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.     

Deaths in custody. Atlanta City Jail and Fulton County Jail, 1974-1985

A total of 53 in-custody deaths that occurred in Atlanta-Fulton County, Georgia, between 1974 and 1985 are reviewed. Custody deaths showed characteristics similar to those described in other geographical areas. The majority of deaths were due to natural causes, about one-fourth were suicides, and homicides were rare. For jails that housed a daily population of about 1,000 prisoners, an average of 4.4 deaths were observed annually. Men predominated, and racial makeup paralleled the general prison population. Seizures, alcohol-related illness, and cardiovascular disease caused over half of the natural deaths. All suicides were accomplished by hanging. Over two-thirds of the incidents that led to death occurred in the prisoner's cell, and about one-half of the victims were found dead in their cells. Two-thirds of those who died in custody had been arrested for crimes in which persons were not harmed, while nearly two-thirds of those committing suicide had been arrested for crimes against persons. Deaths in custody are expected events, and familiarity with the circumstances under which they occur should be helpful in enabling prison managers to establish policies and procedures to minimize their occurrence.     

Deaths among criminal suspects, law enforcement officers, civilians, and prison inmates: a coroner-based study

During the interaction between a criminal suspect and a law enforcement officer, the risk of death to the suspect, police, or civilians is increased. Unfortunately, very little information is available on the death risks arising from this interaction. This study provides an assessment of the risk of death to law enforcement officers, suspects, and bystanders by separating the interactions into the following 4 phases: (1) events prior to and during arrest; (2) police pursuits or chases; (3) transport of the suspects; and (4) during incarceration. A 5-year (1994-1998) retrospective coroner-based study of all deaths that occurred during these 4 phases was conducted in Allegheny County, Pennsylvania. A total of 77 cases were identified; 14 deaths (18.1%) occurred prior to or during arrest, 10 (12.9%) during police chases, 2 (2.6%) occurred while the actors were being transported, and 51 (66.2%) during incarceration. The majority of cases (98.7%) were males, blacks (63.6%), and single (50.6%). The respective risks of death by phase were prearrest/arrest, 6.5 per 100,000 arrests; transport, 0.93 deaths per 100,000 arrests; and incarceration, 268 deaths per 100,000 inmates. Study showed the following: (1) risk of death to offenders was greatest during police pursuits; (2) the risks during arrests are not insignificant and involved an officer being threatened with a weapon in one-third of the events; and (3) deaths among inmates were primarily due to natural causes.     

Adolescent suicide. A review of 87 cases of completed suicide in Shelby County, Tennessee

Suicide among adolescents is reported to be on the increase recently, and much attention from the news media to medical circles has been focused on this problem. This paper presents a comprehensive study of 87 completed adolescent suicides occurring between January 1, 1970, and January 31, 1985, in Shelby County, Tennessee. Factors including age, sex, race, and manner of death are examined as well as psychological, sociological, familial, and other environmental influences related to the deaths. In our series, the older white male adolescent dominated the statistics by far, and the most frequent mode of death was by firearm injury to the head. A brief discussion of studies related to suicide in general, and especially to adolescent suicide, is included.     

Deaths in police custody in England and Wales

Worldwide deaths in police custody are causing public disquiet. An account is given of all the deaths occurring in police custody in England and Wales over a ten-year period from 1970 – 1979 with details of the causes of death and inquest verdicts.     

Police custody: deaths and medical attention

Information was obtained from all the county constabularies regarding deaths and medical attention given to those in police custody. It was presumed that this information covered all deaths in custody in Denmark during the period 1981 through 1985. There is no apparent increase in the absolute number of deaths during detention during the period 1969 through 1985. The number of deaths occurring in custody in relation to the annual number of persons incarcerated has fallen during the period 1955 through 1985. Simultaneously, a marked rise has occurred in the number of persons held in police custody. During the period 1981 through 1985, 7.9 persons were incarcerated per 1000 population per year. One homicide and nineteen other deaths occurred. The most frequent cause of death was asphyxiation as a result of aspiration of gastric contents during alcohol intoxication, drug poisoning, and intracranial hemorrhage. A physician had been consulted but had not diagnosed the seriousness of the condition in 42% of the deaths. All the deceased were men, and all suffered from the effects of social, psychiatric, and physical diseases. The lethality evaluated from hospitalized clients with the same type of life-threatening conditions was found to be 25%. A discussion is presented of the costs which will be incurred if a large group of those kept in police custody were admitted to hospital. Similarly, changes in the present arrangements are suggested that could ensure a greater certainty of avoiding deaths in detention.     

