Autopsy Report: Husham Nafit Ghafar, Abu Ghraib Prison, Iraq (Death Certificate Included) (0139-04-CID789-83995)

<p>Autopsy report, preliminary autopsy report, trauma record, death certificate, and hospital report of death relating to the death of Husham Nafit Ghafar. The cause of his death was a shotgun wound to the head. The circumstances surrounding his death were investigated by the CID report# 0139-04-CID789-83995. According to the opinion of the medical examiner, &quot;White male detainee in U.S. custody died as a result of a shotgun wound o f the head that caused injury to the skull and brain. Toxicology was positive for morphine, which was likely the result of medical therapy received prior to death. One metallic projectile was recovered from the head and turned over to the investigating USACID agent who was present at the autopsy. The manner of death is homicide.&quot;</p>

Doc_type: 
Medical
Doc_date: 
Tuesday, October 12, 2004
Doc_rel_date: 
Sunday, April 17, 2005
Doc_text: 

NonENEMY WOUNDED BY: US/COALITION(Nation q ENEMY " a CIVILIAN (Nation a TRAINING o SELF ACCIDENT El SELF NON-ACCIDENT q SPORTS-RECREATION a OTHER: 0 PROTECTION: q UNK TIME 06 13 cial Use Only / Law Enforcement Use Only Exhibit 15 b)( 6)-4 V • V' •-‘ 11 • • Trauma Record Foi use of this form, see DoD Mance Subject :Trauma Record, dui I APR 04; the proponent agency is OTSG AUTHORITY: - PURPOSE: ROUTE413 USES: DISCLOSURE: AR 40-66 To provide aftandard means of doeornenting all trauma care at echelons 1-3 The "Blanket Routine Uses" set forth at the beginning of the Array compilation of systems of records notice apply. This is protected health information. HIPAA laws apply Wound DTG: 6c..gee..-. ( g atorse0.4(.,j Head & Neck (incl C-spine) A 4.,...64.1 g1..e..._ ecerel 4k,.,' ,otj r '` -1-`71 7 k • Chet • (Inc! T-spine) / . 6 • Abdomen (incl L-spine) (0/1-2 , . Pelvis •..• UPPER /LOWER • Extremities • , ‘,.._• 0/1.efrg eiwil4-- e•-- - •' ' -1q2e--..-?--0-1- h-e4•71-.1 . Skin . • DISPOSTION • DTG: • o o afe-EVAG-to re-60-- • • Evacuation Priority o ROUTINE o PRIORITY o URGENT RTD . a irr CAM, DECEASED (see below) V Damage Control Procedures? Y / N Hypothermic < 34°C)? Y / N Coagulopathy? Y / N Cause of Death at UAirway uHead °Other ,; . • PHYSIOLOGIC: 0 Breathing OCNS DTG . a r-5,-,.e. d1 .0.- --- uPelvis u xtremity pper/Lower) "), • Disruption °Sepsis V 0Multi-organ failure di e,a.a...frop,_ °Hemorrhage OTotal Body ANATOMIC: U Neck u Chest U e domen V . COMMENTS: . SURGEON: (printedName) MEDCOM Test F6rm 1381, JAN 2004 Fib Offi ialgsj 0 wyjftcenwyk449./W. Exhibit 15 1 7/ .( • ( • OUti5i MEDCOM - 990 DOD 004053 ACLU-RDI p.3 Date of Birth Trauma R8COrtie aw Foiuseof this form, see DoD Monica Subject :Trauma Record, did I APR 04; the proponent agency Is OTSG AUTHORITY: PURPOSE: ROUTINE USES: DISCLOSURE: .AR 40-66 To provide a Rtandard means ofdocurnenting all trauma ewe at echelons 1-3 The 'Blanket Routine Uses" set forth at the beginning of the Army compilation of systems of records notice apply. This is protected health information. HIPAA laws apply MTF DESIGNATION: • UAL NAME: F iRsT L-Pcs'r Number CASUALTY SSN:_ b)(6)-4 tot r 'Jul le Group (DT ate ARRIVAL METHOD: a Non-MED GNC WALKED 0 SHIP EVAC CARRIED q GND AMB a Non-MED AIR q AIR AMB q OTHER Rank Nation q US q Host Nation ..Enemy( 6 Coalition( ) Arrive Dot -Ti • 3try ale q Female Service q USA qCivilian q USN pArnbatant q USMC qContractor q USAF o SOF qNGO ( qOther Wound DTG: ig WOUNDED BY: q US/COALMON(Nation a ENEMY " q NonENEMY u CIVILIAN (Nation a TRAINING q SELF ACCIDENT q SELF NON-ACCIDENT O SPORTS-RECREATION q OTHER: 141CHANISM OF INJURY: q KNIFE / EDGE q BURN (thermal, flash) GSW/BULLET , q BLAST q CRUSH 0 BLUNT TRAUMA a CRASH(a/c, veh, peiq FALL a SINGLE FRAGMENT q Chern/Rad/Nucl q - SMOKE Inhalation O MULTI FRAGMENT INJURY Description (Location, nature and size in cm) . A .,•• •.• 4. • V.; tY If "K.1.1:::111 • - R 65 TRIAGE CATEGORY: )nLiao IMMEDIATE "0 DELAYED q MINIMAL q EXPECTANT GLA COW COMA SCALE (circle one) • 8 . 12 15 UNC STUPOR LETHARGY ALERT TIME Pulse Temp B/P Ja3168, Resp 9g TX & PROCEDURES: SEDATED Sout-r-e . 7, 0 L R. air/blood /HTS Time on Time off C-spine ck board HEMOSTATIC DEVICE ' To' C 0. PROTECTION: ' q UNK HELMET FLAK VE...%2, CERAMIC PLATE EYE PROTECTION OTHER: 0 rn q HEAT q COLD q BITE / STING OTHER deo 0 711 SpOs CHEM' PARALYZED • INTUBATED CRIC NEEDLE DECOMP Chest Tube . 10 line COLLOID CRYSTALLOID TOURNIQUET OXYGEN RBC FFP CRYO Plta. •:':" • ,• Fresh Whole Bid rFVIIa EXT Fix /spInt ICU in DTG: Out DTG: SPECIALTY: AM Amputation AV Avulsion P Puncture OR Start DTG: Stop DTG: PROVIDER: BL Bleeding . D Deformity B " Bum F Foreign Body XraCture . S Stab Wnd IF Vent On DTG Off crra-. O Liters/min. Units Units Units Packs Units mcg/kg H Hematoma L Laceration G Gunsh Wnd For Official Use Only / Law Enforcement Use Only Exhibih /(96 MEDCOM - 991 DOD 004054 ACLU-RDI p.4 DOD 004055 DOSE. ROUTE DTO WM: 0023 (ILL. I c mp • v\r • -; N t•T ES MEDCOM - 992 F Theater Trauma Registry Record For usecrid0 fixra see DA PAM MCC: the propoaest agency Ls OTS0 • Observations/Notes (Holding, En route, ez) MN= 131111MILMIIMILICEIMI , SWIM UMW/ TIME 041-V) no P 3 PULSE RES? . p03 MENTALS DRUG A VP U A V P, 8 111 GV-41-k 153(1(1 \111 eitEtxt rAEDicAllota t,4110 L)pai .zeLeAse: _...travit.04. v. • . NCHAmGeD _DeieittoRfaEp I • • . . . • • •;-.- , • : • • • -: • • • t • • • •For Official Use Only• Law Enforcement Use Only Exhibit • •• J a 3 ACLU-RDI p.5 !:;,• ••iiiTlt.;-• • • icial Use Only I Law Enforcem • ' . . Trauma Record DISCHARGE SUMMARY MEDICATIONS: - AlbLe-14) Sa...J.-..a.e_ . tt-is-1.4.A, LABS: XRAYS: PMH: • • Allergies: REGION DIAGNOSIS, PROCEDURES and COMPLICATONS • Face pviol IS Rycot /0111M-c4 l Yupfut-e4 ny\ c9 g6t-e- "AD Irtfad- LAA.N-%Nct. er-Le,--p-tvi•-,- Head & Neck (incl C-spine) &AY\ frat1.6r azieLta --7 wrao (I_ ace, midi IAD .2. v\M-And "7 i'6 ab30 c-conare ay) . Chest (incI T-spine) • , Abdomen (incl L-spine) pis 1\BAU-(, 'CU:141 2t•is-tet--- • :.•• • • Pelvis • - PL( dr-i-E1144. --`T-Q-6-uo/c.