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Clinical Forensic Medicine A Physician’s Guide Margaret M Stark Editor Fourth Edition 123 Clinical Forensic Medicine Margaret M Stark Editor Clinical Forensic Medicine A Physician's Guide Fourth Edition Editor Margaret M Stark Faculty of Forensic and Legal Medicine Royal College of Physicians London UK ISBN 978-3-030-29461-8    ISBN 978-3-030-29462-5 (eBook) https://doi.org/10.1007/978-3-030-29462-5 © Springer Nature Switzerland AG 2000, 2005, 2011, 2020 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Contents 1Clinical Forensic Medicine: History and Development��������������������������   1 J Jason Payne-James and Margaret M Stark 2Fundamental Principles����������������������������������������������������������������������������  23 Margaret M Stark 3Sexual Assault Examination����������������������������������������������������������������������  63 Maria Nittis 4Injury Assessment, Documentation, and Interpretation������������������������ 143 J Jason Payne-James, Margaret M Stark, Maria Nittis, and Douglas R Sheasby 5Physical Child Abuse �������������������������������������������������������������������������������� 195 John A M Gall 6Chemical Crowd Control Agents�������������������������������������������������������������� 239 Sarah L Belsey and Steven B Karch 7Medical Issues Relevant to Restraint ������������������������������������������������������ 255 Philip S L Beh and Margaret M Stark 8TASER Conducted Electrical Weapons �������������������������������������������������� 279 Rich Childers, Ted Chan, and Gary Vilke 9Care of Detainees �������������������������������������������������������������������������������������� 313 Margaret M Stark, Alex J Gorton, and Patrick Chariot 10Infectious Diseases: The Role of the Healthcare Professional �������������� 343 Felicity Nicholson 11Fitness to Be Interviewed and Fitness to Be Charged���������������������������� 393 Margaret M Stark and Keith J B Rix 12Substance Misuse �������������������������������������������������������������������������������������� 421 Margaret M Stark v vi Contents 13Deaths in Police Custody �������������������������������������������������������������������������� 469 Richard T Shepherd 14Traffic Medicine ���������������������������������������������������������������������������������������� 495 Ian F Wall and Margaret M Stark Index�������������������������������������������������������������������������������������������������������������������� 539 Clinical Forensic Medicine: History and Development J. Jason Payne-James and Margaret M. Stark Learning Objectives To describe the recent developments in the field of forensic and legal medicine To discuss the roles of the healthcare professional in general forensic medicine and sexual offence medicine Introduction The term “forensic medicine” is now used to embrace all aspects of forensic work of a medical nature In the past, the term was often used interchangeably with “forensic pathology”—the branch of medicine which investigates death This is further confounded by the recognition of ‘forensic & legal medicine’ or ‘legal and forensic medicine’ as distinct areas of medical specialty practice These terms now broadly embrace all aspects of medicine involving justice systems, and can vary around the world The term “clinical forensic medicine” is however one that can be properly applied to that part of medical practice whose scope involves interaction between the law, the judiciary, and the police involving (generally) living persons Clinical forensic medicine is a term that has become widely used only in the last four decades or so, although the phrase has been used at least since 1951 in the UK, when the national Association of Police Surgeons (which became the Association of Forensic Physicians in 2003 until it in turn was replaced by the Faculty of Forensic & Legal Medicine of the Royal College of Physicians of London) was first established J J Payne-James (*) Forensic Healthcare Services Ltd, Southminster, UK M M Stark Faculty of Forensic and Legal Medicine, Royal College of Physicians, London, UK e-mail: president@fflm.ac.uk © Springer Nature Switzerland AG 2020 M M Stark (ed.), Clinical Forensic Medicine, https://doi.org/10.1007/978-3-030-29462-5_1 J J Payne-James and M M Stark The absence of a defined medical specialty of clinical forensic medicine has resulted in practitioners of clinical forensic medicine having different descriptive names over the years The term “forensic physician” (FP) is now widely accepted internationally, although police surgeon, divisional surgeon, forensic medical officer (FMO) and forensic medical examiner (FME) are examples of other names or titles that have been used to describe those who practice in the specialty of clinical forensic medicine Such names refer more to the appointed role than to the work done Worldwide, there are many who are involved in both clinical and pathological aspects of forensic medicine, and increasing allied healthcare professionals (HCPs), such as nurses and paramedics, may play a role in the delivery of clinical forensic medicine Generally, however, a forensic pathologist does not