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Forensic Pathology in Gunshot Injuries
Forensic pathology is a specialty in medicine used in the judicial system in criminal investigations. It is a field of science where a post-mortem or an autopsy examination is performed to determine the cause and manner of death and to establish whether the death was due to a natural, unnatural (homicide or suicide), or unintentional cause (Menezes and Monteiro, 2020). One of the most complex, traumatic, and violent injuries that forensic pathologists examine is a gunshot wound. It is one of the most common causes of homicidal deaths and one that forensic pathologists usually encounter during criminal investigations.
A proper interpretation of the gunshot wound is critical for providing valuable information that can help in the law enforcement investigation and supporting the justice system on homicide cases. The significance of forensic pathology in solving homicidal deaths due to gunshot wounds is widely recognized. The forensic pathology carried out in gunshot wounds must be systematic to ensure an accurate finding for a criminal investigation to aid the justice system. Due to its crucial role, the interpretation must be made by skilled professionals with proper training in forensic science. This essay about forensic pathology aims to explain the basics of this science and its role in aiding criminal investigations in homicidal deaths due to gunshot wounds, including its clinical significance in delivering justice.
Forensic Pathology and Criminal Investigation
Forensic pathology plays a significant role in a criminal investigation. The findings of forensic pathologists are often presented as evidence in court. They provide their professional or expert opinions on the manner of death of a person who died of a gunshot wound and attest to other important aspects of the shooting incident such as the type of firearm used, the number of shots fired, the range of fire, the location and nature of the wound. They also distinguish whether the death was suicidal, unintentional, or homicidal (Cave, Dimaio, and Molina, 2014). Forensic pathologists are often used as expert witnesses in a criminal investigation where they examine a victim’s gunshot wound and document its size, location, shape, and type, as well as other injuries. They are also responsible for investigating the manner and cause of the injury, identifying the entry and exit wound characteristics, the direction and distance of fire, as well as the fatality of the wound (Shrestha, Kanchan, and Krishan, 2021).
Forensic pathology is one of the branches of forensic science that uses scientific disciplines to solve crimes. Forensic pathology is used as an investigative tool in a criminal investigation. While a criminal investigation uses theoretical frameworks in explaining criminal behavior, forensic pathology uses scientific techniques and natural sciences to solve a crime. The expertise of a forensic pathologist is crucial in the homicide death investigation of a shooting incident. While the primary role of forensic pathology is establishing the cause and manner of death during a criminal investigation, its value is also recognized in criminal law research.
Firearm-caused wounds are one of the most common sources of injuries and death in the United States. It is often associated with gun violence, which makes it a major public health concern. The epidemiological trend of gunshot wounds and firearm-related deaths continues to grow. About 30,000 people are hospitalized each year in the United States for gunshot wounds (Cook et al., 2017). Because the incidence of gunshot injuries and death is increasing, the role of forensic pathology becomes more significant than ever.
Clinical Significance of Forensic Pathology in Gunshot Injuries
The direction of the bullet in a firearm-related injury may have less significance in a patient’s clinical management, but it has profound medicolegal implications. When a person dies from a gunshot wound, the case falls in the hands of the medicolegal death investigation system. Upon examination, the gunshot wound can relay valuable information such as the type of ammunition used, the weapon, the range of gunfire, and identify the manner of death or injury as homicidal, accidental, or suicidal. Forensic pathology can identify whether the gunshot wound is from a low or high-velocity firearm and helps the authorities classify if the firearm used is a small or large arm. The characteristics of a wound also depend on the distance of fire. Contact wound is identified by the presence of a muzzle imprint on the skin.
Flame burns or singeing hair are common in the case of a close-range gunshot wound, while these are not present in intermediate-range gunshot wounds, though signs of gas, smoke, and unburned particles are still present. Forensic pathologists can also analyze whether one suffers from an indiscriminate firing because the wounds are atypical beyond the weapon’s range and appear with an irregular shape. By clinically identifying the range of fire, one can determine what firearm was used. Small firearms like pistols and revolvers eject the flames for at least 15 cm in the distance, while large firearms can eject the flame for at least 30 cm. The identification of the firearm is very important in a criminal investigation.
While a forensic pathologist is not required to be an expert on weapons, the accurate description of the gunshot wound requires them to learn the basics of firearms, ammunition and wound ballistics. Ballistic or firearm examination is a separate field of expertise in forensic pathology that requires specialized training (Denton et al., 2006). The criminal investigation also needs the expert opinion of forensic pathologists in identifying the person who fired the weapon. The chemical composition of the gunshot residue also plays a significant role in the clinical interpretation that can lead to the shooter’s identity. Forensic pathology helps analyze the gunshot residue by scanning it using an electron microscope with an energy dispersive X-ray spectrometer. Gunshot residue is confirmed if the examination reveals the presence of three metal compounds, namely lead azide, antimony trisulfide, and barium nitrate (Mucha, 2011). The finding is labeled consistent with gunshot residue if one or two of the metal compounds are present. The clinical significance of the gunshot residue composition is also important in tracing the manufacturer and is useful in creating the ammunition signature (Fambro, 2016).