--"4-4- et, A-QA.iteki 6-1,„cz...., • -- .M-6 )C 2— UPPER /LOWER • • Extremities - . . 2.- I V15 I k‘ J haw-Ill* mv"' 4aj pArf S c- -1k.1 ii0-& V\.&• C`t"<' I r\ ' IV it 1 — LiZ ii 7..: - (511UNS- Ski. n,. - DISIOSTION DTG: 1 ous4 K o a EV C to , ' Evacuation Priority o ROUTINE o PRIORITY -• - • ez URGENT RTD RI CAcTIP DECEASED (see below) Damage Control Procedures? .Y / N Hypothermic (<34°C)? Y / N Coagulopathy? Y / N Cause of Death at DTG . • • uPelvis LI Extremity (Upper/Lower) -, ii Body Disruption OSepsis 0Multi-organ failure ANATOMIC: UAirway UHead U Neck U Chest uAbdomen 00ther ••• PHYSIOIOGIC: • 0 Breathing OCNS OHemorrhage OTotal COMMENTS: SURGEON: _ • (priakitame) • nly 0139-04-CI D78 - MEDCOM Test F6rm 1381, JAN 2004 • • • For Official Use. Only I Law Enforcement Use Only • --• MEDCOM - 993 Exhibit /' .liUUu54. DOD 004056 ACLU-RDI p.6 Ida! Use Only / Law Enforce Only 0139-04-CI D789-83995 ARMED FORCES INSTITUTE OF PATHOLOGY Office of the Armed Forces Medical Examiner 1413 Research Blvd., Bldg. 102 RoCkville, MD 20850 1-800-944-7912 PRELIMINARY AUTOPSY EXAMINATION REPORT ,b)(8)-4 Name: SSAN: Date of Birth: Unknown Date of Death: 18 AUG 2004 Date of Autopsy: 30 AUG 2004 Date of Report: 30 AUG 2004 Autopsy No.: ME04-629 AFIP Na.: Pending Rank: Detainee in U.S. Custody Place of Death: Iraq Place of Autopsy: BIAP Mortuary, Baghdad, Iraq Circumstances of Death: This Iraqi male was a detainee in U.S. custody at Abu Ghraib prison in Baghdad, Iraq. A group of prisoners became unruly and the guards used lethal force to subdue the crowd. A shotgun was fired and this detainee was struck and killed. Authorization for Autopsy: Armed Forces Medical Examiner, per 10 U.S..Code 1471 Identification: Circumstantial identity is established b detainee and his designation as detainee number rwork accompanying the bX6)-4 CAUSE OF DEATH: Shotgun Wound of the Head MANNER OF DEATH: Homicide These findings are preliminary, and subject to modification pending further investigation and laboratory testing. For Official Use Only / Law Enforcement Use Only MEDCOM - 995 Exhibit 2 f) flUt}058 DOD 004058 ACLU-RDI p.7 !dal Use Only I Law Enforce Only 0139-04-C1D789-83995 Autopsy MEO4-629 2 :b)(6)-4 PRELIMINARY AUTOPSY DIAGNOSES: I. Shotgun Wound of the Head A. Penetrating Shotgun Wound of the Head 1. Entrance: Right side of the back of the head; no evidence of close-range discharge of a firearm on the surrounding scalp 2. Wound Path: Right parietal-occipital scalp, parietal-occipital skull, right cerebrum, left cerebrum a. Recovered: Deformed metallic foreign body located between the medial aspect of the left frontal lobe and the overlying dura 4. Wound Direction: Right to left, back to front, and upward 5. Associated Injuries: Subdural and subarachnoid hemorrhages, bilateral basilar skull fractures, cerebral contusions, and bone fragments along the hemorrhagic wound path H. No evidence of significant natural disease processes, within the limitations of the examination III. Evidence of medical therapy A. Vascular access devices in the left arm, both antecubital fossae, and the left subclavian area B. Oral-gastric intubation C. Endotracheal intubation D. Foley catheterization E. Electrocardiogram monitoring pads on the upper right chest and the left hip F. Contusion over the sternum, consistent with cardiopulmonary resuscitation IV. Changes of early to moderate decomposition V. The recovered projectile is placed in a labeled container and given to the investigating agent who was present at the autopsy VI. Toxicology is pending For Official Use Only / Law Enforcement Use Only Exhibit 20 MEDCOM - 996 DOD 004059 ACLU-RDI p.8 • • • • • Only 0139-04-C1D789-83995 3 F icial Use Only / Law Enforce Autopsy ME04-629 ;13)(13)-4 ADDITIONAL PROCEDURES/REMARKS Documentary photographs are taken by OAFME staff photographer, HMI USN Specimens retained for toxicologic testing and/or DNA identification are: heart blood, spleen, liver, brain, bile, lung, kidney, and psoas muscle Full body radiographs are obtained and demonstrate the metallic foreign body subsequently recovered from the brain Selected portions of organs are retained in formalin, without preparation of histologic slides The dissected organs are forwarded with body Chief Deputy Medical Examiner For Official Use Only I Law Enforcement Use Only MEDCOM - 997 Exhibit 20 wioGO b)(6)-2 DOD 004060 ACLU-RDI p.9 !dal Use Only / Law Enforc Only 0139-04-C1D789-83995 CERTWICATg QF.DEATH (OVERSEAS) . Acts de Mois (D'ONavigier) . mug op otMAatoit.af. 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FORM For Official Use Only / Law Enforcement Use Only MEDCOM - 998 Exhibit 4A ui)U61 DOD 004061 ACLU-RDI p.10 ffit rat US e-OhlyTLaW—E nrciece-- -017grU4-U I Li /69-b.3995- ARMED FORCES INSTITUTE OF PATHOLOGY Office of the Armed Forces Medical Examiner 1413 Itesearch Blvd., Bldg. 102 Rockville, MD 20850 1-800-944-7912 FINAL AUTOPSY EXAMINATION REPORT b)(6)-4 Name: SSAN: Date of Birth: Unknown Date of Death: 18 AUG 2004 Date of Autopsy: 30 AUG 2004 Date of Report: 12 OCT 2004 Autopsy No.: ME04-629 AFIP No.: 2940934 Rank: Detainee in U.S. Custody Place of Death: Iraq Place of Autopsy: BIAP Mortuary, Baghdad, Iraq Circumstances of Death: This Iraqi male was a detainee in U.S. custody at Abu Ghraib prison in Baghdad, Iraq. A group of prisoners became unruly and the guards used lethal force to subdue the crowd. A shotgun was fired and this detainee was struck and killed. Authorization for Autopsy: Armed Forces Medical Examiner, per 10 U.S. Code 1471 Identification: Circumstantial identity is established by paperwork accompanying the detainee and his designation as detainee number 13)(6)-4 CAUSE OF DEATH: Shotgun Wound of the Head MANNER OF DEATH: Homicide For Official Use Only I Law Enforcement Use Only Exhibit iiJduo8 MEDCOM - 1023 DOD 004086 ACLU-RDI p.11 true-OrYty TtaTm Enforte -miry -01n-1-14-Cluit39783•9g5 Autopsy ME04-629 2 b)(6)-4 FINAL AUTOPSY DIAGNOSES: I. Shotgun Wound of the,Head A. Penetrating Shotgun Wound of the Head I. Entrance: Right side of the back of the head; no