Medical examiner response to the drug overdose epidemic in King County Washington: “Real-time” surveillance,data science,and applied forensic epidemiology

As the overdose epidemic overwhelmed medicolegal death investigation offices and toxicology laboratories, the King County Medical Examiner's Office responded with “real-time” fatal overdose surveillance to expedite death certification and information dissemination through assembling a team including a dedicated medicolegal death investigator, an information coordinator, and student interns. In-house testing of blood, urine, and drug evidence from scenes was performed using equipment and supplies purchased for surveillance. Collaboration with state laboratories allowed validation. Applied forensic epidemiology accelerated data dissemination. From 2010 to 2022, the epidemic claimed 5815 lives in King County; the last 4 years accounted for 47% of those deaths. After initiating the surveillance project, in-house testing was performed on blood from 2836 decedents, urine from 2807, and 4238 drug evidence items from 1775 death scenes. Time to complete death certificates decreased from weeks to months to hours to days. Overdose-specific information was distributed weekly to a network of law enforcement and public health agencies. As the surveillance project tracked the epidemic, fentanyl and methamphetamine became dominant and were associated with other indicators of social deterioration. In 2022, fentanyl was involved in 68% of 1021 overdose deaths. Homeless deaths increased sixfold; in 2022, 67% of 311 homeless deaths were due to overdose; fentanyl was involved in 49% and methamphetamine in 44%. Homicides increased 250%; in 2021, methamphetamine was positive in 35% of 149 homicides. The results are relevant to the value of rapid surveillance, its impact on standard operations, selection of cases requiring autopsy, and collaboration with other agencies in overdose prevention.     

Do bone elasticity and postmortem interval affect forensic fractographic analyses?

Forensic fractographic features of bone reliably establish crack propagation in perimortem injuries. We investigated if similar fracture surface features characterize postmortem fractures. Experimentally induced peri- and postmortem fractures were used to assess if fractographic features vary as bone elasticity decreases during the postmortem interval (PMI). Thirty-seven unembalmed, defleshed human femoral shafts from males and females aged 33–81 years were fractured at varying PMIs with a drop test frame using a three-point bending setup and recorded with a high-speed camera. Vital statistics, cause of death, PMI length, temperature, humidity, collagen percentage, water loss, fracture energy, and fractography scores were recorded for each sample. Results showed that fractographic features associated with perimortem fractures were expressed in PMIs up to 40,600 accumulated degree hours (ADH), or 60 warm weather days. Hackle was the most consistently expressed feature, occurring in all fractures regardless of ADH. The most variable characteristics were wake features (78.4%) and arrest ridges (70.3%). Collagen percentage did not correlate strongly with ADH (r = −0.04, p = 0.81); however, there was a strong significant correlation between ADH and water loss (r = 0.74, p < 0.001). Multinomial logistic regression showed no association between fractographic feature expression and ADH or collagen percentage. In conclusion, forensic fractographic features reliably determine initiation and directionality of crack propagation in experimentally induced PMIs up to 40,600 ADH, demonstrating the utility of this method into the recent postmortem interval. This expression of reliable fractographic features throughout the early PMI intimates these characteristics may not be useful standalone features for discerning peri- versus postmortem fractures.     

2,4,6-Tri(2′-pyridyl)-1,3,5-triazine for determination of iron(II), Iron(III), and total iron contents on human palms

When iron-based tools, such as knives or guns, are held, traces of iron can transfer to the skin. However, no previous studies have been published regarding the effect of the elapsed contact time on the transfer of iron species with different valences to the palm. Compared with 3-(2-pyridyl)-5,6-diphenyl-1,2,4-triazine (PDT), 2,4,6-tri(2′-pyridyl)-1,3,5-triazine (TPTZ) was found to exhibit a higher sensitivity to iron(II) spectrophotometrically. This work employed 2,4,6-tri(2′-pyridyl)-1,3,5-triazine (TPTZ) and UV spectrophotometry to determine the amounts of iron(II), iron(III), and total iron transferred to human palms from iron tools. It was found that the palmar moisture level was an important factor in determining the amounts of total iron, including iron(II), transferred to the palm. For identical contact times, the amounts of total iron transferred to the palm was proportional to the palmar moisture, and the difference between the maximum and minimum amounts was 12 μg per hand. However, the amounts of iron(II) transferred to the palm gradually decreased over time for low palmar moisture levels, but steadily increased over time for high palmar moisture levels. Additionally, for average levels of palm moisture, the amounts of iron(II) and iron(III) transferred to the palm gradually decreased and increased, respectively, with longer contact times. Notably, this research could serve as a theoretical basis and guide for the detection of trace iron species with different valences on human palms for criminal investigations.