Current Practice in Forensic Medicine, Volume 2

Dr John Gall is a consultant forensic physician. He is Director of Southern Medical Services Pty Ltd; Associate Professor in the Department of Paediatrics at The University of Melbourne; Consultant at the Victorian Forensic Paediatric Medical Service at the Royal Children's Hospital and Monash Medical Centre; President of the World Police Medical Officers; and Vice-President of the Australasian Association of Forensic Physicians.Jason Payne-James is a Consultant Forensic Physician & Specialist in Forensic & Legal Medicine. He is Honorary Consultant at the Paediatric & Emergency Medicine at St George's Hospital, London; Honorary Senior Lecturer at the Cameron Forensic Medical Sciences, Barts and the London SMD; President at the Faculty of Forensic & Legal Medicine (Royal College of Physicians); and Director of Forensic Healthcare Services Ltd.

• List of Contributors ixPreface xixChapter One: DNA contamination – a pragmatic clinical view 1Contamination considerations 1DNA profiling 6DNA deposits 10Decontamination 11General approach to DNA decontamination 20Contamination 20Cleaning and the DNA laboratory 22Cleaning and decontamination of forensic examination suites – the way forward 26References 31Chapter Two: The toxicity of the novel psychoactive substances 35Introduction 35Acute toxicity 35Chronic toxicity 40Deaths 41References 44Chapter Three: Postmortem gastric content analysis: its role in determining time since death 47Introduction 47The physiology of gastric emptying 48Gastric motility and emptying 49Methods for measuring gastric emptying 52Experimental studies 52Factors affecting gastric emptying (in adults) 53Analysis of gastric contents 56Usefulness of gastric contents in time of death estimations 61Conclusion 62Acknowledgments 63References 63Chapter Four: Conducted energy devices 67Overview 67What are conducted energy devices? 67Modes of use of the TASER ® X26, TASER ® X26P and TASER ® X2 68The electrical outputs of the TASER ® X26, X26P and X2 68Operationally exploited effects of TASER ® CEDs: pain and neuromuscular incapacitation 70Adverse effects associated with use of the TASER ® X26 71Conclusions 76References 77Chapter Five: Autoerotic deaths 81Historical context 81Definition 83Incidence 85Investigation of autoerotic deaths 86Typical methods of autoerotic death 88Atypical methods of autoerotic deaths 91Typical and atypical victims 92Summary 94References 94Chapter Six: Excited Delirium Syndrome: aetiology, identification and treatment 97Introduction 97Aetiology 101Diagnosis 103Initial approach and work‐up 104Medication treatment options for ExDS 106Supportive treatment 110Conclusions 112References 114Chapter Seven: Automatism – wading through the quagmire 119Introduction 119Definitions of automatism 120The law 121Medical conditions capable, or possibly capable, of founding a defence of automatism 123Sentencing and mitigation 134Proposals for reform in England and Wales 135Acknowledgments 135Law reports 135References 136Chapter Eight: Classification of personality disorders, clinical manifestations and treatment 139Introduction 139What is personality disorder? 139Dimensional or categorical diagnostic approaches? 141Prevalence 142The hybrid model 143Assessment 143Specific issues in forensic medicine settings 149References 150Chapter Nine: Driving impairment: the main risk factors 153Introduction 153Legislative approaches 155Sobriety assessment 158Specific drugs 162Forensic specimens in drug driving cases 168Medical conditions and fitness to drive 169Sleep deprivation 171Conclusions 172References 172Chapter Ten: Risk factors for death or harm to health for detainees in short‐term police custody 179Introduction 179The background to healthcare in police custody 179The nature of health problems of detainees 180Deaths and harm in police custody 185Excited Delirium Syndrome 190Broad principles of care 191Identification and diversion 197Prevention of death and harm in police custody 202References 203Chapter Eleven: The utility of radiological investigation of suspected abusive head trauma in children 207Introduction 207Injury patterns 207Anatomy of the head 208Scalp injury 209Skull injury 209Estimate of time of injury of skull fractures 213Mimics of skull fractures 214Tips for investigating suspected skull fracture 217Intracranial manifestations of head injury 218Subdural haemorrhage 219Subarachnoid haemorrhage 233Extradural haemorrhage 234Cortical contusions 235Diffuse axonal injury (shear injury) 235Brain oedema, swelling and hypoxic ischaemic brain injury 236Conclusion 240References 240Chapter Twelve: Child maltreatment: detection and diagnosis 243Introduction 243Defining child abuse and neglect 244The physician’s role in detecting child abuse 244Contributing and risk factors for child abuse 246General signs and symptoms of child abuse 246Physical signs of child abuse 247Fabricated or induced illness 257Specific clinical presentations suspect for child abuse 259Recognizing neglect 260Screening instruments for detection of child abuse in Emergency Departments 260Medical conditions that mimic child abuse 262Summary and conclusion 262References 265Chapter Thirteen: Recovery of remains in potential crimes against humanity investigations – a forensic anthropological approach 269Forensic anthropology and investigations into human rights violations and crimes against humanity 269The characteristics of forensic anthropological investigations into human rights violations and crimes against humanity 272The main mistakes made in forensics 274Phases of the forensic anthropological investigation in the context of human rights violations 275A multidisciplinary approach 281Complex cases 282Lessons learned and considerations 283Conclusions 284Acknowledgments 284References 285Chapter Fourteen: Field missions 287Introduction 287S: Situation 288M: Mission 289E: Execution 289A: Administration and logistics 291C: Communications and command 295S: Security 295Other mission‐related matters 296Strategic security assessments 297Conclusion 311Appendix A-Mission plan template 312Appendix B-Example of team functions for personnel required for the exhumation of human remains from a mass grave 314Index 317