Law enforcement‐associated fatalities: Thirty years of data from the King County Medical Examiner's Office, Seattle, Washington

Tracking law enforcement-associated fatalities is complicated by an absence of a national database. Death certificates often fail to report deaths due to law enforcement activity. Adopting recommendations by the National Association of Medical Examiners, the present study was conducted using records from the King County Medical Examiner's Office of all deaths associated with law enforcement, including deaths in correctional facilities, from 1995 to 2024. A total of 566 deaths were categorized as Pre-Custody (299) or In-Custody (267). Pre-Custody deaths were subcategorized into: Shooting (178), Vehicular Pursuit (57), Restraint (24), and Other (40). An altercation with law enforcement (40 deaths) or with other individuals (11 deaths) was the most common circumstance preceding the fatal event in the Pre-Custody/Shooting subcategory. In the Pre-Custody/Restraint group, multiple factors contributed to the deaths of all but 5, and stimulant drug intoxication contributed to the deaths of 19. No deaths were caused by tasers or pepper spray. In the In-Custody category, manners of death and demographics differed between deaths from jails and prisons. Racial and ethnic disproportionalities, relative to the county population, were evident in both Pre- and In-Custody deaths. Death certificates mentioned law enforcement involvement in 74% of the Pre-Custody/Shooting deaths and in only 12% of In-Custody deaths due to injuries. As public policies evolve to guide modern policing, creating a national database is imperative. Medical examiners and coroners have an important role in this effort by providing appropriate descriptions in the Describe How Injury Occurred section of death certificates.