Pages: 125

No chapter abstract available.

Pages: 10

Forensic & legal medicine is a term used to describe aspects of medicine and healthcare that directly or indirectly interact with legal processes and justice systems, often closely involving human rights and may relate to living and deceased individuals. Forensic & legal medicine (sometimes referred to as legal & forensic medicine) embraces forensic pathology, clinical forensic medicine and medical jurisprudence. Some practitioners work in all three settings, others in one or two of these areas, but all overlap. The development of forensic & legal medicine extends back thousands of years and is often said to have originated in China. Its progression and development as an academic discipline progressed in Europe and the United Kingdom predominantly from the eighteenth century. It should now be considered complementary to the many other specialized forensic scientific disciplines. This Chapter identifies key elements of its development, with examples from around the world.

Pages: 7

This Chapter focuses on the principles of medical ethics summarizing the obligations of health professionals to individuals and to society. These obligations are universal and are incorporated in national and international statements and guidelines and by medical professional bodies worldwide. International ethics guidelines are articulated by the World Medical Association’s Code of Medical Ethics first published in 1949. The central tenet of all health professional ethics is to respect human dignity and always act in the patient’s best interest. A knowledge of human rights and their relevant instruments is increasingly important in a globalized world when faced with issues such as care of migrants who are forcibly displaced, allocation of scarce resources (such as in pandemics), and healthcare inequities. Principles common to all codes of medical ethics include beneficence, non-maleficence, confidentiality, and respect for patient autonomy. Exceptions to this framework are also explored. autonomy, and justice. Exceptions to this framework are also explored.

Pages: 9

In the aftermath of the Nazi and Japanese atrocities in human subject experimentation, international law has evolved to incorporate a strong emphasis on the human rights of research subjects and in an effort to regulate conduct during wartime hostilities. International humanitarian law and criminal processes before the International Criminal Court and the ad hoc tribunals enable exposure of acts that may have constituted breaches of ethical and legal obligations, determined by reference to international instruments, so that denunciation and other deterrent measures can be adopted when conduct that constitutes offenses such as genocide, crimes against humanity, war crimes and acts of aggression is proven. Expert evidence from practitioners in forensic medicine and forensic science is critical in such cases. While there are limited mechanisms for enforcement of rights and obligations in individual local instances, in prominent cases the International Criminal Court has found charges proven and imposed significant penalties. The ongoing endorsement of human rights instruments by most countries increasingly marginalizes States that do not subscribe to the instruments or that breach rights. This is likely to be an ongoing trend with pressures escalating for compliance with key tenets of international humanitarian law.

Pages: 5

The word “Euthanasia” is derived from the Greek words “eu” (good) and “thanatos” (death), so euthanasia literally means “good death”. Because of the benign nature of the word euthanasia, one would assume that the concept is widely accepted, but it is not. This Chapter will discuss reasons for this and current concepts and developments in this area.

Pages: 5

Doctors are accountable for their professional conduct through a variety of mechanisms, including compulsory registration with a regulator. The regulator in the United Kingdom (UK) is the General Medical Council (GMC) whose overarching objective is to protect the public. It sets standards of medical professional conduct against key concepts of medical ethics and professionalism consistent with the law. In Good Medical Practice (GMP), the GMC defines the duties of a doctor and provides guidance to assist doctors in discharging these duties. A doctor’s fitness to practice is measured against these standards. The general principles of GMP apply to all registered medical practitioners in all professional settings including detention establishments, notwithstanding the competing therapeutic and forensic responsibilities of a forensic practitioner. If a doctor’s fitness to practice is called into question, the GMC triggers an investigatory process, which will often conclude with no action. Serious matters are referred to the Medical Practitioners Tribunal Service for a hearing to determine the facts, make findings on impairment and if impairment is found, impose a sanction such as conditions, suspension or erasure. Medicine is a highly regulated profession. However, doctors embrace the standards set for them and remain one of the most trusted and respected professions.

Pages: 8

This Chapter briefly explores the history of nursing professional regulation through to the current day. The Chapter then explores the concepts of professional conduct, with a focus on the importance of professional conduct to protect patients because of the power imbalance that exists between patients and nurses. There are examples of patient-nurse relationships and so-called boundary crossings and violations and being able to recognize and respond to boundary violations. There is a comprehensive overview of the fitness-to-practice process and outcomes associated with the United Kingdom’s nursing regulator, the Nursing and Midwifery Council. Finally, there is advice for those nurses facing a fitness-to-practice investigation or complaint.

Pages: 6

Paramedics working in forensic healthcare face a discourse between their advanced skill set and a reduced and atypical paramedic scope of practice generating moral and ethical dilemmas. Using structured case studies, this Chapter reviews the difficulties paramedics encounter balancing the Quality Standards specified by the Faculty for Forensic and Legal Medicine for nurses and paramedics, and the professional standards defined by the Health Care Professions Council (HCPC) with whom they are registered. The College of Paramedics work on updating the paramedic scope of practice to include ‘’Profession Wide’ as well as “Individual” scopes of practice is reviewed and links between this and the HCPC Standards of Proficiency for paramedics are addressed. Moral and ethical tenets are reviewed in relation to paramedics facing the double bind of being qualified to deliver care which their atypical scope of practice precludes them from undertaking. Duty of Care and negligence are discussed alongside the key issues of harm, vicarious liability and Bolam Standards to support Paramedic Forensic Health Professionals in undertaking safe and evidence-based clinical decision making in the Forensic Healthcare environment.

Pages: 8

The United Kingdom (UK) is exceptional in that it has three Medical Defense Organisations (MDOs), regarded as the leading MDOs, which are mutual organizations to which all dentists and doctors with a licence to practice may belong. This Chapter briefly addresses the history of the oldest MDOs in the UK and their role in supporting and representing their members. Most of the following information about the work and role of the MDOs is in relation to medical practice but applies equally to dental practice in the UK. One of the MDOs also offers membership and support in a number of different countries other than the UK. The advice and support provided by the MDO is given by a range of professionals, including medicolegal advisers or consultants who have been specifically trained not only in a clinical specialty but also in legal medicine and who usually have a degree in law or medical law.

Pages: 7

The principles of death investigation address three core questions: when is a death investigation needed? Why is it needed? And by whom it should be undertaken. These questions are framed within the various legal and criminal systems across different jurisdictions worldwide. Certain categories of death simply need a legal certification by the attending physician as to the cause of death. Other categories such as unexplained, unnatural, violent or suspicious deaths involving a third party require a forensic investigation in a framework of judicial and/or police oversight. Regardless of the legal system, there are common facts to be established: the identification of the deceased; when the death occurred; where it occurred; how it occurred and in what circumstances. The investigation is overseen by a judicial or State authority utilizing the services of the police and/or forensic specialists. It must include an examination of the site of the death; a full autopsy examination of the deceased with appropriate specialist tests (including toxicology, histology, biochemistry, microbiology and radiology; and other imaging techniques such as computed tomography and magnetic resonance imaging where available); and a comprehensive and structured report on the death for the relevant authority. Forensic death investigation may lead to death certification and registration; public non-criminal inquiry; or a criminal prosecution by the State.

Pages: 6

The Coroner holds the oldest judicial office in English Law and this has undergone considerable change since its inception in the Middle Ages. There are no coroners in Scotland and the role is fulfilled by the Office of Procurator Fiscal. While the role encompasses the investigation of all sudden and suspicious deaths in Scotland, it also includes other roles such as public prosecutor, the handling of criminal complaints against the police and the conduct of fatal accident inquiries, which are similar to inquests but unique to the Scottish legal system. Thus, although the roles are similar, they are definitely not congruent.

Pages: 9

The Medical Examiner system in England & Wales is a new element to the medicolegal investigation of death. It is intended to ensure that every death in England & Wales is scrutinized (reviewed) independently, that the cause of death on the Medical Certificate of Cause of Death is accurate and that concerns about care raised by either next of kin of the bereaved, or healthcare professionals are identified and escalated to appropriate investigating bodies such as His Majesty’s Coroners or hospital or community mortality governance systems. This Chapter summarizes the relevant reports, inquiries and government actions that led to the introduction of this system in 2019, in particular the case of the GP Harold Shipman, and a series of hospital-based scandals. The structure and function of the Medical Examiner system is described.

Pages: 10

Public recognition of matters such as torture and war crime has increased in recent years, by virtue of education and the wider availability of information particularly communicated by social media. The current legal basis for and the means by which international crimes can be investigated and prosecuted are reviewed and summarised. Emphasis is placed upon the need for forensic & legal medicine practitioners to understand the background to their role, and the wide range of scenarios when their expertise in documenting and interpretation may be required in the context of the deceased and living complainants of such crimes or human rights abuses.

Pages: 6

This Chapter deals with the primary and secondary prevention of torture. As an example of primary prevention, preventive monitoring of places of detention is described including some of the primary stakeholders carrying out this activity at national and international levels. Secondary prevention through the scrutiny of states is also described including its stakeholders with particular emphasis on the United Nations (UN) human rights treaty bodies and special procedures, regional bodies and civil society organizations. The last part of the Chapter deals with the role of medical doctors in both the prevention and scrutiny of torture and underlines the important roles doctors can play at both international and national levels. This section also briefly deals with the prevention of medical complicity in torture.

Pages: 4

This Chapter provides a deliberately practical guide to every stage of providing expert evidence for courts. It will take you through initial instruction by a solicitor, the “do’s and don’ts” of court report writing, how to approach conferences with a legal team if such a request is made, and the process (including potential pitfalls) of giving contested oral evidence in a Crown or Magistrates court. It deliberately assumes no knowledge of the process on the part of the reader and does not deal with the process of funding expert evidence.

