Repeat visitors to a pediatric forensic medicine program.

Since the inception in 1990 of a Clinical Forensic Medicine Program at the Louisville Office of the Kentucky Medical Examiner Program, six children have undergone repeat evaluations for physical injuries. Herein, we examine the overall number of cases from January 1991 through December 1994, and the circumstances and outcomes of the six children undergoing reevaluation. Despite the implementation of an organized Forensic Medicine Program, some children in our area suffer repeated episodes of recognized abuse and death.

Airbag module cover injuries.

Serious and fatal injuries can be sustained when anatomic structures are in close proximity to an airbag module cover at the moment of airbag deployment. Three cases of injuries in vehicle operators associated with airbag module covers are reviewed and discussed. Injuries ranged from the traumatic avulsion of a thumb to the development of a subdural hematoma with associated cerebral edema and respiratory arrest. Motor vehicle operators should be aware that although airbags can significantly reduce the severity of injuries sustained in frontal collisions the module cover has the potential to inflict serious, even fatal injuries.

Development of a clinical forensic medicine curriculum for emergency physicians in the USA.

To address the forensic needs of living patients, the Department of Emergency Medicine at the University of Louisville School of Medicine in Louisville, Kentucky, USA initiated the first clinical forensic medicine training programme in the USA. In July 1991, formal training in clinical forensic medicine was incorporated into the core curriculum of the USA's second oldest academic emergency medicine training programme. The University of Louisville, in cooperation with the Kentucky Medical Examiner's Office, developed the curriculum to provide the emergency physician with the knowledge base and technical skills to perform forensic evaluations of living patients. Forensic lectures are given monthly by local and regional forensic experts including: forensic pathologists, prosecuting attorneys, firearm and ballistics examiners, law enforcement officers, forensic chemists and forensic odontologists. Topics which are presented include: forensic pathology, forensic photography, ballistics and firearms analysis, paediatric physical and sexual assault, crime scene investigation, forensic odontology, courtroom and expert testimony and the forensic evaluation of penetrating trauma. As a result of the introduction of clinical forensic medicine into the core curriculum of an emergency medicine training programme the residents are now actively addressing the forensic issues encountered in the Emergency department. Key, often short-lived forensic evidence, which was frequently overlooked or discarded while delivering patient care is now recognized, documented and preserved. The development and introduction of a clinical forensic medicine curriculum into emergency medicine training has greatly enhanced the emergency physician's ability to recognize, document and address the forensic needs of their patients who are victims of violent and non-fatal trauma.

The forensic pathologist and the determination of driver versus passenger in motor vehicle collisions. The need to examine injury mechanisms, occupant kinematics, vehicle dynamics, and trace evidence.

Five cases of vehicular homicide are presented in which the determination of an occupant's role in a motor vehicle collision was an important medicolegal question. The identification of the occupant's role in a motor vehicle collision can be determined by the forensic pathologist. The investigation that coordinates an examination of injury mechanisms, occupant kinematics, vehicle dynamics, and trace evidence will facilitate such a determination. This determination protects the innocent passenger, when faced with criminal or civil charges, from being falsely prosecuted as the driver. The examination of the above-mentioned components in a multi-occupant collision takes on particular forensic importance when a surviving driver claims to be a passenger: the victim rather than the assailant.