deal predominantly with living individuals, and an FP does not deal with predominantly with the deceased However there is substantial overlap in the clinical and pathological aspects of forensic medicine and the forensic sciences, and this is reflected in the history and development of the specialty as a whole and its current practice and literature today [1, 2] Table 1.1 gives examples of roles that any HCP/FP may be asked to undertake in the UK [3] The Table also includes examples of additional roles that more senior and experienced FPs may undertake Some HCPs may only perform some of these roles—for example, focusing on general forensic medicine (GFM, custodial medicine) alone, or sexual offence medicine (SOM) alone, or child maltreatment, whereas others may play a more extended role, depending on geographic location (in terms of country and state), local statute and judicial systems HCPs/FPs should have a good knowledge of medical jurisprudence—the application of medical science to the law within their own jurisdiction The role and scope of the specialty of clinical forensic medicine remain ill-defined in global terms, unlike other established medical specialties such as gastroenterology, emergency medicine or cardiology Often doctors practicing clinical forensic medicine may only take on these functions as subspecialties within their own general workload Pediatricians, emergency medicine specialists, primary care physicians, psychiatrists, gynecologists and genitourinary medicine specialists are those who frequently have a part-time role as FPs and such work is commonly a feature of the increasing numbers of medical practitioners with portfolio careers Historical References The origins of clinical forensic medicine go back millenia, and as Smith concluded in 1951 “forensic medicine [cannot be thought of] as an entity … until a stage of civilization is reached in which we have … a recognizable legal system … and an integrated body of medical knowledge and opinion” [4] Forensic medicine developed in a number of jurisdictions in parallel and there is dispute as to when medical expertise in the determination of legal issues was first used It is generally accepted that one of the earliest examples is that identified by Chinese archaeologists who (in 1975) discovered a number of bamboo pieces dating from about 220 bc (Qin dynasty) with rules and regulations for examining injuries 1  Clinical Forensic Medicine: History and Development Table 1.1  Roles of an independent forensic physician [adapted from reference 3] Part A Specific functions Detainee examinations: Custody officers (police officers tasked with the responsibility of welfare of detainees) are obliged to call an appropriately trained health care professional (HCP) when they suspect, or are aware of, any physical illness, mental health problem, or injury of the detainee The HCP in attendance is responsible for the clinical needs of a detainee and should also consider their well-being (food, drink, rest, warmth etc.) The HCP is often requested to provide an opinion on one or more of the following: • Fitness to be detained in police custody (e.g assessment of diabetic control, requirement for medication, referral to hospital) • Fitness to be released (e.g consideration of the medical and physical fitness to release safely, consideration of any risk to public safety, or the personal well-being of the detainee where there are suicidal thoughts or other vulnerabilities, pre-release risk assessment) • Fitness to be charged (e.g competent to comprehend charge, assessing mental capacity or vulnerability) • Fitness to transfer, (e.g when wanted on warrant elsewhere, possibly necessitating a long journey, or fitness to fly) •  Fitness to be interviewed by the police (see Chap 11) • Requirement of an appropriate adult (an appropriate adult in England & Wales law is someone tasked to support those with vulnerabilities—e.g due to age, mental health conditions), support person, interview friend •  Assessment and management of alcohol and drug intoxication and withdrawal • Attendance at the hospital to take samples under the Road Traffic Act or where patients have been seriously assaulted • Assess those detained under Road Traffic Act legislation (e.g determining whether there is a “condition…might be due to a drug”) • Undertake intimate body searches for drugs or weapons (with consent and on premises with appropriate medical and resuscitation support) • Assessment of individuals subjected to restraint, including irritant sprays, batons, handcuffs, etc Detainee and complaint examinations: The HCP is expected to • Ensure the safeguarding of vulnerable adults and children, and to comply with safeguarding principles • Put in place appropriate treatment/referral, including for emergency contraception, post-exposure prophylaxis and sexually transmitted infection (STI) screening •  Accurately assess, document (and with appropriate training interpret) injuries •  Take relevant forensic samples appropriate to police investigations • Examine and treat police officers injured while on duty (e.g needle stick injuries and other at-risk exposure) • Confirm life extinct at a scene of death