Pages: 5

Knowledge of the cell types and processes involved in wound healing is valuable for forensic pathologists who may be required to provide opinions regarding wound age in relation to the time of death. Wound healing occurs along a continuum with sequential overlapping phases. There are four phases of wound healing: Hemostasis – Starting almost immediately after injury, hemostasis establishes a fibrin-based provisional wound matrix and activated platelets release cytokines and growth factors in the wound to stimulate progression toward inflammation. Inflammation – Within 30 minutes to a few hours, neutrophils and then macrophages recruited to the site of injury remove bacteria and cellular debris. Once cleared, macrophages polarize from a pro-inflammatory to an anti-inflammatory phenotype to trigger the proliferation phase. Proliferation – Fibroblasts migrate to the site and proliferate to synthesize disorganized extracellular matrix (ECM). Endothelial cells also proliferate to form new blood vessels leading to granulation tissue formation. Keratinocytes migrate over the granulation tissue in skin and proliferate to close the wound. Remodeling – Starting at approximately 2 weeks after injury, ECM remodeling occurs via the regulated activity of proteases. Scar tissue is removed and replaced by ECM with higher tensile strength approaching that of normal skin. Cellular migration, proliferation and protein synthesis during the different phases of wound healing are regulated by cytokines, chemokines, growth factors and interactions with components of the ECM. Matrix metalloproteinases (MMPs) produced by epidermal cells, fibroblasts and vascular endothelial cells assist in migration of the cells, while proteolytic enzymes produced by macrophages remove ECM components during remodeling of the scar. A number of local and systemic factors may affect the normal progression of wound healing including infection, foreign body, re-injury, diabetes, atherosclerosis, nutritional status and age.

Pages: 18

Vitality and wound age estimation based on the biology of wound healing are phenomena which are closely related to each other, in particular with regard to skin lesions. After tissue trauma, there are different time-dependent phases of wound repair: blood clotting, inflammation, tissue formation, and tissue remodeling. These phases of wound repair have been studied with different methods: routine histology, enzyme histochemistry and, in the last three decades especially, immunohistochemistry. Although a plethora of knowledge has been achieved, wound age estimation remains difficult due to various reasons: different types and intensity of injury, impaired wound healing with age, and immunosuppression etc. In the living, the aging of injuries, mainly the aging of bruises is of special importance in cases of child abuse, elder abuse and domestic violence. Aging of injuries based on color changes has to be done cautiously. Although there is considerable research output on the dating of injuries, precise estimations are not possible due to the great interindividual variability of wound healing and other factors. More important than precision is reliability of wound age estimation to avoid a miscarriage of justice. The best we can achieve is a reasoned estimate, taking into account as many as possible of the underlying influencing factors.

Pages: 462

No chapter abstract available.

Pages: 8

It is a fundamental human right to have a personal identity; this is recognized in international law. Proof of identity is necessary for many reasons; these include social, humanitarian, legal, and financial, and for the appropriate disposal of human remains according to the culture and beliefs of the deceased and their relatives. Accurate identification is essential to avoid the distress that incorrect identification causes to families already traumatized by the death of a loved one. Establishing identity demands a multidisciplinary team approach involving investigating agencies, forensic pathologists, forensic odontologists, DNA experts, fingerprint specialists and anthropologists. Occasionally, the military is also involved. The approach to identification is governed by the number of fatalities involved, the location of the incident, the condition of the remains, and experiential knowledge of which methods will give the best results for a particular situation. The forensic sciences are all closely regulated with regard to accepted techniques, reliability, reproducibility and validity. Current methods involve comparing post-mortem victim findings with known antemortem information; this provides a reliable and scientific basis for identification of human remains. Progress in technology, tools, techniques, training and research will ensure the future advancement of identification procedures.

Pages: 7

Time of death has been the subject of extensive research and can be important in specific deaths. Once death has occurred, post-mortem changes will develop, including the development of hypostatic lividity and rigor mortis. The body will cool and temperature-based methods of determining when death occurred are an important tool in the early post-mortem period. Other techniques in the early period include biochemistry and recently immunohistochemical techniques. Supravitality with electrical stimulation of muscles has also been studied in the early post-mortem phase. Stomach contents have also been used but are now considered wholly unreliable. After the early period, putrefactive changes develop; the speed with which they occur will depend upon environmental temperatures. If the body is exposed, insect activity is common unless the environmental temperatures are low. Forensic entomology utilizing faunal succession is an important science and requires specialist knowledge. Some conditions allow for prolonged preservation of the body with adiopocere formation and mummification; this includes bodies buried in permafrost and in peat bogs where a body may be many years old. Use of carbon dating has been applied to determine the age of these types of cases. In estimating the time of death, a pathologist needs to be cautious and, at best, provide a possible range of time when death may have occurred. Too dogmatic an estimation may result in a miscarriage of justice.

Pages: 7

This Chapter discusses methods for assessing age in deceased individuals in different stages of preservation. In a medicolegal setting, the remains of a deceased individual may range from a small amount of material, e.g. a single tooth, to a well-preserved unidentified body. Hence, several methods covering this spectrum exist. Even though an age assessment is somewhat more reliable in sub-adults than adults, an assessment of age cannot be obtained with high accuracy and should be given as a range. In this chapter, a large range of methods for age estimation in the deceased will be described including observational and destructive procedures as well as imaging modalities. Moreover, newer methods such as DNA methylation will be mentioned.

Pages: 5

The need to perform autopsies to establish the cause and manner of death has existed for a long time. This identifies signs of violence and helps to determine whether a death is due to natural causes, an accident, or the criminal action of another person (1). The developments in medicolegal autopsies have been shaped and greatly influenced by the judicial system adopted in any given country, with the major goals being the detection and investigation of criminal and other unnatural or unexpected deaths. Because of different legal frameworks, medico-legal autopsy rates and practices are quite different between countries. The European Council of Legal Medicine (ECLM), which is an official body dealing with scientific, educational, and professional matters in Europe, has been very active since the early 1990s in proposing guidelines and working to harmonize medico-legal autopsies. The general assembly of the ECLM, held in London in 1995, adopted a declaration entitled: “Harmonization of the Performance of the Medicolegal Autopsy”. This work was conducted by the Council of Europe and led to the adoption of recommendation 1159, concerning the harmonization of autopsy rules, during its 43rd Ordinary Session (1991). This recommendation was followed by the constitution in 1996, under the Committee of Bioethics, of a working party of international experts in legal medicine and law, with representatives of the International Academy of Legal Medicine, as well as Interpol. The purpose of the group was to make a proposal regarding autopsy rules. The group finished its work in November 1998 and European recommendation R (99) 3 on the “harmonization of the medicolegal autopsy rules and its explanatory memorandum” was adopted by the committee of ministers on February 2, 1999, at the 658th meeting of the ministers’ deputies (1). It must be pointed out that this document is only a “recommendation”.

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In most countries, the hospital autopsy rate has declined markedly in the past 70 years. Nevertheless, the autopsy continues to have an important role in medical education (undergraduate and postgraduate), audit and clinical governance. As has recently been demonstrated in the COVID-19 pandemic, the autopsy has a crucial role in determining the pathologies associated with new diseases, and in monitoring the effects of new treatments. This Chapter considers the nature and scope of the modern hospital autopsy, which will likely now include radiology coupled with limited invasive internal examination.

Pages: 6

This Chapter discusses the “Minnesota Protocol” which is a standard guideline for the investigation into unlawful deaths where human rights violation is suspected. This protocol is designed for a prompt, effective, thorough, impartial and transparent investigation into such deaths. From a pathological perspective, this protocol includes a detailed guideline on the conduct of exhumation, autopsies and preparation of final reports. Besides information on appropriate collection and documentation of evidence, its examination in a scientific way is outlined. This protocol is accepted throughout the world and is translated into many different languages providing a useful guide to follow in investigating unlawful deaths.

Pages: 24

Forensic post-mortem imaging refers to the act of performing radiologic examination(s) or other imaging procedures on the deceased to assist in forensic investigations and legal inquiries. It is a relatively new and rapidly developing discipline in the forensic field. Nevertheless, the first application of radiology for forensic purposes occurred over a decade ago. This Chapter briefly discusses the history and evolution of forensic radiology. The procedural and technologic aspects of routinely employed forensic imaging techniques are discussed, such as post-mortem computed tomography (with angiography) and post-mortem magnetic resonance imaging, as well as promising future prospects in this field. Radiologic examination of the living is not the same as radiologic examination of the dead. Post-mortem changes and decomposition represent potential pitfalls for a radiologist inexperienced in post-mortem imaging, as shown in this chapter. The added value of forensic post-mortem imaging is explained for common forensic casework, such as gunshot fatalities and strangulation. Additionally, the role of post-mortem radiology in particular forensic circumstances is discussed, such as the examination of the (initially) undetermined death and the deceased fetus or child. As shown in this chapter, a close collaboration between forensic radiologists and other forensic experts is required to reach the full potential of forensic imaging.

Pages: 6

Although differences between jurisdictions exist, most forensic pathologists are regularly confronted with deaths due to natural causes. Knowledge of the key diagnostic features, differential diagnoses, and clinical effects of a large variety of natural diseases is therefore a prerequisite for every forensic pathologist. This Chapter however does not aim to provide detailed information, as it is better sourced from dedicated subspecialty textbooks or articles than from a general chapter. Rather, this Chapter focuses on various less-often discussed, but nonetheless relevant aspects of such deaths. The Chapter starts with a discussion as to why natural deaths are relevant for forensic pathologists, and why examining such deaths within the context of a medicolegal death investigation system has merit. Then, the definition of “death due to natural causes” is explored, and why such a classification is important but may be challenging. Also, the meaning and use of the terms “sudden”, “unexpected” and “unexplained” is discussed in more detail. Lastly, the determination of the cause of death is discussed, which may not be easy especially when the autopsy findings are non-specific.