evidence of close-range discharge of a firearm on the surrounding scalp 2. Wound Path: Right parietal-occipital scalp, parietal-occipital skull, right cerebrum, left cerebrum 3. Recovered: Deformed metallic foreign body located between the medial aspect of the left frontal lobe and the overlying dura 4. Wound Direction: Right to left, back to front, and upward 5. Associated Injuries: Subgaleal, subdural and subarachnoid hemorrhages, bilateral basilar skull fractures, cerebral contusions, and bone fragments along the hemorrhagic wound path IL No evidence of significant natural disease processes, within the limitations of the examination Changes of early to moderate decomposition IV. The recovered projeetile is placed in a labeled container and given to the investigating agent who was present at the autopsy V. Toxicology is positive for morphine at a concentration of 0.23 mg/L in the blood. No ethanol or other drugs of abuse are detected. For Official Use Only I Law Enforcement Use Only MEDCOM - 1024 Exhibit .2-1 (j Uii 9 DOD 004087 ACLU-RDI p.12 0139--04-Ce7 33995 3 f 'arttstr Only-Maw EnItrce Only Autopsy 111E04-629 .b)(6)-4 EXTERNAL EXAMINATION The remains are received without clothing. No identification bands are present on the body. The unclad body is that of a well-developed, well-nourished appearing, 69-inches, 140-pounds (estimated), White male. The age of the individual is not known. Lividity is posterior and fixed, except in areas exposed to pressure. Rigor has passed. The body temperature is that of the refrigeration unit. Early to moderate decomposition changes are present, including mild skin slippage, prominent vascular marbling, and clouding of the corneae. The scalp is covered with medium length, brown hair in a normal distribution. Facial hair consists of a beard and mustache. The irides are brown and the pupils are round and equal in diameter. The external ears are unremarkable. The nose and maxillae are palpably stable. Bloody fluid is present in the nares. The teeth are natural and in fair condition. The neck is mobile and the trachea is midline. The chest is symmetric. The abdomen is flat. The external genitalia are those of a normal adult male. Pubic hair is shaved. There is no evidence of external trauma to the urogenital area. The buttocks and anus are unremarkable. There are areas of hypopigmentation present on the lower trunk and the extremities. The upper and lower extremities are symmetric and without clubbing or edema. The fingernails are intact. No tattoos or significant identifying body marks are present. Black writing is present on both sides of the chest; "log #2" is on the right side and a series of illegible numbers is on the left side. EVIDENCE OF MEDICAL INTERVENTION • Vascular access devices in the left arm, both antecubital fossae, and the left subclavian area • Oral-gastric intubation • Endotracheal intubation • Foley catheterization • Electrocardiogram monitoring pads on the upper right chest and the left hip • Contusion over the sternum, consistent with cardiopulmonary resuscitation RADIOGRAPHS Full body radiographs are obtained and show a metallic foreign body in the head. EVIDENCE OF INJURY I. Shotgun Wound of the Head There is a penetrating ballistic entrance wound on the right side of the back of the head, situated 4 3/8-inches below the top of the head and 2 1/4-inches right of the posterior midline. The ovoid wound is 1/4 x 3/16-inches, with a 1/16-inch marginal For Official Use Only 1 Law Enforcement Use Only MEDCOM - 1025 Exhibit 2 / 01B 03 11 DOD 004088 ACLU-RDI p.13 Autnnev MF.114.629 ffitiatUse uniy Law—ET:force 0139-04-CID789:819a5 -. 4 b)(6)-4 abrasion from me .i to 5 o'clock positions. No soot deposition or gunpowder stippling is present on the surrounding skin. The wound path goes through the occipital scalp and includes a 5/16 x 3/8-inch defect in the right side of the occipital bone, with appropriate beveling. The wound path through the brain perforates the right occipital, right parietal, and both frontal lobes. A slightly deformed, round, metallic projectile is recovered from the dura overlying the medial aspect of the left frontal lobe of the brain at the anterior midline. The projectile is placed in a labeled container and turned over to the investigating US ACID agent present at the autopsy. The wound direction is right to left, back to front, and upward. Injuries associated with the wound path include fine linear fractures extending across the middle fossae of the basilar skull, a 1-inch linear fracture of the occipital bone extending from the 4 o'clock position of the entrance wound skull defect, and subgaleal, subdural, and subarachnoid hemorrhages. Scattered cerebral contusions and bone fragments along the hemorrhagic wound path are also present. INTERNAL EXAMINATION HEAD: Injuries of the head have been described previously. The vessels at the base of the brain have a normal distribution and appearance. The brain weighs 1150-grams NECK: The thyroid cartilage and hyoid bone are intact. The larynx is lined by intact white mucosa. The thyroid gland is symmetric and red-brown, without cystic or nodular change. The tongue is free of bite marks, hemorrhage, or other injuries. BODY CAVITIES: The ribs, sternum, and vertebral bodies are visibly and palpably intact. Both pleural cavities contain 100-milliliters of decomposition fluid and the pericardial sac contains 20- milliliters of decomposition fluid. There is no abnormal accumulation of fluid in the peritoneal cavity. The organs occupy their usual anatomic positions. RESPIRATORY SYSTEM: The right and left lungs weigh 580 and 550-grams, respectively. The external surfaces are smooth and deep red-purple, with moderate anthracotic mottling. The pulmonary parenchyma is diffusely congested and edematous. No mass lesions or areas of consolidation are present. The pulmonary arteries are unremarkable. CARDIOVASCULAR SYSTEM: The 220-gram heart is contained in an intact pericardial sac. The epicardial surface is smooth, with minimal fat investment. The coronary arteries