Erratum to: Head/skull injury potential of empty 0.5-l beer glass bottles vs. 0.33-l Coke bottles.

In the context of further impact tests with various striking weapons against the skull, it turned out that the manufacturer had incorrectly calibrated the force measuring plate, which was used in our earlier experiments. When the tests were carried out again under the same conditions, the measurement results were significantly higher.

Aspiration-related pneumonia after Taser exposure - A multiple causations mechanism.

Arrest-related deaths in the context of Conducted Electrical Weapon (CEW) deployment are rare. The evaluation of such complex events is a challenge for the forensic scientist. We present a case of a 49-year old man, who was exposed to a Taser X26P during a confrontation with the police. He lost consciousness, vomited, aspirated and died after having been hospitalized for several days at the ICU. Based on the patient´s medical history, autopsy findings, witness testimonies, and reliable clinical and toxicological blood parameters, the most probable cause and mechanisms of his death are discussed. The present work demonstrates, based on one case report, the possibilities as well as limitations of forensic assessment in CEW-related deaths.

Head/skull injury potential of empty 0.5-l beer glass bottles vs. 0.33-l Coke bottles.

The medical and biomechanical assessment of injuries from blows to the head is a common task in forensic medicine. In the context of a criminal justice process, the injury potential of different striking weapons is important. The article at hand compares the injury potential of assaults with a 0.5-l beer bottle and a 0.33-l Coke bottle, both made of glass. The research team hit 30 used empty 0.5-l beer bottles and 20 used empty 0.33-l Coke bottles manually on an aluminum dummy skull set on a force measuring plate, using acrylic and pork rind as a scalp surrogate. There was no significant difference in fracture threshold and energy transfer between the examined beer and Coke bottles. Both glass bottles are able to cause fractures to the facial bones while cranial bone fractures are primarily not to be expected. Blows with a 0.5-l beer bottle or with a 0.33-l Coke bottle to the head can transfer up to 1.255 N and thus are able to cause severe blunt as well as sharp trauma injuries.

Arrest-related death on the basis of a drug-induced excited delirium syndrome.

AIMS: In typical arrest-related death (ARD) scenarios, the victims often show signs of excited delirium syndrome (ExDS), intoxication, exhaustion and/or suffered from a preexisting physical or psychiatrical condition, all of which could have caused or at least triggered the person's death. Since autopsy findings are very rare in such cases, a clear clinicopathologic diagnosis and thus mechanism of death is rarely found. METHODS: We present a case of a 25-year old woman, who died while being arrested by the police. Based on the patient's medical history, autopsy findings, contradicting witness testimonies, and reliable clinical and toxicological blood parameters, the most probable diagnosis is discussed. RESULTS: The cause of death was determined as cardiac arrest subsequent to a combination of excited delirium syndrome, physical exhaustion and respiratory impairment. The manner of death was unnatural and juridically, the charges were dropped. CONCLUSIONS: In cases, where the cause and mechanism of death can only be diagnosed by exclusion, police collaboration, detailed clinical history (past and present) as well as clinical blood parameter analyses are necessary to help evaluating possible contributing factors and the most probable cause of death in ARD.

Beer stein blast to the head a rare case of combined blunt and sharp force trauma.

Cases of combined blunt and sharp force trauma to the head caused by one striking tool are rare. When beer steins are used as an assault weapon, they can cause blunt traumas upon initial contact phase. If the impact force exceeds the mechanical stability of the beer stein, it breaks into several sharp-edged pieces, which then can cause sharp force trauma injuries due to the interaction between the head and the stein fragments.We present a case of a 43-year old man, who suffered from blunt and sharp force head traumas due to one single blow with a 1-l beer stein. A forensic-biomechanical analysis of the event, together with witness testimony evaluation and experimental comparison helped to reconstruct the most probable chain of events. Based on these findings as well as on the medical diagnoses and treatment, the assault was assessed as a nonacute life-threatening, but potentially fatal offence. The case was indicted as grievous bodily harm.

Autopsy rates in Iceland.

A clinical as well as forensic autopsy is a uniform medical investigation of the deceased, which mainly serves to verify the plausibility of information on the cause, mode and mechanism of death provided by the police and/or medical personnel. Despite its importance in the context of a conclusive assessment of a person's medical history and in detecting any criminal correlation or malpractice, a significant decline in autopsies is evident in Iceland. This article gives an overview on autopsy rates in Iceland and compares the situation with European countries.