and give a preliminary opinion on whether there are any suspicious circumstances •  Give an opinion at certain scenes in relation to bony remains (e.g are they human) •  Give advice to the police when requested •  Undertake mental state examinations (continued) J J Payne-James and M M Stark Table 1.1 (continued) In addition, HCPs with sufficient training and experience may be requested to •  Examine adult complainants of serious sexual assault and the suspects •  Examine alleged child victims of neglect, physical or sexual abuse (doctors only) •  Conduct formal mental health assessments under the Mental Health Act (doctors only) • Examine those detained under terrorism legislation and be responsible for leading a multidisciplinary team and setting a management plan (doctors only) • Assess a detainee who has been subjected to a conducted electrical weapon (CEW e.g TASER®) Part B Senior forensic physicians and those with particular skills may also have other broad roles including: Giving expert opinion in courts and tribunals Death in custody investigation Assessments related to: •  Victim of torture or cruel inhumane and degrading treatment •  War crimes e.g the physical capability of an individual to withstand trial •  Female genital mutilation •  Refugee medicine medical and forensic issues •  Asylum seeker medicine medical and forensic issues For all the examinations outlined above it is essential that the HCP accurately documents findings and when needed produce these as written reports for appropriate civil, criminal, coronial courts or other agencies such as disciplinary tribunals The HCP must be able to present the information orally, clearly and concisely to a court, tribunal or other forum inscribed on them Other historical examples of the link between medicine and the law can be found around the world In the English language, the specific terms forensic medicine and medical jurisprudence (also referred to as juridical medicine) date back to the early nineteenth century In 1840, Thomas Stuart Traill [5] made reference to the connection between medicine and legislation and stated “it is known in Germany….by the name of State Medicine, in Italy and France it is termed Legal Medicine; and with us [in the United Kingdom] it is usually denominated Medical Jurisprudence or Forensic Medicine” Amundsen and Ferngren [6] in studies of physicians in legal settings concluded that forensic medicine was used by Athenian courts and other public bodies and that the testimony of physicians in matters of a medical nature was given particular credence although this use of physicians as expert witnesses was “loose and ill-defined” [7] In the Roman Republic, the “Lex Duodecim Tabularum” (laws drafted on 12 tablets and accepted as a single statute in 449 bc) had minor references to medico-­ legal matters, including length of gestation (to determine legitimacy), disposal of the dead, punishments dependent on the degree of injury caused by an assailant, and poisoning [8] Papyri related to Roman Egypt dating from the latter part of the first to the latter part of the fourth century ad contain information about forensic medical examinations or investigations [9] The evidence for a relationship between medicine and the law in these periods is undoubted, but the specific definition and role of forensic medicine, as interpreted by historical documents, is imprecise, with the degree and extent of forensic medical input acknowledged depending on the particular historian undertaking the assessment or review 14  Traffic Medicine 531 of the following controlled drugs: opiates, amphetamines, methamphetamine, cocaine, benzodiazepines, cannabinoids, methadone and ecstasy (MDMA) An expert panel [128] determined the respective levels based on a road safety risk based approach but following a consultation, the UK Government set a ‘lowest accidental exposure limit’ for the drugs most associated with illegal use and ‘road safety risk based limits’ for eight controlled drugs Legislation was introduced creating a new offence making it unlawful to drive with any of the listed drugs in the body in excess of the prescribed level ‘Accidental exposure’—zero tolerance approach Benzoylecogonine Cocaine Delta-9-tetrahydrocannabinol Ketamine Lysergic acid diethylamide (LSD) Methylamphetamine Methylinedioxymethamphetamine (MDMA) 6-monoacetylmorphine (heroin) Threshold limit (μg/L) 50 10 20 10 10 In addition, the UK Government also set levels for certain prescription drugs based on a ‘road safety risk based’ approach ‘Medicinal’ limit—road safety risk based approach Clonazepam Diazepam Flunitrazepam Lorazepam Methadone Morphine Oxazepam Temazepam Amphetamine Threshold limit (μg/L) 50 550 300 100 500 80 300 1000 250 On March 2015, a new law was introduced as Section 5A of the RTA 1988 via the Crime and Courts Act 2013 making it a new offense to drive with certain controlled drugs, including some prescription drugs, above specified limits, there being no need to prove impairment in Court Although the legislation has been introduced UK wide, it has not yet been enacted in Scotland or Northern Ireland There is a statutory defense for drivers who have taken medicines containing