are present in a normal distribution, with a right-dominant pattern. Cross sections of the vessels show no significant atherosclerosis. The myocardium is homogenous, red-brown, and soft, with early decompositional changes. The valve leaflets are thin and mobile. The walls of the left and right ventricles are 1.1 and 0.3-centimeters thick, respectively. The endocardium is smooth. The aorta gives rise to three intact and patent arch vessels. Fatty streaking of the aorta is noted. The renal and mesenteric vessels are unremarkable. For Official Use Only I Law Enforcement Use Only MEDCOM - 1026 Exhibit 29 0 LUO31 DOD 004089 ACLU-RDI p.14 ---fffirtat-Use-Ontyl-ta'vrEnfor—ce- Autopsy ME04-629 a9-O =CIII78-9:81gg5-- 5 (b)(6)-4 LIVER & BILIARY SYSTEM: The 1050-gram liver has an intact, smooth capsule and a sharp anterior border. The parenchyma is tan-brown and congested, with the usual lobular architecture and changes of early decomposition. No mass lesions or other abnormalities are seen. The gallbladder contains 15-milliliters of green-black bile and no stones. The mucosal surface is green and velvety. The extrahepatic biliary tree is patent. SPLEEN: The 240-gram spleen has a smooth, intact, red-purple capsule. The parenchyma is soft, maroon, and congested, with changes of early decomposition. PANCREAS: The pancreas has the usual lobular architecture and early decompositional changes. No mass lesions or other abnormalities are seen. ADRENAL GLANDS: The right and left adrenal glands are symmetric, with yellow cortices, gray medullae, and decompositional changes. No masses or areas of hemorrhage are identified. GENITOURINARY SYSTEM: The right and left kidneys weigh 150 and 120-grams, respectively. The external surfaces are intact and smooth. The cut surfaces are red-tan and congested, with uniformly thick cortices and distinct corticomedullary junctions. The pelves are unremarkable and the ureters are normal in course and caliber. White bladder mucosa overlies an intact bladder wall. The urinary bladder is empty. The prostate gland is unremarkable. The testes have no masses and exhibit no evidence of trauma. GASTROINTESTINAL TRACT: The esophagus is intact and lined by smooth, hemorrhagic appearing mucosa. The stomach contains approximately 70-milliliters of dark brown fluid. The gastric wall is intact. The duodenum, loops of small bowel, and colon are unremarkable. The appendix is present. MUSCULOSKELETAL: No non-traumatic abnormalities of muscle or bone are identified. MICROSCOPIC EXAMINATION Selected portions of organs are retained in fonnalin, without preparation of histologic slides For Official Use Only I Law Enforcement Use Only Exhibit VI • MEDCOM - 1027 DOD 004090 ACLU-RDI p.15 refOirt ry — —ons,ort-rei 789-8O9g5--- - 6 triartis-e-Driryltakiv-Ertforce Autopsy MEO4-629 ADDITIONAL PROCEDURES/REMARKS • Documentary photographs are taken by OAFME staff photographer, 1.1M1 1(b)(6)-2 USN • Specimens retained for toxicologic testing and/or DNA identification are: heart blood, spleen, liver, brain, bile, lung, kidney, adipose, and psoas muscle • Full body radiographs are obtained and demonstrate the metallic foreign body subsequently recovered from the brain • The dissected organs are forwarded with body OPINION This White male detainee in U.S. custody died as a result of a shotgun wound of the head that caused injury to the skull and brain. Toxicology was positive for morphine, which was likely the result of medical therapy received prior to death. One metallic projectile was recovered from the head and turned over to the investigating USACID agent who was present at the autopsy. The manner of death is homicide. 13)(6)-2 13)(6)-2 M.D., DMO/FS 33)(6)-2 CDR MC USN Chief Deputy Medical Examiner For Official Use Only / Law Enforcement Use Only Exhibit 21 MEDCOM - 1028 DOD 004091 ACLU-RDI p.16 tciat Use Onlyt LaW Eirciteerne -Only —01-39-04C I D78T88995 LZ LY TO ATTENTION OF DEPARTMENT OF DEFENSE ARMED FORCES INSTITVIE OF PATHOLOGY WASHINGTON, DC 203014000 AFIP-CME-T pAnfitaMMEIPA32M AFIP Accessions Number Sequence TO: 2940934 00 Name OFFICE OF THE ARMED FORCES MEDICAL EXAMINER ARMED FORCES INSTITUTE OF PATHOLOGY WASHINGTON, DC 20306-6000 'b)(8)-4 SSAN: Autopsy: ME04-629 Toxicology Accession #: 044550 Date Report Generated: September 27, 2004 CONSULTATION REPORT ON CONTRIBUTOR MATERIAI 4 AFIP DIAGNOSIS REPORT OF TOXICOLOGICAL EXAMINATION Condition of Specimens: GOOD Date of Incident: 8/18/2004 Date Received: 9/7/2004 VOLATILES: The BLOOD AND BILE were examined for the presence of ethanol at a cutoff of 20 mg/dL. No ethanol was detected. DRUGS: The BLOOD was screened for acetaminophen, amphetamine, antidepressants, antihistamines, barbiturates, benzodiazepines, cannabinoids, chloroquine, cocaine, dextromethorphan, lidocaine, narcotic analgesics, opiates, phencyclidine, phenothiazines, salicylates, sympathomimetic amines and verapomil by gas chromatography, color test or immunoassay. The following drugs were detected: Positive Opiate: Morphine was detected in the blood by immunoassay and confirmed by gas chromatography/mass spectrometry. The blood contained 0.23 mg/L of morphine as quantitated by gas chronaatography/mass spectrometry. b)(8)-2 ,b)(8)-2 PhD b (8)-2 TO, DABFT For Official Use Only I Law Enforcement Use Only Exhibit 2 ci Certifying Scientist, Forensic Toxicology Laboratory Director, Forensic Toxicology Laboratory Office of the Armed Forces Medical Examiner Office of the Armed Forces Medical Examiner MEDCOM - 1029 DOD 004092 ACLU-RDI p.17 or Official Use Only / Law Enforcement nsitive 0139-04-CID259-83395 o , Automated Facsimile ..4PAT1ENT TREATMENT RECORD COVbR SHEET For use of this form, see AR 40-400, the proponent agency Is OTSG 1. Register Nbr (b)(6)-2 2. Name lbx6)-4 3. Grade Admission Remarks B. Race I 7. Religion I, 8. LnthOISvc , 9. EPS 10. PnevAdm OTH MUSLIM 4. Sax M S. Age 14. Ward EMT 12. SSN 1 13. Organization (b)(6)-4 11. FMP 20 15. FlyStatus 17. Dept / Ben K91-HUMANITARIAN 18. BranchCorps 19. UIC / ZIP 20. Type Case BC 21. Source of Admission Direct from ER 22. Hour Of Adm: 07:34 23. Clinic Service - ABO - TRAUMA CENTER 24. Name/Relation of Emergency Addressee 25. Type Disp CRO/ER 26. Date of Dlsp 2004-08-18 27a. Address of Emergency Addressee 27b. Telephone No 28. Date This Adm: 2004-08-18 Admitti Officer. 