Forensic Medicine

An autopsy is a specialized examination of a corpse to determine how and why someone died and to investigate any disease or injury. There are two classifications for autopsies: forensic and clinical. A forensic autopsy is required in cases where criminal activity is suspected, cases where the body has not been identified, cases where the cause of death is not clear and many cases involving accidental death. A clinical autopsy is done in an attempt to better understand disease progression and effects of treatments and to learn how to prevent deaths.

Autopsies are done by medical doctors who specialize in diagnosing disease, or pathologists. They may be assisted by an autopsy technician (sometimes known as a “diener”). Forensic pathologists have special training in autopsies and evidence collection. An autopsy usually involves an examination of the exterior of the body and a surgical examination of internal systems and organs. Additional examinations and analyses are done to reveal cellular changes and the presence of various chemicals in the body.

A forensic autopsy team may include forensic anthropologists and forensic toxicologists. A forensic anthropologist is called on to apply archeological and physical anthropology techniques, particularly when the remains are significantly decayed or skeletalized. A forensic toxicologist analyzes samples from the body to detect the presence of drugs and poisons. New advances in imaging techniques allow digital autopsies, magnetic resonance imaging (MRI) and multislice computed tomography (MSCT) to supplement or, in some cases, replace physical autopsies.

In North Carolina, a medical examiner is responsible for determining the cause of death in all accidents, unexpected deaths, unwitnessed deaths, drug overdoses and suspected homicides and suicides. If a person doesn’t die of a known disease at a hospital, the case is usually the responsibility of a medical examiner, who must view the body and determine the cause of death. The medical examiner decides if an autopsy is needed and orders one, if necessary. The time and cause of death have important legal implications for insurance, wills and criminal cases. If the medical examiner requires an autopsy, permission from the family is not required.

Autopsy Procedures

Autopsy procedures begin when a body is received, typically by a hospital morgue or a medical examiner’s office. Particularly in the case of forensic autopsies, specific procedures are followed to preserve evidence and avoid contamination. For example, the corpse’s hands are bagged to preserve evidence, such as blood under the fingernails and gunshot residue. The body is covered and transported in a new body bag or evidence sheet to reduce the possibility of evidence contamination during transport. Otherwise, a stray hair from someone legitimately at the scene could confuse the investigation.

At the morgue, the pathologist and any assistants or observers wear gowns, gloves and face shields to protect themselves from potential infection and to avoid contaminating evidence. Notes and photographs are taken at each step. An X-ray is taken of the body, which preserves evidence of fractures and the location of any bullets.

The pathologist examines and photographs the body in the clothes in which it arrived. Evidence, such as gunshot residue, hair samples and fibers, is collected and preserved. Once the evidence is collected, the body is undressed and examined carefully for wounds and external abnormalities. For example, tiny dots of blood under the eyelids are a sign of petechial hemorrhage, which indicates the person may have suffocated while trying to breathe against resistance. Once the examination is complete, the body is cleaned, weighed and measured, and all identifying features, such as sex, race, eye color, hair type/color, apparent age, scars, tattoos and birthmarks, are noted. At this point, blood, oral fluid and tissue samples may be taken for toxicological analysis.

After the external examination, the pathologist opens the body to examine the internal organs. This begins with an incision that exposes the rib cage and abdomen so the pathologist can remove and weigh the internal organs and check them for injuries and abnormalities. As the pathologist examines internal organs, he or she may collect tissue samples for microscopic study, culturing disease organisms or toxicology analysis. If the brain must be examined in detail, it is removed and placed in formalin fluid for several weeks so it can be sliced. When internal examination is complete, the pathologist puts the body back together, hiding signs of the autopsy so the family of the deceased person can view the body and release it to a mortuary to prepare for a funeral.

Vocabulary Study

Define these words.

Mortis is the Latin word for “death.” Look for the root word mort in the following terms:   

• Livor mortis •         Mortician •         Mortuary •            Postmortem •              Rigor mortis

Can autopsies be used to convict or renounce conviction  in a case that has already been closed and someone convicted? What if the cases are 10, 20 or even 30 years old?

Decomposition of the body proceeds in predictable stages and is caused by the growth of bacteria in various tissues. Environmental conditions, especially temperature and moisture, affect the speed of decomposition. Digestion also proceeds at a predictable rate, so the contents of the stomach and intestines can provide valuable clues. Certain insects typically lay eggs in dead bodies at predictable times after death. These eggs mature into larvae and pupate on a predictable timeline. A forensic entomologist may be called in to examine insects found on a decaying body and provide an estimate of time since death. For instance, evidence from forensic entomology was important in exonerating Alan Gell of the 1995 murder of Allen Jenkins in Bertie County, N.C., when it showed Gell already was in jail when the murder took place.

(Visit deathpenaltyinfo.org/ node/1905 to read more.)

The Virtual Autopsy

The Virtual Autopsy is a website created by British medical students that has numerous case studies with photos of tissues and organs. Students can click on the different parts of the body, review the photos and findings, and then choose a cause of death. Interactive feedback guides student understanding of the underlying medical condition and autopsy findings.