specified controlled drugs in accordance with medical advice Thus, with the use of a drug screening device, there is no longer a need for a HCP’s opinion whether the person has a ‘condition that might be due to a drug’ The levels are set in blood only as levels cannot be set in urine reliability and a urine sample cannot be used as an option for Section 5A cases Preliminary results [129] of the new legislation showed increasing convictions for drug driving with more prosecutions under the new Section 5A than for pre-­existing 532 I F Wall and M M Stark Section impairment drugs and a conviction rate of 98% There appeared to be no evidence that users of prescribed medicines that fall into those categories of drugs covered by the legislation had been adversely affected by the new regulations Further research continues to try and identify if there are any other alternative biological matrices for use as an evidential sample for drug driving An expert panel [130] recommended that consideration should be given to expand the list of typeapproved screening tests to include, in addition to cannabis and cocaine, the amphetamine type drugs (methamphetamine and MDMA) and ketamine to reflect the growing use of these compounds in the driving population and that hair testing may be an appropriate matrix for re-licensing decisions as it would enable the determination of a history of past exposures to illicit or medicinal controlled substances Conclusions There is an urgent need to reduce drink driving globally as this is a major contributory factor for road traffic collisions with resulting deaths and seriously injured drivers and pedestrians Since 2014, 22 additional countries have amended their laws on one or more key risk factors to bring them in line with best practice, covering a potential additional one billion people or 14% of the world’s population [1] In the UK there have been repeated calls for Government to reduce the drink drive limit and for a review of policy to reduce unnecessary deaths [131] There are three approaches to establishing a legal framework for drug driving—zero tolerance, an impairment standard, and a per se approach with many jurisdictions using a combination [132] The introduction of limits for drug driving has overall simplified the process Key Points • Many medical conditions affect driving HCPs should be aware of the requirements relating to assessing fitness to drive so they can advise patients accordingly • Drink driving limits vary by age, jurisdiction, and type of vehicle • It is essential to be aware of the drink and drug driving procedures in your jurisdiction and have a process for taking samples in the police station or hospital • There is vast case law on drink and drug driving and it is important to be aware of common examples Self-Assessment Exercises How would you advise an insulin dependent diabetic who wanted to apply to be a bus driver? List the factors that affect the absorption, distribution, metabolism, and excretion of alcohol in the body? What are the drink drive limits for alcohol in breath, blood and urine in your jurisdiction? 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effects on the actual driving performance of patients and healthy volunteers in a standardized test An integration of three studies Neuropsychobiology 31:81–88 103 Barbone F, McMahon AD, Davey PG, Morris AD, Reid IC, McDevitt DG et  al (1998) Association of road-traffic accidents with benzodiazepine use [see comments] Lancet 352:1331–1336 104 Bramness JG, Skurtveit S, Mørland J (2003) Clinical impairment of benzodiazepines— relation between benzodiazepine concentrations and impairment in apprehended drivers Pompidou Group, Strasbourg 105 Gunja N (2013) In the zzz zone: the effects of z drugs on human performance and driving J Med Toxicol 9:163–171 106 Chesher GB, Dauncey H, Crawford J, Horn K (1996) The interaction between alcohol and Marijuana Report to the Australian Federal Office of Road Safety Department of Pharmacology, University of Sydney, Sydney 107 Sexton BF, Tunbridge RJ, Brook-Carter N, Jackson PG, Wright K, Stark MM, Engelhart K (2002) The influence of cannabis and alcohol on driving TRL Report 543 TRL Limited, Crowthorne, England 108 Hindmarch I (1993) Psychiatry in Practice Winter:23–25 109 O’Hanlon JF, Robbe HW, Vermeeren A, van Leeuwen C, Danjou PE (1998) Venlafaxine’s effects on healthy volunteers’ driving, psychomotor, and vigilance performance during 15-day fixed and incremental dosing regimens J Clin Psychopharmacol 18:212–221 110 Bhatti JZ, Hindmarch I (1989) The effects of terfenadine with and without alcohol on an aspect of car driving performance Clin Exp Allergy 19:609–611 111 Choi H, Baeck S, Kim E, Lee S, Jang M, Lee J (2009) Analysis of cannabis in oral fluid specimens by GC-MS with automatic SPE. Sci Justice 49(4):242–246 112 Tunbridge RJ, Keigan M, James FJ (2001) Recognising drug use and drug related impairment in drivers at the roadside TRL report 464 TRL Ltd, Crowthorne, England 113 A Code of Practice (2017) https://assets.publishing.service.gov.uk/government/uploads/ system/uploads/attachment_data/file/607267/Fit_Code_of_Practice_1st_April_2017.pdf Accessed 16 June 2019 