Pages: 9

Since the beginning of the pandemic, it has been clear to the forensic and clinical pathology community that autopsy data are fundamental to understanding the pathophysiology of SARS-CoV-2 infection. Despite an initial reluctance to perform autopsies due to the fear of contagion, more and more knowledge about the macro- and microscopic findings in such cases has been gradually collected. SARS-CoV-2 could affect many organs and not only the lung, even if the pulmonary manifestations are the most frequent. In particular, some authors demonstrated there is direct vascular involvement. Moreover, the role of the host’s inflammatory response and the possible development of a “cytokine storm” are other two fundamental aspects of the pathologic features of the infection. Therefore, COVID-19 should be considered a systemic disease. In this Chapter, we aim to summarize the current evidence concerning autopsy and histopathologic findings of SARS-CoV-2 decedents, to highlight the complex network of pathophysiologic mechanisms that underlie this disease.

Pages: 7

Vehicular crashes are one of the leading causes of morbidity and mortality globally. They account for nearly 1.3 million deaths yearly, with 20 to 50 million people suffering from non-fatal injuries. Fatalities due to vehicular crashes are predominant in countries with low- and middle-socioeconomic status, with the highest rate reported in the African region. Also, the majority of the deaths involve young adults with significant male preponderance. Factors responsible for vehicular crashes include speeding, driving under the influence of alcohol or any psychoactive substance, non-use of a helmet, seat belt or child restraint, distracted driving, unsafe road infrastructure, unsafe vehicle and inadequate road safety laws or their non-stringent application. Inadequate post-crash care is also responsible for increasing fatalities from vehicular crashes. Vehicular-related deaths are attributed to a varied spectrum of injuries involving the various body parts. The pattern and the mechanism of injuries sustained in vehicular crashes differ in pedestrians, occupants of vehicles and motorcyclists.

Pages: 9

The examination of aviation fatalities forms a small but important part of a typical autopsy pathologist’s workload. In this chapter, practical guidance is provided to assist the practitioner in preparing for participation in the investigation of such deaths, understanding their role at the scene and performing an appropriately in-depth and focused examination of the remains. Emphasis is placed on a collaborative approach with other participants in the air crash investigation.

Pages: 11

Accurate certification of deaths in custody that occur either during or immediately following contact with law enforcement personnel (especially physical contact) involves consideration of one or more modalities of contact. These modalities include physical restraint (hand/ankle cuffing, prone positioning, application of pressure on the torso and/or limbs, maximal prone restraint, application of conducted electrical weapons) and chemical restraints (lacrimal agents/chemical irritants) in the setting of psychotic illness/agitation, struggle/physical exertion, intoxication with stimulant drugs and underlying cardiovascular pathology that can predispose to sudden death. Assessment of these case are often not straightforward, and their certification can be some of the most difficult cases that a forensic pathologist can be faced with in respect to the determination of both cause manner of death. Perceived unfair and/or unpopular certifications of these cases can result in professional criticism, allegations of bias, complicity or bias by certifying pathologist, social dissatisfaction/unrest and violent public protests. Recent deaths in custody in the United States (US) are typical examples of this phenomenon. This Chapter outlines the main clinicopathologic considerations that must occur in the pathologic assessment of these cases

Pages: 9

The environment has always been a source of multiple causes of human mortality with deaths being caused by trauma related to specific locations including drowning at sea, animal attacks in forests or falling from heights in mountains. Temperature-related deaths occur when humans exposed to extremes of temperatures are unable to either compensate for these or take evasive action. The apparent increase in natural disasters, in part attributable to climate change, such as hurricanes, landslides, flooding and bushfires further contribute significantly to human morbidity and mortality. Additionally, there has been a resurgence of diseases such as malaria and dengue that were once thought to be contained, in addition to the emergence of new infections such as Ebola fever and Severe Acute Respiratory Syndrome Coronavirus 2 - SARS CoV 2 (COVID19). The evolution of bacteria resistant to multiple antibiotics also means that traditional therapies may no longer be effective. The exacerbation of natural diseases by air pollution and storms is yet another example of human vulnerability to the environment.

Pages: 10

Deaths in the young relevant to the forensic pathologist include intrapartum and neonatal deaths as well as deaths during infancy and childhood. Several aspects of the perinatal postmortem are particularly important in a forensic setting. If a fetus is found discarded, the pathologist needs to ascertain the fetal age and the appropriateness of growth, whether the infant was born alive or dead, and the possible causes of death. If the placenta is available, this should be submitted for examination as part of the forensic post-mortem. Neonatal deaths may occur as complications of labor (intrapartum asphyxia and/or trauma), neonatal infections (congenital or acquired after birth), complications of prematurity, lethal congenital abnormalities, metabolic diseases, etc. Death in infancy and childhood may be expected, due to a known lethal condition, or sudden and unexpected. In this case, a thorough post-mortem investigation may show a cause of death. If after such an autopsy, in conjunction with careful review of the clinical history and examination of the scene of death, no cause can be found, the death will be generally classified as SIDS (sudden infant death syndrome) or SUDC (sudden death in childhood).

Pages: 7

Maternal deaths remain a significant global health problem. While the mortality rate has vastly decreased in developed countries over the last century, it remains a significant issue and it is still necessary for a multidisciplinary approach to try and reduce the global health burden caused by these deaths. Forensic pathology plays a key role in the analysis of maternal deaths. In this chapter, the accepted global definitions and classifications are discussed along with some of the difficulties involved in the classification and recording of maternal death cases. A discussion of the approach to the maternal death autopsy is presented along with some of the more complex conditions and case types. There are multiple issues surrounding embolic conditions including thromboembolic disease, amniotic fluid embolism and vascular air/gas embolism. Hypertensive conditions associated with pregnancy and the broad spectrum of cases that make up unascertained maternal death cases are also presented.

Pages: 16

Deaths occurring during or after a surgical procedure are commonly encountered by autopsy pathologists. The examinations may be complex and technically challenging. Most deaths are as a result of predictable natural disease, although in a small number there may be issues related to surgical technique or no obvious identifiable cause. This Chapter addresses our approach to the post-operative autopsy, describes important general post-operative complications and highlights some specific procedures and novel surgical interventions.

Pages: 10

Immersion in water results in a significant number of deaths worldwide every year. Controversy exists in the literature as to definitions of drowning. In the forensic setting, problems continually arise in establishing the cause and manner of death. Complex death scenes extending over many kilometers, nonspecific autopsy findings and lack of reliable diagnostic tests are all potential medicolegal issues. Putrefaction due to prolonged post-mortem intervals coupled with post-mortem injuries, including animal predation, may also complicate the assessment of possible trauma. Determining whether an individual was alive or dead before entering the water is often a key question and the contribution of underlying organic disease to the fatal episode may be difficult to ascertain, as disease may have either caused death, contributed to a fall into water or instead may merely have predisposed to drowning. Genetic causes of cardiac arrhythmias associated with swimming will not be discernable at autopsy and concluding whether a death has been the result of an accident, suicide or homicide may just not be possible. Drowning represents one of the more problematic areas of forensic pathology.

Pages: 11

Asphyxia occurs when inadequate amounts of oxygen are delivered to tissues and organs to maintain normal metabolic processes. This deficit may result from a variety of mechanisms including interference with the intake, transport and cellular uptake of oxygen. Classifications of asphyxia vary, with some using circumstances such as crushing, choking or hanging. This contrasts with other systems that focus more on pathophysiological processes resulting from significantly lowered environmental oxygen levels, decreased transfer of oxygen from the alveoli to the blood, reduced transport of oxygen from the lungs to the tissues and impaired or reduced transfer across cell membranes. The autopsy diagnosis of asphyxia may be difficult as signs that were once considered diagnostic, such as fluidity of the blood, cyanosis, engorgement of the right side of the heart, congestion, edema and petechial hemorrhages are now recognized as being unreliable. Diagnosis of an asphyxial event therefore requires careful post-mortem synthesis of autopsy findings with the circumstances of death and an evaluation of the possible contribution, or not, to the fatal episode of other injuries, toxicologic findings and/or concomitant morbidities.

Pages: 10

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide and a frequent cause of death in forensic medical practice. A practical understanding of clinical elements of TBI and the neuropathology of trauma is therefore essential for pathologists who perform medicolegal autopsies and specialists in other disciplines allied to forensic pathology. This Chapter will outline the key pathologic features that occur in the brain caused by blunt force trauma and inertial injury. This Chapter will also discuss the pathology associated with abusive head trauma in infants and children and offer practical guidance for post-mortem examination in cases of death related to traumatic brain injury.

Pages: 7

The neck is a relatively narrow and unprotected part of the human body, while it contains many vital anatomic structures. Many injuries to the neck have therefore fatal potential, and neck injuries are among the most frequently encountered in forensic pathology practice. Fatal neck injuries can be grouped based on their mechanism, and classified as compressive trauma, non-compressive blunt force trauma and sharp force trauma respectively. A special subtype of compressive neck trauma is presented by the so-called “sexual asphyxias”. This Chapter provides a detailed discussion of the various types of fatal neck injury, their classification, and their autopsy findings. It is furthermore discussed how the various autopsy findings can be used to determine cause, mechanism and manner of death. Special emphasis is placed on compressive neck trauma since this is the most frequently encountered type of fatal neck trauma in most forensic pathology practices.

Pages: 5

Annually, between 250 000 to 500 000 people suffer a spinal cord trauma (SCT) worldwide. The typical patient is male and between 20–29 or over 70 years of age. Most of the SCT cases stem from preventable causes such as motor vehicle crashes, falls, or interpersonal violence. SCT has enormous consequences for patients, relatives and society. The symptoms of SCT depend on the extent of the injury, including loss of sensory or motor control, and of autonomic regulation. In comparison with persons without SCT, patients with SCT are two to five times more likely to die prematurely. Mortality risk is highest in the first year after the traumatizing event and remains high compared to the general population. Usually, patients succumb to infectious complications due to immobility because of motor paralysis. A rare life-threatening condition in the early phase of spinal cord trauma is neurogenic shock. Spinal cord trauma may be divided into primary and secondary mechanisms of injury. Neuropathologic findings in the traumatized spinal cord include contusions, compressive damage, lacerations, or transections.

