Entry Wound Altered by Medical Care

If an entry wound is altered by medical care, then the pathologist needs further information from hospital personnel regarding what was done (Fig. 41; refs. 16, 66, 99, and 134). The major concern, in an emergency setting, is the care of the patient who has sustained a life-threatening firearm wound. The focus is on internal injuries, but the accurate documentation of external trauma is important for a medicolegal investigation, particularly if the individual survives (173). Medical personnel, inadequately trained to interpret the features of firearm injuries and pressured by the time constraints of resuscitation, miss wounds and misinterpret entry and exit wounds (16,99,132,174). There

Fig. 31. Self-inflicted firearm injury. Hands covered by paper bags to preserve evidence.

may be varying descriptions of the wounds in the clinical records, and discrepancies regarding the size and shape, range, location, and direction of fire arise (173,174). A wound in a hospitalized patient is also altered by infection and healing (16). Continuity of evidence issues also can arise in the clinical setting (174).

Specimens from the wound site and track may be resected and submitted for pathological examination (175). The pathology laboratory must have a system to ensure continuity of evidence. The specimen should be examined by a pathologist with forensic experience and documented with photographic images. Inquiries may be made by the police regarding a specimen and any recovered projectiles. Provision of this evidence to the police is only with a patient's consent or under legal warrant and must be recorded.

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