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Deaths from Firearms






The correct handling of a death from gunshot wounds begins at the scene. Here valuable evidence on the body can be lost or altered and bogus evidence may be inadvertently introduced through mishandling of the body. Before a body is touched, its position and appearance should be documented photographically and diagrammatically. The most important rule at the scene is to handle the body as little as possible so as not to dislodge trace evidence that may be clinging to garments or to the body surface. Hands should never be pried open, and fingerprints should never be taken at the scene. Fingerprint ink can either mimic or obscure powder soot as well as introducing contaminating materials that may render subsequent examination of the hands for primer residues of questionable validity. Manipulation of the hands is of even greater potential danger if it is done by a police officer who, theoretically, can transfer primer residues from his hands to those of the deceased. After all, as part of the job, the officer handles and fires weapons, thus putting them in an environment where hands may be contaminated with primer residues. Before transportation of the body to the morgue, paper bags should be placed over the hands to prevent loss of trace evidence. Paper bags should be used rather than plastic, because condensation will form in the bags if the body is refrigerated. This can wash away primer residues and make fingerprinting more difficult. Some authorities claim that it is possible for the hands to be contaminated by barium from the paper bags, thus rendering analysis for this metal by flameless atomic absorption spectrophotometry (FAAS) invalid. Once the paper bags are securely placed around the hands, the body should be wrapped in a white sheet or placed in a clean transport bag. On arrival at the morgue, the body should be logged in as to the deceased’s name, the date and time of arrival, who transported it, and who received it. A case number should be assigned. At the time of the autopsy, an identification photo should be taken with the case number prominently displayed in the identification photo. Because of this, complete medical records of the deceased from the time of admission to the death should be obtained before the autopsy. All hospitals in the area served by the medical examiner system should be informed that in all medical examiner cases, no tubing should ever be removed from the body after death, e.g., endotracheal tubes, intravenous lines, or Foley catheters. Injection sites should be circled in ink by the hospital staff to indicate that they are of therapeutic origin and did not antedate hospitalization. Thoracotomy, laparotomy, and surgical stab wounds should be labeled or described in the medical records. If death occurs within a few hours after hospitalization, paper bags should be placed on the hands, just as if the death had occurred at the scene. The body and any clothing worn by the deceased should be transferred to the medical examiner’s office. All medical records detailing the procedures performed should accompany the body. Any blood obtained on admission to the hospital should be obtained for toxicology. Admission blood obtained for transfusion purposes in trauma cases often is saved for one to two weeks in the hospital blood bank. The blood bank should be queried for retained initial blood samples. Before examination by the forensic pathologist, the body should not be undressed, washed, embalmed, or fingerprinted. Examination of the clothing is as much a part of the forensic autopsy as examination of the body. Embalming can induce artifacts, change the character of wounds, and make toxicological analyses impossible or extremely difficult. After receipt of a body, the pathologist should have x-rays taken. X-rays should be taken in all gunshot wound cases whether the missile is believed to be in the body or to have exited. The clothing should not ordinarily be removed before x-ray. On occasion, bullets have exited the body and become lodged in or among the clothing. In one case the bullet exited the right chest and fell into the inside pocket of a jacket. A hole was present in the bottom of the pocket, and the bullet then fell into the lining. It would not have been found had x-ray not revealed it to be in the clothing. The next step is to recover any primer residue from the hands. This can be done by the use of swabs or lifts. At the same time, the hands should be examined for the presence of trace evidence, e.g., powder grains, fibers, hair, etc. Next, the body is examined with the clothing still on it. Attention is paid as to whether the defects in the clothing correspond in location to wounds in the body. The clothing should be examined for the presence of powder, soot, and other trace evidence. Following this, the clothing is removed and laid out on a clean, dry surface. The clothing should not be cut from the body except under very unusual circumstances. The body is then examined without the clothing and without cleaning. One should search for trace evidence, powder grains, and soot. One may want to take photographs of the uncleaned wounds at this time. The body is then cleaned and re-examined for any other wounds that may have been concealed by dried blood. Photographs of the cleaned wounds may then be taken. The prosector should go back to the clothing and again correlate the observed entrances and exits with defects in the clothing. They should re-examine defects in the clothing for the presence of powder or soot. The use of a dissecting microscope is strongly recommended. At least two photographs of each entrance wound should be taken. One should be a placement shot showing where the wound is in relationship to other body landmarks. The second should be a close-up showing the appearance of the wound. Most individuals take a third shot between the two extremes. It is helpful if there is a scale and the number of the case in the photograph. Each wound should be examined, and notes should be taken as to its exact location and appearance. Pertinent negatives should be noted. It is strongly recommended that the wounds be examined with