Investigation of elderly deaths in nursing homes by the medical examiner over a year

Despite death being one of the most common reasons for discharge from a nursing home, fewer than 1% of nursing home resident deaths are autopsied. To evaluate our role as medical examiner in nursing home deaths, we conducted a retrospective review of all decedents in Jefferson County, Alabama, for the year 2001. Death certificate data indicate that 995 deaths occurred in nursing homes in Jefferson County in 2001. Of those 995 deaths, 119 (12%) were reported to the Jefferson County Coroner/Medical Examiner Office. Jurisdiction was accepted in 5 cases in which the circumstances already made clear that the death was a nonnatural event. In the remaining 96% of nursing home deaths reported to the medical examiner, the statements of the reporting person were taken to be true concerning the expected nature of the death. An independent scene evaluation was provided by a police officer or paramedic in 82% of the cases reported to the medical examiner's office. Elderly individuals, as a group, are expected to die, but the death of a particular elder may or may not be expected. In our jurisdiction, only 12% of all nursing home deaths are reported to our office, and only 4% of reported deaths are actively investigated. Actively investigating each nursing home death would overwhelm the resources currently available to our office. We advocate the study and development of criteria to aid in determining whether the death of an individual elder is sudden and unexpected.     

So-called accidental firearm fatalities in children and teenagers in Tennessee, 1961-1988.

Tennessee State medical examiner reports of firearm fatalities classified as accidents involving victims aged 19 year or less from 1961 through 1988, were reviewed to evaluate circumstantial and contributing factors. A total of 225 were analyzed. The peak age for victims was 17 years, and there were more than five times more male than female victims. In Shelby County (Memphis), the racial distribution of fatalities was approximately that of the general population. Playing with a gun was the most frequent circumstance. The person responsible for pulling the trigger was equally likely to be a friend, a family member, or the victim. Head or neck were injured in most cases. The urban mortality rate was nearly twice that of the rural rate. More than half of the deaths in urban counties occurred indoors and involved handguns, whereas in rural counties only a third were due to handguns and the location was more often outdoors. Deaths in rural counties showed a seasonal variation that corresponded with the hunting season; by contrast, a peak in early summer was noted in the urban deaths. Defective guns or guns unsafe in design caused several deaths. (Semiautomatic pistols, which can be fired after unloading the ammunition magazine, are conspicuous examples of guns unsafe in design.) An important observation of this study is that medical examiners vary considerably in their classification of accidental manner, particularly when children are involved. Furthermore, medical examiner reports need to include much more information than is currently recorded if they are to be useful in guiding public policy to reduce firearm injuries.     

A 10-year epidemiologic review of homicide cases in children younger than 5 years in Fulton County, GA: 1996-2005

The primary purpose of this study was to present the epidemiologic review of homicide deaths certified by the Fulton County Medical Examiner's Office from January 1, 1996 through December 31, 2005 in children younger than 5 years. The secondary purpose of this study was to determine if the observed cases of homicide deaths among children younger than 5 years in Fulton County are significantly greater than expected when compared with those in the State of Georgia. For purposes of this study, only homicide deaths of Fulton County residents were included. The authors reviewed all homicide cases in children younger than 5 years: infancy (<1 year) and early childhood (1-4 years). χ values were calculated using Epi Info (version 3.4.1; Centers for Disease Control and Prevention, Atlanta, Ga) to determine differences in homicide among age group, race, and sex variables. In addition, a χ test at the α level of 0.05 was done to determine if the observed cases of homicide deaths among children younger than 5 years in Fulton County were significantly greater than expected when compared with those in the State of Georgia. There were 49 homicide cases in children younger than 5 years identified over this 10-year period. The yearly distribution of these 49 homicide deaths ranged from 1 death in 2003 to 9 deaths in 2004. Most of the patients were male (n=29, 59.2%) and black (n=44, 89.8%). Between infancy and early childhood cases, homicide victims were nearly equally divided between the 2 groups. However, χ values showed that decedents younger than 5 years are more likely to have died of homicide compared with decedents 5 years or older (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.29-2.35). Black decedents younger than 5 years are more likely to have died of homicide compared with other races (OR, 3.21; 95% CI, 1.21-9.28). Male and female decedents are equally at risk to have died of homicide (OR, 1.14; 95% CI, 0.61-2.11). The authors also determined that the total homicide risk for children younger than 5 years in Fulton County during the years 1996 to 2005, at the α level of 0.05, is 1.8 relative to the state. Brain injury was the primary cause of death in most cases (n=23, 46.9%). Although this study was unable to collect information on the victim's suspect/offender characteristics, it was noted that only 37% of the cases (n=18) went to trial. Most homicide investigations were under the Atlanta police jurisdiction (n=28, 57.1%). Results from this study may assist local and state government officials in recognizing the epidemiologic characteristics of children at risk to help them allocate limited resources efficiently and implement preventive measures to at-risk populations effectively.     

