Current Practice in Forensic Medicine

Forensic medicine is a broad and evolving field with areas of rapid progress embracing both clinical and pathological aspects of practice, in which there may be considerable overlap. This is the second volume in a series that provides a unique, in-depth and critical update on selected topics of direct relevance to those practising in the field of clinical forensic medicine and related areas including lawyers, police, medical practitioners, forensic scientists, and students.

The chapters endeavour to maintain a relevance to an international, multi-professional audience and include chapters on:

• DNA decontamination,

• The toxicity of novel psychoactive substances,

• The relevance of gastric contents in the timing of death,

• The effects of controlled energy devices,

• The main risk factors for driving impairment,

• The risk factors for harm to health of detainees in short-term custody,

• Autoerotic deaths,

• Child maltreatment and neglect, and

• The investigation of potential non-accidental head injury in children.

Also included are chapters on excited delirium syndrome, automatism and personality disorders. Two topics not generally covered in standard clinical forensic medical textbooks include a forensic anthropological approach to body recovery in potential crimes against humanity and risk management and security issues for the forensic practitioner investigating potential crimes against humanity in a foreign country.

Autorentext

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.

Inhalt

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 workup 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 shortterm 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 ...