Pages: 7

Injuries to chest and abdominal organs and vasculature may arise from a variety of types of blunt and sharp force trauma, and other more specific methods such as firearms and crushing or compression. The features of such injuries are described whether the trauma is associated with external or internal signs of injury at autopsy or not. Deaths may result from hemorrhage, air embolism, asphyxia or sepsis. Certain underlying medical conditions such as infectious mononucleosis may predispose to spontaneous rupture of organs such as the spleen or increase the risk of rupture with minor trauma and should therefore be considered when undertaking autopsy.

Pages: 5

Musculoskeletal Diseases (MSD) and musculoskeletal injuries are one of the most important health problems worldwide. According to the World Health Organization (WHO) in 2000, various kinds of injuries resulted in the death of 5.1 million people and accounted for 12% of disability-adjusted life years (DALYS) worldwide which is expected to increase over the next couple of decades as a result of technical developments. It is also becoming one of the major factors in health-related absence of work. Forensic experts have a major role not only in the disability evaluation process but also in the investigation of musculoskeletal related deaths.

Pages: 14

Death during sporting activities may be related to trauma that is integral to the contact part of the activities being undertaken, such as head injury in boxing, or it may be an unanticipated consequence of equipment failure such as a parachute not opening in sky diving. A wide range of sporting activities exist where serious injury and death are potential outcomes with risks varying depending on the nature of the underlying activities. The possibility of unexpected collapse and death from occult or diagnosed/treated medical conditions also exists with, for example, exercise adding additional stress to certain cardiovascular conditions provoking lethal arrhythmias. Drug screening should be undertaken at autopsy in deaths related to sports as stimulants such as amphetamines that may have been taken to enhance performance may also have had a cardiotoxic effect. Genetic screening will also be required in certain cases.

Pages: 9

Sharp force injuries refer to tissue or organ damage caused by objects or weapons with sharp edges or pointed ends. Such injuries may be classified as stab, incised or chop wounds. Sharp force injuries differ from blunt force lacerations in having clean edges with no surrounding abrasions/bruises or tissue bridges within the depths of the wound. The Chapter will provide descriptions and images of typical sharp force injuries, the investigation of which requires careful descriptions with measurements, dissection and photography.

Pages: 12

Blunt force injuries occur when the body is hit with an object or strikes against an object or surface, such as the ground. Types of blunt force injuries include abrasions, contusions, lacerations, and fractures, and these may be encountered as the result of motor vehicle collisions, falls, inflicted blows, and many other scenarios. Blunt force injuries are commonly encountered in autopsies and may or may not be the cause of death or a contributing factor in the death. They can also be sustained during resuscitation efforts, and it is important for the pathologist to recognize and not misclassify these injuries. This Chapter discusses specific types and classifications of blunt force trauma.

Pages: 13

Fatal falls from height constitute a subset of cases in most forensic pathology institutions and are a category of death that tends to be of interest to many outside agencies as they are often preventable. Falls are the second leading cause of accidental death, a frequent method of suicide, and presumably only rarely homicides. Determination of manner of death may be challenging and is only rarely apparent on post-mortem examination alone. Importantly, there are few specific autopsy findings to indicate that a case may be a homicide; even injuries to neck structures tend to be ubiquitous in fatal falls. The circumstances under which falls occur are varied. Forensic pathologic formulation therefore necessitates integration of the post-mortem examination, investigation, scene examination, toxicologic examination and post-mortem imaging in every case. The literature contains multiple studies that attempt to correlate patterns of injuries sustained in falls with factors such as manner of death, height of fall, and demographics, among other aspects. Unfortunately, there is little consensus in the results. Injury patterns in an individual case may, however, give some insight into the manner in which an individual fell and / or landed.

Pages: 10

Burns occur with exposure of the body to dry heat, i.e. through contact with hot objects (contact burns) or flames. The classification most commonly used in forensic medicine divides them into four degrees. Fire-related deaths are often challenging for the pathologist. Fire-related death may occur at a scene or in a hospital, during treatment. Regarding hospital treatment of burns, the most important prognostic factors include their degree, total body surface area burnt and age, as well as the presence of inhalation injuries. The most common causes of death, especially early on, include shock, sepsis and respiratory insufficiency. In cases of death at a scene, in bodies without significant carbonization, the causes of death due to fire and exposure to high temperature generally involve smoke inhalation and CO toxicity, with airway injury and local burns to the skin. In cases with significant charring, determining the cause of death may be challenging, and knowing and differentiating signs of vitality, as well as post-mortem heat artifacts is crucial for adequate interpretation of the autopsy findings. The manner of death in bodies recovered from fire is most commonly accidental but may also be suicidal (self-immolation) and homicidal. The approach to fire-related death should involve careful evaluation of case circumstances, as well as precise autopsies with careful interpretation of macroscopic and microscopic findings.

Pages: 6

Lethal hypothermia is most likely to be caused by accidental exposure to low environmental temperatures, contributed to by inadequate or wet clothing, and damp or windy conditions. The environmental factors may be exacerbated by many other factors, individually or together including low body mass index, trauma, extremes of age and underlying medical conditions. At post-mortem, findings are often non-specific include superficial gastric lesions (Wischnewski spots), pink discoloration of the skin often over the large joints, acute pancreatic inflammation with fat necrosis, fatty change in cells of the heart, liver and kidneys, skeletal muscle hemorrhage and vacuolization of renal tubular cells. The circumstances predating the finding of the deceased may be crucial in determining how the hypothermia developed and confirming it as the cause of death.

Pages: 7

There is a spectrum of heat-related disease with the most severe being heatstroke. Heatstroke is diagnosed when an individual presents with a core body temperature at or above 40.6°C (105°F) associated with altered mental state. There are two forms of heatstroke, classical heatstroke where it affects vulnerable individuals in a hot environment (e.g. vehicle entrapment, elderly in a warm environment) and exertional heatstroke, which is due to strenuous activity, usually in hot weather. Malignant hyperthermia is a pharmacogenetic skeletal muscle disease, that usually manifests after exposure to certain anesthetic drugs. Another group of heat-related disease is drug-induced, with more common conditions being neuroleptic malignant syndrome and serotonin syndrome. There is a paucity of external findings regardless of the type of heatstroke death. The core body temperature should be raised if measured in a timely manner. There is usually accelerated post-mortem change. Burns can be present either due to direct prolonged exposure or to contact with hot surfaces. Petechial hemorrhages may be seen, mainly on the conjunctiva. There may be no internal findings of hyperthermia apart from visceral petechial hemorrhages, most commonly in the intrathoracic region. Natural disease should be recorded. In those with a period of survival (more than 6 hours), there may be features of disseminated intravascular coagulopathy. Features of myoglobinuria are usually present in the kidneys and there may be liver injury, usually in a centrilobular pattern. Toxicology examination is an essential part of the post-mortem examination, but further post-mortem investigations are usually unhelpful. The most useful examination is review of the circumstances and medical notes if available. The cause of death can be directly attributed to heatstroke or natural disease with heatstroke being a significant contributor. If there is no documentation of body temperature reading but the circumstances are appropriate, the term “heat-related death” may be used.

Pages: 8

Electrocution results from the passage of an electric current through the body with lethal mechanisms involving the heart with ventricular fibrillation, or the respiratory muscles or brain stem respiratory centers with respiratory paralysis/cessation. Current flow depends on the resistance of the conducting material. Contact with alternating current is more dangerous than direct current and is 4 to 6 times more likely to be fatal. In some cases, death may be caused by burning from the electric current, or from trauma or drowning secondary to the event. In cases where there has been survival for some time sepsis and/or multiorgan failure may occur. Most deaths are accidental, with suicides being far less common and homicides being very rare. Fatal electrocutions are attributed to low voltage if under 1000 volts, high voltage if over 1000 volts, or to lightning. A number of issues that arise during the autopsy evaluation of suspected cases will be discussed.

Pages: 10

Elder maltreatment, occurring in individuals 60 years of age and older, is a global concern. Most cases are often overlooked as elders have and are usually thought to die of natural diseases. However, elders are a vulnerable population making them susceptible to neglect and physical abuse including sexual assault. To adequately understand the problem, one must first understand the physiology of the aging body. Therefore, a thorough medicolegal investigation is necessary in an attempt to separate normal or expected findings from maltreatment.

Pages: 7

Regardless of age, suicide is a significant public health issue. According to the World Health Organization (WHO), 800 000 people worldwide die by suicide, accounting for 1.4% of all deaths. In Canada and the United States, suicide is ranked the 9th and 10th leading cause of death, respectively. Death by suicide is more common in males than females and can occur in individuals as young as 13 years or as old as 90 years. This Chapter provides an overview of suicide and the many problems that may arise in the evaluation and investigation of suspected cases.

Pages: 16

Homicides may result from a variety of different injury types and mechanisms involving blunt and sharp force trauma, gunshots and strangulation. Less common methods involve immersion, incineration and poisoning. Methods vary greatly among different communities and countries, often influenced by the availability of a particular weapon. For practitioners, it is important to be aware of local patterns of homicide. The characteristic features of different categories of homicide are described with listing of the corresponding pathologic findings at autopsy.

Pages: 20

Cardiac death, in its sudden and unexpected form, is universally one of the most encountered tasks in autopsy routines. Despite advances in early diagnostics, therapy and prevention, cardiovascular deaths are still globally one of the greatest killers according to the mortality statistics. In investigation of suspected cardiac deaths, skilled dissection technique and thorough gross anatomic observations are important, but recent development of immunohistochemical staining technologies, and particularly genetic analysis have gained more significance in the detailed analysis of such deaths. Utilization of these tools in the post-mortem setting is also pivotal for further progress in cause of death investigations, as well as for clinical medicine. Such data from post-mortem investigation is of utmost importance for the family members, who may carry a risk for sudden and unexpected events in early life. This Chapter provides an overview of various types of cardiac conditions that may underlie sudden cardiac deaths, and which can be encountered in medico-legal autopsies.