a dissecting microscope. If there is any question as to range which cannot be settled at this time, the wound should be excised and retained for analysis by scanning electron microscope-energy dispersive x-ray (SEM-EDX) or energy dispersive x-ray (EDX). In routine gunshot wounds, it is not necessary to excise and retain entrance and exit sites. Microscopic sections of the entrance and exit do not ordinarily contribute any information that cannot be gained by examination with the naked eye or with a dissecting microscope. In some cases, microscopic sections may be misleading, especially to the novice. In homicide cases, a complete autopsy involving the head, chest, and abdominal cavities should be performed. All viscera should be removed and examined. The track of the bullet should be followed and the point it lodges or exits measured in relationship to the entrance. In shotgun cases, it is not necessary to recover all pellets but only a representative sample. Wadding should always be recovered. Wounds ordinarily should not be probed as they can create false wound tracks, distort a wound, or dislodge a missile. In all gunshot wound cases, blood, vitreous, urine, and bile, should be retained. In cases, of advanced decomposition where these materials are not present, muscle (from the thigh, preferably) should be retained. In preparing an autopsy report in a death caused by gunshot wounds, it is always best to group the description of wounds in one area labeled “Evidence of Injury,” rather than scattering this information throughout the protocol. Thus, when a bullet entering the left chest perforates the left lung, the heart, the right lung, and exits the back, one should have all this information in one area of the autopsy report rather than scattering it among the External Examination and the description of the individual internal organs. Once the description of the injury to the organ has been made in this section, there is no need to redescribe the injury in the area of the report devoted to the organs. Each entrance wound should be fully described as to location, appearance, path of the missile, injuries produced and site of lodgement or exit before description of the next bullet wound is given. There is no necessity to assign a number to an exit. The first information to be noted in the autopsy report is the location of the entrance wound. The wound should be located in terms of its general geographic area, e.g., the left upper chest, followed by its distance from either the top of the head or the soles of the feet; the distance from the right or left of the midline; and most importantly its relationship and distance from a local landmark such as the nipple. Describing a gunshot wound in relation to a local landmark is usually of greater value than locating the wound from the top of the head or so many centimeters or inches to the right or left of the midline. It is easier to visualize the location of a gunshot wound of the left chest as being “one inch above the level of the nipples” and “ one inch medial to a vertical plane through the left nipple,” rather than “20 inches below the top of the head” and “three inches to the left of the midline.” The value in using local landmarks becomes obvious if one considers the location of a wound 20 inches below the head in a six foot 11 in. basketball player compared to a five foot secretary. After the entrance wound is located, the size, shape, and characteristics of this wound should be given. The presence or absence of an abrasion ring, its symmetry, and its width should be described. The presence or absence of soot and powder should be noted in all cases. When soot is present, the configuration of the deposit along with its size and density should be described. Searing of the edges of the wound or adjacent skin should be noted and described in detail. When powder tattoo patterns are present, the maximum dimensions of the pattern and its density should be described. In measuring the pattern, occasional stray tattoo marks from the main powder tattoo pattern should be ignored. Unburned or partially burned grains of powder may be recovered. If so, an attempt should be made to identify them as flake, ball, or cylindrical powder. Grains should be retained for identification by a firearms examiner if the prosecutor is unsure of the type of powder present or wishes independent confirmation. The relationship of the bullet entrance hole to the distribution of the tattooing around it should be described. An eccentric abrasion ring may be said to average one (1)-mm wide, except from the 3 to 6 o’clock positions, where it averages three (3)-mm wide. After the external appearance of the wound is described, the path of the missile through the body should be given.

The organs injured and the amount of blood present in the body cavities should be noted. The point where the bullet either lodges or exits the body should be described. The prosector should try to avoid terms, such as “medial,” “dorsal,” “ventral,” “superior,” or “inferior” in describing the bullet trajectory, since most lay people are unfamiliar with this terminology and forensic autopsies are more often read by lay persons than by physicians. When a bullet is recovered from a body, removal should be done with the fingers, not with an instrument. Using instruments to recover a bullet can result in scratching of the surface and interference with ballistic comparison. If a bullet is recovered, it should be described briefly in the autopsy protocol. The general appearance of the bullet, i.e., deformed, un-deformed, lead, jacketed, or partial metal-jacketed; and the approximate caliber (if known) should be stated. In the case of shotgun wounds, the size of the shotgun pellet pattern or the entrance hole (if the pellets have not “opened up”) should be described in the autopsy report. With shotgun pellet patterns of the skin, just as in tattooing, one should ignore stray pellets and measure only the primary pattern. A representative number of pellets and all wadding (if any) should be recovered.


Acknowledgements:

The Police Department;
www.politie.nl and a Chief Inspector – Mr. Erik Akerboom     ©

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