Browsing by Subject "Forensic Medicine"

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    Open Access
    Death by electrocution: a retrospective analysis of three medico-legal mortuaries in the eThekwini district of KwaZulu Natal from 2006 to 2016.
    (2023) Awath- Behari, Anez; Martin, Lorna
    Background: Electrocution is a well-documented cause of unnatural death globally. Identification of demographic and spatial trends in developed countries has assisted in highlighting contributing factors and identifying areas at risk. This information and the appropriate institution of changes have proven worthwhile in reducing fatalities internationally. Less developed countries have shown increasing trends in electrocution fatalities related to rural-urban migration and growing electricity demand. Additional challenges plaguing such countries include illegal electricity connections and load shedding. The association of such issues to electrocution deaths have been sparsely explored. There remains a paucity of information regarding electrocution fatalities in South Africa and Africa as a whole. A general trend of increasing electrocution fatalities referred for medico-legal autopsy was observed at three medico-legal mortuaries in the eThekwini district of Kwa Zulu Natal, South Africa, from 2006 to 2016. Objectives This study aimed to analyse the epidemiology, characteristics and trends of deaths resulting from electrocutions. Methods. A retrospective descriptive study was conducted. Fatal non-lightning electrocutions autopsied at three medico-legal mortuaries in the eThekwini district over an 11year period, from 1st January 2006 to 31st December 2016, were analysed. Data sources included clinician notes, emergency services documentation, scene scripts including South African Police Services(SAPS) 180 form completed by SAPS representatives, postmortem and histology reports, toxicology reports from Forensic Toxicology unit, contemporaneous notes, postmortem death registers, daily listings of postmortem case allocations and electronic postmortem databases. Data were collated and categorised on an Excel spreadsheet and then analysed on statistical package STATA 13 (Stata Corp, TX, USA). 12 Results: There were 512 non-lightning electrocution fatalities from 1 st January 2006 to 31st December 2016. The trend of electrocutions indicates a general increase in cases from 2006, reaching a peak in 2013 followed by a gradual decrease until 2016. Most fatal electrocutions occurred in domestic environments amongst males in the third and fourth decade of life. However, a bimodal distribution showed a considerable number of electrocutions under 10 years of age, predominantly amongst females. The largest number of electrocutions were admitted to the chief medico-legal mortuary servicing the metro, Gale Street mortuary (43,95%). However, the highest concentration of cases was observed in Tongaat, a suburb on the outskirts of the metro. This contributed to the highest prevalence of electrocution cases (1,25% of all electrocution cases) being admitted to the Phoenix medico-legal mortuary, which serves predominantly Northern eThekwini, including Tongaat, and which lies on the fringe of the metro. Deaths from electrocution tend to occur mainly during the midday period, during the weekends, and commonly during the summer months. Injuries associated with fatal electrocutions in all age groups studied generally affected the extremities and predominantly involved the upper limbs. Blood alcohol concentrations were established in just over a quarter of cases and were mostly negative. Conclusion: Electrocution is an easily preventable unnatural death that remains poorly documented and analysed, especially in developing countries, with a paucity of studies in South Africa. Preventative measures and protocols cannot be generalised amongst populations. An appreciation of the demographic and temporal trends of electrocutions is crucial in order to institute preventative policy.
