Intra- and perioral shooting fatalities.

Determination of the manner of death in the case of intra- and perioral firearm wounds can be difficult especially if death scene investigation is unclear and inadequate. In this study, we investigated some characteristics of these firearm wounds which were autopsied in Istanbul. During the 5-year period from 1991 through 1995, there were 15 intra- and perioral firearm fatalities investigated. In all the cases, only one shot was fired into the mouth. They constituted 1% of all the firearm fatalities. The mean age of the victims was 27 years and males constituted 73.3% of the victims. Most of the wounds were caused by handguns. Homicides accounted for 53.3% of these deaths. Three of 15 cases could not be identified as intraoral firearm wounds by general practitioners during the scene investigations.     

Fatal firearm accidents in Sweden

According to Swedish law, it is prohibited to possess and use firearms without a special permission (license), which is given only after a detailed personal investigation. This restrictive legislation accounts for the fact that deaths due to firearms in Sweden are rare in an international comparison. The number of accidental firearm fatalities in Sweden is 0.074/100,000 living persons. We have previously published a series of accidental firearm fatalities during hunting, and now we present an investigation on the non-hunting fatalities. The mean age of the victims was 27 years, and males predominated. Handguns, military rifles, and shotguns caused most of the accidents. The first published case of fatal thoracic airgun wound is also included. Slightly more than half of the accidents were caused by another person and were inflicted at close range. Unsafe handling of the guns, especially "playing" with the gun or during military training caused most of the accidents. It is doubtful that one could further decrease the low number of fatal firearm accidents in Sweden by even more restrictive legislation. Instead, it is concluded that the most important factor to stress is the safer handling of weapons.     

Fatal Firearm Injuries in Tennessee: A Comparison Study of Tennessee's Two Most Populous Counties 2009–2012

Firearm injuries are a leading cause of violent death in Tennessee. This study was designed to compare the demographic and epidemiologic features of fatal firearm injuries in Shelby County and Davidson County, Tennessee between 2009 and 2012. We identified 1081 gunshot fatalities for the study period in these two counties. Shelby County had a higher overall, age‐adjusted gunshot mortality rate, a higher male age‐adjusted gunshot mortality rate, and a higher age‐adjusted gunshot homicide rate than Davidson. Age groups 25–34 years and 35–44 years had higher crude mortality rates for gunshot deaths in Shelby County than Davidson County. Both counties had higher age‐adjusted gunshot mortality rates for black males than white males, higher homicide rate for black race than white, and higher suicide rate for white race than black. Homicide was the most common manner of death, and handguns were the most common type of firearm used in both counties.     

Unintentional Nonhunting Firearm Deaths in Sweden, 1983–2012

We examined the association between unintentional nonhunting firearm deaths and changes in firearm legislation in Sweden. There were 43 fatalities during the study time frame 1983–2012, representing 46% of all unintentional firearm deaths during the same period. The victims were predominantly young males (mean age 25 years). Slightly more than half of the deaths were caused by another person and were inflicted at close range. The main cause of the incidents was human error. The majority of the involved firearms were legal; however, most victims killed with illegal firearms were under the influence of alcohol and/or drugs at the time. The death rate decreased significantly following the introduction of the hunter's examination in 1985. Education and training associated with the hunter's examination was at least partially responsible for the decline in fatalities after 1985. Future prevention should target the availability of illegal firearms.     

Impact of the Stand Your Ground law on gun deaths: evidence of a rural urban dichotomy

We explore the impact of the Stand Your Ground (SYG) law on gun deaths by degree of urbanization. Unlike firearm homicides the definition of firearm deaths does not depend on the broadening of the self-defense provision that the SYG law represents. Using a difference-in-difference design, we find that the SYG law had no impact on gun deaths at the state level. However, once the U.S. states are disaggregated into portions by degree of urbanization—central city, suburb, small urban area and rural area—we find that the law increased gun deaths in the central cities and the suburbs, and had no impact in smaller urban areas and rural areas. These findings are consistent with the fact that there is a great divide between urban and rural areas in terms of ownership and usage of guns, attitudes towards guns, and the implications thereof. The finding of increased violence in the suburbs is of particular interest in the historical backdrop whereby the growth of the suburbs, to a large extent, may have been motivated by a desire to escape crime and violence.     