Forensic Pathology: Systematic Examination of Gunshot Wounds
Projectile injury assessment is one of the important aspects of forensic pathology. It involves the examination of the projectile path of the weapon and identifying the exit and entrance wounds (Harcke et al., 2007). The description of the projectile helps identify whether the shot was made in front or behind the victim. By defining the entrance and the exit wounds, one can determine whether the victim of the gunshot injury was running away from the shooter or maybe defending himself from an attack. This aspect of forensic pathology has significance in criminal law because it helps differentiate between, for example, first-degree murder offense and self-defense.
The systematic examination of the gunshot wound includes looking for the entrance wound, which is typically smaller than the exit wound. The entrance wound is typically round in shape showing a circumferential margin of abrasion around the tissue injury from the bullet. The abrasion appears as the bullet scrapes the skin as it pushes inward the body. A concentric abrasion typically occurs when the bullet penetrates the skin nose on with the scraped skin in uniform thickness as the bullet enters the skin perpendicularly. When the bullet enters the body at an angle, it will typically create an eccentric abrasion. One can identify the direction from which the bullet came from by the thick area formed in the eccentric abrasion.
An atypical gunshot entrance wound occurs when the bullet is destabilized before it hits the body and enters it at an angle or sideways (Molina, Rulon, and Wallace, 2012). It is irregular in shape and shows tears on the margin. Forensic pathologists can distinguish a contact wound (which is usually characterized by soot on the skin as well as a muzzle imprint and laceration due to the effect of gases) from a distant range wound (which lacks powder stippling). Several factors are considered in identifying gunshot residue and the amount of its distribution during the examination, for example, the diameter and length of the barrel, the distance of the firing, the angle between the victim and the firearm, gunpowder characteristics, the clothing of the victim, tissue type, blood marks and the environment condition like the heat, moisture, and wind (Romolo and Margot, 2001).
The elasticity of the tissue also affects the size of the bullet entrance hole. In an elastic tissue, the radial displacement is reversible with a narrowing of the entrance hole after the bullet passes. The entrance holes are likely to be smaller from round nose bullets, and they are largest with wadcutter bullets. If the bullet has a truncated cone, the wound tends to be medium-sized. When a bullet enters the skull, the wound is likely to be round or oval (Quatrehomme and Iscan, 1999). A bullet that enters a cranial cavity may fracture the bone because of the energy it expends on the entrance. Forensic pathologists assess the pattern of the fracture to help identify the direction and sequence of fire. They use Puppe’s rule to reconstruct the sequence of injuries, which is possible when more than two fracture lines of the skull occur due to the intersection of various blunt forces (Geserick, Krocker, and Wirth, 2012).
Commonly, a bullet does not exit the body, and the projectile remains intact, or it could be fragmented within the body. Penetrating a wound occurs when the bullet enters the body, causing a laceration, disruption on the tissues, and even destroying the surrounding tissues or organs without exiting the body. Due to the high-intensity kinetic energy, the bullet may take an unpredictable pathway and affect internal organs. With fragments and shrapnel left inside the body, it can further cause more injuries (Forbes and Burns, 2021).
Most exit wounds are generally larger because the bullet expands after entering the body (Thierauf et al., 2013). Exit wounds most likely occur if the bullet has high kinetic energy, meaning it comes from a rifle or a large firearm (Bhardwaj, 2013). It does not show any gunshot residue or may have lesser residues as compared to those found on the entrance wound. In some cases, the exit wound may take different shapes: oval, rectangular, square – and is mostly irregular in shape as compared to the entrance wound. The beveling of the bullet on the bone helps the forensic pathologists identify the direction of the wound. The forward-moving force from the bullet causes beveling, creating a cone-shape deformity as it penetrates the bone. One will know which direction the bullet came from with the tip of the cone pointing in that direction.
Upon examination of the exit wound with a microscope, the lacerations appear to be irregular with protruding collagen fiber (Sriraman, 2021). It is also possible that the exit wound is abutted by firm clothing or other materials upon exit and thus, may appear with similar characteristics as the entrance wound, for instance, an abraded margin. The examination of the characteristics of a gunshot wound is not only useful in determining the velocity, direction, distance, and size of the firearm used in the shooting, but it also helps forensic pathologists and the police reconstruct an event during a criminal investigation.
Forensic Pathology Technology in Gunshot Injuries
Forensic pathology in gunshot injuries also relies on technology to determine bullet fragments, assess the fractures, examine the gunshot wound at the microscopic level, and identify the bullet track. Imaging technology plays an important role in the identification of a fracture that can help determine the direction and the sequence of fire. Prior imaging is also helpful in identifying whether the fragment seen is one from a different injury or due to the present injury. Radiography assists the forensic pathologist in examining the post-mortem anatomy of the victim in different dimensions without the need for a dissection, which is useful when the site of the injury is difficult to dissect.