114 Burns M, Adler E (1995) Study of a drug recognition expert (DRE) program, in T95: Proceedings of the 13th International Conference on Alcohol, Drugs, Traffic Safety, Adelaide, 1994 115 Lamping S (2007) Oral presentation Royal Society of Medicine, London 116 Kidwell DA, Holland JC, Athanaselis S (1998) Testing for drugs of abuse in saliva and sweat J Chromatogr B Biomed Sci Appl 713:111–135 117 Beck O, Leine K, Palmskog G, Franck J (2010) Amphetamines detected in exhaled breath from drug addicts: a new possible method for drugs-of-abuse testing J Anal Toxicol 34(5):233–237 118 Tunbridge RJ, Rowe DJ (1999) Roadside identification of drug impaired drivers in Great Britain 10th International Conference on Road safety in Europe, Malmo 119 FFLM (2018) Drug-driving competencies https://fflm.ac.uk/wp-content/uploads/2018/02/ Drug-Driving-Competencies-Dr-Will-Anderson-Feb-2018.pdf Accessed 19 June 2019 120 DRUID (2012) Summary of Main DRUID Results Driving Under the Influence of Drugs, Alcohol, and Medicines TRB 91st Annual Meeting, Washington DC, January 2012 http:// www.druid-project.eu/Druid/EN/Dissemination/downloads_and_links/2012_Washington_ Brochure.pdf? blob=publicationFile Accessed 16 June 2019 538 I F Wall and M M Stark 121 O’Keefe M (2001) Drugs driving—standardized field sobriety tests: a survey of police surgeons in Strathclyde J Clin Forensic Med 8:57–65 122 O’Keefe M (2013) An Investigation into Field Impairment Tests and an evaluation of their validity and reliability as clinical tests of drug-related impairment of driving ability Thesis for the Degree of Doctor of Philosophy University of Edinburgh, Edinburgh 123 Sexton BF, Tunbridge RJ, Brook-Carter N, Jackson PG, Wright K, Stark MM, Englehart K (2000) The influence of cannabis on driving TRL Report 477, TRL Ltd for the Road Safety Division, DETR; and Sexton BF, Tunbridge RJ, Board A, Jackson PG, Wright K, Stark MM, Englehart K (2002) The influence of cannabis and alcohol on driving TRL Report 543, TRL Ltd for the Road Safety Division Department of Transport 124 Leetham v D.P.P. Q.B 488 (1998) 125 Angel v Chief Constable of South Yorkshire (2010) EWHC 883 (Admin) 126 Oliver JS, Seymour J, Wylie FM, Torrance H, Anderson RA (2006) Monitoring the effectiveness of UK Field Impairment Tests Road Safety Research Report No 63 Department for Transport, London 127 Odell MS (2002) Expert Opinion in DUID Cases Based on Interpretation and Observation and Toxicology in T2002 Proceedings of the 16th International Conference on Alcohol Drugs and Traffic Safety, Montreal 128 Wolff K, Brimblecombe R, Forfar JC, Forrest AR, Gilvarry E et al (March 2013) Driving under the influence of drugs Report from the Expert Panel on Drug Driving https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/167971/drugdriving-expert-panel-report.pdf Accessed 15 June 2019 129 Risk Solutions (April 2017) Evaluation of the new drug driving legislation, one year after its introduction A report for the Department of Transport https://assets.publishing.service.gov uk/government/uploads/system/uploads/attachment_data/file/609852/drug-driving-evaluation-report.pdf Accessed 16 June 2019 130 Johnston A, Wolff K, Agombar R, Clatworthy A, Cowan D et al (April 2017) Exert panel review of alternative biological matrices for use as an evidential sample for drug driving Queen Mary, University of London The United Kingdom Department for Transport (Online), report no RM4825 SB-2988 https://qmro.qmul.ac.uk/xmlui/handle/123456789/27903 Accessed 16 June 2019 131 Tunbridge R, Harrison R (2017) Fifty years of the breathalyser—where not for drink driving, PACTS http://www.pacts.org.uk/wp-content/uploads/sites/2/129256_ PACTS_50YearsBreathalyser_V5-1.pdf Accessed 15 June 2019 132 Stark MM (2016) Chapter Driving impairment: the main risk factors In: Gall JAM, Payne-­ James JJ (eds) Current practice in forensic medicine, vol Wiley, West Sussex Index A Abdominal injuries, 211–212 Abrasions, 198, 207, 210 Abused children, 204, 205, 211, 212 Abusive head trauma (AHT), 197, 198, 213, 215–219, 230 Access, 24, 26, 38, 39, 41, 47–49 Accidental bruising, 201, 202 Accidental injuries, 212–214 Additional juvenile risk assessment, 319 Advisory Council on the Misuse of Drugs (ACMD), 441 AEP, see Attenuating energy projectiles Agents, riot control, 239 AHT, see Abusive head trauma Alcohol, 500–502 effects of, 480 and fitness for interview, 407–408 influence of, 475, 481 intoxication, 435, 452–456 result, 480 withdrawal, 407, 408, 444, 456–458 ALTE, see Apparent life threatening events Amnesia, retrograde, 412 Amphetamine-type stimulants (ATS), 440–441 Anal swabs, 120, 122 Anatomical location, 163–164, 181, 183, 185 Apparent life threatening events (ALTE), 217, 225 Appendix, 324, 325, 335–337 Applications, 294, 299, 300 human probe, 282 probe-mode, 290, 295 Asphyxia, 176–178 Asphyxiation, 481, 484–486 Assailant, 167–169, 178, 179, 181, 182 Assessment and documentation, 144, 145, 400, 401, 404–406 © Springer Nature Switzerland AG 2020 M M Stark (ed.), Clinical Forensic Medicine, https://doi.org/10.1007/978-3-030-29462-5 Association of Chief Police Officers of England, 265 Asthma, 320–321 Asystole, 294, 296, 298, 300, 301 Attack, 