Confusion between firearms and electrical weapons as a factor in police shootings.

Conducted electrical weapons (CEW) have risks including trauma associated with uncontrolled falls, probes penetrating the eye, and fume ignition. A lesser-known risk is weapon-confusion error with officers mistakenly discharging their firearm when they intended to deploy their electrical weapon. We searched for incidents of possible weapon confusion with the TASER® brand CEWs via open-source media, litigation filings, and a survey of CEW law enforcement master instructors. We found 19 incidents of possible CEW weapon confusion in law enforcement field uses from January 2001 to April 2021. We eliminated a case as not meeting our criteria for probable weapons confusion leaving 18 cases, thus giving a demonstrated CEW discharge risk of 3.9 per million with confidence limits (2.4-6.2 per million) by Wilson score interval. Ipsilateral carry of the weapons was historically correlated with increased risk vs. contralateral carry. Officer gender was not a predictor of weapon confusion. The psychological issues behind weapon confusion under stress are discussed. The concurrent carry of electrical weapons and firearms presents a very small but real risk of injury and death from confusion between an electrical weapon and a firearm.

Two Cases of Tandem Bullets-One Homicide and One Suicide.

We report 2 unusual cases of tandem bullets. Case 1 is a homicide involving a piggyback screw. Case 2 is a suicide involving multiple tandem bullets as a result of improper ammunition size. Tandem bullet injuries can have a wide variety of presentations. Therefore, it is essential that forensic pathologists understand the mechanisms of tandem bullet wounds and familiarize themselves with the autopsy and radiological findings seen in tandem bullet injuries. This report supports that use of incorrect caliber ammunition and the lodgment of foreign objects in the barrel of a gun are possible causes of tandem bullet injuries.

Which Knife Was Used?: Using a Porcine Model to Assess Stab Wound Size.

Forensic pathologists who autopsy stab wound victims may be called upon to determine whether a specific weapon recovered as evidence caused the decedent's wounds. Some forensic training programs instruct pathologists to excise wounds and place them in formalin. There is little published information about the reliability of these assessments. To address these deficiencies, a porcine model was used to establish the limits of in situ knife wound measurements of wounds caused by 3 knives of different widths stabbed at 90 degrees to the skin surface. The results indicate that within the 95% confidence interval, most stab wounds when measured on the surface of the skin will be within 1 to 3 mm of the size of the knife blade. Four wounds from different anatomical areas of the pig were excised from the body, and after excision, their measurements differed from their in situ length. After fixation in a 10% buffered formalin solution, one wound stayed the same, one wound lengthened, one shrunk minimally, and the one from the thinner abdominal skin shrunk by 6 mm (11%). This study presents a porcine model that can be used to define parameters for testimony.

Vertebral artery dissection complicating occipital injection of heparin for treatment of thoracic outlet syndrome.

A 38-year-old woman with a 2-year history of chronic neck pain radiating down her right arm underwent radiological and neurological evaluations, which revealed no anatomical cause for her pain. She sought alternative therapies including intramuscular heparin injections. Following a right occipital injection of heparin, cyanocobalamin, and lidocaine, she had a sudden cardiorespiratory arrest and was successfully resuscitated, but did not regain consciousness.Computed tomography of the head and neck and subsequent autopsy revealed a right vertebral artery dissection, but at autopsy, no significant subarachnoid hemorrhage was noted at the base of the brain. This is the first case report where heparin (a potent anticoagulant) used in an occipital injection was documented to cause a vertebral artery dissection. It is also the first reported case where radiographically and histologically documented vertebral artery dissection did not present with overwhelming subarachnoid hemorrhage at the base of the brain. The subtle gross anatomical findings in this case highlight the importance of evaluating the cervical spinal cord in any case of sudden cardiorespiratory arrest following even apparently minor neck injury.

Cognitive bias in forensic pathology decisions.

Forensic pathologists' decisions are critical in police investigations and court proceedings as they determine whether an unnatural death of a young child was an accident or homicide. Does cognitive bias affect forensic pathologists' decision-making? To address this question, we examined all death certificates issued during a 10-year period in the State of Nevada in the United States for children under the age of six. We also conducted an experiment with 133 forensic pathologists in which we tested whether knowledge of irrelevant non-medical information that should have no bearing on forensic pathologists' decisions influenced their manner of death determinations. The dataset of death certificates indicated that forensic pathologists were more likely to rule "homicide" rather than "accident" for deaths of Black children relative to White children. This may arise because the base-rate expectation creates an a priori cognitive bias to rule that Black children died as a result of homicide, which then perpetuates itself. Corroborating this explanation, the experimental data with the 133 forensic pathologists exhibited biased decisions when given identical medical information but different irrelevant non-medical information about the race of the child and who was the caregiver who brought them to the hospital. These findings together demonstrate how extraneous information can result in cognitive bias in forensic pathology decision-making.

Gunshot wound trajectory analysis using forensic animation to establish relative positions of shooter and victim.

Forensic pathologists who autopsy the victims of gun violence are often called upon to answer questions in both criminal and civil proceedings about the relative position of the shooter and the victim. In this case report of an officer-involved shooting incident, the statement of the police officer appeared to be in direct contradiction to the statements of other eyewitnesses, the evidence at the scene, and the final resting position of the decedent's body. Trajectory analysis of two gunshot wound pathways (only one of which was instantaneously incapacitating) was performed to assess the veracity of the officer's statement and forensic animation was used to create a court exhibit. A discussion of the current peer-reviewed literature is included.

Anthropological and radiographic comparison of vertebrae for identification of decomposed human remains.

This case study demonstrates the importance of involving an anthropologist in forensic situations with decomposed remains. Anthropological consultation was used in conjunction with the comparison of antemortem and postmortem radiographs to establish positive identification of unknown, decomposed remains. The remains had no traditional identifying features such as fingerprints or dental. Through anthropological analysis, it was determined the decedent was male, between 20 and 23 years at time of death and c. 5'2'' tall. This information allowed for a presumptive identification and a request for antemortem radiographs. The missing person was identified comparing the spinous processes of the cervical and thoracic vertebrae between ante- and postmortem radiographs.

Dissecting and Streamlining the Medical Record Acquisition Process in Death Investigation Systems.

Though medicolegal death investigation (MDI) systems are generally associated with criminal justice, they serve an integral role in the realm of public health and safety. Medicolegal death investigation offices collect information, including medical records, from a variety of outside sources. For data to travel efficiently, transmission should be fully integrated between the MDI office and external organizations. This is often not the case. Delays in the transmission of medical records in particular lead to subsequent delays in autopsy report completion and death certification or to resource waste in cases where a timely record would have let the pathologist know an autopsy was not required. Almost no peer-reviewed literature currently exists regarding the problem of record acquisition by MDI systems. To develop a better understanding of how electronic medical records have impacted MDI systems, we conducted a mixed methods survey through the National Association of Medical Examiners (NAME) e-mail listserv. We inquired about the medical records acquisition processes at MDI systems around the nation to gauge opinions about the use of electronic health data and the integration of MDI data in public health. Concurrently, we piloted a quality improvement project at the Alameda County Sheriff-Coroner's Office (ACSCO) in Oakland, California, in which we worked with various hospitals to get ACSCO employees direct access to decedents' electronic health records. With data from the survey and pilot project, we were able to document the barriers encountered when attempting to reform medical record acquisition and to suggest systemic changes to reduce delays and wasted resources.