A multishot suicide arouses suspicions of homicide, and the autopsy is an essential part of the investigation excluding this possibility (22,55,57,59,60,67,72,109,111, 128,129,145). A North Carolina series of 58 multishot suicides showed that they comprised 1.6% of firearm suicides and 0.7% of gunshot wound deaths (67). A Swedish series showed that 3% of firearm suicides were multishot, compared with 57% of
homicides (37). A German study showed that more than one gunshot injury was found in 5.6% of suicides, compared with about 54% of homicides (51).
There are various reasons why multiple shots are fired in a suicide: lacking anatomical knowledge, the victim misses vital organs (see Heading 14.); the victim's hand flinches when the trigger is pulled; defective, improper, or low-velocity ammunition is used and penetrates the body (e.g., skull) superficially; and certain types of weapons are used (16,22,33,46,55,57,59,67,109,111,117,146). Grazing and superficial perforating wounds are seen (Fig. 24; ref. 16).
Multishot suicides commonly involve the precordium, alone or in combination with head and abdominal wounds (55,67,145). Up to 14 entries in the chest have been described (.22-caliber rifle with a clip ). The exclusive presence of head wounds in multishot suicides is unusual (see Fig. 25 and refs. 22, 67, 111, 117, 120, and 146). Up to five gunshot entries have been observed (.32-caliber revolver ). Eight wounds to the head and neck using blank cartridges have been described (73).
More than one weapon can be used and fired simultaneously (16,55,147,148). Intraoral wounds have been noted in multishot suicides (22).
Tandem bullets fired through one entry are attributed to misfire, i.e., insufficient or defective powder owing to contamination or deterioration (149,150). Other reports have described multiple shots through a single entry (96,145).
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