29. ReportingMTF 1180 - 31st CSH 30. Date inn Adm 32. Units Blood Components 31. Selected Administrative Data Marital Status: Z DoB: In/Out Patient Inpatient MOS: • 33. Cause Of Injury: GSW TO HEAD 34. Diagnosis / Operations and Special Procedures: TRAUMATIC BRAIN INJURY 35 Tote! Days This Facility Absent Sick Days Other Days ConLv / Coop Care Days . Supplemental Care. Bed Days Total Sick Days 35. Total Days This Facility Absent Sick Days I Other Days ConLv / Coop Care Days Supplemental Care Bed Days I Total Sick Days . [Inn nnlv / Law Enforcement Sensitive MEDCOM - 1030 lijiO35 EXHIBIT 30 DOD 004093 ACLU-RDI p.18 #r Official Use Only / Law Enforcement sitive 0139-04-CID259-83395 HOSPITAL REPORT OF DEATH NAME AND LOCATION OF HOSPITAL FOR USE OF THIS FORM, SEE AR 40-2; THE PROPONENT AGENCY IS OFFICE OP THE SURGEON GENERAL. instnietions - Medical Officer in attendance will: Send form, without delay to the Registrar or Administrative Prepare, in one copy only, Items 1 through 10 and sign Item 11. of the Day, !or necessary acfion and fat a, 41210.*11!inr, cl requi Orefdf icer Print or type entries. number of copies. 3. MEDICAL EXAMINER/ CORONER'S CASE q YES q NO 5. ,CF9PLAIN NOTIFIED .66 YES q NO 6. NAME, ADDRESS AND RELATIONSHIP OF RELATIVE OR FRIEND PRESENT AT DEATH 1. PATIENT DATA (Patient's ward plate will be used to imprint identifying data if available) :13)(0-4 SECTION A • ATTENDING MEDICAL OFFICER'S REPORT PE SOMAL DATA 2. TIME OF DEATH (Hour-day-rnonth•yearl Ofe 18a 11 116 200 4. RELIGION MlAs v.,\ Patient's name (Last. first, middle initial) Grade, Social Security Account No., Register Number and Ward Number CAUSE OF DEATH APPROXIMAT E INTERVAL BETWEEN ONSET AND DEATH 7a. DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (This does nor mean Me mode el dying. e.g.. heart Wont asthenia, arc. Jr TIM the disease. injury. or complication which caused death) Th. ANTECEDENT CAUSES (Morbid conditions, II any, giving rise to the above cause, stating the underlying condition last, DUE TO (or as a consequence of) F 'caw.. DUE TO (or as a consequence of) (1) (ISO ilttA-Cki (2) 8. • 8. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO THE DEATH. BUT NOT RELATED TO THE DISEASE OR CONDITION CAUSING IT b. SIGNATURE EDICAL OFFICER IN ATTENDANCE 10. TYPED OR PRINTED NAME AND GRADE OF MEDICAL OFFICER IN—ATT.NDANCE I3)(6)-2 MC, SECTION B ADMINISTRATIVE ACTION 9. DATE tff Pitt7 '744 HOUR YT AP OF RESPONSIBLE OFFICER TYPE OF ACTION 12. TELEGRAM TO NEXT OF KIN OR OTHER AUTHORIZED PERSON 13. POST ADJUTANT GENERAL NOTIFIED 14. IMMEDIATE CO OF DECEASED NOTIFIED 15. INFORMATION OFFICE NOTIFIED 16. POST MORTUARY OFFICER NOTIFIED 17. RED CROSS NOTIFIED 18. OTHER (Specify) 19. 20. AUTOPSY PERFORMED ill yes, give dare and place) YES q NO . SECTION C RECORD OF AUTOPSY 21. AUTOPSY ORDERED BY 'Signature! 22. PROVISIONAL PATHOLOGICAL FINDINGS 23. DATE 24. TYPED NAME AND GRADE OF PHYSICIAN PERFORMING AUTOPSY 25. SIGNATURE OF PHYSICIAN PERFORMING AUTOPSY 26 DATE 27. TYPED NAME AND GRADE OF REGISTRAR 28. SIGNATURE OF REGISTRAR For Ilea (Ink/ I atur Fnfnrectinent Sensitive MEDCOM - 1031 Wi 0036 EXHIBIT 30 DOD 004094 ACLU-RDI p.19 r Official Use Only / Law Enforcement sitive 0139-04-C1D259-83395 CERTIFICATE OF DEATH (OtrERSEAS) Acte de tidal (D'Outre-Mer) NAME OF DECEASED Dad. AM MitSAN Morn du eiceee Ikon, it atedernel GRADE Grade BRANCH OF SERVICE Am.* SOCIAL SECURIT∎ NLIMBEA Num*. rte 1 Any ro.(cv Sz...ot. [b)(6)-4 * ow,. A to ZA TlEiN 0,d annalnin i NATION re.s . tinitAl Sheen Pays .14'61 • DATE OF BIRTH Dints dr ninationte -7' SEX ,...kir. MAL F 4141 „•,;, _. RACE nee MARITAL STATUS SINGLE Ci.11iNeline Etat Con' Lia.X1X),,j DIVORCED D.vatO fl HELIGiON PROTESTANT Protests: Cvliv i4 i.o.."; • 2. OTHER ilnin•ei.. 1 Amu. 40,ITA.• I CAUCASOID Calitesimit MARRIED Mane C " X i • NEGROID Nediaisa ,4 Cl 'Si.) il ") ! * , Csdnunausi d ..,Dowip v.., SEPARATE') ..,... 1 JEVIIV-1 J.+, —f XI OTHER ISnecarl 1 r,.ci (.6 . i .p.0 In (5Pri 'Or" N., ME Or NEXT OF KIN Nom du diet selectee unseen RELATIONSHIP TO DECEASED Parente si, Meese, aver it aeon: STREET ADDRESS Diomede a [Real CITY OF TOWN AND STATE dean* VF auto VON, ICude. 0.7n47al zurnoris: MEDICAL STATEMENT Decletettatt midteile CAUSE OF DEATH iF..xur oft/vont tank per 614 1 Cause du leans InEinnloune wrung taus* pae Kral INTERVAL BETWEEN , ousel. AND DEAT , • trma/Lau. at+1,p I . Mlailte it kr dicess _ . ---..-..____ -,,;:, ASI 014 CONDITION DIRECTLY LEADING TO DEATI7 t m.vadio va conilli.en mre:ierrker.1 rseReinedble de IF n,C" • • 1 --,- - i'aLko)litikR421 PU T a.4,-..... T. rk-Alk,„. HORRID CONDITION, IF ANY ANIECEDENI ' LEADING TO PRIMARY CAUSE ,:ANDES Co.d): n :, nm, tvde I'd Ya beg., (_,;• th.). t jt-e ,,4 : —..,,, .,. GILISE futrtkater t:•.curt.wft GIVING RISE 1,0 PRIMARY 1 CAUSE iN ,0 rrt9,1 I Raison lOntlaITIIIntale, el y e lieu. swwa n la ruultem rximaira ..i.:,:ret .nn • I J 4INDERIVIENC7 CAUSE, IF ANY, _ . ....—.— ,: 1 , , •R. sAiro:cArtI CONDITIONS 7 A: • ,,.7 .. C.”....1.,, .tv,IICAIreVe m0E:I De MATH :751.11...• , dr da,le. AUTOPSY PERFORMED Aotopsle etfactuee II YES OW 1,:j NO Nei. — CIRCUMSTANCES SVRROUNDWG DEATH DUE TO EXTERNAL CAUSES MAJOR ciNoINDS DF AUTOPSY Conclusions peincIpalen de l'autopsin Cveansrantn, le. In MCII• ,, mi - .1055 pal des causes eeterieures 1 rlaeLINAL 1 0.1..,1 ,,atuko.le ACCIDENT 45... I seewentelle I —1 1 SUICIDE . 1 5...cicIR NAME OF PATHOLOGIST Nom du pethologiste .- I i I41.)..4:VIDF ,,,,,,,,dr SIGNATURE Signmtirx . DATE Date AVIATION ACCIDENT A0c1101. , 0 0 ..a- III YES 0 .. ( I NI, NE., CI A ! E of DEA I el Wow. der. month yew) Date :IC deal ,Thews.: Jen, It new. tarosiri PLACE OF DEATH Lieu de dAces I HAVE vEIWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS r,l'ATED AeovE ..1.51 anomie* Ins mates nionnis du ddlunt ells cantle' qui le diens ant survenu b PhaUts Indigene at I, Is Sults des causer; enun.M1 , oes •:. elet&ir. .