Pages: 9

Neglect of a person at any age is a global complex social problem which can lead to grave medical consequences. It has been present throughout human evolution and manifests variably in different culture and countries. Neglect is not a simple outcome of the breach of caregiver or care provider and care receiver equation. There is overlap in definitions of neglect, abuse and maltreatment. The terms are often used interchangeably. The practitioner should be aware of local definitions and the context in which they are used. The clinical or pathologic assessment of neglect in any setting may be considered incomplete unless it also makes some reference and identifies the causes perceived to contribute to it. Neglect is frequently associated with vulnerabilities such as poor physical and mental health or intellectual (learning) disability. It may also be associated with social status and related to criminal activity, such as trafficking and modern-day slavery. Where pre-existing disease or illness are present, neglect may contribute to a fatal outcome by exacerbating those conditions. The victims of neglect commonly encountered in healthcare settings generally represent extremes of age. They may present with acute traumatic condition or exacerbation of a long-standing illness or complications of trauma. A thorough clinical or pathologic assessment of such patients must be supplemented by a careful analysis of circumstances. As “neglect” can apply to all sectors of modern society, solutions for it require the concern and cooperation of communities and professions such as policy making, education, health, law, economics and social work, all of which have the primary responsibility for reporting, assessing and making decisions to maintain appropriate standards of life.

Pages: 5

Self-neglect is a condition peculiar to the frail geriatric population when a self-conscious individual voluntarily refuse to address one’s basic physical, emotional or social need. The end result is a constellation of findings bearing similarity to physical abuse and neglect. There may be injuries including bruising and fractures, signs of dehydration and malnutrition, presence of decubitus ulcers, poor hygiene in the context of unsanitary living conditions. Underlying psychiatric conditions affecting decision making capacity may be implicated. Normal aging process of organ systems and increased geriatric comorbidities render them vulnerable to accidental injuries and delayed management of treatable medical conditions in an isolated home environment. During medicolegal investigation, it is essential to identify features that differentiate from genuine elder maltreatment. Diogenes Syndrome is an extreme form of fatal self-neglect for individuals in social isolation with hoarding of rubbish or household items. This presents considerable forensic difficulties because of the mysterious circumstances, a lack of medical history, suspicious findings on the body including purging of putrefactive fluids and injuries following falls or post-mortem animal predation in a chaotic scene.

Pages: 30

Fatal starvation is a rare cause of death in industrialized countries. However, it may have major medicolegal importance if death results from the deliberate withholding of food, especially from infants and elderly. In such cases, the task of the forensic pathologist and the medical examiner, respectively, is to clarify the cause of death and give an expert opinion on the degree and duration of starvation. Several classification systems have been developed to estimate protein–energy malnutrition (PEM) in developing countries. Simpler classifications, such as the Gomez classification, use the weight expected for the respective age group as the standard. However, smaller infants will be lighter, and therefore the classification may not be accurate in this case. Following the Waterlow classification, the extent of stunted growth (referring to growth retardation in cases of chronic malnutrition) is calculated using the ratio of the measured body height to that expected for the age. Using such classification systems, grading of stunting and wasting can be achieved and may greatly help in the assessment of a given child’s nutritional status in legal cases. The application of the Waterlow classification to the authors’ case material and previously published cases in the literature is herein demonstrated. The Waterlow classification is not only of importance for grading the final stage of fatal starvation, but also for the chronologic development of the nutritional status if anthropometric data have been repeatedly recorded from the affected individual in vivo.

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Drug deaths in their various forms continue to contribute to a substantial number of preventable deaths; often in combination with two or more psychotropic drugs. In recent years, there has been a significant increase in the number of the new psychotropic drugs (NPS) that have added substantially to the already widespread availability of the existing illicit, and other drugs, used recreationally. This is not only challenging the analytic laboratories to detect these drugs but also the ability to interpret their likely toxicological role in presumed sudden drug deaths. This Chapter provides an overview of the drugs of most interest causing death and the various factors involved in the interpretation of toxicological results, including collection of specimens, pharmacokinetic and pharmacogenomic considerations, and artefacts arising after death that affect tissue concentrations.

Pages: 6

Poisoning is one of the leading causes of morbidity and mortality. Based on the circumstances of the case, poisoning may be deemed homicidal, suicidal or accidental. Various factors such as the properties of the poison, intake quantity, route of exposure, duration of exposure, age, and body composition of an individual, etc. determine the lethality of the poison. Poisoning is an unnatural occurrence for which medicolegal investigation is mandated in almost all countries globally. Investigation into poisoning in the clinical setting usually depends upon the history, clinical manifestations and body fluid analysis, whereas in post-mortem investigation of fatal poisonings, tissue samples and body fluids are subjected to chemical analysis in forensic science laboratories. While investigations into poisoning deaths in the past, mostly relied on history and confessions or material evidence of poison at the scene of death, modern toxicology techniques can make qualitative assay of the poison and also quantify how much poison the person was exposed to with precision. Safekeeping of the poisonous substances and adoption of safety measures can help in prevention of unintentional poisoning deaths. Restriction of over-the-counter sale of drugs and poisonous substances can help lower the incidence of intentional poisoning.

Pages: 10

Forensic practitioners must be aware of the varied nature of sexual activity and its possible fatal outcomes. Death may occur as a rare complication of consensual sexual activity and those cases considered to be natural or accidental may not need criminal investigation. Investigation will use the evidence of the forensic practitioners to explain the cause of death and the manner of death to ensure that the appropriate conclusions are recorded. The forensic pathologist must be aware of the nature of evidence collection recording and how sexual activity may result in death and be aware of how trends in fatalities from sexual activity can change. Sexual homicides will be subject to fully criminal investigation. This Chapter outlines and gives examples of natural, accidental and criminal deaths linked to sexual activity.

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Autoerotic deaths are defined as accidental deaths that occur during solitary sexual activities in which a device, substance, or prop used to enhance sexual stimulation caused the unintentional death in some way. Common typical autoerotic practices include asphyxiation by strangulation/hanging, plastic bagging and gas inhalation. Atypical methods (insertion of a foreign object, electrical stimulation, or compression of the breast) account for approximately 10% of all autoerotic deaths. Predominantly, men between 20 and 40 years of age are affected, whereas autoerotic deaths in women are rarities. The death scene is often bizarre. Victims are usually found alone in hidden places or places protected from public view. The genitals are often exposed. Fetish clothing is sometimes worn. An examination of the death scene, a forensic external post-mortem examination, and the autopsy are therefore of immense importance in determining the circumstances of death. The involvement of a forensic pathologist on the part of the police can already help to clarify the situation at the death scene. For the diagnosis of autoerotic death, suicide, homicide, and death from internal causes must be ruled out. Since intoxication can also occur during autoerotic acts, toxicological examinations and blood alcohol concentration determinations should be undertaken.

Pages: 4

The practice of dowry involves a bride’s family transferring money, property and other goods to a bridegroom, his parents, or his relatives as a condition of the marriage. Although it was originally intended as economic support for a newly married couple dowry violence has developed. This is usually perpetrated by the husband and/or the parents-in-law in a bid to extract more gifts from the bride’s family. Failure to acquiesce to these requests frequently results in physical, mental or sexual violence, or even death. The majority of dowry death homicides involve burning, hanging/strangulation, drowning or poisoning. Another feature of dowry-related crime is abetted suicide where women are encouraged to commit suicide, often by self-immolation with kerosene, or by hanging. The National Crime Records Bureau of India recorded a total of 8618 female deaths related to dowry disputes in 2011. In 2019, reported dowry death cases in India amounted to more than 7100. Honor killings refer to a specific form of homicide committed by family members toward a female, ostensibly to protect or restore a family’s “honor”. There has been much debate on the validity of the term “honor” crime, however included under the umbrella of such crimes are domestic violence, female genital mutilation, forced marriage and homicides. Reasons for honor killings of women include loss of virginity outside marriage, pre-marital pregnancy, infidelity, having unapproved relationships, refusing an arranged marriage, asking for a divorce, requesting custody of children after a divorce, leaving the family or marital home without permission, and falling victim to a rape. Dowry deaths and honor killings persist and, in certain communities, the numbers appear to be on the increase, in some cases protected by legislation which makes international initiatives difficult to enforce.

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Femicide is the most extreme form of violence against women, that is their murder. Despite the phenomenon has been focused for decades by researchers and supranational organizations, a shared definition is still lacking, and this leads to underestimation of the problem and not comparable statistical data. Several forensic pathologists are studying autopsy cases in order to find features that could help to better understand this kind of murder. This Chapter examines the work of forensic pathologists in the field of murder of women and tries to delineate a framing of the phenomenon. The result is the need for a scientific method that is standardized and known to the international community to all cases of female murder to identify instances of femicide, inform the legislator, recognize risk factors and ultimately contribute to prevention.

Pages: 22

More than one million people suffer gunshot wounds and blast related injuries annually, the vast majority of these in a civilian setting. The overall personal, economic, and sociocultural impact of this global injury epidemic cannot be measured. It is the responsibility of forensic scientists and pathologists to assist in the proper investigation of such events and injuries, to aid in the administration of justice. Such practitioners must not only have expert knowledge of the actual injuries and their mechanisms of causation but must also have at least a basic understanding of weapons and ammunition, and the settings under which such injuries are sustained.

Pages: 14

Ballistic and blast injuries generally result in hemorrhage combined with tissue injury. Blast injuries are classified according to the forces causing injury. The reflex cardiovascular responses to hemorrhage and nociception (due to tissue damage) can interact and accentuate shock in some organs. The cardiovascular response to hemorrhage is also modified by blast injury and can be confounded by burns and the response to resuscitation. In trauma, shock (tissue oxygen delivery failing to meet demand) can be due to inadequate blood flow and/or oxygen content at the systemic or organ level. At the microvascular level shock can arise due to regional deficiencies in oxygen delivery and/or diffusion limitation of oxygen delivery to cells. Inflammation is associated directly with traumatic tissue injury and as a secondary injury arising from shock, with implications for morbidity and mortality. The interplay between cardiovascular control mechanisms, inflammatory and coagulation systems is complex, with each affecting the other, and is further complicated by therapeutic interventions. Finally, the response of the central nervous system (CNS) to blast exposure has received a lot of attention. CNS injury can be also associated with altered responses to haemorrhage, coagulopathy, and inflammatory responses.

