1. Autopsy
BMT Forensic Unit

2. What is an Autopsy?
It is a specialized examination of a corpse to determine how and why someone died and to investigate any disease or injury
It is a medical procedure performed respectfully and carefully to objectively

3. Two classifications of Autopsy
Clinical: done in attempt to better understand disease progression, effects of treatments and to learn how to prevent deaths.
Forensic: REQUIRED in cases where criminal activity is suspected, the body has not been identified, cases where the cause of death is not clear and cases involving accidental death.

4. Who does the autopsy in NC?
Clinical autopsy can be done by medical doctor specializing in disease diagnoses or by medical examiner.
Forensic autopsy is performed by a general pathologist or a forensic pathologist at the request of the medical examiner
Forensic autopsy team of specialists can be involved: anthropologist, archeologist, geneticist, toxicologist, entomologist, odontologist, etc.

5. When is a forensic autopsy indicated
Medical examiner is responsible for determining the cause and manner of death in:
All accidents
Unexpected deaths
Unwitnessed deaths
Drug overdoses
Suspected homicides
suicides
NC OCME 2014

6. The medical examiner can be called upon when someone does not die of a known disease at a hospital. His role would be to determine the true cause of death.
The time and cause of death have legal implications for insurance, wills and criminal cases.
If the medical examiner determines that an autopsy is required, permission from family is not required.

7. Autopsy SOP
Body must get to the medical examiner’s office or hospital morgue
Great effort to preserve evidence (without contamination):
Hands are bagged (blood could be under fingernails; gunshot residue)
Body covered and transported in a new body bag to reduce the possibility of evidence contamination during transport.

8. Autopsy external inspection
Once in morgue, the pathologist and assistants put on gowns, gloves, and face shields.
Photos are taken during each step
Xray is taken of the body (this preserves evidence of fractures and any bullets)
First examination is performed with the clothing on. Evidence (gun shot residue, fibers, hair samples) is collected and preserved.

9. Signs of petechial hemorrhage is assessed (dots of blood under the eyelids); this would indicate the person may have suffocated.
One external inspection is complete, the body is cleaned, weighed, measured and all identifying features (sex, race, eye color, hair type, color, apparent age, scars, tattoos and birthmarks) are noted.
Blood, oral fluid and tissue samples may now be taken for toxicological analysis.

10. Autopsy internal inspection
Y shaped incision made that exposes the rib cage and abdomen

11. Pathologist removes and weighs internal organs and checks for injuries and abnormalities.
May also collect tissue samples for microscopic study, culturing disease organisms or toxicology analysis
If brain must be examined, it is placed in formalin for several weeks so that it can be sliced.

12. Once internal inspection is complete, organs are put back into the body and skin sewn up discretely so that the family can view the body and the mortuary can prepare for the funeral.
The medical examiner (Coroner) must complete the Report of the Investigation and sign the Death Certificate both of which should specify the CAUSE and MANNER of DEATH

14. Time of Death
In forensic cases the time since death (post mortem interval) is important
The body decomposes in predictable ways after death.

15. Time of Death indicators
Potassium levels in ocular fluid
(vitreous humor of the eye)

16. Algor mortis indicator
Algor mortis: Body cools at a predictable rate (approximately one degree/hour until it reaches ambient temperature). Obesity and warm climates slow the process.

17. Liver mortis indicator
Liver Mortis: Blood settles to the lowest parts of the body resulting in discoloration of the tissue. This helps determine the position of the body at death.

18. Rigor mortis indicator
Rigor mortis: stiffening of the body muscles after death occur due to chemical changes (build up of calcium in muscles causing the muscles to contract). Rigor mortis begins between 2-6 hours after death and reaches maximum stiffness at 12 hours after death. Thereafter the muscles gradually relax.

19. Other time of death indicators
Decomposition starts with growth of bacteria (this is hastened in warm moist temperatures)
Digestion proceeds at a predictable rate, contents of stomach and intestines can provide valuable clues
Insects lay eggs in dead body at a certain point after death. These eggs mature into larvae and pupate on a very predictable timeline

21. Autopsy as a clinical research tool
In clinical medicine, it is the BEST way to confirm certain disease diagnoses
This is important to policy and public health decisions
Can act as a quality control measure for doctors and hospitals and new treatments
Can provide understanding of how treatments are working and shape recommendations regarding clinical practice.

22. Barriers to Autopsy
Autopsies in the US have declined sharply from 19% in 1972 to 8.5% in 2007
It is uncommon for an autopsy to be performed in a hospital due to disease
This is partly because of the cost that insurance does not cover
Clinician fear that the autopsy may reveal sub-standard care was given
Many believe that modern imaging tools have reduced the need for autopsies

23. Autopsy research
Has revealed that many patients were misdiagnosed and might have lived if proper diagnosis was made
They can show when the need for treatment protocols need to be made

24. Are consents required for autopsy?
Forensic autopsy does not require a consent from the family member. It is determined by the medical examiner.
Clinical autopsy are ordered by the medical physician and must have family consent.

25. Religion and Autopsy
Most religions have specific beliefs and practices related to death and the treatment of bodies
Some encourage immediate burial
Some forbid desecration of the body
11 states allow a family to express religious objection that must be taken into consideration by the medical examiner when deciding to do the autopsy. The medical examiner makes the final decision