B. Karger et B. Brinkman, MULTIPLE GUNSHOT SUICIDES - POTENTIAL FOR PHYSICAL-ACTIVITY AND MEDICOLEGAL ASPECTS, International journal of legal medicine, 110(4), 1997, pp. 188-192
Out of 138 clearly defined gunshot suicides which were autopsied, 11 p
ersons (8%) fired two or more gunshots to the body. From these 11, 5 c
ases involved 2 gunshots to the head where the bullets fired first had
missed the brain. The trajectories were restricted to the chest in th
ree cases and a combination of gunshots to the head and chest includin
g two perforating heart wounds without immediate incapacitation occurr
ed in three more cases. Reliable incapacitation is based on physiologi
cal effects (tissue disruption) and can only be achieved by decreasing
the functioning capability of the CNS. This can be accomplished by di
rect disruption of brain tissue or indirectly by cerebral hypoxemia fr
om massive bleeding. Targets of immediate incapacitation are restricte
d to certain CNS areas and targets of rapid incapacitation include the
heart, the (thoracic) aorta and the pulmonary artery. Other major blo
od vessels and major organs (lungs, kidneys, liver, spleen) constitute
targets of delayed incapacitation. This general classification can be
derived from the literature and is illustrated by the cases presented
. A thorough post mortem can exclude or quantify the potential for phy
sical activity. Typical features of single gunshot suicides such as co
ntact shots, classical entrance wound sites and soot/backspatter on a
hand also occur in multiple gunshot suicides.