Multiple suicidal gunshots to the head

We report two cases of suicide by multiple gunshots to the head. The first victim (of two shots) fired the first shot, which was observed, into his mouth, leading to damage to the left optic nerve and frontal lobe. The man still was able to drive his car home, where he shot himself in his right temple. He died 2 days later. The second victim (of three shots) was a 58-year-old man who was found dead on his bed. Reconstruction of the case disclosed that the first shot had passed through his tongue and slightly damaged the second cervical vertebral body. He then shot himself in his right temple, leading to damage of the temporal lobe. Finally, he shot himself in his left temple, resulting in destruction of the pons. In the first case, an amateurishly modified 8-mm blank revolver firing 6.35-mm- (.25)-caliber ammunition was used; in the second case, a rifle firing 5.6-mm (.22)-caliber ammunition with a reduced charge was used. In both cases, low-energy transfer to brain tissue by the initial bullets was due to low bullet energy or due to the bullets' missing the brain or vital centers.     

Two simultaneous suicidal gunshots to the head with robbed police guns

The suicidal infliction of two gunshot wounds to the head represents a critical issue for medicolegal investigation. In principle, simultaneous infliction with two firearms or third parties' involvement, i.e. two consecutive gunshots, have to be considered. We report for the first time on a case of suicidal infliction of two simultaneous gunshots to the head (oral, temporal) with Action 4 expanding ammunition. A male had robbed two service guns and committed suicide thereafter under the influence of high-dose alcohol and cocaine. Interestingly, Action 4 ammunition had been used, leading to an uncommon gunshot wound morphology and extensive backspatter. At the scene, these findings caused confusion; moreover, the number of gunshot wounds was unclear, until autopsy revealed two gunshot wounds to the head, which had obviously been inflicted simultaneously. Expanding ammunition like QD-PEP and Action 4, used by several German federal state police forces, can cause an atypical gunshot wound morphology, most probably due to its peculiar deformation behaviour. Investigators should be careful when interpreting gunshot wound morphology at the scene after usage of such expanding ammunition. With regard to reconstruction in cases of two gunshot wounds to the head and two guns at the scene, two simultaneous gunshots should be taken into consideration.     

Backspatter on the firearm and hand in experimental close-range gunshots to the head

The deposition of backspatter on the firearm or person shooting can greatly assist the reconstruction of shooting incidents. Backspatter was investigated in experimental transverse gunshots (9-mm Luger) to the heads of calves (n = 9) from shooting distances of 0 to 10 cm. The firearms were examined with a magnifying glass; the surgical gloves and the right sleeve worn by the person shooting were examined with a stereomicroscope. On the firearms, backspatter of blood was found in five of the nine cases, and one or both gloves showed bloodspatter deposits in six and the right sleeves in four cases. Most droplets were 1 to 3 mm and circular or elongated. In addition, a fine spray of tiny blood deposits was present on the firearm and textiles in four cases. The distribution of the droplets on the firearms varied: the areas included regions shielded by prominent parts, and the droplets were predominantly located on the extensor side of the fingers and the radial aspect of the hands and sleeves. Backspatter of tiny bone fragments was recovered from the firearm and sleeve in only one case, but tissue (bone, fat, muscle, skin) was present on the ground in front of the entrance wound in seven cases. A careful investigation, including appropriate lightning and magnification, is necessary for reliable statements concerning the absence of backspatter or the extent of backspatter present.     

Multifactorial analysis of firearm wounds to the head with attention to anatomic location.

Firearm wounds to the head are often fatal and are routinely encountered in the practice of forensic pathology in the United States. Often, the anatomic site of the entrance wound is used to support or refute the manner of death indicated by the scene investigation and/or circumstances of the case. The present retrospective study of 120 fatalities resulting from 140 firearm wounds to the head correlates the anatomic region of the entrance wound and range of fire with the manner of death. Other demographic data analyzed include age, race, and gender of the decedents, as well as evidence of drug and/or ethanol use. It is hoped that this study will provide concrete data to support the largely anecdotal associations between the specific site of entry of firearm injuries to the head and the manner of death.     

Suicidal gunshot wounds to the head: a retrospective review of 406 cases

A retrospective review of 406 suicidal gunshot wounds to the head, investigated at the Medico-Legal Laboratory of Pretoria, between 1997 and 2000 was performed. Fifty-seven percent of fatal suicidal firearm injury to the head occurred in the 21- to 40-year age range in both male and female victims. Eighty-two percent of all these victims of suicidal firearm fatalities to the head were male. Of the 406 cases, 63% were white, 31% were black, and 6% were of mixed ethnic and/or Asian decent. There was a slight increase in incidence around spring and autumn. Handguns were used in the majority of cases with shoulder weapons being used in 18 of the 406 cases. Ninety-two percent of the suicidal gunshot wounds to the head occurred indoors. A positive blood alcohol concentration was seen in 40% of cases. Of those examined, 81% were contact gunshot wounds. The trajectory was upward in 51% of cases and horizontal in 24% of cases. The right temple was the most common entrance gunshot wound site. Findings are in keeping with previously published literature.     