Fatalities Caused by Spherical Bullets Fired from Blank Cartridge Guns in Istanbul, Turkey

Abstract:  Blank cartridge guns are generally regarded as being harmless and are not considered to be firearms in the legal sense in most countries. To show the danger of these guns upon simple modifications, we report 59 fatalities resulting from these simply modified blank cartridge guns in Istanbul, Turkey. The great majority of the victims were males and the age of those ranged from 11 to 61 years. In 55.9% of these cases, homicide was the origin followed by suicide (39%). The right temporal region was detected to be the preferred region in suicidal shots by blank cartridge guns with a frequency of 56.5%. In trial shots, all these guns were detected to discharge steel or lead spherical objects, generally 4 or 5 mm in diameter, successfully. Our findings strongly suggest that these guns should also be considered as handguns in the legal sense.     

Weapon location following suicidal gunshot wounds

The location of the gun following suicidal gunshot wound was studied by reviewing 574 such deaths in which the scene was investigated by a medical examiner investigator and the body was examined at the Bexar County Medical Examiner's Office in San Antonio, Texas. The position of the gun could not be established in 76 cases. In the remaining 498 cases, the gun remained in the deceased's hand in 24% of the cases. In 69% of the cases, the gun was on or near the body but not in the hand (i.e., touching the body or within 30 cm of the body). The gun was found >30 cm from the body in the remaining 7% of cases. In the case of handguns, the gun was found in the hand in 25.7% of individuals. For individuals using long guns, the firearm was in the hand of the decedent in 19.5% of cases. The gun had a greater chance of remaining in the deceased's hand if the person was lying or sitting when the gunshot wound was received. Variables such as gender of the individual, wound location, and caliber of handgun were not significant in predicting whether the gun stayed in the hand after a suicidal gunshot wound.     

Development of an immunoassay for the differentiation of menstrual blood from peripheral blood

This study examined all unintentional firearm fatalities while hunting that occurred in Sweden between 1983 through 2008. The circumstances as well as the impact of the hunter's exam on fatality frequency were analysed. During these 26 years, there were 48 such fatalities, representing 53% of all (n=90) unintentional firearm deaths during the same period. The average annual number of fatalities decreased over the last few decades. Very restrictive firearm legislation in Sweden combined with the introduction of a mandatory hunter's exam since 1985 accounted, at least partly, for this finding. Moose hunting accounted for 46% of the fatalities and small game hunting for the remaining cases. The mean age of the victims was 50 years and 96% of them were males; all shooters were males. During moose hunting, most of the victims were mistaken for game, whereas in small game hunting most of the fatalities were related to falls and improper handling of the weapon. Human error was thus the main cause of these fatalities.     

Firearm fatalities in Edirne, 1984–1997

During the 14-year period from 1984 to 1997 there were 85 firearm fatalities investigated by the Department of Forensic Medicine and the Department of Pathology in Edirne, Turkey. We determined the characteristics of these 85 firearm deaths which comprised 17.03% of all medicolegal autopsies. The overall incidence was 1.58 per 100 000 population. The median age was 35.5 years. Fifty-four percent of the victims were aged between 20 and 40 years. Males constituted 82% of the victims. The most frequent manner of death was homicide (68.3%). Handguns accounted for 62.4% of the weapons used. The most common sites for the firearm entrance wounds were both head–neck–nape (32.8%) and chest (32%). In conclusion, our study shows that, in spite of legal restrictions, illegal access to firearms is easy and deaths by firearms are still increasing.     

Child and adolescent victims in forensic autopsy: a 5-year retrospective study

Children of more than 3 years of age and adolescents have been largely overlooked in the forensic literature, especially the 4-9 age group. Thus, the present study was undertaken to address this particular issue of child and adolescent victims in forensic autopsies. On a 5-year period (2000-2004) in Quebec province (Canada), all forensic autopsy cases of children and adolescents from 4 to 19 years of age were retrospectively studied. A total of 223 cases of child and adolescent deaths (148 males, 75 females; 6.6% of all forensic autopsies) were reviewed. Age, gender, manner of death and cause of death were analyzed for all victims organized into three groups of age: 4-9, 10-14, and 15-19. Moreover, homicide cases (n = 54) are further analyzed in terms of method(s) used (firearm, sharp force, asphyxia, blunt force, intoxication). This 5-year retrospective study may contribute to a better understanding of typical deaths in the 4-19 group of age and therefore, bring a working basis for the forensic pathologist or medical examiner/coroner.     