Peri- and post mortem hemorrhages in the anterior neck after chin-collar application.

Intense blunt compression trauma to the neck can result in subcutaneous, intramuscular or laryngeal mucosa bleedings of different intensity. While these findings can easily be detected through a layer-wise dissection of the neck muscles and soft tissue during autopsy, it can be difficult to distinguish between peri-/post- and ante mortem hemorrhages solely based on macroscopic findings. Especially when an initial preliminary diagnosis is required, possible artifacts have to be excluded. The study at hand examines possible peri- and post mortem hemorrhages in the anterior neck after NorMors™ chin-collar application. In routine clinical and forensic autopsy cases, where such a chin-collar has been placed around the neck of the deceased in close proximity after death, focus was directed to the soft tissue and muscles of the neck. The results of our analysis could prove that the use of chin-collar shortly within the first 1 ½ hours after death applies just enough pressure to the neck to be able to cause superficial hemorrhages within the surface of the sternocleidomastoid muscles, which can mimic vital compression trauma injuries. Based on location, morphological outlines and intensity of the injuries, it is possible to correlate them with the position of the applied collar. Together with histological analyses, asphyxia by a second party involvement can be excluded. However, the application of chin-collars should be prohibited in any case, where an autopsy might be performed.

Injury potential of one-litre beer steins.

Injuries resulting from blows with beer steins are a frequent occurrence during annual autumn fairs or at beer halls in South Germany and Austria. The majority of these cases are tried in court and thus being assessed by a forensic medicine expert. The article at hand gives a short overview on the injury potential of one-litre beer steins and explains the key variables to consider when analyzing beer stein injuries. On the basis of representative cases, which were assessed by specialists from the Institute of Legal Medicine of the Munich University over the last 5 years, the main biomechanical aspects and resulting injuries of one-litre beer stein assaults are discussed. Several severe and potentially life-threatening injuries have been observed after an assault with a one-litre beer stein. There is a discrepancy between the mechanical stability of brand new and used steins and the corresponding injuries, which can be explained by a decrease in impact tolerance of the steins with their use. In general, a blow with a one-litre glass or stonework beer stein to the head can cause severe and even life-threatening blunt as well as sharp trauma injuries.

Restraint-related asphyxia on the basis of a drug-induced excited delirium.

Cases of intoxication in combination with extreme agitation, physical exertion and restraint are mainly associated with restraint-related deaths (RRD) in the context of police use of force. In these cases, the mechanism of death usually mentioned is RRD associated with drug-induced excited delirium. To the best of our knowledge, there are no cases published on RRD that occurred during a physical encounter among civilians. We present a case of a 39-year old man, who died during a struggle with another person while being chokehold in a prone position with a knee on his back. Detailed witness testimonies as well as reliable blood parameters, which were taken immediately after his death, helped to define a most probable diagnosis. The deceased suffered from schizophrenia, consumed amphetamine and bupropion. He showed typical symptoms of an agitated delirious state, most likely induced by bupropion intoxication. The cause of death was restraint asphyxia by a second party on the basis of an excited delirium. The manner of death was concluded to be manslaughter.

Adrenergic and metabolic effects of electrical weapons: review and meta-analysis of human data.

INTRODUCTION: Electronic control with the CEW (conducted electrical weapon) has gained widespread acceptance as the preferred force option due to its significant injury reduction. However, a CEW application does stress the human body. In the case of the CEW, the human body response is similar to the challenge of physical exercise combined with emotional stress over a very short time interval. There has been concern whether the tension of the skeletal-muscle system together with the emotional stress of being exposed to the effects of a CEW, can lead to severe metabolic dysfunction. METHODS: A systematic and careful search of the MedLine database was performed to find publications describing pathophysiological effects of CEWs. Additional publications were collected through a manual search of reference lists in retrieved articles. After preliminary exclusions, we carefully reviewed the remaining publications and found 24 papers reporting prospective human clinical research data on adrenergic, ventilation, or metabolic effects. Where there were multiple studies on the same endpoints, we performed meta-analyses. RESULTS: A CEW exposure provides a clinically insignificant increase in heart rate (7.5 BPM) and a drop in both systolic and diastolic blood pressure. Alpha-amylase goes down but cortisol levels increase-both epinephrine and norepinephrine levels are increased by levels similar to mild exercise. A CEW exposure increases ventilation but does not appear to interfere with gas exchange. Lactate is increased slightly while the pH is decreased slightly with changes equivalent to mild exercise. The lactate and pH changes appear quickly and do not appear to be affected by increasing the exposure duration from 5 to 30 s. CONCLUSIONS: Thorough review and meta-analyses show that electrical weapon exposures have mixed and mild adrenergic effects. Ventilation is increased and there are metabolic changes similar to mild exercise.