Characteristics of gunshot wounds caused by the special forces shooting knife (NRS and NRS-2)

Gunshot wounds of skin and long cortical bones inflicted by the special intelligence knife (NRS and NRS-2: special silent cartridges SP-3 and SP-4) from different distances were examined. Stereomicroscopy, emission spectral analysis, contact-diffusion method and regression- step-by-step analysis were made use of within the case study. A lack of mechanical, thermal or chemical impact from firing gas and of fire soot as well as presence of particles of rubber, copper and sealing varnish, i.e. the most informative shot products, were found to be the main distinctive features in the said wounds. The data obtained can be used in the differential diagnosis of a type and model of the used gun.     

Multiple self-inflicted gunshot wounds to the head: report of a case and review of the literature

Multiple self-inflicted gunshot wounds to the head are rare and usually present a challenge to the pathologist and to the police in determining the manner of death. We report a case of two suicidal gunshot wounds to the head. The literature is reviewed, and the pertinent findings, including location of the wounds, location of the brain injuries, types of weapons used, and criteria important to determine the manner of death, are discussed.     

Early post-mortem animal bites after suicidal gunshot wound to the head of a police dog handler]

A 41-year-old police officer committed suicide in his office by firing a contact shot to the left temple. When the body was found 12 hours later, the German shepherd dog the officer had been in charge of had caused considerable damage on the lower half of the face and the adjacent parts of the neck. The clothing of the suicide was undamaged. Blood traces in the shape of paws were found at the place of death. The wound margins of the postmortem animal injury were nicked and jagged by the canine teeth. The entrance and exit wounds were not affected by the soft tissue defect. The findings gathered are discussed in reference to the relevant literature.     

Complex suicide by two gunshots to the chest and consecutive hanging: circumstances and aspects of reconstruction

In cases of suicidal gunshots, the capacity to act may be preserved for a certain period of time, so that the suicide may be completed with another method. In the presented case a 74-year-old man was found hanged on the first floor of his house with two gunshot wounds in the chest. Both on the ground and the upper floor traces of suicidal acts were detected. As shots to the precordial region suggest rapid incapacitation, a suicide extending over two floors seemed almost impossible without knowledge of the cause of death and evaluation of the ability to act. The autopsy findings confirmed vital signs of hanging. Moreover, a through-and-through gunshot wound of the chest and abdomen affecting the spleen and a shot lodged in the body without injuring the lung were found. The injury findings thus sufficiently explained the preserved ability to act. The presented case shows characteristics of a complex suicide not yet described so far, but could be clearly classified as suicide in congruity with the pertinent literature.     

Medicolegal aspects of witnessed suicide due to gunshot to the head. II. Legal medicine aspects and examination of the firing hand

The second part of the paper on suicides by gunshots to the head in the presence of witnesses focuses on relevant morphological autopsy findings such as entrance site, signs of close range or contact shots, bullet path etc. and also discusses selected aspects of ascertaining gunshot residues. For the identification of the shooter an integral medicolegal assessment of all the facts including the investigation results and the autopsy findings is essential. However, the morphological findings alone do not allow safe diagnosis, as for example in a homicide the temporal region, which was affected in all our cases, may have been deliberately chosen by the perpetrator as a localization typical of suicide. Thus methods to ascertain gunshot residues on the firing hand (by means of adhesive films and the polyvinyl-alcohol collection method--PVAL) are of great practical importance. In seven cases adhesive films and/or the polyvinyl-alcohol collection method were used. In one case the gunshot residues (GSR) were analysed by means of tape lifts and subsequent scanning electron microscopy (SEM). It was found that especially the combined application of topographical (adhesive tape/PVAL) and cumulative (SEM) methods allowed for the doubtless identification of the shooter, thus usually confirming the suicide. By the example of one case it is demonstrated that without the immediate collection of evidence at the scene objective reconstruction of the event becomes impossible. On the basis of the reported cases recommendations are finally given for a differentiated approach in the medicolegal evaluation of alleged witnessed suicide by gunshot (to the head).     

Gunshot wounds of the head in soldiers wearing military helmets-- general aspects and experiments and observations on the biomechanics and wound morphology

With respect to wound ballistics, the situation is different if the person wearing a military helmet suffers head injuries from a bullet. The mechanisms of injury were investigated in four experimental series and supplemented by a case history. The study showed surprising results: in the majority of cases, the helmet does not protect the wearer, but instead intensifies the damage caused by the bullet. The reasons for this phenomena are changes in the stability of the projectile and deformation of or damage to the bullet. All of these mechanisms result in the bullet striking the tissue with higher energy. In this investigation, Kevlar helmets were also tested, which are not penetrated by 9 X 19 mm parabellum bullets. Even so, however, severe injuries of the skull and brain can occur because the projectile causes intensified impressions on the skull under the helmet and, in addition, an acceleration of the head.     

