118. Current Practice In Forensic Medicine

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118. Current Practice In Forensic Medicine

118. Current Practice In Forensic Medicine



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List of Contributors ix
Preface xix
Chapter One: DNA contamination – a pragmatic clinical view 1
Contamination considerations 1
DNA profiling 6
DNA deposits 10
Decontamination 11
General approach to DNA decontamination 20
Contamination 20
Cleaning and the DNA laboratory 22
Cleaning and decontamination of forensic examination
suites – the way forward 26
References 31
Chapter Two: The toxicity of the novel psychoactive substances 35
Introduction 35
Acute toxicity 35
Chronic toxicity 40
Deaths 41
References 44
Chapter Three: Postmortem gastric content analysis: its role in determining
time since death 47
Introduction 47
The physiology of gastric emptying 48
Gastric motility and emptying 49
Methods for measuring gastric emptying 52
Experimental studies 52
Factors affecting gastric emptying (in adults) 53
Analysis of gastric contents 56
Usefulness of gastric contents in time of death estimations 61
Conclusion 62
Acknowledgments 63
References 63
Chapter Four: Conducted energy devices 67
Overview 67
What are conducted energy devices? 67
Modes of use of the TASER® X26, TASER® X26P
and TASER® X2 68

The electrical outputs of the TASER® X26, X26P and X2 68
Operationally exploited effects of TASER® CEDs: pain and neuromuscular
incapacitation 70
Adverse effects associated with use of the TASER® X26 71
Conclusions 76
References 77
Chapter Five: Autoerotic deaths 81
Historical context 81
Definition 83
Incidence 85
Investigation of autoerotic deaths 86
Typical methods of autoerotic death 88
Atypical methods of autoerotic deaths 91
Typical and atypical victims 92
Summary 94
References 94
Chapter Six: Excited Delirium Syndrome: aetiology, identification
and treatment 97
Introduction 97
Aetiology 101
Diagnosis 103
Initial approach and work-up 104
Medication treatment options for ExDS 106
Supportive treatment 110
Conclusions 112
References 114
Chapter Seven: Automatism – wading through the quagmire 119
Introduction 119
Definitions of automatism 120
The law 121
Medical conditions capable, or possibly capable, of founding a defence
of automatism 123
Sentencing and mitigation 134
Proposals for reform in England and Wales 135
Acknowledgments 135
Law reports 135
References 136
Chapter Eight: Classification of personality disorders, clinical manifestations
and treatment 139
Introduction 139
What is personality disorder? 139
Dimensional or categorical diagnostic approaches? 141
Prevalence 142
The hybrid model 143
Assessment 143

Specific issues in forensic medicine settings 149
References 150
Chapter Nine: Driving impairment: the main risk factors 153
Introduction 153
Legislative approaches 155
Sobriety assessment 158
Specific drugs 162
Forensic specimens in drug driving cases 168
Medical conditions and fitness to drive 169
Sleep deprivation 171
Conclusions 172
References 172
Chapter Ten: Risk factors for death or harm to health for detainees
in short-term police custody 179
Introduction 179
The background to healthcare in police custody 179
The nature of health problems of detainees 180
Deaths and harm in police custody 185
Excited Delirium Syndrome 190
Broad principles of care 191
Identification and diversion 197
Prevention of death and harm in police custody 202
References 203
Chapter Eleven: The utility of radiological investigation of suspected
abusive head trauma in children 207
Introduction 207
Injury patterns 207
Anatomy of the head 208
Scalp injury 209
Skull injury 209
Estimate of time of injury of skull fractures 213
Mimics of skull fractures 214
Tips for investigating suspected skull fracture 217
Intracranial manifestations of head injury 218
Subdural haemorrhage 219
Subarachnoid haemorrhage 233
Extradural haemorrhage 234
Cortical contusions 235
Diffuse axonal injury (shear injury) 235
Brain oedema, swelling and hypoxic ischaemic brain injury 236
Conclusion 240
References 240
Chapter Twelve: Child maltreatment: detection and diagnosis 243
Introduction 243
Defining child abuse and neglect 244

The physician’s role in detecting child abuse 244
Contributing and risk factors for child abuse 246
General signs and symptoms of child abuse 246
Physical signs of child abuse 247
Fabricated or induced illness 257
Specific clinical presentations suspect for child abuse 259
Recognizing neglect 260
Screening instruments for detection of child abuse in Emergency
Departments 260
Medical conditions that mimic child abuse 262
Summary and conclusion 262
References 265
Chapter Thirteen: Recovery of remains in potential crimes against humanity
investigations – a forensic anthropological approach 269
Forensic anthropology and investigations into human rights violations
and crimes against humanity 269
The characteristics of forensic anthropological investigations into
human rights violations and crimes against humanity 272
The main mistakes made in forensics 274
Phases of the forensic anthropological investigation in the context
of human rights violations 275
A multidisciplinary approach 281
Complex cases 282
Lessons learned and considerations 283
Conclusions 284
Acknowledgments 284
References 285
Chapter Fourteen: Field missions 287
Introduction 287
S: Situation 288
M: Mission 289
E: Execution 289
A: Administration and logistics 291
C: Communications and command 295
S: Security 295
Other mission-related matters 296
Strategic security assessments 297
Conclusion 311
Appendix A-Mission plan template 312
Appendix B-Example of team functions for personnel required
for the exhumation of human remains from a mass grave 314
Index 317



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