412, 413 Attenuating energy projectiles (AEP), 258, 273–274 ATS, see Amphetamine-type stimulants B BAC, see Blood alcohol concentration BBVs, see Blood borne viruses Bite marks, 163, 180–189 analysis, 180, 185–188 evidence, 187 plane, 185 in skin, 180, 182 Biting, 163, 180–183 Blood, 159–161, 164, 166, 177 Blood alcohol concentration (BAC), 425, 449, 452, 453, 458 Blood borne viruses (BBVs), 344–348 Body, 144, 155, 170, 174, 176, 177, 181 Body chart, 148, 158 Body worn cameras (BWC), 257, 258 Breath test, 505, 507–508 hospital procedure, 508–509 police station procedure, 509–510 Bruises, 200–205, 210, 216, 230 Bruising, 155, 158–164, 169, 178, 180–182, 189, 198, 200, 202–205, 212, 219, 261–263, 266, 274 Bullet, 171, 173, 174 Buprenorphine, 431, 433–434, 458 Burns, 198, 207–210 BWC, see Body worn cameras 539 540 C Camera, 153, 154, 184 Cannabis, 422, 423, 442, 518–519 Cardiac deaths, sudden, 476 Cardiac rhythms, 295, 300 Carers, 34, 35, 45, 196, 219, 220, 223–226 Carfentanyl, 250 Cases, 284–286, 288, 289, 292, 295, 297–302 index, 376, 381 new, 357, 377 Cause, 283, 288–290, 293, 301, 303 CEW, see Conducted electrical device Chemical Weapons Convention (CWC), 247, 248 Chicken pox, 361–365, 388 Chief police officers, 265 Child/children, 33, 34, 36, 44, 45, 58, 160, 164, 179, 181, 182, 195–198, 200, 201, 203, 205, 207–210, 212–217, 219, 220, 223–227, 229 condition, 220 interaction, 219, 220 physical abuse, 198 young, 205, 230 Child abuse, 196, 197, 199, 205, 207, 209, 213–215, 219, 223, 227, 230 detecting, 197 Chloroacetophenone (CN), 240, 242–244 Chlorobenzalmalononitrile (CS), 240–244, 246, 247 exposure, 244, 246 Chronic hepatitis, 349, 354, 356 Clinical forensic medicine practice, 16, 17 Clonidine, 497 Clothing, 146, 147, 156, 172, 174, 181 CN, see Chloroacetophenone Cocaine, 284, 303, 304, 520–521 Complainants and suspects, 68, 97, 98 Conducted electrical device (CEW) activations, 297, 298 discharge, 289, 298, 302, 304 exposure, 289, 292, 293, 295–296, 304, 305 probe wounds, 287 use, 284, 285, 292 Consent, appropriate, 33 Contact wounds, 172–174 Contaminated bedding, 346, 353, 356 Contemporary clinical forensic medicine, 11–16 Corneal abrasion, 243–245 Countries, 421–423, 425 Covert video surveillance (CVS), 227–230 Crimes, 394, 396–398, 403 Index CS, see Chlorobenzalmalononitrile Cuffs, 266, 271 Custodial deaths, 470, 481 Custody officers, 314, 315, 327 Custody setting, 314, 321, 322, 327, 335 Custody staff, 313–318, 320, 321, 325, 326, 330, 472, 475, 490 CVS, see Covert video surveillance CWC, see Chemical Weapons Convention D Dart, 288, 292, 296, 297 Deaths, 263–265, 269–271, 275, 422, 423, 435, 437, 439–441, 445, 447, 453, 455, 457 restraint-related, 490 sudden, 476–482 Defibrillation, 283, 298, 299 Degree, 161, 181–184 Dementia, 413–414 Dentition, 181, 183, 188, 189 Dermatitis, 244, 246, 247 Detained overnight, 313 Detained person (DP), 314, 321, 336 Detainees, 26, 27, 36, 39, 40, 50, 56, 425–429, 436, 447, 455–458 custody, 317 pregnant, 330 terrorist, 335 Deterioration, 298, 301 Development, 476–478 Diabetes, 498 Diagnostic Imaging of Child Abuse by Kleinman, 213 Disclosure, 31, 38–45, 52, 54 confidential information, 38, 41, 44 Diseases, 476–478, 488 tropical, 385–387 Disorder, mental, 401, 402 Distortion, 183, 189 Doctor’s duty, 28, 38 Documentation, 144, 145, 147, 175, 176, 179, 189 of injuries, 145, 147 Dopamine, 431 Dose, 429, 433–435, 438, 446, 452 high, 434, 435, 443, 444 DP, see Detained person Driver and Vehicle Licensing Agency (DVLA), 497 Drink-drive accident, 500 Drink-drive offenders, 505–506 Drivers, 496 Index alcohol, 500–502 with angina, 497 drink-drive offenders, 505–506 drugs and driving, 517–518 hypertension, 497 myocardial infarction, 497 Drugs, 241, 250, 317, 324, 331–333 detainees drug history, 316 recreational, 438, 439 Dysrhythmias, 497 E Ears, child’s, 224 Effect of physical illnesses on fitness for interview, 410 Electrocution, 281, 294, 299, 300, 303, 304 Electrodes, 281, 283, 284 Emotional abuse, 196, 198 England, 350, 369, 370, 377–378, 421–424, 428 Entrance wounds, 172–174 Epilepsy, 405, 410–411, 498 Escape, 290 Evidence, 30, 41, 50–57 in court, 41, 54 Excessive force, 264, 265 Excited delirium (ExDS), 488, 491 Expert, 49–52 evidence, 50, 51, 54 witness, 51, 54, 55 Expertise, 49, 50, 52, 55 Exposure hours post, 286, 287, 291 secondary, 243, 250 Eye disorders, 499 F Fabricated or Induced Illness (FII), 219–225, 227 Fabrication, 219, 220, 223, 224 Faculty of Clinical Forensic Medicine, 18 Faculty of Forensic and Legal Medicine (FFLM), 15, 16, 18, 24, 33, 36, 37, 50, 51 Father, 210, 211, 220, 229 Femoral fractures, 213 FFLM, see Faculty of Forensic and Legal Medicine FII, see Fabricated or Induced Illness Findings, 84–86, 88, 89, 91–93, 118, 119 Firearm injuries, 171 Fitness, 541 assessment of, 404, 405 detainee’s, 404 person’s, 406 Fixed link handcuffs, 266 FME, see Forensic medical examiner Force impact, 273 peak, 273 tactics, 257 Forensic and legal medicine, 16 Forensic medical examiner (FME), 56, 57 Forensic medicine, 2, 4, 6, 11, 16–18 principles of, 6–9, 11 specialty of clinical, Forensic pathology, 1, 11, 16, 17 Forensic physicians, 1, 2, 15 G Global Clinical Forensic Medicine, 16–19 