A proclaimed accidental fall of an infant-an experimental case reconstruction study.

The differentiation between a non-accidental injury and injuries resulting from accidents, such as falls to the ground or onto various objects, is a challenge not only for forensic experts but also for all clinicians caring for children. The forensic-biomechanical analysis of accidents in infants aims at the assessment of the loading characteristics based on the reconstruction of the particular incident. It includes an evidence-based analytical comparison between the actual injuries presented and the injuries that should be expected as a result of the proclaimed accident. With the help of kinematical and dynamical parameters of the described actions and the resulting loading situations, the forensic-biomechanical analysis can assess the plausibility of the proclaimed course of the event and thus contribute to the differentiation between accidental and non-accidental injuries. The quality of such a forensic-biomechanical expert opinion depends on the accuracy and quantity of available data regarding biomechanical tolerance of tissues, organs, and body parts. Case-specific measurements can contribute significantly to the insight of the kinematics and dynamics of the proclaimed event, its feasibility, etc. The present article demonstrates, based on one case report, the potential as well as the limits of such an analysis of proclaimed accidental fall injuries.

An unusual exit wound as a result of a shotgun suicide to the head.

The location of a gunshot entrance wound as well as the wound path trajectory are the main findings that help to determine the position from which a weapon was fired and thus distinguish firearm suicides from homicides and accidents. We present a case of a 28-year old man, who was found dead in his car. Because of an unusual position of the firearm, which was clamped into the steering wheel, and an unclear entrance/exit wound, an autopsy was performed. The deceased showed typical signs of a contact shotgun wound to the head with an entrance wound in the right temporal region and an exit wound in the midface. With the help of gunpowder attachments and a muzzle imprint at the entrance site, a wound channel from the right lower posterior part of the temporal region to the left anterior part of the mid-facial region could be reconstructed. The stellate wound in the midface was assessed as an atypical exit wound. The cause of death was a contact shotgun shot to the right temple with a consequent central regulatory failure due to extensive brain injury. The manner of death was concluded to be a suicide.

Network analysis: a novel method for mapping neonatal acute transport patterns in California.

OBJECTIVE: The objectives of this study are to use network analysis to describe the pattern of neonatal transfers in California, to compare empirical sub-networks with established referral regions and to determine factors associated with transport outside the originating sub-network. STUDY DESIGN: This cross-sectional database study included 6546 infants <28 days old transported within California in 2012. After generating a graph representing acute transfers between hospitals (n=6696), we used community detection techniques to identify more tightly connected sub-networks. These empirically derived sub-networks were compared with state-defined regional referral networks. Reasons for transfer between empirical sub-networks were assessed using logistic regression. RESULTS: Empirical sub-networks showed significant overlap with regulatory regions (P<0.001). Transfer outside the empirical sub-network was associated with major congenital anomalies (P<0.001), need for surgery (P=0.01) and insurance as the reason for transfer (P<0.001). CONCLUSION: Network analysis accurately reflected empirical neonatal transfer patterns, potentially facilitating quantitative, rather than qualitative, analysis of regionalized health care delivery systems.

Muscle pathologies after cervical spine distortion-like exposure--a porcine model.

OBJECTIVE: Histological evaluation of porcine posterior cervical muscles after a forceful translational and extensional head retraction simulating high-speed rear end impact. METHODS: Four anesthetized pigs were exposed to a cervical spine distortion (CSD)-like motion in a lying position. After 2 different survival times of 4 and 6 h (posttrauma), the pigs were euthanized and tissue sampling of posterior cervical muscles was performed. A standard histological staining method involving paraffin-embedded sections was used to analyze the muscles, focusing on injury signs like hemorrhage and inflammatory cell reaction. A pig that was not subjected to impact was used as a control pig and was subjected to the same procedure to exclude any potential artifacts from the autopsy. RESULTS: The differentiation of 8 different posterior neck muscles in the dissection process was successful in more than 50 percent for each muscle of interest. Staining and valid analysis was possible from all extracted samples. Muscle injuries to the deepest posterior neck muscles could be found, especially in the musculus obliquus samples, which showed laminar bleedings in 4 out of 4 samples. In addition, in 4 out of 4 samples we were able to see increased cellular reactions. The splenius muscle also showed bleeding in all 4 samples. All animals showed muscle injury signs in more than three quarters of analyzed neck muscles. Differences between survival times of 4 and 6 h in terms of muscular injury were not of primary interest and could not be found. CONCLUSIONS: By simulating a CSD-like motion we were able to confirm injuries in the posterior cervical muscles under severe loading conditions. Further studies need to be conducted to determine whether these muscle injuries also occur under lower exposure forces.