Regulation of Firearm Dealers in the United States: An Analysis of State Law and Opportunities for Improvement

Firearms were associated with 30, 136 deaths in the United States in 2003. Most guns are initially sold to the public through a network of retail dealers. Licensed firearm dealers are an important source of guns for criminals and gun traffickers. Just one percent of licensed dealers were responsible for more than half of all guns traced to crime. Federal law makes it difficult for ATF to inspect and revoke the licenses of problem gun dealers. State licensing systems, however, are a greatly under-explored opportunity for firearm dealer oversight. We identify and categorize these state systems to identify opportunities for interventions to prevent problem dealers from supplying guns to criminals, juveniles, or gun traffickers. Just seventeen states license gun dealers. Twenty-three states permit routine inspections of dealers but only two mandate that those inspections occur on a regular basis. Twenty-six states impose record-keeping requirements for gun sales. Only thirteen states require some form of store security measures to minimize firearm theft. We conclude with recommendations for a comprehensive system of state licensing and oversight of gun dealers. Our findings can be useful for the coalition of more than fifty U.S. mayors that recently announced it would work together to combat illegal gun trafficking.     

Deaths at the workplace. Accidents or homicides?

The medical examiner is responsible for certifying and determining the cause of death of any person dying from criminal violence, accident, suicide, when unattended by a physician, in police custody, or in any suspicious or unusual manner. A less well-recognized, but no less important, responsibility of the medical examiner is the investigation of deaths of individuals who die at the workplace. The manner of death of most job-related fatalities has been traditionally classified as accidental. In recent times, prosecutors have scrutinized these cases more carefully. The results of some investigations have prompted them to bring criminal charges against employers for blatant negligence that contributed directly to injuries and deaths of employees. This paper is devoted to a review of the controversy surrounding the issue of industrial homicide, illustrative cases, and the role of the medical examiner in the investigation of deaths at the workplace.     

Firearms fatalities in Denmark 1970-1979

In the 10-year period from 1970 to 1979 933 firearm fatalities occurred in Denmark which represent an increase of 45% during a little more than 10 years. Eighty-eight per cent were suicides, 8% homicides, and 4% accidents. Accidental shootings have decreased from 8% to 4% and the fall seems to be a result of fewer accidents in connection with hunting, probably due to a more restrictive legislation about hunting. An increasing share of the total number of deaths, now responsible for 57% of the fatalities, are by shotgun. There has been a remarkable increase in the use of sawn-off long barreled weapons. Still considering the marked increase of firearm fatalities, fatal shootings are of very limited importance in Denmark, especially homicidal shootings of which there are 2-3 per year. Shotguns are at the present time the only procurable dangerous weapons which have led to an increased share of the total firearm fatalities. Restrictions in the use of shotguns during hunting seem to have had positive effects on the reduction of hunting accidents. As mentioned above, the most valuable method of bringing the firearm fatalities under further control seems to be increased control over the procurement and possession of shotguns.     

A "back door" approach to analysis of ethanol-associated risks and behavior

Ethanol has been detected in the majority of medical examiner cases involving nonnatural death and in a substantial number of natural deaths. The higher the serum alcohol concentration (SAC), the greater were the odds that death was due to external (traumatic) causes. We identified 149 medical examiner cases that were positive for ethanol and negative for 11 major drug of abuse groups, and studied those cases to further clarify ethanol-related risk factors and behaviors. Based on terms of frequency of occurrence, the data identify SACs of 201 mg% to 300 mg% as a particularly high risk factor for sudden, unexpected, traumatic death. Traumatic deaths associated with SACs below 100 mg% were infrequent, and attendant opinions concerning the contributory role of ethanol must be made with circumspection. SACs below 150 mg% could not be used to predict whether or not the decedents had been engaged in active or sedentary behavior prior to death because both situations occurred with equal frequency. At SACs between 151 mg% and 350 mg%, active situations were observed three times as often as sedentary situations. When SACs were 350 mg%, sedentary situations were observed twice as often as active situations. Suicide victims and driver fatalities rarely showed SACs above 350 mg%; therefore finding such SACs in apparent suicidal or driver fatality situations should prompt a thorough investigation to rule out other possibilities.(ABSTRACT TRUNCATED AT 250 WORDS)     

Observations and statistics relating to suicide weapons

The weapon at the scene of a suicide provides a resource in addressing such questions as frequency of blood in or on the weapon, location of the weapon with respect to the body, and evidence of firearm discharge residues on the hand. The first 195 weapons were tested for blood by a technique different from the following 202 weapons. Results were obtained which caused procedural changes in blood detection. Data are presented for frequency of blood in and on the muzzle of weapons, relative frequency of location of suicidal gunshot wound, and percent "positive" findings of gunshot residue metals on the hands. It was found that suicidal gunshot wounds were 3 times more frequent to the head than the chest, and that no significant difference was noted between males and females in this study. Scene photographs reveal that the suicide weapon is in or resting on the hand of the decedent 20% of the time with handguns and 11% of the time with long guns.     