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    Gender-based violence: strengthening the role and scope of prehospital emergency care by promoting theory, policy and clinical praxis
    (2017) Naidoo, Navindhra; Artz, Lillian; Martin, Lorna J
    Gender-based Violence has a considerable prevalence globally, but it is South Africa that has recorded the highest femicide rate in the world. Prehospital Emergency Care providers appear to be well positioned (as first responders) to respond to abuse early. The aim was to understand and strengthen current/potential practice of domestic violence intervention by prehospital emergency medical systems in the context of global health-sector responses. The paradigm was critical theory and the methodology was exploratory sequential mixed methods. Interviews with managers/policy-makers, focus group discussions of clinician-educators and non-participant observation of simulated practice resulted in hypothesis generation. The quantitative phase involved a survey and cohort study with a screening intervention in a public emergency service. The qualitative phase found challenges and threats to responses require organisational/ideological change as paradoxical practice exists relative to the domestic violence behavioural pathology. Further, role-definition, identity and violence re-contextualisation is needed amidst ambivalent and contradictory positions. Emergent theoretical propositions include: typologies of victims, perpetrators and stakeholder responses; an eco-systemic relationship of state/societal expectations; and a 'conceptual compass' for preventing systemic research bias. The cohort study found bio-psycho-social responses and prehospital screening for domestic violence effective and that the evaluation of prehospital met/unmet need was prudent. The historical domestic violence detection rate was found to be 5,1/1000. A nine-fold increase in detection following the screening training and implementation translated to 47,9/1000 emergency care patients, with no adverse events. These rates are unprecedented for South African emergency care and support screening-policy implementation. The difference in domestic violence detection, quantifies the extent of the practice gap, with an alarming missed case detection of 42,8 per 1000 patients (females, 14 years plus). Conceptualisation of the emergency care burden of domestic violence and an awakening to the unacceptability of current practice is warranted. There is a risk of regulatory and organisational 'capture' mediated by masculine hegemony and resuscitation bias. Professionalization should enable a community of practice approach to violence prevention. Recommendations include the national implementation of screening policy; mitigation of regulatory capture risk and professionalising responses through curriculum-reform. The proposed Risk-Need-Responsivity practice-model promotes clinical coherence in Emergency Care. This elevation of the emergency care discourse is likely to benefit the victim and emergency medicine community. Research is warranted in the evolving epidemiology of domestic violence, the acute/clinical needs of victims/perpetrators and the role of emergency medical systems and surveillance, in promoting health and preventing the associated morbidity/mortality, both as a forensic emergency care burden and as a social determinant of health.
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    Post-mortem toxicogenetics: determining the suitable of blood samples collected for routine toxicological analyses for use in subsequent genetic analyses
    (2018) Vuko, Loyiso Abongile Marvin; Davies, Bronwen; Heathfield, Laura; Auckloo, Kathrina
    South Africa has one of the highest prevalences of drug misuse and abuse in Africa. Salt River Mortuary (Cape Town, South Africa), along with other national Forensic Pathology Service providers, receives many cases of suspected drug-related deaths. In some cases, the traditional autopsy – when viewed together with the decedent's history – is not able to indicate whether a drug-related death is accidental or suicidal in relation to altered drug metabolism. Literature has shown that this can be investigated by sequencing gene(s) encoding the implicated metabolising enzyme(s) in a postmortem genetic analysis. However, as such an analysis would normally be performed following the obtainment of postmortem toxicological results, it is imperative to investigate whether blood samples retrieved back from a toxicology laboratory would be sufficient for the said genetic analysis, despite the handling involved in the process of toxicological investigation. To this end, blood samples from 30 deceased individuals in which drug use/abuse may have contributed to death, were collected into two red-top tubes (plain), two grey-top tubes (containing sodium fluoride and potassium oxalate) and one EDTAcontaining purple-top tube (control). DNA was immediately extracted from one of each colour tube, while the duplicate red-top and grey-top tubes first underwent a process of toxicological analyses, and then underwent DNA extraction. The concentration, degradation, purity, contamination, and quality of DNA were assessed using real-time PCR, spectrophotometry, forensic DNA profiling, and Sanger sequencing. In contrast to the grey-top tubes, the results showed that the red-top tubes were most suitable for the aforementioned genetic analysis. Overall, the study not only demonstrated that postmortem genetic analysis using samples retrieved from a toxicology laboratory is possible in the local context, but also provided guidelines around the pre-analytical phase of the analysis. These results illustrate the opportunity to investigate these toxicogenetic avenues further, particularly in future expansion of services currently provided at Salt River Mortuary, which may provide families more information about circumstances of their relative’s death.