Death Investigation

English speaking countries- coroner is the gov. agent charged with responsibility for death investigations When the US was formed, death investigation was considered a local, governmental, or county function was created and no provision was made in the US Constitution for a coroner Federal gov. had no death investigation operations, except DC until the creation of Armed Forces ME’s Office in the Armed Forces Institute of Pathology in the 1990s. Each state enacted coroner’s laws and coroners are most likely elected county officials.

1877, Mass. Adopted by NYC, Baltimore, and Richmond around WWI, DC switched to ME system in 1970 Legislature passed a statute that replaced coroners with medical examiners which are required to be licensed to practice medicine Change was set into motion by local scandals arising from deaths improperly investigated by coroners Several NYC deaths caused by incompetent administration of anesthesia during surgery. Coroner system has become antiquated and is no longer considered the best structure for systematic scientific death investigation

Served as NYC’s 1st Chief Medical Examiner (1918-1935) Tenure spanned explosion of Wall Street and implosion of the stock market, Prohibition, and Gang Warfare He pioneered the structure of medical examiner’s offices in the US

Physicians specialized in the diagnosis of disease Subspecialized in area between law and science that emphasizes the determination of cause of death

disease or injury that led to death; underlying cause

fashion in which the COD came to be 1. Natural 2. Accidental 3. Homicidal 4. Suicidal Undetermined/ Unclassified

cooling cooling of the body that occurs after death Algor means “coldness” Mortis means “of death”

stiffening of muscles that occurs following death Stiffening of muscles that occurs following death Early onset – 0.5 hours Fully fixed – 12 to 24 hours Caused when glycogen in muscles is used up Disappears during the period from 24 to 36 hours after death

pooling of blood discoloration from the settling of RBCs after the blood stops circulating onset 30 mins. to 2 hrs lividity becomes fixed ~ 12 hours after death

Sudden death – occurs w/in a few hours of the onset of symptoms or death w/o any symptoms Example- diagnosis of cardiovascular disease = death not unexpected Is the death sudden? is the death unexpected? check medical records forensic pathologists do not recognize a statute of limitations for fatal injuries examine the scene of the death

autopsy: to look at oneself necropsy: surgical examination of a dead body

color bones in a Y shape heading down the abdomen to the genitalia

postmortem dissection is mandatory if a death is properly within the jurisdiction of the coroner or medical examiner, and the cause of death is not determinable without dissection. Examine brain- incision from behind one ear to behind the other – scalp peeled upward and backward; circular cut of skull- remove skull cap Brain- either dissected immediately or put in formaldehyde to fix the tissue for better examination and dissection. Fixation- chemical process that causes proteins to harden; it preserves the tissue and prevents further decomp. Suspected child abuse cases- occasionally- posterior neck dissection to check for any injury to the muscles, ligaments or spinal cord. In cases of suspected child abuse, incisions may be made to show that bruises that may not show externally. Samples- toxicology and DNA exams (urine, blood, bile) DNA typically a blood spot card and head hairs (must get roots) Tissues- typically preserved in paraffin blocks, mounted on glass slides (often by histologists)

Mechanical Thermal Chemical Electrical

Sharp force- incised wounds like stabbings most common COD is when the brain has been significantly injured or the heart has been lacerated blunt force- car accident Firearms are most common: Extent of the injury produced by a firearm projectile increases as the square velocity increases High velocity – high-powered hunting rifles; military rifles; only handgun capable of this (on the lower end of high) is the .44 magnum

Penetrating – entrance but no exit; projectile must be recovered

Perforating- exit and entrance

Hematoma- hema “blood” and toma “tumor”- tumor of blood caused by leakage from damaged blood vessels; forms a blood-filled space

bruise caused by bleeding beneath the skin

Result from the use of drugs and poisons Drugs of Abuse Depressants Stimulants Carbon Monoxide Cyanide Ethanol is most common contributory drug

hypothermia and hyperthermia Both cause death via breakdown in the normal mechanisms that maintain body temperature (37C or 98.6F) Diagnosis requires the absence of other causes of death coupled with a history of exposure to an environment that can cause it.

Circuit of alternating current (AC) at low voltages(<1000) crosses the heart = ventricular fibrillation (quivering that leads to non-resuscitability within minutes; AC acts like a pacemaker; AC in the US alternates from + to – 3600 times/min…. Produced ~300 quivers/minute in the heart (as fast as the heart can beat); electrical burns are not typical High voltage- v-fib less likely because the amount of current becomes defibrillatory; forces the heart into tetany (sustained contraction only broken when the current is broken). Heart will start in normal rhythm again but electrical burn can occur within a fraction of a second. The flow of current also causes holes in the membranes of the cells (poration); causes devastating loss of limbs

Where does asphyxial death fall? Caused by interference of oxygenation of the brain. Can occur from mechanical (strangulation), chemical (cyanide poisoning), electrical (low-voltage electrocution)

biochemical or physiologic abnormality produced by COD