Unusual blood spatter patterns on the firearm and hand: a backspatter analysis to reconstruct the position and orientation of a firearm.

When it comes to firearm fatalities, the main goal of forensic analysis is to distinguish firearm suicides from homicides and accidents. Apart from the location of the entrance wound, wound path trajectory and gunshot residue, blood stain pattern analysis of gunshot-related backspatter on the hands of the victim can be an essential tool not only to determine which hand was holding the firearm, but also to reconstruct the position from which a weapon was fired. We present a case of a 90-year-old man, who was found dead in his house. Because of unclear circumstances and an unusual position of the deceased with a gunshot entrance wound to the right temporal region and a firearm found on the left side of his body, an autopsy was performed. Due to the unusual bloodspatter stains on the hands and the firearm, it was possible to deduce the position and orientation of the hands and the firearm of the deceased. We could reconstruct that the man held the weapon in his right hand, using the left hand to stabilise the firearm and the right thumb to pull the trigger. A contact shot to the right temple led to central regulatory failure due to extensive brain injury. The manner of death was concluded to be a suicide.

Acute pathophysiological influences of conducted electrical weapons in humans: A review of current literature.

Conducted electrical weapons (CEWs) deliver short high-voltage, low current energy pulses to temporarily paralyze a person by causing muscular contraction. The narrative of this article is a methodical analysis on acute pathophysiological changes within the central nervous system, cardiovascular, neuroendocrine, sympatho-adrenergic and muskuloskeletal system which can occur after application of conducted electrical weapons on human subjects. The results are based on wide-ranging literature analysis and source studies. The majority of the recent scientific publications on humans classify the health risks of an appropriate use of the CEWs device as minor. However, there still is an uncertainty about possible side-effects of these devices. Therefore medical supervision with human application is advised.

Accidental head explosion: an unusual blast wave injury as a result of self-made fireworks.

A 33-year old hobby pyrotechnician sustained a lethal craniofacial trauma secondary to a salute fireworks blast. He was examining a misfire of a self-constructed salute gun, when it detonated, causing an explosively rupture of his forehead, which led to his immediate death. An autopsy was performed to achieve knowledge of the injury and to be able to reconstruct the events that lead to it. The pressure effect of the explosion caused a shredded rupture of the forehead with a regional spread of brain tissue and small polygonal skull fragments up to 30m from the detonation site. Furthermore multiple cinderlike fragments of black powder were embedded in the skin of the face and the anterior aspect of the neck (s.c. blast tattoo). The complete destruction of the forehead in combination with the multiple blast tattooing suggested that the explosion detonated while he was leaning over the device.

Blood stain pattern analysis.

Bloodstain pattern analysis (BPA) refers to the collection, categorization and interpretation of the shape and distribution of bloodstains connected with a crime. These kinds of stains occur in a considerable proportion of homicide cases. They offer extensive information and are an important part of a functional, medically and scientifically based reconstruction of a crime. The following groups of patterns can essentially be distinguished: dripped and splashed blood, projected blood, impact patterns, cast-off stains, expirated and transferred bloodstains. A highly qualified analysis can help to estimate facts concerning the location, quality and intensity of an external force. A sequence of events may be recognized, and detailed questions connected with the reconstruction of the crime might be answered. In some cases, BPA helps to distinguish between accident, homicide and suicide or to identify bloodstains originating from a perpetrator. BPA is based on systematic training, a visit to the crime scene or alternatively good photographic documentation, and an understanding and knowledge of autopsy findings or statements made by the perpetrator and/or victim. A BPA working group has been established within the German Society of Legal Medicine aiming to put the knowledge and practical applications of this subdiscipline of forensic science on a wider basis.