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Background: The captive bolt gun is a tool for stunning animals in the meat industry and is not considered a firearm under the Swedish firearm legislation. This study aimed to explore the involvement of such devices in human fatalities, with an emphasis on suicides. Epidemiological characteristics from a longitudinal perspective, as well as risk factors and injury patterns were analyzed.

Method: Suicides involving captive bolt guns in Sweden 2009–2023 were studied. Data, including demographics, circumstances of the incident, and autopsy reports, were collected from the National Board of Forensic Medicine.

Results: During the 15-year study period, there were 39 suicides involving captive bolt guns, accounting for an annual average of 2.6 suicides, or 0.3 suicides/1,000,000 living people. The incidence was relatively stable over the period. The county-level suicide rate increased with decreasing population density. Older males with mental health issues represented a high-risk group. Four cases were complex suicides, and in two cases, a victim sustained two separate bolt gun injuries in consecutive attempts. Injuries caused by modern captive bolt guns exhibited typical characteristics and could be distinguished from those involving older devices with projectiles. Brain injuries predominated as cause of death.

Conclusion: Suicides involving captive bolt guns are rare. Older males in rural areas, especially those with mental health issues and access to such devices, represented a high-risk group. Since access to these devices is unrestricted, prevention efforts should address individual risk factors, restriction of means and systemic measures aimed at promoting better mental health in rural communities.

This chapter presents the organization of forensic medicine in Sweden, which covers both medico-legal autopsies (forensic pathology) and examination of living persons (clinical forensic medicine). A national body, the National Board of Forensic Medicine, is responsible for all medico-legal autopsies and most issued certificates of medical evidence in clinical forensic medicine. In Sweden, forensic medicine is a recognized medical specialty, tasked to deliver impartial and evidence-based medical expert opinions to the legal system, and the only medical specialty which does not involve medical care or “patients.”

Background: Despite declining over the past three decades, unintentional drownings still account for an estimated 236 000 annual deaths worldwide. Susceptibility persists amongst demographic groups and is influenced by sex, age, and socio-economic status, emphasizing the need for targeted interventions. Due to rapidly evolving population dynamics, particularly within Europe, there is a further responsibility to understand the impact of ethnicity on the risks of drowning to guide prevention.

Methods: We conducted a national population-based retrospective study using data from the Swedish National Board of Forensic Medicine and Statistics Sweden for the years 2002 to 2021. The analysis includes variables such as age, sex, presence of alcohol and narcotics as well as activity undertaken at the time of drowning and type of water body. Furthermore, we considered ethnicity to identify subpopulations at greater risks.

Results: Results revealed a plateau in unintentional drowning rates in Sweden since 2012, despite an overall decrease from 2002 to 2021. Findings confirm the trend that males are overrepresented within drowning statistics across all age groups, and that individuals aged > 50 constitute over half of all unintentional drownings. Men aged between 40-69 years boating, and individuals of non-Swedish origin, particularly those < 20 years of age, face a notably greater risk of drowning, underscoring the need for subpopulation-targeted prevention strategies.

Conclusion: The ten-year plateau in unintentional drowning signals the need for an official national prevention strategy with annual evaluations. Suggestions also include improved parental supervision of children, further avoidance of alcohol while swimming and boating, as well as targeted swimming lessons and water competency training for individuals of non-Swedish origin.

The goal of a medico-legal autopsy is primarily to determine the cause and manner of death. To this end, the pathologist often uses auxiliary analyses, including histology. However, the utility of routine histology in all medico-legal autopsies is unknown. Earlier studies on the utility of routine histology have shown inconsistent effects, with some studies recommending it and others rejecting it. To study the degree to which histology informs on the underlying cause of death, we sent autopsy reports from suspension-, immersion-, fire-, and traffic-related deaths to senior board-certified forensic pathologists and had them assess the cause of death, first without knowledge of the histological findings and then with knowledge thereof. Fifty cases were identified in each of four subgroups: fire-, immersion-, suspension-, and traffic-related deaths. The autopsy reports were anonymized, and the histological findings and conclusions were removed. Two board-certified forensic pathologists independently reviewed the reports in each subgroup and assessed the manner and underlying cause of death (including their certainty of this assessment on a five-level scale) with and without access to histological findings. The probability of changing the underlying cause of death posthistology was low in all study groups. There was a slight increase in the degree of certainty posthistology in cases where the underlying cause of death was not changed, but only when the antehistology certainty was low. Our results suggest that histology does not meaningfully inform on the underlying cause of death in suspension-, immersion-, fire-, and traffic-related deaths except when antehistology certainty is low.

Research on child‐related risk factors for filicide is scant. We investigated whether prior healthcare use for injury (including poisoning) influences filicide risk. Victims (0–14 years; n = 71) were identified in a national autopsy database for the years 1994–2012 and compared to matched, general population controls (n = 355). Healthcare use data were retrieved from a national patient registry. Risks were estimated using odds ratios (ORs) and 95% confidence intervals (CIs). For females, prior inpatient care for injury conferred a statistically significant sevenfold risk (OR = 6.67 [95% CI: 1.49–29.79]), and any prior injury‐related healthcare use conferred a statistically significant fourfold risk (OR = 3.57 [95% CI: 1.13–11.25]), of filicide victimization. No statistically significant risks were found for males. Healthcare personnel should be aware that children treated for injuries, especially females, may be at an elevated risk of filicide victimization. Nevertheless, the filicide base rate remains low, and parents may be stigmatized by unfounded alerts; thus, prudent reflection should precede reports to the authorities.

Nitrous oxide is an inflammable gas that gives no smell or taste. It has a history of abuse as long as its clinical use, and deaths, although rare, have been reported. We describe two cases of accidental deaths related to voluntary inhalation of nitrous oxide, both found dead with a gas mask covering the face. In an attempt to find an explanation to why the victims did not react properly to oncoming hypoxia, we performed experiments where a test person was allowed to breath in a closed system, with or without nitrous oxide added. Vital signs and gas concentrations as well as subjective symptoms were recorded. The experiments indicated that the explanation to the fact that neither of the descendents had reacted to oncoming hypoxia and hypercapnia was due to the inhalation of nitrous oxide. This study raises the question whether nitrous oxide really should be easily, commercially available.