The computed tomographic (CT) imaging technology is widely used to complement forensic autopsy and is viewed as a convenient, cost-efficient, effective, practical, and simple technology to use (Grabherr et al., 2015). It gives multiple high-resolution views, which helps identify the radiolucent component of the bullet shell. Post-mortem computed tomography is acknowledged to be an effective technique that helps in elucidating the patterns of injuries and conveniently identifying the location of the fragments of the bullet. Research studies identify its advantages that include objectivity and the ease of evaluating the wound path and finding the bullet fragments (Maiese et al., 2014).
Another modern technology used in forensic pathology is multi-detector computer tomography (MDCT), which provides advanced 3D imaging of body segments and injured tissues. MDCT helps forensic pathologists track down gunshot projectiles and describe whether the projectile enters the body anteriorly or posteriorly, superiorly or inferiorly, and from left or right. Carrying out the trajectory track analysis using the MDCT helps characterize the penetrating gunshot injury non-invasively and supports the findings of a forensic investigation. However, MDCT has a limitation: it cannot differentiate between the organ and vascular structures in the absence of contrast material. But forensic pathologists often rely on its ability to track down the collection of gas or fluids or the presence of a hematoma that predicts the presence of a vascular injury.
Post-mortem magnetic resonance imaging (MRI) is hardly used in taking a radiologic assessment of a gunshot wound, although it has an advantage over the traditional computed tomography (CT) when it comes to imaging soft tissue injuries (Gascho et al., 2020). Literature indicates that MRI can complement the findings of a CT by providing descriptive presentation of soft tissue injuries, especially in gunshot wounds in the abdominal area. MRI imaging can affect the post-mortem examination of gunshot wounds since it can affect the trajectory findings, but it may be useful whenever a bright starburst artifact interferes with CT imaging interpretation. Different imaging technologies are helpful, especially under the circumstances where the family of the victim is highly conservative and prefers the less invasive approach than an autopsy (Vanezis, 2004).
To maximize the findings, forensic pathologists resort to the process of maximizing the preservation of the examination object using laboratory methods. Among them, the most common are contract photography, microphotography, macrophotography, and photography of objects in ultraviolet and infrared rays.
In macrophotography, pictures are taken using measuring scales, background, arrows, and indicators. The process does not use a microscope but only involves the enlargement of the photos using a close-up lens to capture the smallest details of the gunshot wound (Gouse et al., 2018).
Microphotography is used to capture the smallest details of the wound that other photography technology and visual inspection cannot otherwise capture. Using reflected ultraviolet rays on objects is preferred when the objective is detecting gun-lubricating grease. The infrared ray helps detect bullet wipes, grains, and soot powder, as in the case of dark color or blood-stained fabric. Histological assessment is also done to determine the distance and type of gunpowder, wound appearance, and injury remoteness; it also helps perform a differential diagnosis by examining the entrance and exit wounds. Tsokos (2008) noted that histopathology becomes an ancillary part of an investigation when the macroscopic examination is not feasible to yield good findings and is used to confirm and refine a macroscopic diagnosis.
Other forms of test carried out in forensic pathology in wound examination include the biological study of the blood to identify the blood type, gender, and origin, as well as the examination of hair on the wound and the soft tissues. X-ray method helps determine the nature of the injury in a gunshot wound, the localization of the injured bones and organs, size and shape of fragments and wound tracks, detect foreign objects and the level of metal spattering on the surrounding tissue of the wound. Both soft and hard radiation allow detecting the stuck fragments of the firearm container. In the examination of skin graft, fabrics showing traces of damage from a gunshot, bones, and projectile forensic pathologists employ spectroscopic analysis. This laboratory test offers a non-destructive, highly specified, and universal way of analyzing the chemical composition and unknown biological stains (Mistek and Lednev, 2018).
The prevalence of gunshot injuries in criminal investigation makes forensic pathologists an important part of the team in the delivery of justice. A gunshot wound is a common cause of homicidal death, and the examination of the wound can reveal crucial medicolegal information that is not obvious from the naked eye. The main objective of forensic pathology in gunshot injuries is to reveal crucial information about the nature of a victim’s death (homicidal, suicidal, or unintentional), the ammunition used, the range of fire, and even the entire crime scene. Gunshot injuries are often complex, hence requiring forensic pathologists to be skilled and equipped with advanced technologies to carry out laboratory tests to unfold the hidden stories behind a gunshot wound. Given the importance of forensic pathology in criminal investigation, forensic pathologists should be aware of its implications and the standards needed to deliver accurate autopsy findings and gunshot wound interpretation to ensure the proper delivery of justice in gunshot injuries.
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