Using Forensic Toxicology to Enhance Medicolegal Death Investigations.

ABSTRACT: The Milwaukee County Medical Examiner's Office performed an evidence-based review of natural deaths certified without autopsy or toxicology testing. Three hundred fifteen such cases from 2020 and 2021 were selected. This study reviewed the deaths to determine if the cause was drug-related instead due to natural disease.Blood samples were screened by liquid chromatography-quadrupole mass spectrometry with time-of-flight detector. The analytes detected were evaluated for contribution to the cause resulting in a change in manner from natural to accident or suicide. Confirmatory analysis was performed where appropriate, and results were reported to the forensic pathologist for evaluation. Where appropriate, the death certificate was amended.As a result of the screening and confirmatory work, 18 cases were identified where significant drugs were detected, and thus the cause and manner of death were amended. One case was amended from natural to suicide after a conversation with the family about the toxicology findings. The remaining cases were amended to a manner of accident. The scope of drugs responsible for the deaths included prescription and illicit.

Examining the Examiners: How Medical Death Investigators Describe Suicidal, Homicidal, and Accidental Death.

This study describes differences in medicolegal death investigators' written descriptions for people who died by homicide, suicide, or accident. We evaluated 17 years of death descriptions from a midsized metropolitan midwestern county in the United States to assess how death investigators psychologically respond to different manners of death (N = 10,408 cases). Automated text analyses suggest investigators describe accidental deaths with more immediacy relative to homicides, while they also described suicidal deaths in less emotional terms than homicides as well. These data suggest medicolegal death investigators have different psychological reactions to circumstances and manners of death as indicated by their professional writing. Future research may surface context-specific psychological reactions to vicarious trauma that could inform the design or personalization of workplace-coping interventions.

Opioid Deaths in Milwaukee County, Wisconsin 2013-2017: The Primacy of Heroin and Fentanyl.

Heroin and fentanyl are the overwhelming and increasing cause of opioid deaths in Milwaukee County, Wisconsin. We reviewed all drug and opioid deaths from 2013 to 2017 to delineate the specific opioid drugs involved and changes in their incidence. From 2013 to 2017, 980 deaths were due to opioids, rising from 184 in 2013 to 337 in 2017. In 2017, opioid deaths exceeded combined non-natural deaths from homicide and suicide. Illicit heroin and fentanyl/analogs caused 84% of opioid deaths and 80% of drug deaths, with no increase in deaths due to oral prescription drugs such as oxycodone and hydrocodone. Any approach to decreasing this dramatic increase in opioid deaths should first focus on interdicting the supply and cheap availability of these illicit opioids. Fentanyl and its analogs represent the most deadly opioids and the greatest threat to human life in our population.

Two cases of firearm grip impressions on the hands of suicide victims.

Many factors are used to help distinguish firearm suicides from homicides and accidents, including range of fire, location of entrance defects, wound path trajectory, backspatter (blowback), and gunshot residue. Specifically, authors have discussed examination of the hands for backspatter, gunshot residue, cylinder gap effects, iron staining, and trauma as means of supporting a person having held a firearm while committing suicide. Here, we discuss 2 cases where suicidal gunshot wounds were accompanied by unique firearm grip impressions on the hands of the decedents. In 1 case, a "negative"[ impression of a grip pattern was left in a decedent's hand and in another case a grip pattern was left on the decedent's hand in dried blood. Such impressions can be used to provide support for establishing suicide as the manner of death.

KneePR--Substantial injuries caused by unorthodox resuscitation technique.

We report a case of cardiopulmonary resuscitation involving chest compressions performed with the rescuer's knee. The substantial injuries caused by this unorthodox technique could have been mistaken for the cause of death were it not for careful scene investigation and documentation.