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.     

Piercing the surface: A mechanical analysis of stabbing with household tools

Estimating the applied power during a stabbing incident, or estimating the minimal force necessary to penetrate the body with a certain weapon is a challenging task in forensic practice. A thorough forensic evaluation of stabbing forces needs objective numerical experimental data. Stabbing tests of 12 different weapons – including knives, a pair of scissors, a fork, screwdrivers, a rasp, a corkscrew, and a utility knife blade – were performed with a Mecmesin MultiTest-dV material tester on pork loin and ballistic gel to estimate the stabbing forces and dynamics. Penetration force (F_p) and maximal force (F_max) were recorded, and the registered force curves were analyzed. F_max was 159.8–212.07 Newton (N), 30.56–30.58 N, 168.9–185.48 N for various knives; 171.39–190.43 N for the pair of scissors, 233.6 N for the fork; 532.65–562.65 N, 370.31–367.19 N and 314.51–432.89 N for various screwdrivers, 44.14–56.62 N for utility knife during pork loin stabbing. The butter knife, corkscrew and rasp were not able to penetrate the pork loin, and the curved fork bent during stabbing. The results prove that weapon characteristics greatly influence the force necessary for penetration. Maximal stabbing force depends mostly on tip sharpness, and the force sharply decreases after penetration occurs, which indicates that edge sharpness is not as important as tip characteristics during stabbing perpendicular to skin surface. The penetration force during stabbing with a pair of scissors is comparable to the penetration force of knives. Stabbing with screwdrivers generally needs larger force than average knives but depends greatly on screwdriver size.     

Fatal exsanguination following complete transection of femoral vessels due to angle grinder injury in an industrial accident

Angle grinders are one of the most dangerous and frequently used tools in industrial settings. Angle grinder injuries range from superficial cuts to deep penetrating injuries with underlying fracture-dislocation and vascular trauma. The injuries caused by angle grinders mostly involve the head, face, or upper limbs, while the lower limb is an unusual site. The high-speed rotating disc of the angle grinders does not respect anatomical boundaries or structures; therefore, the injuries caused may be disfiguring, permanently incapacitating, or even fatal. We report a fatal case of an angle grinder injury to the lower limb. The victim sustained a sharp cut over the left thigh while woodworking in an industrial setup. The rotating disc of an angle grinder had transected the skin, subcutaneous fat and muscles, and both the femoral vessels of the left side, which led to fatal exsanguination within 10 min of the incident.     

The role of alternative hypotheses in reducing bias in forensic medical experts’ decision making

Medical opinions are often essential evidence in criminal cases but relatively little is known about the factors that impact forensic doctors’ decision making. This research examines the role and impact of having an alternative hypothesis while forming a medical opinion. A scenario-based experiment with forensic doctors (n = 20) was conducted. In two out of three scenarios, the existence of alternative hypotheses impacted the actual opinions reached, the confidence in the judgments and the perceived consistency with the plaintiff hypothesis. Investigative and legal actors should be aware of the possibility of biases and importance of having alternative hypotheses when requesting and evaluating medical opinions.     

A Retrospective Demographic and Clinicopathologic Review of Deaths Resulting from Minefield Explosions During Migrants’ Attempts to Enter Greece from Turkey Between 1997 and 2008

Until 2008, the easternmost land borders of the European Union (Greek‐Turkish land zone) were planted with minefields spanning 11 km. Therefore, numerous fatalities occurred in peacetime as migrants attempted to avoid Greek border checks. Numerous fatal incidents (51) were detected inside the Greek minefields between 1997 and 2008. Determination of age, sex, time of death, and nationality were evaluated in every case. The injuries’ anatomical dispersion, their severity, and the mechanism of death were examined in relation to the victims’ position at the moment of the explosion. Data research indicated that all victims were male, aged 18–30 in their majority, crossing border minefields mainly during the night. Their distance and position in relation to the point of detonation was a key factor in the trauma localization and severity. This review highlights the devastating consequences of the residual mines during peacetime, a situation that continues to be a persistent international problem.     