Carbon monoxide-related deaths in a metropolitan county in the USA: an 11-year study

Carbon monoxide (CO) poisoning as a cause of death is well documented in industrialized countries. The objective of this study was to compare demographic data in deaths due to accidents (in fires) and suicides in the same population between 1988 and 1998. Furthermore, the potential effect of a community wide education effort regarding safety in the home was assessed. Postmortem reports were reviewed for all deaths examined at the Office of the Cuyahoga County Coroner in Cleveland, OH, USA. During the study period, there were 209 accidental deaths due to fires in the home (6.5% of all accidents in the home) and 182 CO deaths by suicide (9.8% of all suicides). Demographic characteristics of the two groups differed: while males represented the majority of cases in both groups (55% of accidents, 70% suicides), race specific death rates were higher for whites than blacks (18/100,000 white, 3/100,000 black) in suicides compared with 29/100,000 deaths for blacks and 11/100,000 for whites in accidental cases. Fire deaths were prevalent in the young (0-9 years) and old (>60) whereas in the suicide group the age specific death rate was highest for those over 70 years. The majority of fire deaths occurred in the city of Cleveland but suicides were prevalent in the suburbs. More fire deaths occurred in December than any other month whereas more suicides occurred in April. In 1992, there was a community wide effort to provide free smoke detectors to residents in Cleveland. In 1992, there were 4.2/100,000 fire deaths in the city. This decreased to 0.6/100,000 in 1996, increased to 1.2/100,000 in 1997 followed by a decrease to 0.8/100,000 in 1998. This suggested that the program may have aided in decreasing these types of deaths. Deaths due to fires in the suburbs were <1/100,000 throughout the study period.     

The descriptive epidemiology of unnatural deaths in Oregon's state institutions: a 25-year (1963-1987) study. III. A 25-year overview of unnatural deaths in the mental and correctional facilities.

I document 25 consecutive years (1963-1987) of unnatural deaths within the State of Oregon's mental and correctional institutions in Marion County. This study includes 93 unnatural deaths in the Oregon State Hospital, 18 in the Forensic Psychiatric Program, 52 in the Fairview Training Center, and 45 in the Corrections Department facilities. These institutional unnatural deaths are compared with the 2,618 unnatural deaths that occurred during this same period in Marion County (exclusive of these state facilities). Death rates are shown in five 5-year blocks of time to illustrate death trends. Accidents and suicides were the predominant types of unnatural death in the Oregon State Hospital; suicides predominated in the Forensic Psychiatric Program and the corrections facilities; and accidents predominated in the Fairview Training Center. Extremely high total unnatural death rates were found in the Oregon State Hospital (approximately 520/100,000 or 8.46 times that found in Marion County) and the Forensic Psychiatric Program (approximately 561/100,000 or 9.13 times that found in Marion County). The overall accident death rate for the Fairview Training Center was approximately 119/100,000 or 2.84 times that found in Marion County. The overall total unnatural death rate for the corrections facilities was approximately 75/100,000 or 1.23 times that found in Marion County. I compare these data with those of other investigators in the United States, Canada, and western Europe. The total unnatural death rate appears to represent a valid criterion of violent death within a community.     

