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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