and Hejna [3]. In contrast, other autopsy findings after unsuccessful CPR are well documented.

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Stress and Resilience in Military Mortuary Workers: Care of the Dead From Battlefield to Home

Death Studies Vol 39 Iss 2 2015

The death of a military service member in war provokes feelings of distress and pride in mortuary workers who process the remains. To further understand their reactions, the authors interviewed 34 military and civilian personnel to learn more about their work stresses and rewards. They review stresses of anticipation, exposure, and experience in handling the dead and explore the personal, supervisory, and leadership strategies to reduce negative effects and promote personal growth. These results can be applied to many other situations requiring planning, implementing, and supervising mortuary operations involving mass death.

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The Basics of disaster victim identification

Journal of Forensic Radiology and Imaging Available online 30 January 2015

Mass fatality incidents can occur due to an environmental, medical, vehicle, industrial or terrorist event. They can be major, mass or catastrophic in size and generally involve large numbers of victims. Identification of these victims is of upmost importance in these situations for legal and compassionate reasons. Whilst radiography has been used for this purpose since 1949, it has since been suggested that post-mortem computed tomography (PMCT) could provide a more rapid and logistically beneficial modality-reducing the number of on-site personnel and minimizing the number of different imaging modalities required. The International Society of Forensic Radiology and Imaging (ISFRI), who include Disaster Victim Identification (DVI) as one of their six key areas of development, support this idea. The DVI sub-group of the ISFRI supports the use of radiology including PMCT in mass fatality responses through the DVI group’s published positional statements. This review will discuss the basics of disaster victim identification and the role that radiology has in it, both in the past and in the future.

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