Comparison of findings identified at traditional invasive autopsy and postmortem computed tomography in suicidal hangings.

Cases of suicidal hanging are a common death referred for medico-legal autopsy throughout the world. Although some advocate using postmortem computed tomography (PMCT) without traditional invasive autopsy (TIA) to investigate such deaths, others reject this approach. There is currently limited evidence to guide practice. In this context, the TIA reports and PMCT images of 50 cases of suspected suicidal hanging during an 11-month period were reviewed. The reviewers were blinded to the findings of the other modality. A Cohen's Kappa coefficient (K) was calculated to assess agreement between TIA and PMCT across a range of pertinent findings. This analysis demonstrated perfect agreement for identification of a ligature (K = 1.00) and a strong level of agreement for identification of a ligature suspension point (K = 0.832) but only a minimal level of agreement for overall ligature mark (K = 0.223). PMCT demonstrated a weak level of agreement for fractures of hyoid bone (K = 0.555) and thyroid cartilage (K = 0.538). Three probable fractures not identified at TIA were identified on PMCT. TIA was shown to be superior in the identification of intramuscular and laryngeal fracture-related haemorrhage/bruising whereas PMCT was superior to TIA in identifying body gas deposition. There was overall good correlation between the natural disease and trauma identified elsewhere in the body during the TIA and PMCT. The study demonstrates that PMCT can assist the investigation of suspected suicidal hangings. However, the accuracy of many findings is limited, and if it is used as an alternative to the TIA, potentially pertinent findings, such as fractures of the laryngeal cartilages, could be missed.

Postmortem Computed Tomography: An Overview for Forensic Nurses Involved in Death Investigation.

The traditional invasive autopsy has been considered the "gold standard" for death investigation worldwide. However, this has now been challenged by a new minimally invasive approach that utilizes cross-sectional radiological imaging to investigate the death. Globally, postmortem computed tomography is the most commonly used modality and is becoming increasingly available throughout the world. Forensic nurses working in association with coroners and medical examiners' offices, as well as mass fatality incidents, now need to update their knowledge base to understand these innovative techniques, the advantages and disadvantages to their use, and how they impact on medicolegal death investigation and the care of the deceased and bereaved. Using the example of the coroner system of England and Wales, this article provides a comparison between the traditional invasive autopsy and postmortem radiological alternatives and presents the impact postmortem radiology is now having on death investigation.

Did the participants of the mass fatality exercise Operation Torch learn anything?

There are a number of reasons why facilitating and participating in a mass fatality exercise may be viewed as continuous professional development for those ultimately engaged in the response to a mass fatality incident. These include, amongst other objectives; team integration, organization and preparedness, psychological and emotional effects, developing attitudes and behavioral responses as well as testing infrastructure, equipment, command and control. The objectives of attending an exercise from a player or observers point of view however may be completely different to those planning and running an exercise. This was identified at the exercise Operation Torch. The paper illustrates this and questions whether these two separate purposes can be fully achieved in one exercise. It puts forward proposals to assist exercise planners identify, plan, exercise, evaluate and implement both capability gap or educational exercises by assisting planners to deliver the purpose of the exercise which needs to be decided at the early stage of planning. It makes recommendations for the need for a national mass fatality exercise database to ensure that the correct exercise is delivered and a wider audience can be informed of the exercise outcome.

Perceptions of near virtual autopsies.

INTRODUCTION: We present for the first time to our knowledge an insight into pathology/medico-legal practitioners' and general public perceptions' of the use of computed tomography (CT) scanning as an alterative to the invasive autopsy. SUBJECTS: The study arises from questionnaires at two professional meetings before and after an informative talk on the current use of CT in medico-legal autopsy practice. A total of 45 general public and 27 pathologists/medico-legal practitioners completed both parts of the study. A combination of open and closed questions were used to allow thematic and descriptive statistical analysis. RESULTS/CONCLUSIONS: The results show commonalities and differences of opinions between the two study groups. A desire was identified from the public to use CT scanning as an alternative to invasive autopsy if available. However, the majority of the public questioned indicated that they would not object to an invasive autopsy being undertaken on their relative if one was authorised by a coroner; it was the pathologists who questioned the need for the examination. However, although they raised this question, the pathologists still expressed the preference of the traditional invasive autopsy over a CT scan.

Does England need a new genesis of forensic nursing?

This article begins by providing a global picture of violence and the possible effects it is having on the development worldwide of the forensic nurse examiner. A debate follows as to where the boundaries of this advancing nursing practice should lie in conjunction with medicine and postulates where this evolution in nursing may or may not be an advantage to the world of forensics. An analysis is then presented concerning violence in England and whether a need exists for registered nurses to expand and advance their practices, as already developed in other countries, in order to assist in civil, coronial, and crime investigations. This article closes by putting forward implications for nursing practice in England, the consequent multiprofessional issues that need to be debated to ensure that any such developments are not detrimental to legal investigations and health care, and recommendations for future needed research.