Pages: 270

No chapter abstract available.

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The role of the forensic physician and the development of the clinical (living) forensic medicine has developed and evolved in the last half century although the medical roles and functions have been practiced for far longer. The forensic physician (and other health professionals such as nurses and paramedics) working in clinical forensic medicine settings have the same duties to their patients as they do in non-forensic contexts. For many forensic physicians, the majority of the workload may relate to police custodial settings, police and law-enforcement matters and sexual offense medicine. The standards by which forensic physicians and other healthcare professionals should work are laid out in many different forms, but broadly with the same global primary duties of consent and confidentiality. Political, social, cultural, ethnic and religious factors may place significant pressures upon forensic practitioners who need to have the skills, competence and expertise to assess and manage their patients appropriately and raising concerns where necessary.

Pages: 10

This Chapter looks at the role of the sexual offences examiner (SOE) in managing and providing care to complainants of rape and sexual assault, describing a trauma-focussed approach and best practice guidance. The steps taken in the planning and carrying out of the forensic medical exami-nation (FME) of sexual assault complainants are described, and the considerations that need to be taken at each stage are explored. The Chapter discusses the different stages of the FME, including anticipating additional needs of the patient, preserving forensic evidence, and obtaining informed and valid consent for the examination. It also looks at the importance of accurately describing, documenting, and interpreting findings and the role of the SOE in providing evidence for court purposes. Lastly, an overview of developing the role of the SOE is given.

Pages: 9

The roles of nurse and paramedic within the police custody setting in the United Kingdon is reviewed with practical examples These rules generally apply to all police settings although there may be local variation. The nurse or paramedic working in custody is an autonomous practitioner working within the boundaries of their clinical competence, and so their roles may vary according to their clinical background and experience.

Pages: 8

Persons detained in police custody are referred to as detainees and are vulnerable. This Chapter discusses fitness to detain and some of the common physical and mental health problems associated with that detention and how vulnerability is increased. Guidance is given on safe management of the detainee where medical care must remain paramount over forensic issues. Fitness to interview is then discussed along with a scheme of assessment.

Pages: 8

Road traffic deaths are avoidable. A further Decade of Action for Road Safety 2021–2030 has been proposed by the UN General Assembly with the aim of preventing 50% of road traffic deaths and injuries. The number of road traffic deaths remains high with 1.35 million people killed every year and 50 million people injured worldwide. The importance of traffic medicine cannot be underestimated. This Chapter provides an overview and discussion of traffic medicine, a medical discipline concerning the prevention of harm from motor vehicle collisions and making driving as safe as possible. Drivers under the influence of alcohol and substances and those with specific underlying medical conditions cause substantial harm from motor vehicles. Although jurisdictional licensing regulations vary, underlying medical conditions and their treatments may impact on the ability to drive safely, assessing fitness to drive is a key preventative strategy used by traffic medicine specialists.

Pages: 14

The broad principles and origins of child safeguarding are identified and outlined. Child safeguarding and protection may be of direct or indirect relevance to the forensic physician and other forensic colleagues and they must be aware, within their own jurisdiction, of their duties and obligations. Forensic practitioners may be directly involved in the assessment of children or, as part of other functions, become aware of concerns or risks that must be escalated to appropriate organizations and integrated into standard processes to safeguard and protect the child. This may be part of custodial medicine or the sexual offense medicine role or in other settings, such as the assessment of refugees and complainants of torture or other maltreatment. Whatever the reason, the forensic practitioner must understand the escalation and referral routes, and what factors will trigger these.

Pages: 7

Substance use (including alcohol and licit and illicit drugs) in detention settings may have consequences predominantly as a result of intoxication or withdrawal. The degree and nature of substance use varies from country to country and from region to region. For forensic physicians and allied forensic practitioners encountering those who may be suffering from the effects of substances, it is important that they understand how such issues may be managed in the short-term. This Chapter addresses the management of substance misuse in short-term police custody by using England & Wales as the predominant example. The broad principles apply in any setting including, for example, Sexual Assault Referral Centers and immigration centers where such issues may also present.

Pages: 9

The use and prevalence of new synthetic drugs has increased substantially over the last decade and a half. The increasing potency and range of compounds presents an emerging challenge for clinicians and forensic practitioners. Many of these drugs referred to as “novel psychoactive substances” (NPS) have resulted in hospitalization as well as increasing numbers of deaths. These drugs vary significantly in pharmacologic efficacy and the need to detect and monitor the harm associated is essential as large numbers of NPS mimicking traditional drugs are manufactured, distributed, and consumed across the world. Sensitive, reliable and reproducible analytic toxicology techniques such as liquid chromatography coupled with mass spectrometry is required to detect and identify these substances in a variety of different matrices. The interpretation of these NPS in medicolegal casework can be difficult as there is often a lack of pharmacologic information.

Pages: 12

There are many methods of restraint and control used in law-enforcement. This Chapter focusses on those used for restraint and control, particularly of individuals who may be acutely behaviorally disturbed (see Chapter 72). Some of these methods may include devices classified internationally as less-lethal weapons (see Chapter 85). States and governments are generally responsible for their implementation and how they are utilized. Forensic practitioners may be asked to assess medical effects which are part of the intended effect of the method of restraint or control, or to assess injuries and other unintended consequences of such deployment. Methods of restraint and control including handcuffs, batons, chemical irritant sprays, kinetic energy projectiles are discussed and their effects and complications summarized.

Pages: 13

Knowledge and controversy surrounding excited delirium syndrome (ExDS) continues to evolve. ExDS subjects have features that are overwhelmingly similar, especially in the context of arrest-related deaths. Those features include tolerance to pain, constant or near constant physical activity, failing to respond to police presence, superhuman strength, rapid breathing, not tiring despite heavy exertion, naked/inappropriately clothed, sweating profusely, hot to the touch, and attraction to or destruction of glass. Features are not identical between cases and all features are not required for diagnosis. It is unclear whether any symptom cluster predicts mortality. Early recognition as a medical emergency is important to potentially reduce associated mortality.

Pages: 15

Children can be subjected to the four types of child abuse (emotional abuse, physical abuse, sexual abuse and neglect) in a myriad of ways. This Chapter discusses the features of each type of abuse focussing on features that differentiate abuse from accidents and medical mimics. Abusive skin and bone injuries are common and may display features enabling a confident determination of causation by assault. The forensic assessment of pediatric neurotrauma and factitious illness by proxy is more complex and requires high-level forensic skill. Knowledge around child sexual abuse and neurodevelopmental sequelae of childhood trauma continues to evolve. Worldwide, child neglect remains one of the most pervasive and harmful forms of child abuse and emotional abuse is recognized with increasing frequency in first-world countries. As knowledge around child abuse increases and diagnostic processes are subjected to scrutiny in court with increasing frequency, forensic practitioners are required to provide medical testimony mindful of the strengths and limitations of the evidence base upon which diagnoses are made. This Chapter discusses some of these strengths and limitations.

Pages: 7

The Istanbul Protocol is the United Nations Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and is a document of international standing. This Chapter provides a summary and key references for the forensic practitioner to understand the scope of the Istanbul Protocol and its relevance to wider forensic practice beyond the assessment of victims of torture. There is explanation of the assessment of the levels of consistency used for interpretation of the probable relationship between physical and psychological findings and alleged torture or other ill-treatment. The key principles around absence of evidence, consideration of other possible causes for findings, the assessment of potential fabrication and the importance of the overall evaluation are discussed. Guidance is also found on medical ethics for forensic practitioners, working with interpreters, issues involving memory, disclosure and inconsistencies, and assessment of victims of violence directed at their sexual orientation or gender identity.

Pages: 15

Injury assessment, documentation and interpretation is one of the primary functions of practitioners working in forensic pathology and clinical forensic medicine. Forensic practitioners should be able to assess, document and interpret visible injuries, wounds, cutaneous marks or scars which have been sustained as a result of trauma or violence. This should be documented injury in written, diagrammatic and imaging forms to enable evidence to be reviewed and understood by other forensic practitioners and non-healthcare professionals such as judges, juries, law-enforcement professionals and lawyers. Classification of injury should be simple, reproducible and unambiguous and, wherever possible, standardized reporting should be undertaken. Injury classification and documentation systems have been used in many settings and some of these could be adapted to a standardized, international, forensic reporting format.

Pages: 11

Radiology and imaging play a significant role in the clinical diagnosis and treatment of victims of trauma but also in the forensic assessment of injuries sustained by such victims. The majority of victims of accidental and deliberate third-party or self-inflicted trauma, where significant, will undergo some form of radiologic imaging. This typically, in the acute setting, takes the form of CT (computed tomography) scanning to evaluate and direct medical and/or surgical treatment of any significant injuries. Some surviving victims may also undergo subsequent MRI scans to evaluate injuries and prognosticate on the likely morbidity associated with certain injuries. These scans provide a wealth of forensic evidence which allow the forensic radiologist to contribute significantly to the forensic investigation in relation to mechanism of injury, wound profiling and injury causation as well as the age and significance of any pre-existing injuries and, particularly in relation to post-mortem imaging of fatalities, human identification. Such acute radiologic imaging may also be particularly useful as contemporaneous physical evidence may no longer be available by the time a forensic investigation has been initiated (for example, cold case investigations or intimate partner violence). The facility of imaging of trauma in the living, particularly from a forensic perspective will be the subject of this Chapter as well as the limitations of such radiologic imaging.