__ —.....— u Insestiv 3 vkakm TITLE OR DEGREE T.vo 00 diplomf •,,,,r !:.•r F.V.E.ill.AL Dr(6)-2 bo ..._....... .................._...... ,. J.,. , Tin rm ;St A-A kJ- I ....._..............._ _...... ..., .. ., 1)3)(8)-2 I ''. I i 41. i I \ r - bijOti.j7 For Official Use Only / Law Enforcement Sensitive EXHIBIT 3o MEDCOM - 1032 DOD 004095 ACLU-RDI p.20 TOTAL TOTAL Chem, INTAKE ' AMOUNT OuTPuT AMOUNT • TITLE It) Stacjeen! kneilh NAME (Print) TIME PROCEDURE SIZE SITE ET n 0 Oral 9- 0 Nasal Intubofion Teeth 23 Gastric it .14..0ral Tube 0 Nasal Urinary 0 Meatus 0Suara-Pubilc DPL iLaw Enforcement - tive TIME PROC.: 1 ACCOMPANED BY RETURN 0139-04-CID259-83395 Chest Tube # I Chest Tube # 2 L R L R 12 Lead Rhythm 0 Opened o Closed BE PCO I poi 0 • Air 0 B100c1 C Pleutavec cm • AU1ohonst user Air 0 Blood O Pleuravoc_1-2P 0 AUtotransluser MEDICATION TIME 0 ETCO2Chonge O BBS Post Int Post CXR e 'Had I Abd Pelvis 0 Alr Ei Contents DC-Spire 0 IL Spine LChes1 Verified -- SuctIon: Y N • ... O Return ' A-GramSile: • O Horhe Dip: .1- • o Secured o Grossly: + - Cell count Sent @ TIME I G UW S0 SITE IVF TYPE 'AMT UP AMI IN . , 77. 1-'1J.;1 iYiN : I 11A01 Y N I. YiNI 1 CT Scan: 0 Contrast 1131 MED/CATIONS N IV ACCESS & FLUIDS TIME LABS TIME ; LABS 0 D-stick 0 Shot 0 D-stIck 0 Shot )licCBC 'Ahem ,PT/PTT 0 ETOH X&S OT&C x ____ Xohest Initial ... ICI Chest Past ET 14 l. -.: Chest Posl CT • ';',7 !"'•.:: •LAB RESULTS &OUTPUTr,"?.• IVF Wine NOT ! ., _. NGT Blood ; EBL Other CDC. Other TRAUMA TEAM ARRIVAL VALUABLES & CLOTHING I PAGED RESPONDED Given to Family Inventoried and Released to Patient Pest Fundt1C01) See 04 P1 ,11 e'9c other See Nuts:nrj 11:;t For Official Use Only I Law Enforcement Sensitive MEDCOM - 1033 STATUS OUU8 EXHIBIT 30 r Official Use • I • ABG SITE TIME %02: PH ,Lt4P-10/ Comments TTT DOSE RTE TIME I DOSE! PIE TIME DOSE RTE < x-Roy RT Ortho 0 Home 0 Aemilled lo • • DOD 004096 ACLU-RDI p.21 TIME ON X _ 0°2 - 1 ernin D C-Spine Immo Made: 0 "WI qNone Dyes: Allergies: q UKN q None q Yes: Tetanus: q UKN q Current Last Meal/Fluid Intake IMP: q hrs TIME' MED COM: Di 0 ETA UNIT: C-spine tenderness Pain f0.: JVD: El RN b)(0)-2 3)(6)-2 (Con lnve on reverse) PATIENTS IDENTIFICATION (For typed or written entries give: Nome•Lost. First middle; grade: date; hospital or medical facility' ;b)(8)-4 DEPARTMENT SERVICE CLINI 0/1/7 q HISTORY/PHYSICAL q OTHER EXAMINATION OR EVALUATION DATE q FLOW CHART q OTHER (Specify) r Official Use Only I Law Enforcemen nsitive 0139-04-CID259-83395 MEDICAL RECORD-SUPPLEMENTAL MEDICAL DATA For use of this form see AR 40.66 the proponent agency is the Office of the Surgeon General REPORT TITLE TRAUMA FLOWSHEET The Pt0Peeed b DePT enteceri EMS REPORT OTSG APPROVED(Dale) Ar-1;:.-1 11 .1,,r ARRIVAL STATUS PRIMARY SURVEY PULSE; Present BLEEDING- FIT! HEART TONES: AIRWAY qNatural Patient El Ykrr q ;Secretions BRUNING (Labored 0 Unlabeled q Absen1 TRACHEA dline q Devtated CHEST SYMMETRY: CIRCULATION 0 Absent SKIN qWarn qCeal 0 Hot ..3Pinit 0 Pale C Cyanotic q Cleat U Muffled 3 Dry 0Maal CDAahatetic SECONDARY SURVEY HEAR; ABDOMEN Baled '211 RHYTHM: Replay (!Rigid Non•tendef EP W PULSES, &antral KPeripher al q Tenet), LUNGS .PELVIS BREATHSOUNDS:!Flat aunt 1 Clear 15joitirc7:1 Unstable ;Decreased g0 Abaeril T —L JitrJ - Blood a1 rriox:.n.,/ug•la • " Wheezes CIRI Crackles !IA Herne • • • Prailale - Minn ITY GCS E SPHINCTER TONE: Nona ‘314.4.1.1s HEAD PUPILS Equal liFiled 0 React TM n Cleo/ °Blood NECK USE DIAGRAM TO DOCUMENT INJURIES AND PAIN VASCULAR ASSESSMENT (AB)rasion (AMP)utation (AV)ulsion Battle's Signs (3 Weeding (B)urn ID)ef ormity (E)cchyrnosis (F)oreign Body (H)ematoma (LAC)eration (P)uncture (W)ound (Pain) (S)eatbelt (S)ign (S)tab (W)ound (GSW) Gun Shnt Wound + + Strong I + Palpable I D Dopler n DIAGNOSTIC STUDIES OU'609 For Offit-i21 I Ica nniv I Law Enforcement Sensitive EXHIBIT 30 MEDCOM - 1034 DOD 004097 ACLU-RDI p.22 VITAL SIGNS jr Aectal Tamp GLASGOW COMA SCALE EYE OPENING .1 VREELE RESPONSE MOTOR RESPONSE r Official Use Only Law Enforcement sitive 0139-04-C1D259-83395 TIME BP HR RHY - - = - 4 la_g__ 1 RR,, . it1 13 SAQ2 : .. F102 70 tO D r! 1A-ir -1---- [ : _MODE ' E ( LV1M 1T t14- Spontaneous 15- Oriented t • toys commands s, , ../161.a M / / OM l i I J I 4. Confused 5- Localizes Pain • 2. To Pain 1 T 3- Inapp Words 4. Withdraws to Pain i , -1-- r ---T..._, r 1: -1. ....._ 1. None ! 2- incomp Speech 3- Flexion to Pain / I - None 2- Extension to Pain r [ I f i. None • T.I ME I PROCEDURE PERFORMir) BY " . 8ackooardenroved : BY: I .-: downgraded ' — I BY: / r . ; I iI, . / / , / I 1 NOTES / ka cc , — ka,.Zrtf er-7 1 , / . r Aeett ' be 34v31- /,-, t— 1 1 [ . 1 1 1.,.>", c42,:z , (b)(6)-2 r e://‘ / / / . / / / • 1 / / UU 0 0 0 For Official Use Only / Law Enforcement Sensitive EXHIBIT 30 MEDCOM - 1035 DOD 004098 ACLU-RDI p.23 r Official Use Only / Law Enforcement fqt)1 Itrika)04-CID259-83395 Trautha Record DISCHARGE SUMMARY MEDICATIONS: Onk-e6 6t-cs1AA. LABS: • XRAYS: PMH: Allergies: . REGION . DIAGNOSIS, PROCEDURES and COMPLICATONS - Face pv,p1 15 pi yt4 / di I Aftet i rupturd P-0 sti6te, 5911*Act- Ickx.,•\.Nct Crt-o--p t\44- 4-c Head & Neck (incl C-spine) brotO tratt6r aieCANA I 7 Wrap hCG a 00 C--colkirecty) 0.. wokrela no ,i2K vvcrvIrA. AA.I.A.As-P Chest (incl T-spfne) C • Abdomen (incl L-spine) F4fi MI -Ctolci ' -zeis-I6-'t- • •' • ' Pelvis rs r171,6Y GArri-i•Era -a uQ-..- se-ef..tru)/a-r"--i4-ut. . 11(- Y: 2— . UPPER /LOWER Extremities 2- (V15 (1-` J 1-\M,f hot Movtdall ball orf '.:, IhCC 'tic(' th'r-e- 11(‘'f-' C° " <"' 1 r\ iv # 1 - Ltz lti: - ShANS:- Skin WtxA---v''• ) CH - DISPOSTION DTG: e.,(16q ( 4611<--if\t) 4 K EV C to • Evacuation Priority q ROUTINE q PRIORITY az URGENT o RTD RT C.Acw q DECEASED (see below) Damage Control Procedures? V/ N Hypothermic (<34°C)? Y / N Coagulopathy? Y TV Cause of Death at DTG ANATOMIC: uAirway uHead u Neck U Chest uAbdomen uPelvis u Extremity (Upper/Lower) qOther PHYSIOLOGIC: 0 Breathing qCNS qHemorrhage OTotal Body Disruption OSepsis 0Multi-organ failure OU 0101 For Official Use Only / Law Enforcement Sensitive EXHIBIT 3o MEDCOM - 1036 DOD 004099 ACLU-RDI p.24 Official Use Only I Law Enforcement sitive 0139-04-CID259-83395 .., awn.. I nuuuwrit.g.r.4 TIME kruxua.us, 11 .c1.1 a vui.c, PULSE c...._.j ROUTE IMEMMENIIMICIIIINIMEMEINIIIIIMI i RES? t•o, MENTAL S DRUG DOSE DT.