Fatal positional asphyxia associated with rollover crashes

Motor vehicle rollover crashes result in complex occupant kinematics with the potential for severe injury. Five cases of fatal asphyxia in occupants suspended from their safety belt upside down after a rollover crash are presented. These fatalities accounted for 13.5% of all motor vehicle related asphyxia deaths in San Diego County over a 10-year period. This study supports previous research noting that incapacitation due to other injuries, alcohol, or obesity may be associated with fatal positional asphyxia due to inversion during rollovers. Safety belts are proven to prevent serious injury in motor vehicle crashes and should always be worn. However, redesign of the buckle could be considered to permit easier release by an occupant. We also suggest that pre-existing heart disease may contribute to the possibility of a fatal asphyxia outcome. Although this is a rare cause of motor vehicle related death, our results suggest that these are potentially preventable deaths.     

63例监管场所非暴力性死亡的法医学分析

目的通过收集监管场所非暴力性死亡的案例,分析其法医学特点和相关影响因素。方法收集某鉴定中心2000—2015年间所受理的监管场所在押人员非暴力性死亡案例63例,对其致死性疾病的类型、发病季节、既往病史、临床表现、处理措施及病程进行回顾性分析。结果监管场所因病死亡者以男性居多,高发于中青年人群;主要致死性疾病以心源性死亡居于首位(50.8%),慢性炎性疾病包括胃肠道穿孔、肺结核病、肺炎、肝炎和胰腺炎等数量也较多。夏季是发病高峰,猝然发作的症状为睡眠中急骤发病、突然晕倒,慢性起病的以呕吐、腹痛、乏力、胸闷、气短、发热、纳差等最为常见。结论监管场所的管理制度、监管场所条件、医疗水平和相关知识等仍有改善空间,进行鉴定时需注意健康资料收集、尸体解剖、组织学检查和毒物检验等。     

Hypothermia-related Deaths: A 10-year Retrospective Study of Two Major Metropolitan Cities in the United States*

Hypothermia-related deaths affect vulnerable populations and are preventable. They account for the vast majority of weather-related deaths in the United States. The postmortem diagnosis of hypothermia can be challenging, as there are no pathognomonic signs. The electronic databases of the New York City Office of Chief Medical Examiner and Harris County Institute of Forensic Sciences were searched for all fatalities where the primary cause of death included hypothermia, between January 2009 and July 2019. There were 139 hypothermia deaths in New York City (NYC) with an average annualized rate of 1.7 per million. During this same time, there were 50 hypothermia deaths in Houston with an average annualized rate of 2.4 per million. Males were more likely to die of hypothermia compared to females in both cities. The rate ratio (RR) in NYC was 3.55 (95% CI 2.40, 5.25), while the RR in Houston was 2.83 (95% CI 1.50, 5.32). Age- and sex-specific standardized hypothermia mortality rates were 18.2 (95% CI 15.1, 21.2) per million in NYC and 30.1 (95% CI 21.7, 38.6) per million in Houston. The comparative hypothermia death ratio was 1.66 (95% CI 1.19, 2.30), indicating hypothermia mortality in Houston was 66% higher than in NYC. There was no correlation between zip code poverty rates and hypothermia-related deaths. The most consistent autopsy finding was Wischnewski spots (56.6%), and ethanol was the most common toxicological finding (36.5%). Local agencies can use this data to target these higher-risk populations and offer appropriate interventions to try to prevent these deaths.     

监管场所25例非正常死亡的法医学分析

目的通过对监管场所非正常死亡案例进行筛选、收集,分析其影响因素及法医学特点。方法收集某鉴定中心2000—2015年间受理的监管场所在押人员非正常死亡案例25例,从性别、年龄、历年发案数、死亡原因、死亡方式等方面分析其特征,并对公安类监管场所和监狱类场所的案件性质进行对比。结果涉案死者均为男性,中青年人群为高危人群,历年发案数量呈逐年下降趋势。公安类监管场所的伤害案件发生率(64.7%)大于监狱类场所(12.5%),而监狱类场所的自杀率(62.5%)高于公安类(23.5%)。死亡原因以损伤和窒息为主,其他还有中毒和电击等。结论监管场所非正常死亡案件暴露出执法不规范、监管有漏洞、医疗水平差等问题。进行全面、细致的尸体解剖对于查明此类案件的死因有重要意义。     