Pages: 9

Radiology plays a central role in the forensic investigation of suspected non-accidental injury. The presentation of the infant and child victim of non-accidental injury may be varied and may take the form of physical or sexual or emotional abuse or neglect, as well as fabricated or induced illness (FII) (formerly referred to as Munchausen Syndrome by proxy), for example, poisoning. This chapter will focus on the commoner radiologic features of non-accidental injury - specifically, those occurring in physical child abuse - including soft-tissue injuries and skeletal fractures and abusive head trauma. The salient features which should alert the medical professional to suspected non-accidental injury will be discussed as well as the appropriate imaging investigations used in the forensic radiologic evaluation of the commoner injuries that may occur.

Pages: 7

This Chapter focuses on the types of evidence, forensic samples, which might be collected from complainants and suspects. It is essential to have recommendations for the taking of forensic samples that are based on all available evidence. Regularly reviewed and updated guidelines ensure consistency, currency of practice and help identify knowledge gaps that need to be filled by future research. It is essential that forensic practitioners have training in the field of evidence collection prior to taking on the role to ensure that they are competent to manage the complex cases that present in the clinical forensic medical setting.

Pages: 7

DNA contamination of forensic specimens may lead to unintended consequences. This Chapter discusses the reasoning as to the need for the implementation of measures to minimize DNA contamination within the forensic medical examination suite. Suitable DNA decontaminants are discussed and a generalized approach to the development of guidelines for DNA decontamination and contamination minimization within clinical forensic examination suites is presented.

Pages: 10

This Chapter discusses the medical, psychological and social sequelae of sexual violence within the context of a clinical forensic medical response. Although definitions of sexual violence vary between jurisdictions, a standardized approach to medical care and forensic evidence collection apply to many jurisdictions. Addressing medical needs always take priority over forensic evidence collection. The nature of physical violence in sexual assault cases varies, but there are common patterns of injury which can be described. There are also limitations of findings with various explanations detailed in this chapter. Substances including alcohol may affect the history and findings following sexual assault and rape. Other medical consequences of sexual violence include the acquisition of sexually transmissible infections, resultant pregnancy and psychological distress.

Pages: 16

Sexual crimes against children differ from those involving adults because of emotional, developmental and physical differences between adult and pediatric victims, the identity of prevalent assailants and legal differences. The epidemiology, medical approach to history and physical, return on forensic sampling, and interpretation of anatomic findings, as well as the provision of medical care is altered by these factors. In particular, consideration of intra-familial abuse with only historic evidence or minor non-acute anatomic changes make sex crimes against children substantially different than the rape of an adult. This Chapter supplements Chapter 86 – Evidential Sampling, adapting adult care for the pediatric population.

Pages: 7

Sexually transmitted infections (STIs) are infections primarily passed on through person-to-person sexual contact. They cause a variety of clinical diseases but can be asymptomatic. In the context of sexual assault, they can be transmitted during the assault but may be pre-existing in the victim. The methodology for testing for STIs has changed dramatically in recent years which has impacted on the sensitivity and specificity of tests and how they can be used in a legal context. It has also resulted in testing being less invasive and therefore less traumatic and more acceptable to victims and also to forensic practitioners. There have also been advances in the prevention of STIs following assault and in particular for post-exposure prophylaxis for HIV as well as vaccination against Hepatitis B and Human papillomavirus (HPV). The presence of STIs and their significance in medicolegal cases is fraught with difficulties. In adults, the presence of an STI can be used as evidence of assault or used to bring into question the previous sexual behavior of the victim and discredit them. In the case of children, an STI may be the first indicator of sexual assault/abuse or used to link a perpetrator to victim; however the possibility of transmission vertically, or fomite transmission can be used to argue against sexual transmission and a false diagnosis of sexual abuse can have major long-term repercussions on the child, parents or carers and other children in the family.

Pages: 9

Self-harm is a common phenomenon worldwide with many precipitating factors. Perceptions of what is considered self-harm may be influenced by cultural, societal and religious beliefs. There are many types of self-harm. Self-harm leading to death is a common presentation for forensic pathologists. Forensic physicians and allied forensic healthcare professionals may often see patients who present with self-harm or who have a history of self-harm. Management of those who have self-harmed in custody may be challenging as actual or threatened self-harm may be used for secondary gain. The issue of self-harm is discussed in general with emphasis on the diagnostic challenges. Features relating to the presentation that may assist in suggesting the diagnosis of self-harm are reviewed.

Pages: 12

Non-fatal strangulation has become recognized as a predictor for future violence and fatality. It is associated with intimate partner violence, sexual assault and other crimes of violence. It is a significant event that has previously been poorly recognized and documented. Recognition of its seriousness has allowed further consideration of how it might present, and the signs and symptoms with which it is associated. Medical and legal bodies have identified the need to separate non-fatal strangulation from other forms of physical assault. In many jurisdictions, non-fatal strangulation is now a separate criminal offense, and this trend is continuing. The forensic practitioner needs to be able to recognize signs and symptoms, and ensure that appropriate investigations and documentation are undertaken to ensure the safety and future well-being of individuals who have been subject to non-fatal strangulation.

Pages: 16

Freedom of speech, freedom of peaceful assembly and the right to protest are fundamental human rights; enshrined in both international law and in the national laws or constitutions of nearly every State. Despite these legal protections, there is a tendency across the globe to label entire assemblies as violent and use less lethal weapons to disperse them. This Chapter examines the weapons most frequently used by police against public assemblies in past two decades. Focussing on striking weapons (batons), chemical irritants, kinetic impact projectiles and stun grenades, the Chapter uses examples from various countries to illustrate how these weapons are being used and the associated human rights and health impacts. Worrying trends identified include the use of dangerous or untested equipment, such as thermal foggers to deploy chemical irritants; the use of inherently abusive weapons, such as whips or sjamboks; and the increasing use of certain types of munitions, specifically indiscriminate kinetic impact projectiles. The Chapter seeks to demonstrate the importance of medical and forensic professionals being familiar with the weapons being used in the countries they practice in, the effects of those weapons, and being aware of the clinical aspects in the presentation and care of those exposed.

Pages: 10

Human electronic control with conducted electrical weapons (CEW) has gained widespread acceptance as a preferred law enforcement intermediate force option. There have been over 4.2 million field uses of CEWs and over 6 million uses including training. Subject mortality has been shown to be reduced by two-thirds compared to other use of force techniques thus substantially lowering the arrest-related death (ARD) rate. Subject injuries, requiring medical attention, have been shown to be reduced by 80%, but have included fatality, for example, from head injury from unrestrained fall. A CEW is an electronic muscle stimulator. The primary difference between the therapeutic muscle stimulator and the CEW is that the CEW uses short sharp probes to create the connection while the muscle stimulator uses adhesive electrodes. Those probes introduce the most common demonstrated serious complication — penetrating eye injuries. Fatal complications of CEW use include burns and a rare risk of electrocution in the event of a probe contacting the ventricular epicardium in an extremely slender individual. Non-fatal complications include injuries from probe penetration of organs and body cavities, particularly to the eyes as well as burns. Injuries due to muscle contractions as well as from falls associated with the neuromuscular incapacitation from use are also reported.

Pages: 10

This Chapter describes Female Genital Mutilation/Cutting (FGM/C). FGM/C is a form of child abuse against women that is perpetuated through generations. Forensic practitioners should be familiar with forms of FGM/C and the medical practice’s legal mandatory reporting requirements in their relevant jurisdiction. The Chapter considers the cultural background of FGM/C, prevalence, variation and the effect of globalization and modernization on the practice. The short-term and long-term consequences are described. Patients with a history of FGM/C, or children with suspected FGM/C should be referred to specialist clinics to help diagnose, support, educate, and manage any long-term complications. A trauma informed assessment should be employed by clinicians seeing children and women with FGM/C.

Pages: 8

Herbal medicines consist of a range of plant-derived materials or preparations marketed for their purported therapeutic or other health benefits. They are derived from raw materials such as leaves bark, seeds and roots and may be processed in the form of powders, teas, tablets or capsules. In addition to naturally occurring organic toxins, analyses of herbal substances have revealed prescription medications, heavy metals and toxic chemicals which may exacerbate pre-existing conditions or cause significant morbidity or mortality. In addition to possible idiosyncratic reactions to herbal preparations, there exists the potential for serious herb-herb and herb-drug interactions. As the regulation of the herbal industry is less strict (and sometimes completely unregulated) when compared to pharmaceutical drugs, issues also arise with undeclared ingredients, inaccurate labeling of products, purity and variable dosages. Given that there may be no history of herbal ingestion, that herbal products are often not documented by police at death scenes, and that the detection of toxic plant products may not be possible using standard toxicological screening, the role of herbal medicines in medicolegal deaths remains unclear.

Pages: 136

No chapter abstract available.

Pages: 12

The quality of forensic material recovered from crime scenes is critical to the success of forensic science in criminal investigations. It is essential that all evidence submitted for forensic examination and analysis reaches the laboratory or examining forensic unit in the best possible condition and no contamination, interference, or loss or addition of material has occurred. Crime scene management is concerned with the methodical and systematic application of methods employed in crime scene investigation to ensure that all relevant forensic evidence is identified, recorded, and recovered and ensuring the integrity and continuity of that evidence. This Chapter provides an overview of what constitutes a crime scene, the roles and responsibilities of crime scene practitioners, the importance of the forensic awareness of first responders and early actions at incident scenes, the principles of crime scene management from an investigative and forensic point of view, and stages in the crime scene examination process. Documentation of the crime scene and reporting of results will be addressed and the development of scene examination strategies and forensic strategies for investigations of volume, serious and major crime.