° (;) . t . ice: ragnIMMENIllealra rVePnAsNmIIIMoEuNraIIIiIaMmIIIMmEu1m11 rmulawisuormraimummummi .Avpe Willtillillffilli A V P JVITYMNIIIIIMi Itm MI 1 r,-, 0 „ 3 i , 2, A v P el warm o> Ci C0 CV-44 15 l_ MP 4-N 3 1 I t•ortr 1 I I ' 61 6ta : III • • COW t)11101+1 _1 nwk.04aD /Urachm.16!,6 . teTeRt 0 11' 1 1 VPDV z6.1..e.A-66 ostfv'T ED ! r.r.k %LA) I 151 ti R RC-,1 E I 1.1c.iiR C:C.T s cf /4 .. . , LP itgetvl MED. ICATI OW —Cot_ Nur ES : • .- .: . •• ..• .- -: : • . . .. • • ;-, • .... - ; :... .7. L. . . I: . • :' • i1c:;! . . • , . • 6Uoia2 r Off.^'^" "— r'^'•• " C.`4^••E,ment Se a EXHIBIT D MEDCOM - 1037 DOD 004100 ACLU-RDI p.25 Arrive Da -Ttc Group (DT Rink 1/ TRIAGE CATEGORY: IMMEDIATE 1- 0 DELAYED O MINIMAL q EXPECTANT (I) L. C 11.1 a. TIME ()Co /6 Pulso 9 z/ Temp B/P 516p, Resp :13)(6)-4 -Ear Official Use Only / Law Enforcement active 013121,525.#35..., Trauma Record Foi use of this form, see DoD Memeo Subject :Trauma Rerionl,dtd 1 APR 04; the proponent agency is OTSG AUTHORITY: PURPOSE: ROUTINE USES: DISCLOSURE: IATF DESIGNATION: 7F Number TVeopt is AR 40-66 Top:mirk a Itandard roans of doctuncating all trauma care at echelons 1-3 The "Blanket Routine Uses" set forth at Me beginning of the Array compilation of systems of records notice apply. Tis Is protected health 111Fonnation. TIMAA Imes apply r 6)-4 A,m IA LTY NAMEL F %%ST b)( bate of Birth /adcr alc q Female. b)(6)-4 LAST I CASUALTY SSN)., Unit O Non-MED GNC O SHIP EVAC O GNO AMB 1:1 AIR AMB .fIVAL METH +D: WALKED CARRIED q Non-MED AIR o OTHER Nation US a Host Nation nemy( Coalition( Service q USA o Civilian crUSN itfarnbatant n USMC o Contractor o USAF o SOF o NGO a Other Wound DTG Iig OY PROTECTION: q UNK q q a 0 0 0 0 CI WOUNDED BY: LIS/COALITION(Nalion ENEMY q CIVILIAN (Natiorf NonENEMY HELMET TRAINING SELF ACCIDENT SELF NON-ACCIDENT SPORT'S-RECREATION OTHER: FLAK VEST CERAMIC PLATE EYE PROTECTION OTHER: a 70 CHANISM OF INJURY: 0 GSW/BULLET 0 BLUNT TRAUMA 0 a SINGLE FRAGMENT 0 CI MULTI FRAGMENT cs E en GLA COW COMA SCALE tomle one) 31 8 12 15 / 4 I. UNC STUPOR LETHARGY ALERT' KNIFE EDGE BLAST CRASH(afc, veh, pet° Chem/Rad/Pim! 0 BURN (thermal, flash) CRUSH FALL SMOKE Inhalation O HEAT O COLO O BITE I STING O OTHER nature and size in cm) AM Amputation BL Bleeding 0 Deformity AV Avulsion B ` Bum F Foreign Body P Puncture X rra cture S Stab Wnd IDR Start DTG: Vent On DTG 1 ICU in DTG: II Stop DTG: Off i , Ott DTG. INJURY Description (Location, I N1/4 rt.4:•.,..." R L ;; • L R NEEDLE DECOMP CRIC • Chest Tube 10 line COLLOID INTUBATED "7, 0 CRYSTALLOID TOURNIQUET 011 C-spine ck board HE MO STATIC DEVICE OXYGEN units units units Packs RBC FFP CRYO Pits Fresh Whole Bld rFV1I.2 /HTS rn Time on Time off L R air/blood mcg/k Units ml H Hematoma L Laceration G Gunsh Wnd TX & PROCEDURES: SEDATED CHEM PARALYZED For Official Use Only / Law Enforcement Sensitive MEDCOM - 1038 UJU i ti3 EXHIBIT 30 DOD 004101 ACLU-RDI p.26 SIDRA XAtit !NATION-CS) REQUESTED AGISE:4(iSSPI Moon:or) FILM NO. REQU (WM-2 ,.. *RADIOLOGIC CONSULTATION REQUEST/REPORT - •(Asdielogyifilirdest.WodickeitIltmaxbrd/CompurstI romomphy Examen:Wads) IWARD/CLINIC REGISTER NO. L1 PREGNANT 0 YES NO TEL-PHONEIPAGE NO DATE REQUESTED tt PA 661 3ECIFIC REASONS) FOR REQUEST (COMplaints and )ndErld4 . S4,„ GSti.3 iDIOLOGIC REPORT ATE OF EXAMINATION (Won daY, Yawl DATE OF TRANSCRIPTION (Month. &C.% 750r) DATE OF REPORT (Month. day, year.) *Official Use Only/ Law Enforcement sitive 0139-04-CID259-83395 / ON 7610-14-1654251 . • 519-1 • IE N7 5 IDENTIFICATION (For typed or Le — last, first, middle, Medical Facility) written entries give: !LOCATION OF MEDICAL RECORDS For Offg rin' I Ian (Ink/ I I aw Fnfnntament Sensitive 30 MEDCOM - 1039 DOD 004102 ACLU-RDI p.27 r Official UAINly4fratkeitecement sitive . 0139-04-CID259-83395 itesakt Farm 41 ift1.120ra 1-STAT G3+ 111/7-17Ittle pt: 2396 Pt Halve= ti TCO2 2 mm01/L Rt 37C PH 7.441 PCO2 27.8 mmHg P02 124 mmHg HCO3 19 Mm01/L BEecf -5 mm01/1. 502* 99 % *calculated 0.8-L51 0.74.214 Falun 1314 &trim Awn ILIA 9B-107 junta/ PT .t N For Official Use Only I Law Enforcement Sensitive MEDCOM - 1040 Sample TYpe_: 18AUG94 07:29 over: )\ Physician: EXHIBIT 30 Serit 42015 ver: JAM5048D CLEW R95 DOD 004103 ACLU-RDI p.28 b)(6)-2 (b)(6)-2 Admitting Officer (Signature, as required) Signature of Admi ling Official Use Only 1 Law Enforcement Ssitive 0139-04-C1D259-83395 1. Reporting MTF 1180 - 31st CSH 2. MTF Lot IZ Admission algt.;oding For use of this form, see AR Information 40-400; the proponent agency Is OTSG 3. Register Number Name (Last, First, MI) 4. Pay Grade s 5. Sex M WO)-4 lb)(6)-4 I 6. DoB (YYYYMMOD) 7. Age at Admission 8. Race ' OTH 9. Ethnicity Z Religion MUSLIM 10. Length of Service ETS 11. FMP 20 12. Social Security Number (b)(6)-4 Organization (Active Duty Only) 15. Beneficiary Category K91-HUMANITARIAN 13. Marital Status Z Hour of Admission 07:34 Branch / Corps: 14. Flying Status 16. Zip Code of Residence: 17. Unit Location ; 18. MOS I F., . 