The importance of scene photography in routine coronial practice: Results of an audit with an illustrative case of suspected suicidal fatal air embolism

Abstract

Pathologists providing a coronial autopsy service are very reliant on the information, including that concerning the body at the scene, provided prior to the post-mortem examination. This ensures the case is appropriate for a non-forensic autopsy and allows proper interpretation of the pathological and laboratory findings. We present the results of an audit of the extent and accuracy of the information provided (in terms of a set of descriptors), in relation to the body at the scene; whether just the information on the coronial autopsy request form 97a is used, or if it is supplemented with details from the police form 97 and statements from attending officers and scene witnesses. The scene photographs were then reviewed to assess the accuracy of the other information sources and their value to the reporting pathologist. The audit showed that scene photographs are undertaken surprisingly frequently (29.6%) but this was only clear from the coronial request in 22% of referrals. More information was consistently available in the police information for most of the scene descriptors. This was usually accurate, but only partially so, with an average of 19% of relevant features. Viewing the scene photographs was deemed beneficial or essential in 51% and 41.1% of cases. The value of scene photography is then illustrated in a case of suspected suicidal venous air embolism, where subsequent review of the images pointed strongly to the rapidity of death, with minimal blood loss but obvious targeting of a very large varicose saphenous vein in the upper thigh.

Suicide by air embolism introduced by means of a bicycle pump

“…There are a few cases described in which people connected an oxygen supply with tubes to a venous cannula to In one suicide case a man blew air through a system of tubes and a cannula into a vein in one arm [39], in another case an oral air insufflation is assumed in a patient in hospital after suicidal cutting of the veins of the wrist [40]. Another case describes a fatal air embolism of a manaftercutting his varicose saphenous vein in apparently suicidal intention [41]. Moreover, one case is presented in which a man committed suicide by compressing a 2000 mL plastic bottle containing air linked to a system of tubes and a venous cannula with his body weight [42].…”