Causes and consequences of juvenile crime and violence: Public attitudes and question-order effect

This article examines issues in juvenile justice that include public opinion about the causes and the consequences of juvenile crime and violence. Data for the study were collected in 1996 by means of a telephone survey of 492 respondents from Shelby County, Tennessee. The study explores the relationships between attitudes about juvenile crime and sociodemographic factors. Results are consistent with national surveys aimed at assessing public attitudes toward issues in juvenile justice. Finally, the article discusses how survey instrumentation may influence responses regarding the issues surrounding juvenile crime and violence.     

Deaths associated with choking in San Diego county

Death from choking is the fourth most common cause of unintentional-injury mortality, but little data are published on causes or locations of these episodes. These deaths typically are peaked at the extremes of age, with young children and the elderly having the greatest rate of fatal choking. Our objective was to characterize the causes of fatal airway obstruction in adults. The San Diego County Medical Examiner's database was searched for deaths attributed to choking in decedents 18 years and older during the 10-year period from 1994 to 2004. Data were abstracted regarding the underlying medical conditions, items choked on, location of the choking, and treatments involved in the individual cases. We found 133 victims who died from choking, with 14% having using alcohol or other sedatives and 55% having a documented neurological deficit or anatomic difficulty with swallowing. The most common specified food objects that victims choked on were meat products, and 45% occurred at home, followed by 26% at supervised facilities, and 14% at restaurants. Of the 19 choking episodes occurring in restaurants, only one employee was documented to attempt a resuscitative effort. Most victims who choked to death had an underlying neurological deficit, and occurred at home or supervised facilities appear to have an appropriate initial-response intervention.     

Nursing home deaths which fall under the jurisdiction of the coroner: an 11-year retrospective study

Twenty percent of deaths in the United States occur in nursing homes, yet less than 1% come to autopsy. The current study analyzed causes and manners of death in all nursing homes between 1993 and 2003, investigated by the coroner of Allegheny County, PA, which has the second highest elderly population in the United States. Two hundred eight decedents were identified, aged 19 to 91 years, 58% women and 42% men, 88% Caucasian and 22% African-American. Fifty-eight percent were accidental and 38.5% were natural manners of death, with 2 homicides, 2 suicides, and 3 undetermined cases. The manner of death was significantly different between Caucasians and African-Americans, with 92.6% of accidental deaths occurring in Caucasians and 6.6% in African-Americans (P < 0.1). Most common natural deaths were arteriosclerotic cardiovascular disease, nonarteriosclerotic cardiovascular disease, pneumonia, pulmonary thromboembolism, chronic obstructive pulmonary disease (COPD), seizure disorder, and atraumatic intracranial hemorrhage. Blunt force trauma was the single most commonly identified traumatic accidental death. Accidental deaths were more common in Caucasians than African-Americans. Homicides and suicides were rare events (<2%). Blunt force trauma is a major autopsy finding in accidental nursing home deaths, and a root-cause analysis may be helpful in developing policies and procedures to decrease the incidence of blunt force trauma.     

Deaths in Unlicensed Alcohol Rehabilitation Facilities,

Non‐English‐speaking people do not always seek medical care through established institutions. This paper reports a series of deaths in unlicensed alcohol rehabilitation facilities serving Spanish‐speaking men. These facilities are informal groups of alcohol abusing men who live together. New members receive various treatments, including administration of ethanol or isopropanol, restraint, and seclusion. We reviewed 42 deaths in unlicensed alcohol rehabilitation facilities in Los Angeles County during the years 2003–2014. Data gathered included age, length of time spent in the facility, blood alcohol and drugs at autopsy, and cause and manner of death. Causes of death included acute alcohol poisoning, alcohol withdrawal, and a variety of other causes. Three cases were considered homicides from restraint asphyxia. The Department of Medical Examiner‐Coroner has worked with the police, district attorney, and State Department of Health Services to try to prevent additional deaths in unlicensed alcohol rehabilitation facilities. Nevertheless, prevention has been difficult.