One Hundred and One Cases of Plastic Bag Suffocation in the Milan Area Between 1993 and 2013—Correlations,Circumstances, Pathological and Forensic Evidences and Literature Review

Plastic Bag Suffocation is a rare cause of death in developed countries and almost unknown in the rest of the world. This study aims to retrospectively evaluate cases of PBS _asphyxia in Milan's Department of Legal Medicine from 1993 to 2013. Cases were selected from the database of 21,472 autopsies performed in the considered timeframe. One hundred and one cases were considered to be cases of Plastic Bag Suffocation, comprised of 100 suicides, no accidental events and 1 homicide. The most relevant elements pertaining to this type of death were evaluated for both the corpses and the crime scenes. From this study the typical PBS victim is an adult male, aged 52.3 years on average, depressed or afflicted by chronic or terminal diseases, and found at home. In 42.6% of cases, the victims were found with the plastic bag still positioned over their head, fastened by tying. Also common among these cases are drugs, alcohol and chemical abuses. According to the collected data, it is impossible to outline a pathognomonic detrimental background that leads to this cause of death. Crime scene investigation is, therefore, the one and only technical resource for evaluating these cases.     

Suicide by Shotgun in Southeastern Minnesota

Suicide by shotgun is a common method of suicide with high regional variation. We sought to describe their distinct, challenging features and provide demographic and risk characteristics. We reviewed 228 gunshot wounds autopsied at Mayo Clinic from 1994 to 2014; of these, 75 (32.9%) were shotgun wounds. All were suicides and contact range. Ages ranged from 14 to 92 years old; of these, 97% were men. The majority involved the head (70.9%), were intraoral (48.2%), and had upward (73.2%) and backward (73.2%) directionality. Next most common was the chest (21.5%), with backward (94.1%) and downward (64.7%) directionality. Four involved multiple wounds. Wadding was recovered in 16 (21.3%) cases. Six (8.0%) had a survival period. Most (66.7%) took place at home. Seventy‐one percent had a known psychiatric history; 32.4% had positive toxicology. Although contact range shotgun wounds cause severe destruction, entrance wound and other characteristic are identifiable with thorough scene, autopsy, and radiographic documentation.     

实验大鼠胃Kappa-阿片受体与死亡时间的相关性

目的研究实验大鼠餐后死亡不同时间段的胃主细胞Kappa-阿片受体(KOR)的表达变化。探讨其变化、表达规律与死亡时间(PMI)的相关性。方法实验雄性大鼠,随机分为对照组和实验组,进食后断颈处死后于不同时间提取组织检材,对组织进行免疫组织化学染色,采用图像分析软件测定阳性面积、积分光密度、平均光密度、平均灰度等参数,用SPSS统计软件对各参数与死亡时间的关系进行相关性分析。结果死后9d内的胃主细胞上Kappa-阿片受体随着死亡时间(PMI)的延长,其积分光密度和阳性面积与死亡时间(PMI)存在一定的相关回归关系。结论实验大鼠死后胃主细胞上Kappa-阿片受体的变化规律与死亡时间有相关性。     

Petechial Hemorrhages and Ethanol in Deaths from Intoxication

Petechiae in conjunctivae and in the palpebrae/skin of the eyelids are of particular interest for the forensic pathologist, because of their association with pressure on the neck. They have been described in the eyelids of intoxicated persons both in case reports and in text books of forensic pathology. We studied 590 deaths caused by intoxication, and 75 had petechiae either in the conjunctivae, the eyelids, or in both locations. We examined the influence of drugs and ethanol on the location of the petechial hemorrhages in these deaths. Deaths with ethanol in blood and in urine/vitreous humor more often had petechiae in both locations than those without. This association was statistically significant, independent of body position and livor mortis. No association between the location of petechiae, medicinal drugs, or narcotics was found. These results suggest that ethanol may contribute to the development of petechial hemorrhages in deaths from intoxication.     

Detection of Diatoms by a Combination of Membrane Filtration and Transparentness,

Diagnosis of drowning remains a difficult issue in current forensic sciences. A large number of diatoms were lost by removing the supernatant after centrifugation in the conventional forensic diatom test. We developed a novel membrane filtration method to enrich diatoms from samples. A new solution using different ratios of acetic acid and eugenol is prepared to make the membrane transparent. These processes allow the diatom‐containing membrane to be visualized and identified easily by light microscopy. The tissues contaminated by water rich in diatoms were detected by the new method for the recovery of diatoms. Eleven drowning cases were analyzed by both the new method and the conventional method to compare the sensitivity of both methods. The recovery of the novel diatom test method was 54.2 ± 23.1%. The positive rate of the novel method has been proven to be superior to the conventional method in the diagnosis of drowning.