Gloves, 345, 346, 366–369, 385 Guardian, 33, 34, 46 Guilty, 394–395 H HCV, see Hepatitis C virus Health and Care Professions Council (HCPC), 25, 28 Health care professionals (HCPs), 23, 24, 26, 34, 35, 38, 39, 41, 51, 421, 424, 425, 427–429, 436, 446, 447, 455, 456, 458, 508 Health records, access to, 39, 48–49 Heart, 283, 294, 296, 297, 300–304 Hepatitis C virus (HCV), 347, 354–356, 359, 373, 374, 383, 384, 388 High-Risk offender scheme, 506 Hospital, 426, 434, 436, 455, 457, 458 assessment, 324 Hours, 424, 425, 428, 433, 437, 438, 441, 442, 449, 451, 452, 457 Human bite marks, 180, 188, 189 in skin, 180 Hymeneal rim, 80, 82, 84, 85, 87 Hypertension, 497 I ICDs, see Implantable cardioverter defibrillators ICO, see Information Commissioner’s Office IDDs, see Intellectual and Developmental Disabilities Index 542 IEC, see International Electrotechnical Commission Illicit drugs, 316, 326, 332 Illness, child’s, 220, 227 Image and performance enhancing drugs (IPEDs), 442–443 Images, 153, 154, 158, 188, 190 Implantable cardioverter defibrillators (ICDs), 294, 302 In custody deaths, 474 Independent Advisory Panel on Deaths in Custody, 473 Independent Office of Police Conduct (IOPC), 273, 470, 471, 473, 490, 491 Independent Police Complaints Commission (IPCC), 470, 473 Individual police forces, 260 Individual’s neck structures, 263 Induced VF, 294, 295, 298, 299, 301, 304 Induction, 294, 295, 297, 298, 301 Infant children, 216 Infants and young children, 200 Infectious diseases, 344, 347, 361 Information, 316, 317, 328 protected, 41 share, 47–48 Information Commissioner’s Office (ICO), 48 Injecting drug users, 368–371, 384 Injuries, 474, 479, 480, 482–484, 486 abusive abdominal, 212 baton, 262 bite mark, 180, 189 blunt contact, 155, 156 blunt force, 155, 157, 167 bowel, 211, 212 crush, 217 defense, 169, 174–175 diffuse axonal, 218 intraoral, 204, 205 mixed type, 155, 157, 167 patterned, 188, 189 presenting, 196 sharp, 156, 157 sharp force, 157, 159, 174 spinal, 214, 215, 219 visceral, 197, 198, 212 visible, 143, 144, 156, 182 Intellectual and Developmental Disabilities (IDDs), 328–329 Interests, best, 28, 32, 33, 37, 45, 47 International Electrotechnical Commission (IEC), 282, 296, 300 Interview style, 395 Interviewer, 394, 408 Investigation of Deaths in Custody, 472–475 IOPC, see Independent Office of Police Conduct IPCC, see Independent Police Complaints Commission IPEDs, see Image and performance enhancing drugs Irrigation, 244–246 L Lacerations, 86–94, 118, 198, 201, 205, 207, 210, 211 Law enforcement personnel, 275 Legal medicine specialty, 19 License, 496 Location, 84–86, 105, 128, 129 Lubricants, 99, 105, 113, 119–122 M Magnetic resonance imaging (MRI), 213, 218, 219 Management, 25, 41, 48, 49 Margins, 166, 167, 169, 172–174 Medication administration of, 317–318 detainee’s, 317 Memory, 398, 399, 407, 411–413 Mental health problems, 314, 325 Mental illness/medication/injuries, 284, 285, 292, 316 Metal handcuffs, 265 Methadone, 429–431, 433, 451, 458, 459 Methamphetamine, 299, 303, 304, 520–521 Methyldopa, 497 Methyl isobutyl ketone (MIBK), 240, 241, 246, 247 Minutes, 284, 295–301, 303, 304 subject’s alertness, 299 Mother, 202, 220, 229 MRI, see Magnetic resonance imaging Muzzle, 171–174 N Naloxone, 433, 434 National Deaths in Custody Program (NDICP), 470 Neck, 480–489 individual’s, 263, 264 injuries, 265 pressure, 483 Nerve agents, toxic, 250 Nitrogen, 241 Non-abused children, 203 Index Non-lethal force, 260 Notes, 40, 48, 54, 55, 57 Novel psychoactive substances (NPS), 423, 430, 446–447 Number, 258, 260, 268, 269, 274 Nurses, 23–26, 28, 36, 50 O Objects, 88, 89, 95, 96, 106, 155, 157, 164–166 impacting, 155, 156, 162, 165, 166 OC, see Oleum capsaicin Odontologist, 184–187 Officers, 289, 290, 292, 300, 304 Oleum capsaicin (OC), 240–244, 247 Opiate withdrawal, 430, 432, 433, 436 Opiates, 519–520 Opinion, 39, 50–54 Opiate substitution treatment (OST), 429, 458 P PACE, see Police and Criminal Evidence Act Pacemaker patients, 301–303 Pacemakers, 301–303 Pain, 153, 155, 156, 158, 175, 178, 181 Parent, 33, 34 Parental responsibility, 33–35, 58 Patient confidentiality, 47–48, 57 Patients, 144–147, 154, 162, 190, 285, 288, 294, 298, 304 Patient’s consent, 31, 37, 38, 40, 41, 43 Patterned bruising, 162 Peak, 281, 282 Pelargonic acid vanillylamide (PAVA), 240, 241 Pellets, 171–173 People who inject drugs (PWID), 350–353, 357, 360, 368, 369, 371, 384 PEP, see Post-exposure prophylaxis Pepper spray exposure, 247 Person, 65, 67, 70–72, 76, 96, 99, 101 young, 34, 44 Personal confidential data, 46, 47 access to, 47 Personal information, 41, 42, 44 Personality disorders, 395, 409, 410 Phases, 474–475 Photographic distortion, 183–186 Physical child abuse, 196, 197, 229 Physical illnesses, 399, 410 Physical restraining devices, 265–267 Physicians, 198, 199, 201, 205, 216, 220 investigating, 198, 199 543 PIRC, see Police Investigations and Review Commissioner Plastic wrist restraints/body cuffs, 258 Pneumothorax, 289 Police, 284, 290, 292, 299 Police and Criminal Evidence Act (PACE), 393, 395, 400, 402, 403, 409 Police custody, 313–315, 317, 319, 324, 325, 329, 330, 470, 471, 475–478, 488–490 deaths in, 469–472, 489, 491 environment, 315 following, 