Variation of the chemical contents and morphology of gunshot residue in the surroundings of the shooting pistol as a potential contribution to a shooting incidence reconstruction

A study of the chemical contents and sizes of gunshot residue originating from 9×18mm PM ammunition, depositing in the vicinity of the shooting person was performed by means of scanning electron microscopy and energy dispersive X-ray spectrometry. Samples of the residue were collected from targets placed at various distances in the range 0-100cm as well as from hands and clothing of the shooting person. Targets were covered by fragments of white cotton fabric or black bovine leather. In the case of cotton targets microtraces were collected from circles of 5 and 10cm in radius. Results of the examinations in the form of numbers of particles, proportions of their chemical classes and dimensions revealed a dependence on the distance from the gun muzzle, both in the direction of shooting and in the opposite one, i.e., on the shooting person. The parameters describing gunshot residue differed also depending on the kind of the target substrate. The kind of obtained information gives rise to understanding the general rules of the dispersion of gunshot residue in the surroundings of the shooting gun. Thus, it may be utilised in the reconstruction of shooting incidences, especially in establishing the mutual positions of the shooter and other participants of the incident.     

Homicidal and suicidal sharp force fatalities in Stockholm,Sweden.: Orientation of entrance wounds in stabs gives information in the classification

A comparative study of 174 homicidal and 105 suicidal sharp force deaths in the Stockholm area is presented in order to identify variables of importance in the differentiation between homicides and suicides. In homicides, a significantly (p<0.05) higher number of cut and stab wounds were seen in the head, upper and lower extremities and a significantly higher number of vertical stab wounds were found in the chest. Lower numbers were seen in the wrist and the crook of the arm. When counting the injured areas, irrespective of the number of injuries, abdominal wounds and horizontal chest stab wounds were also significantly more often found in victims of homicide. Injuries to the back and to the genitals were not seen in suicides. The suicide victims were significantly older and had significantly lower blood alcohol levels. A new variable pointing at a statistically significant difference between homicides and suicides was found: In homicides, stab wounds with a horizontal axis of entrance wound in the chest was found to be less common than those with a vertical axis. Other variables studied were prevalence of defence and tentative wounds, farewell notes and suicidal ideation, earlier parasuicides, venue, gender of the victims and the types of sharp objects used.     

Assessment of shooting distance on the basis of bloodstain analysis and histological examinations

A 28-year-old man was shot using a pump-gun. The main question to be resolved was whether the biological stain pattern on the suspect's trousers, and in particular the bloodstains, can provide evidence to assess the shooting distance between the suspect and the position of the victim's body. The biological stain pattern (i.e. bloodstains and brain tissue) showed backspatters from the shot entrance wound on the back of the head, while the victim was lying face down and the suspect was standing close behind his head.     

Carrying the misery to adulthood: the impact of childhood sexual abuse on adulthood impulse control through depression and suicidal thoughts

Childhood sexual abuse (CSA) has been linked to a wide range of negative outcomes, including the development of low impulse control in adulthood. Because previous studies have identified impulsivity as a robust predictor of antisocial and criminal behaviors, CSA may be an important early-in-life risk factor to consider. But the pathway between CSA and impulsivity is not well understood. Research suggests CSA is an important predictor of various forms of psychopathology, such as depression and suicidal thoughts. Pulling this all together, we investigated the possibility that CSA impacts depression and suicidal thoughts and that those experiences go on to affect the development and manifestation of impulse control in adulthood. We drew on a nationally representative sample of adolescents and adults (Add Health) to test the pathways by which CSA might affect impulse control. We found that CSA negatively influences impulse control, and that depression and suicidal thoughts may mediate this relationship. Our findings highlight the importance of trauma-oriented interventions for survivors of CSA – on top of their other benefits, such interventions may have an influence on the development of impulse control later in life.     

Retrograde transthoracic venous bullet embolism. Report of a case following a single gunshot with multiple wounds in the left arm and chest

Bullet embolism of the arterial, venous and paradoxical types are well known but rare complications of penetrating missile injuries. Retrograde transthoracic venous bullet embolization is extremely rare with only four cases previously reported in the literature. Single gunshot can cause multiple wounds, mainly because the bullet passes through an intermediate target before striking the victim. We present the autopsy findings of a retrograde transthoracic bullet embolism to the right external iliac vein after a single gunshot with multiple wounds in the left arm and thorax. Problems related to medico-legal investigations of gunshots are reviewed.