Congestion bleedings of the face and cardiopulmonary resuscitation--an attempt to evaluate their relationship

OBJECTIVES: Are any other factors besides the factor "cause of death" involved in the development of petechial hemorrhages (PET) of the head? The significance of the cause of death is well known, other factors have been rarely investigated in medical literature. Do they include cardiopulmonary resuscitation (CPR), as has been claimed in several forensic publications? MATERIALS AND METHODS: (a) 473 consecutive autopsy cases (without strangulation) evaluated by one examiner, which were appropriate for this investigation; (b) analysis of 181 cardiac deaths (investigated by all physicians of our institute). RESULTS: Petechiae were found in 13.3% of all cases and were clearly dependent on the cause of death, up to 20% were found in burn victims, intensive-care patients and cardiac fatalities. Petechiae were more frequently observed in the middle age groups (>20%) than in old persons (<10%). The number of PET cases increased with body mass but was lower in extremely obese persons, a greater number of cases with PET was also observed with increasing heart weight. PET were observed in 11% of the deaths without CPR compared to 19% with CPR. This difference was predominantly caused by the subgroup "acute coronary death", especially if victims younger than 60 years were considered, whereas in many other causes of death no difference in the prevalence of PET with or without CPR could be observed. CONCLUSION: Besides the cause of death, other factors (age, body mass and possibly even heart weight) influence the development of petechiae. The hypothesis that CPR alone produces PET is not confirmed by our experience.     

Suicide by air rifle and shotgun

We report the case of a 39-year old white male who committed suicide by shooting himself with an air rifle and a shotgun. The ballistics of air guns and rifles, with particular reference to the Sheridan air rifle, are reviewed. Only two cases of multiple firearm suicide have been reported; both involved simultaneously fired handguns. Ours is the first case, to our knowledge, of an air rifle and a shotgun used in sequence to commit suicide.     

Sudden epilepsy deaths and the forensic pathologist

Sudden unexpected deaths in epileptic persons are not rare events, most commonly encountered by the forensic pathologist rather than the clinician. Such deaths may represent 1-1.5% of all "natural" deaths certified by the medical examiner or coroner. The typical victim is a black male about 30 years of age who tends to abuse alcohol, with a history of generalized epilepsy for more than 1 year and likely for more than 10 years. There are a lack of obvious anatomic causes for the death at autopsy, but 60-70% of cases will have a lesion in the brain (most commonly old trauma) to explain the epilepsy. Most victims have no blood levels of anticonvulsant medications at the time of death. We have evolved a form for use by medical examiner/coroner's investigators at the scene to collect relevant information which will be of assistance to the pathologist in interpreting the case. Estimated prevalence of sudden epilepsy death, mechanisms, and other features of such cases are reviewed briefly.     

Fatal hunting injuries in North Rhine-Westphalia

The investigation covers 14 fatal hunting accidents which occurred in North Rhine-Westphalia in the last 23 years, among them 13 firearm fatalities. All the accidents happened during the statutory hunting season reaching a peak in the main small game season. 86% of the persons causing the accidents and 73% of the victims were over 41 years and experienced hunters. 36% of the accidents were caused by the victims themselves. The fatal gunshot injuries were inflicted by rifle bullets in 7 cases (54%) and shotgun pellets in six cases (46%). No accidents were due to shotgun slugs or handgun ammunition. The main factors responsible for the fatalities were: covering the victim while swinging on the game (31%), failure to discharge the firearm while descending from the raised hide or transporting the weapon in vehicles (31%), mistaking the victim for game (15%), failure to discharge the weapon during a hunting break or while pressing down obstacles or careless handling of the weapon (23%). In no case was the accident caused by a defective weapon or ammunition. In conclusion aspects of preventing fatal hunting accidents are discussed.     

CRIMES, DISORDERS, AND THE DEMAND FOR HANDGUNS: An Empirical Analysis

In a recent paper, Bordua and Lizotte (1979) analyze determinants of firearm ownership using cross-sectional data for Illinois counties. Noting that firearms may be purchased for the purpose of sport, self-protection, or crime, they present clear evidence of sporting demand and limited evidence of defensive motives in the pattern of gun ownership. Crime rates are significant only in the equation explaining gun ownership by women (1979: 161). The purpose of the present article is to supplement the findings of Bordua and Lizotte and earlier empirical studies by focusing on the demand for handguns alone. In particular, the article analyzes the role of crime rates and fear of violence in motivating citizens to buy and keep handguns. For this purpose, aggregate time-series and cross-sectional data on handgun sales were collected and analyzed. Because handguns are durable pieces of equipment, it is necessary to use a model that distinguishes the stock of handguns at any one time from the rate of handgun purchases.