Pages: 8

Recently, the perceived risk of a deliberate release of a chemical, biological or radioactive (CBR) agent has increased in terms of use by state and non-state actors: for assassination, terrorism and group conflict. As such, it is increasingly important to recognize a deliberate release event, identify the symptoms and signs in casualties, diagnose and provide appropriate medical countermeasures. Alongside casualty management and healthcare, emergency response to an event environmental and bioanalytical samples can be used to understand immediate and ongoing requirements for medical countermeasures, PPE and environmental recovery necessities (e.g. decontamination). This Chapter provides information on the features of common chemical, biological and radiologic threats and includes the characteristics of dispersal/spread, identification of clinical syndromes/toxidromes and how casualty decontamination can be accomplished in conjunction with personal protection so responders do not become casualties themselves.

Pages: 8

This Chapter outlines the principles of forensic photography. For consistency of image quality and faithful digital representation of the injury, DSLR’s with suitable lenses and flash units should be used. For consistent forensic analysis, distortion to the shape of injury in the photography should be limited. To limit distortion, the camera must be perpendicular to the injury with appropriate scale placement. 3D photography should be considered the gold standard for the image capture of injuries in forensic medicine, as image distortion is negligible. To date IR and UV offer limited information not already available with standard imaging. However cross-polarized imaging has shown some promise, particularly with highly reflective injuries.

Pages: 6

Forensic odontology is the specialized field of dentistry in which the interest of the law deals with the proper handling and examination of dental evidence. Often working intimately in a multidisciplinary approach, a forensic odontology practitioner not only needs a sound understanding of the natural sciences and the fundamentals of dental practice but must also understand the legal systems, the law and relevant jurisdictional legislation, and have an in-depth knowledge of oral and dental anatomy and pathology. This Chapter discusses the primary types of casework performed including human identification, assessment and examination of injuries caused by teeth, age estimation in both living and deceased individuals, assessment of oral facial injuries following accidents or assaults, and the provision of expert opinions on dental evidence.

Pages: 6

Toxicological analysis involves the detection, identification and quantitation of toxicologically relevant substances and the interpretation of the results. The Chapter introduces forensic toxicology, including the areas of post-mortem toxicology, behavioral and human performance toxicology, and forensic drug testing. It reviews tools in toxicological assessments and discusses challenges in interpretations. Drugs, poisons most often involved, analytic methods, matrixes used, and chain of custody issues are considered.

Pages: 14

For the purposes of this Chapter forensic microbiology is defined as the discipline of applying scientific methods to the analysis of microbiological evidence in criminal and civil cases for investigative purposes. The same methods and approaches developed for this field also can serve as diagnostic tools for detection of causative pathogens in determining, for example, cause of death. The recent technologic advancements in microbiome research have brought new importance to modern forensic microbiology. As seen with the human microbiome project (HMP), these high-resolution and big data solutions have promoted vigorous research and applications in the broad subfield in forensics and legal medicine. These extraordinary tools of today bring capabilities that a short time ago were unthinkable.

Pages: 10

Since Alec Jeffreys discovered minisatellites in the genome that could be used to produce a virtually unique DNA “fingerprint”, DNA technology has been used in civil and criminal justice settings to assist in questions of human identification, enabling perpetrators of crimes to be brought to justice and resolve complex kinship issues. Early DNA fingerprints were difficult to interpret and required high (microgram) concentrations of DNA from a single-person source, limiting its usefulness. The combination of the polymerase chain reaction (PCR) and short tandem repeat (STR) loci has led to the DNA “profile” that continues to form the mainstay of DNA analysis worldwide today. Not only can complex mixtures be analyzed, but it can also be achieved with picogram quantities of DNA. This Chapter explores STR typing as applied to criminal cases, including complex mixtures. Applying this methodology to the male Y chromosome has proven exceptionally useful in sexual assault. New technologies that sequence the small, repeated blocks of DNA sequences through massively parallel sequencing will be introduced, as will the application of sequence variations to provide intelligence to assist in cold cases and disaster victim identification (DVI) in both nuclear and mitochondrial DNA. Modifications to the DNA molecule can help answer other unresolved questions, as can the wider comparison of inherited elements across the genome when combined with genealogic information.

Pages: 8

The term Disaster Victim Identification (DVI) is used to describe the procedures which may be applied in case of an event with many fatalities, surpassing the possibility of the authorities to conduct identification using the normal standards. The events may be natural disasters such as earthquakes or man-made such as terrorist events or they may be accidents such as aircraft crashes or shipwreck. The participants in a DVI operation varies with the nation(s) involved but will usually be comprised of the police and medical experts, such as forensic pathologists, odontologists, geneticists and anthropologists. They must have plans for conducting the investigations and practice the procedures beforehand. There must be agreement as to the extent of the investigation. Ideally it will follow INTERPOL guidelines, involving the use of the three primary identifiers fingerprints (pressure ridge analysis), odontology and genetics, and if they fail, secondary identifiers (medical information and effects found on or near the body) may be used. Identification requires unequivocal agreement between the antemortem and the post-mortem information. The success of a DVI operation may be measured by the numbers identified but the prime object is to provide the relatives with certainty of the fate of their loved ones.

Pages: 13

Blood is a frequent finding at the scenes of violent crimes. Its arrangement and distribution at crime scenes and on exhibits provide information about the mechanisms leading to its deposition. Such considerations might employ aspects of fluid dynamics, mathematics and specialist image capture, and they are reliant on the accurate recording of observations based on a consistent classification system and terminology. This Chapter provides an overview of blood pattern analysis from its early and somewhat gruesome scientific beginnings, to the use of modern digital reconstruction techniques, via a variety of landmark experiments and cases. Discussion of the effect of changing conditions on the behavior of single blood drops provides a useful background from which to consider the variety of airborne and other blood distributions that might be formed as a result of forces acting on wet blood during a variety of scenarios most commonly encountered in violent crimes against the person.

Pages: 7

Forensic anthropology is defined as the application of physical anthropology knowledge and techniques to matters of medicolegal significance, particularly those relating to the recovery, documentation, and analysis of human remains. The forensic anthropologist may be employed by a government or non-government organization and apply their skills to routine jurisdictional casework, disaster victim identification, recovery and identification of servicemen and women missing in action, or individuals missing (presumed deceased) as a result of political, ethnic and/or religious violence. Depending on the context and the nature of the investigation, the forensic anthropologist may provide information to assist in determining if the remains are of medicolegal significance, developing a biological profile to aid the identification process, and/or documenting and analyzing skeletal trauma to contribute information about what happened to the individual around the time of death.

Pages: 11

Veterinary forensic medicine is a rapidly growing discipline, involving both domestic animals and wildlife. Animals play a part in various ways in criminal or other legal actions. They can be either the victim or the instigator of an incident; serve as sentinels or witnesses or be a source of evidence. Veterinary forensics may be part of the broader categories of “animal forensics” or “comparative forensics” and other specialities are emerging. Such experts may contribute to a forensic team in animal-related litigation. Whether veterinarians or not, these forensic investigators require a deep interest in the natural world, a well-honed ability to observe, an intense spirit of curiosity and a good grounding in the relevant law. There is a need for greater recognition of “comparative forensic medicine” combining veterinary and medical expertise as an important emerging discipline.

Pages: 6

The media is highly influential in how the public see forensic evidence. Those with “an interest in” true crime are now content producers, who fail to understand the genre’s complexities, their responsibilities, and the impact of unreliable or biased content creation. However, the ever-increasing public interest in true crime, and by extension forensic practice, is also a mechanism by which the media can be used to dispel some of the widely held myths and misunderstandings. The aim of this Chapter is to review some of the positive and negative aspects of the media’s engagement with forensic science, and criminal cases more broadly. It will focus on three types of media influence, using cases to contextualize the discussion: Firstly, the impact of online material, and social media more specifically, on the criminal justice process; secondly, the police use of the media to engage the public with ongoing investigations; and thirdly, the powerful affect the media can have to raise awareness of wrongful convictions. In conclusion, a balance must be found between responsible creation and consumption of true crime. Through our choices as consumers, we can support a responsible media that assists victims, survivors, and their families, as well as the wrongfully convicted.

Pages: 7

Forensic evidence can be a powerful tool for investigators and the triers of fact. However recent years have seen increased scrutiny of forensic disciplines, with a growing concern that not all forensic evidence is as reliable and robust as it should be. Misinterpretations and fallacies have crept into the forensic process leading to wrongful convictions and lengthy incarceration of the innocent. Misinterpretations occur when there is an incorrect inference drawn from the forensic examination and fallacies refer to understandings attributed during the forensic examination that have later been shown to be false. In general, these misinterpretations and fallacies in forensic evidence can be attributed to one of two main causes: insufficient application of scientific principles to the underpinning validity and reliability of forensic disciplines and a lack of understanding of the limitations and assumptions related to forensic evidence. The role of the expert is also pivotal in providing a robust and reliable forensic service.

Pages: 8

Forensic entomology is the study of insects as applied to legal problems. This Chapter concentrates on the medicolegal branch of forensic entomology. Time of death is the most common question posed to forensic entomologists, who can provide an estimate of the minimum post-mortem interval based on growth rates of insect larvae (especially maggots), as well as the semi-predictable order and timing of colonization of a dead body by various carrion insect species. Such estimates can be crucial for reconstructing timelines and events in criminal investigations. Entomologists may also be able to provide information about whether a body has been moved, and assess parasite infestations in neglected persons in care. Entomotoxicology is a sub-branch that encompasses insects as alternative toxicology specimens when maggots ingest drugs while feeding on a deceased person, and entomologists also need to be aware that some drugs can affect the timing of maggot growth. DNA analysis techniques and molecular genetics can assist insect identification and recovery of victim DNA from the guts of insects that have fed on a body.

Pages: 10

Age estimation (age evaluation, age assessment) in the living individual is required for many reasons and is often a politically sensitive subject. There are no single specific direct markers for accurate age, but assessments using clinical, dental, maturity and radiologic parameters by those trained can provide relevant timeframes that may be appropriate for the legal decision-making for which knowledge of age is required. In some jurisdictions, methods used for age estimation have not been tested for accuracy or repeatability and may result in miscarriages of justice. The main methodologies for age estimation are outlined and broad principles with examples of different approaches to age estimation and sources of further information provided.