Visit www.le.ac.uk/pathology/teach/va

HowStuffWorks The article How Autopsies Work provides a step-by-step explanation of the autopsy with pictures and links to other sites.

Visit science.howstuffworks.com/autopsy

Do you think it’s possible  for the Medical Examiner to make mistakes when performing an autopsy? Why or why not?

Post Mortem:

Death Investigation in America For a series of articles and programs on forensic investigations done by ProPublica and PBS Frontline, visit propublica.org/ series/post-mortem and pbs.org/wgbh/ pages/frontline/post-mortem.

For an article that includes discussion of Dr. Virmani’s work on stents, visit propublica.org/article/without-autopsieshospitals-bury-their-mistakes.

Background Information

From Perry Mason to Colombo to NCIS, murder investigations have been a prominent part of TV programming for decades. Largely due to the popularity of these shows,the public often believes it “knows” what happens to a body once a murder has been discovered. However, many people would be shocked by the procedures and time required to gather,test and analyze samples from crime scenes. This activity is designed to introduce students to concepts related to when an autopsy is required, what happens during the autopsy and what can be learned from the autopsy. The process of crime scene investigation varies from locality to locality, and autopsy rules vary from state to state.

This activity focuses on the processes outlined by the U.S. Department of Justice and the North Carolina Office of the Chief Medical Examiner. If you are interested in other processes, many of the resources will provide alternative perspectives. The extension activity will help students see how problems with crime investigations perpetuate problems into the justice system. Autopsies traditionally have required the cadaver to be examined both externally and internally. The internal examination typically requires cutting the cadaver open and examining internal organs and examining internal organs and removing tissue samples. This disturbance of the body and delay of burial causes problem for some religious and cultural groups. With the advancement of MRIs and CT scans, virtual autopsies now are possible in many situations. Students will look at the special concerns of some groups and how virtual autopsy can assist pathologists and medical examiners.

Teaching Notes

Murder scene investigations are popular classroom activities. If you are interested in conducting an investigation virtually, here are some resources.

• Incorporating Biotechnology into the Classroom: Crime Scene Investigation (www.public.asu.edu/~langland/forensics.html)

• Autopsy of a Murder (centredessciencesdemontreal.com/static/autopsy/flash.htm) Pathology & Forensic Science: Autopsy 33 • CSI the Experience: Web Adventures (forensics.rice.edu)

Safety Remind

Students to have mature conversations about this subject. It is important to remember that a student might have experienced the traumatic death of a loved one. It is essential for teachers to create a safe place for students to discuss this material. This is a great time to discuss the ethical behaviors that should be seen in medical and law enforcement personnel.

Procedure Begin by showing a clip from a television crime investigation. Many shows have YouTube channels with clips, such as NCIS (youtube.com/show/ncis).

Complete Procedure for Virtuality Autopsy and answer all questions.

Complete Autopsy Worksheet question 1-4 using website and hyperlinks.

Extra Credit Extension choose one hyperlink and complete it. Free writing essay of 1 page worth 10 points.

Procedure for Virtuality Autopsy

Students are to start , Pathology & Forensic Science: Autopsy 33 • CSI the Experience: Web Adventures (forensics.rice.edu) . This is a virtuality assignment.

1. Clinic on the link.

2. Click on Case1 Rookie Training

3. Beginner Play as a guest.

4. Start

5. Medical Examiner

6. Follow prompts

Answer the following question about the virtuality autopsy.

1. Give three reasons to perform an autopsy.to remove the outer layer of skin? If so how is it done and what is it called?

2. Is there a specific way

3. List the instruments used in the autopsy and what they are used to remove.

4. Why are the markings of an external exam be important?

5. Who is the person who performs autopsies?

6. Why do you need to do an internal exam of the organs?

7. Name the three PPE to be worn by the person completing autopsy.

8. When using a syringe to collect blood what organ is it collected from?

9. What happened in the Brain that was significant to the death?

10. What was was the manner of death for this person?

11. Name all the manners of death and the percentages that they are defined by.

12. Cause of death was? DUe to ?

Answer these questions from the former notes given on this page and other resources provided.

1. “What are the reasons an autopsy may be required in North Carolina?”

2. “What happens during the internal portion of the autopsy?”

Extension

Encourage students to choose an autopsy case study, such as those provided by the University of Pittsburgh Medical School database(path.upmc.edu/cases.html). Students may then examine the visual and written data from the autopsy and try to formulate a simplistic diagnosis. Students may check their diagnoses by clicking on the final diagnosis. Students also may watch Post Mortem: Death Investigation in America (pbs.org/wgbh/pages/frontline/post-mortem). This PBS show will introduce students to many of the challenges faced by police and crime scene investigators in the current legal system.

Autopsy Worksheet

1. Read the Guidelines, Rules, and Statutes of the North Carolina Office of the Chief Medical Examiner.com/autopsy4.htm),) and answer the following questions:

a. When does the state of North Carolina require an autopsy to be done on a body?

b. Who conducts a required autopsy?