471 process, 474–475 Police detainees, 314 Police detention, 469 Police forces, 257, 260, 262, 264, 402 Police interview, 394–395, 410 Police Investigations and Review Commissioner (PIRC), 473 Police involvement, 470, 474 Police officers/staff, 256–258, 260, 268, 273, 344, 345, 385–387, 394, 395, 397, 400, 402, 409, 470, 472, 474, 478, 485, 486, 489, 491 mounted, 260 senior, 259 Police Ombudsman of Northern Ireland (PONI), 473 Police risk assessment, 321 Police station, 470, 474, 479, 481, 486, 489 Police surgeons, 1, 2, 13, 15 Police use of force, 257 PONI, see Police Ombudsman of Northern Ireland Posterior fourchette, 78, 79, 85–87, 90, 91, 112, 118 Post-exposure prophylaxis (PEP), 360, 361, 388 Postmortem examinations, 472, 473, 478 Posture distortion, 183, 184 Prazosin, 497 Pressure, 482–487 Probes, 280, 283, 286, 288–290, 292, 296–299, 302 Prone position, 269, 275 Psychiatric illnesses and personality disorders, 409 Psychological dependence, 434–437, 440, 441 Psychosis, 435, 439, 442 Pulses, 282, 283, 298–300, 302 Puncture wounds, 168, 169, 173 PWID, see People who inject drugs Index 544 Q Quantity, 96, 103, 104, 112, 114–116, 123 R RCIADIC, see Royal Commission into Aboriginal Deaths in Custody Recognition, 1, 17, 19 Records, 39–41, 46–48, 56 electronic, 46, 48 Reduction, 285, 288 Release, 40, 43 information, 41, 43 Report, 27, 43, 47, 49, 50 Reserpine, 497 Restraint, 334, 469, 472, 483–485, 490 asphyxia, 484–486 positions, 269–271 situations, 261 Retinal haemorrhages (RHs), 216, 217 Risk assessment, 314, 316, 321, 322, 325, 329, 334 pre-release, 328 screening, 314 Risk, increased, 294, 304 Roadside screening tests, 526 Road Traffic Act 1988, 496, 506 Road traffic death, 495 prevention, 495 rate, 495 Road traffic legislation, 502–503 Royal Commission into Aboriginal Deaths in Custody (RCIADIC), 470 S Sampling, 80, 108–110, 112, 113, 119–122, 125 SARS, see Severe acute respiratory syndrome SBG, see Spit and Bite Guard Scaled photograph, 180, 186–189 Seconds, 293–301 Sedative-hypnotics, 521–522 Self-harm, 169–171, 320, 326–328 Self-infliction, 170 Severe acute respiratory syndrome (SARS), 343, 380, 381 Sexual assault cases, 97, 98, 102, 110, 119 Sexual assault complainants, 66, 89, 128, 129 Sexual assault services, 64, 65, 71 Sexual assault units, 69, 70, 124, 129, 130 Sexual intercourse, 89, 91, 92, 108 Shingles, 362–365 Shocks, 298, 302 Signs of child physical abuse, 198 Sites of injury, 147, 159, 166 Skeletal injuries, 198, 212, 214 spinal, 213, 214 Skin, 204, 205, 207, 210 overlying, 163, 181 surface, 156, 157, 159, 161, 173, 174, 182 wound, 169 Spermatozoa, 77, 98, 101, 110–112, 114, 116, 117, 120, 122, 124 Spit and Bite Guard (SBG), 256, 268 Statement, professional witness, 40, 50 Stimulants, 285, 303, 304 Strangulation, 162, 177–179 Subject, 469–472, 491 Subject injuries, 284 Substance misuse, 427–429 Suicidal deaths in custody, 486 Suspect, 145, 146, 189, 190, 279, 284, 285, 288, 289 Suspect biter, 180, 186–188 Suspected child, 195, 229 Swabs, endocervical, 112, 113, 116 Swine, 295–297, 301 heart, 297 studies, 293, 297, 298 Symptoms, 245, 246, 249, 250 exposure, 245 T Table, 146, 147, 153, 155–157, 160, 164, 170, 425, 426, 430–432, 434–440, 446, 447, 451–453, 472, 474, 488, 490 TARP, see Total appendage restraint position TASER probe, 288 Teeth, 163, 178, 180–182, 187–189 Test, prudent patient, 30 Time, 257, 260, 261, 268–270 Time since intercourse (TSI), 98, 115, 116 Tissues, 157–159, 161, 166, 167, 172, 173, 181–183 Torture, 143, 144, 146, 175–176 Total appendage restraint position (TARP), 270 Toxicity, ocular, 244–245, 250 Treatment options, 30–32 TSI, see Time since intercourse U UAC, see Urine alcohol concentration UK police officers, 260 United Nation, 495 Urine alcohol concentration (UAC), 425 Urine samples, 74, 99, 123–125 US child abuse mortality figures, 197 Index V Vaccine, doses of, 352, 353, 362, 385 Vaginal penetration, 76, 85, 88, 89, 91, 98, 112, 115, 124 Vaginal swabs, 106, 107, 114–116, 122, 124 high, 99, 113, 115 Valid consent, 29, 33 VF induction risk estimates for humans, 297 Violence, domestic, 179–180 Volatile substance, 290, 292 Vulnerabilities, detainee’s, 414 Vulnerable persons, 401–403 W Wales, 470–473 Webster, 294, 295 Withdrawal, 405, 408, 425, 427, 430, 432–435, 444, 448, 455–459 545 symptoms, 430, 432, 435, 441, 442, 444, 448, 456 Witness, 51, 52, 54–57 Wound margins, 157, 172–174 Wrists, restrained, 266 X X26, 281–283, 294, 300, 302, 303 Y Younger age groups, 476–478 Z Z-drugs, 435 ... obtaining qualifications in clinical forensic medicine https://fflm ac.uk/wp-content/uploads/2018/08/Advice-on-obtaining-qualifications-in -clinical- forensicmedicine-Dr-M-Stark-Jan-2018.pdf Accessed 23/06/2019... Physicians London UK ISBN 97 8-3 -0 3 0-2 946 1-8     ISBN 97 8-3 -0 3 0-2 946 2-5  (eBook) https://doi.org/10.1007/97 8-3 -0 3 0-2 946 2-5 © Springer Nature Switzerland AG 2000, 2005, 2011, 2020 This work is subject... https://doi.org/10.1007/97 8-3 -0 3 0-2 946 2-5 _1 J J Payne-James and M M Stark The absence of a defined medical specialty of clinical forensic medicine has resulted in practitioners of clinical forensic medicine
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