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.

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.

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(r) X26, TASER(r) X26P and TASER(r) X2 68
 
The electrical outputs of the TASER(r) X26, X26P and X2 68
 
Operationally exploited effects of TASER(r) CEDs: pain and neuromuscular incapacitation 70
 
Adverse effects associated with use of the TASER(r) 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