 (www.ocme.dhhs.nc.gov/rules/guidelines) and answer the following questions:

a. When does the state of North Carolina require an autopsy to be done on a body?

b. Who conducts a required autopsy?

2. Read How Autopsies Work (science.howstuffworks)from the external to the internal investigations of an autopsy.

a. What happens in an external investigation?

b. Where is the first cut on the body usually made?

c. What happens to the internal organs? d. How is the head examined?

Virtual Autopsy

3. Read/watch 2 of the following articles/videos:

» Virtual Autopsy in Forensic Medicine (medical.siemens.com/siemens/it_IT/gg_ct_FBAs/files/CIP/Out_of_the_ordinary/ Virtual_Autopsy_in_Forensic_Medicine.pdf)

» Forensics Revolution: Virtual Autopsies Provide New Insights into Death (spiegel.de/international/europe/new-virtual-autopsy-procedure-is-changingforensics-a-875657.html)

» Virtual autopsy: does it spell the end of the scalpel? (guardian.co.uk/science/2013/feb/23/virtual-autopsy-virtopsy-forensic-science)

» Die Zukunft heisst Virtopsy / The future is Virtopsy (www.virtopsy.com/movies; scroll down to find the video and choose one of the English versions of the activity)

a. What tests or scans may be conducted in a virtual autopsy?

b. What are the benefits of virtual autopsy?

Autopsy Worksheet

Virtual Autopsy Activity

4. Visit The Virtual Autopsy (www.le.ac.uk/pathology/teach/va) and choose a case. Review the data from the autopsy and try to diagnose the cause of death. Check to see if your cause of death was correct.

a. Which case did you choose?

b. What is your initial cause of death? (If you do not know the specific medical term, explain which part of the body causes concern.)

c. Did you diagnose the case correctly?

d. Which piece of information helped (or would have helped) the diagnosis?

Procedure for Virtuality Autopsy

Students are to start , Pathology & Forensic Science: Autopsy 33 • CSI the Experience: Web Adventures (forensics.rice.edu) . This is a virtuality assignment.

1. Clinic on the link.

2. Click on Case1 Rookie Training

3. Beginner Play as a guest.

4. Start

5. Medical Examiner

6. Follow prompts

Evaluation

Rubric for Questions

Conclusion-Learning Outcomes

• Students will examine what happens to the body from the time of death until the autopsy.

• Students will be able to list when forensic autopsies are required in the state of North Carolina.

• Students will be able to describe what happens during both a traditional autopsy and a virtual

autopsy.

•Students will perform a virtual autopsy and determine the cause of death from information provided

Resources

Pathology & Forensic Science Curriculum Supplement Published July 2013

(Visit deathpenaltyinfo.org/ node/1905

www.le.ac.uk/pathology/teach/va

science.howstuffworks.com/autopsy

propublica.org/article/without-autopsieshospitals-bury-their-mistakes.

(www.public.asu.edu/~langland/forensics.html)

(centredessciencesdemontreal.com/static/autopsy/flash.htm)

(forensics.rice.edu)

(youtube.com/show/ncis).

(path.upmc.edu/cases.html)

(pbs.org/wgbh/pages/frontline/post-mortem)

.com/autopsy4.htm)

(www.ocme.dhhs.nc.gov/rules/guidelines)

(medical.siemens.com/siemens/it_IT/gg_ct_FBAs/files/CIP/Out_of_the_ordinary/

Virtual_Autopsy_in_Forensic_Medicine.pdf)

(spiegel.de/international/europe/new-virtual-autopsy-procedure-is-changingforensics-a-875657.html)

(guardian.co.uk/science/2013/feb/23/virtual-autopsy-virtopsy-forensic-science)

(www.virtopsy.com/movies; scroll down to find the video and choose one of the English

versions of the activity)

(www.le.ac.uk/pathology/teach/va

www.ocme.dhhs.nc.gov/

http://webquest.org/index-create.php

N.C. OCME Contact Information

Hours

• General Business: 8:00 a.m. - 5:00 p.m., Monday-Friday

• Morgue: 8:00 a.m. - 4:30 p.m., Monday-Saturday, including most state holidays.

Phone

• Document Requests: 919-743-9012

• General Business: 919-743-9000 (1-800-672-7024)

• Media Requests: For any media requests regarding the Office of the Chief Medical Examiner, please call the DHHS Communications Office at 919-855-4840.

• Medical Examiners or Pathologists (case reporting): 919-743-9010 (someone is on call 24 hours a day)

If you are a transporter or funeral home calling about delivery or removal of a body, call 919-743-9010 during hours the morgue is open.

Family members or others calling about a case can call 919-743-9000 or toll-free 800-672-7024 during business hours.

Fax

919-743-9099

Address

Physical:

4312 District Drive

Raleigh, NC 27607

Mailing:

Office of the Chief Medical Examiner

3025 Mail Service Center

Raleigh, NC 27699-3025

https://sites.google.com/a/hcs.k12.nc.us/hchs/home/departments/career-t…