19. Trauma BC Prey. Admission 20. Source of Admission Direct from ER Ward: EMT Name / Relationship of Emergency Addressee Address of Emergency Addressee Name and Location of Medical Treatment Facility: 1180 -; Telephone Number of Emergency Addressee • 21. Type of Disposition CRO/ER 22. MTF Transferred To 23. Date of Disposition (YYYYMMOD) 2004-08-18 24. Clinic Svc - Admitting ABO - TRAUMA CENTER 1' 25. MTF Transferred From 26. Date this Admission (YYYYMMDD) 2004-084 8 27. Location of Occurrence IZ 28. MTF of Initial Admission 29. Date of Initial Admission FOR LOCAL USE Type Patient (Inpatient / Outpatient): Inpatient Diagnosis Narrative: TRAUMATIC BRAIN INJURY Procedure Narrative(s): • Cause of injury Narrative: GSW TO HEAD For Official-Ilse-.Only I Law Enforcement Sensitive EXHIBIT 30 MEDCOM - 1041 DOD 004104 ACLU-RDI p.29 .i lie - cipts q 0/ 39--6 i - e/O-ri5- I 395 CERTIFICATE OF DEATH (OVERSEAS) Acte de dimes (D`Orstre-Mer) NAME OF DECEASED Rte, Am, Middle) NOM du decide Rom et per) GRADE Grad* BRANCH OF SERVICE Anne SOCIAL SECURITY NUMBER Ruiners de PAssurance Socials lb)(6)-4 13)03)4 ORGANIZATION Organ cation . • • NATION (e.g.. United States) Pops DATE OF BIRTH Data de nal:mance -r SEX Saxe ,MMALE leas:Win • FEMALE Feminin RACE Race MARITAL STATUS Etat Civil /Mk • trir) RELIGION Cake tf//1/61 ekt„,2 CAUCASOID CALICO:4We SINGLE °limos DIVORCED Divorce PROTESTANT Protestant OTHER (Space) Autre dpolfred i VS1,1 y CATHOLIC NEGROID NegrOide MARRIED Marie Catholique SEPARATED Separe • JEWISH JO X OTHER (Specify) 1 ra ct . Autry (Specifier) WIDOWED Vied NAME OF NEXT OF KIN Nom du OA mobs parent un Knn o w RELATIONSHIP TO DECEASED Parente du decOde avec (a susdit STREET ADDRESS Damicile i (Rue) CITY OF TOWN AND STATE anclede MP Code) VIM (Code postal cornpris) MEDICAL STATEMENT Declaration mfdleala CAUSE OF DEATH (sser only one cause per Hite) Cause du dikes IN'indltwer eu'une CALM Pat WHO • INTERVAL BETWEEN ONSET AND DEATH Intervene entre l'attaque el le dices DISEASE OR CONDITION DIRECTLY LEADING TO DEATH ' Maladie ou condition directement responsable de Ia moat! • PAIMYtalt-i, B reu......., T ANTECEDENT CAUSES Symptemes. pricurseurs MORBID CONDITION, IF ANY, LEADING TO PRIMARY CAUSE Condition nu:abide. WO y a lieu. menant a Ia cause primalre 1I3 tkeA.,1 UNDERLYING CAUSE. IF ANY. GIVING RISE TO PRIMARY CAUSE Raison fondamentale, s'il y a Beth avant auscite la cause pitmans de Is mon. • OTHER SIGNIFICANT CONDITIONS 2 Autres conditions slgniticatives2 MODE OF DEATH Condition de cleats AUTOPSY PERFORMED Autopele 'Ream% 111 YES Out q NO Non CIRCUMSTANCES SURROUNDING DEATH DUE TO EXTERNAL CAUSES Circonstanciss de la mon suscitees par des causes exterieures • MAJOR FINDINGS OF AUTOPSY Conclusions earKipaleS de Pautopile • NATURAL Mort release. ACCIDENT Mort accidentelle SUICIDE Suicide NAME OF PATHOLOGIST Nom du pathologiste - HOMICIDE Homicide SIGNATURE Signature I DATE Date AVIATION ACCIDENT Accident a Anion NI YES Ow • NO Non DATE OF DEATH (Hour, day, math. year) Date de daces Once. k fay, It Me; reneee) PLACE OF DEATH Lieu de dikes . I HAVE VEIWED THE REMAINS OF THE DECEASED AND DEATH OCCURRED AT THE TIME INDICATED AND FROM THE CAUSES AS STATED ABOVE. J'ai examine las tastes mortals du dittunt at le condos qui le deeds est survenu a l'heure Indiquee at h, Is suite des causes anumerdes ci dessus sanitake I NAME OF MEDICAL OFF 7.41--.--..--.-...-..............-•-...-""dicin TITLE OR DEGREE Titre au diploma GRADE Grade M A—1.. . INS UN Au1)RESS Installation ou adresse '(b)(3)-1 ..ear , DATE Date 1 tr it46 6"-k b)(6). .. ' State diseese. Minty or complication width eemmm-e, rom-lermovir...vis at heart folLtre, cm 2 Stare candizians.contributhal to the death, but em rolosidto thedeeremfrottprogustart. ' Preciser I a ,neem de is melodic. de la biline o et de M coteplicatinFthileriptoWN4v3Pit nokjekerafiBlielle qo an arc& do cow. etc. i U - - 2 Miser to condition qui a cearrtlrut a L2 :nom mall n'ayant mate rapport awe la make& cm d la contiltion gad a provoque la man. i l I DD FORM 2064, APR 1977 REPLACES DA FonisARVSENFOIRMMENPREattWER (PAM, 26 SEP 1975, WHICH ARE OBSOLETE. MEDCOM - 1042 USAPA V1.00 FIrt 8 DOD 004105 ACLU-RDI p.30 0/51 -.0 1-/-eld7r5-13135" DOD 004106 17. RED CROSS NOTIFIED 18. OTHER (Specify) SECTION C . RECORD OF AUTOPSY 21. AUTOPSY ORDERED BY (Signature) 20. AUTOPSY PERFORMED ill yes, give dare and place) 0 YES 0 NO 22. PROVISIONAL PATHOLOGICAL FINDINGS 24, TYPED NAME AND GRADE OF PHYSICIAN PERFORMING AUTOPSY 25 SIGNATURE OF PHYSICIAN PERFORMING AUTOPSY 28. SIGNATURE OF REGISTRAR REPLACES DA FORM 8-257, 1 JAN 61, WHICH WILL BE USED. FOR OFFICIAL USE ONLY W rAirermr•rmFikrr CrysiTivr. MEDCOM - 1043 DA FORM 3894, OCT 72 USAPPC V2.00 oUtti i) 9 • HOSPITAL REPORT OF DEATH I NAME AND LOCATION OF HOSPITAL FOR USE OF -FIRS FORM. SEE AR 40.2: THE PROPONENT AGENCY 15 OFFICE OF THE SURGEON GENERAL. Instructions - Medical Officer in attendance will: Prepare, in one copy only, Items 1 through 10 and sign Item 11. Send form, without delay to the Registrar or Administrative Officer Print or type entries. of the Day, for necessary action and for preparation of required number of copies. SECTION A ATTENDING MEDICAL OFFICER'S REPORT 1. PATIENT DATA (Patient's ward plate will be used to imprint identifying data if available) Patient's name (Last, first, middle mita ra Social Security Account No., Register Number and Ward Number CAUSE OF DEATH 2. TIME OF DEATH ow.”--dav-month-v•ari OVD lrAub 200 4. RELIGION KM LI V4\ 6. NAME, ADDRESS AND RELATIONSHIP OF RELATIVE OR FRIEND PRESENT AT DEATH APPROXIMATE INTERVAL BETWEEN ONSET AND DEATH PERSONAL DATA 3. MEDICAL EXAMINER/ CORONER'S CASE YES 0 NO 5. CHAPLAIN NOTIFIED YES El NO 7a. DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (This does not mean the mode of dying. e.g.. heart failure, asthenia, etc. It means the disease, injury. or complication which caused death! 7b. ANTECEDENT CAUSES (Morbid conditions, if any. giving rise ro the above cause. mating the underlying condition last/ DUE TO (or as a consequence of) '1"C lot.u.. AA0.11: c_ FlyrcLA..v.d DUE TO (or as a consequence ofl 8. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO THE DEATH. BUT NOT RELATED TO THE DISEASE OR CONDITION CAUSING IT 9. DATE tV 194th 14 TYPE OF ACTION . 04(6 o ninorai ncFir.FR IN ATTENDANCE M fV%/ rAC/ SECTION B - ADMINISTRATIVE ACT HOUR DAY INITIALS OF RESPONSIBLE OFFICER YEAR 10. TYPED OR PRINTED NAME AND GRADE OF MEDICAL OFFICER IN ATTENDANCE 13)(6)-2 12. TELEGRAM TO NEXT OF KIN OR OTHER AUTHORIZED PERSON 13. POST ADJUTANT GENERAL NOTIFIED 14. IMMEDIATE CO OF DECEASED NOTIFIED 15. INFORMATION OFFICE NOTIFIED 16. POST MORTUARY OFFICER NOTIFIED (1) 12) b. ACLU-RDI p.31

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8892
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72