2UNIFORM DETERMINATION OF DEATH ACT Definition of DeathUNIFORM DETERMINATION OF DEATH ACTIrreversible cessation of circulation of blood in the bodyIrreversible cessation of all respiratory functionsIrreversible cessation of all function of the entire brain (including the brain stem)
3Autopsy An autopsy is also known as a post-mortem investigation. The word "autopsy" comes from the Greek words "auto" and "opsis", and it literally means "to see for oneself".An autopsy is performed to determine the cause, manner and mechanism of death.
4AutopsyThe first known legal autopsy was ordered by a magistrate in Bologna in 1302.To understand the human anatomy better, and to improve their skills, the artists Leonardo da Vinci and Michelangelo each performed autopsies.The autopsy really became significant in 1761, when Giovanni Morganni published his great work On the Seats and Causes of Diseases as Investigated by Anatomy. This work contained descriptions of 700 autopsies.
5Autopsy Today there are two types of autopsies: medical and legal. A medical or clinical autopsy is performed to determine the medical cause of death or for research purposes.A legal or forensic autopsy is performed when the cause of death is a possible criminal manner.
6Before Body DisposalOrgan donation – the removal of tissues from a recently deceased body or a living donor.Organs, tissues, stem cells and blood and platelets may be donated.Most people can be donors (HIV positive, cancer active or systemic infection cannot donate).
7Before Body Disposal (cont) The organs that may be donated are the kidneys, heart, lungs, liver, pancreas, and the intestines.Donated organs must be transplanted within 6-72 hours and cannot be stored.Tissues, stem cells, blood and platelets may be stored for later use.
8Before Body Disposal (cont) Currently, 99,450 people are on the waiting list for a donation.
9Body DisposalThere are many opinions about the correct way to dispose of a body.These opinions may be influenced by religion, fear, cultural beliefs and taboos.Methods of disposal include:BurialEco-CemeteryAt seaSky burialCremationMummificationMedical ResearchStuffedLyeFreeze dried
10Who Performs An Autopsy A medical autopsy will be performed by a pathologist at the hospital.A forensic autopsy will be performed by a Medical Examiner (M.E.) at the Morgue.A coroner does not perform an autopsy.A funeral director or mortician does not perform an autopsy.
11What is the Purpose of An Autopsy? The M.E. will perform an autopsy to:Identify the deceasedEstablish approximate time and date of deathDetermine the manner, cause and mechanism of deathOther duties of the M. E. include:Collecting Evidence from the clothing and body of the deceasedProtecting the estate of the deceasedNotifying the next of kin
12The Body Arrives at the Morgue or M.e.’s Office 1. The body bag is unsealed and opened.2. The body is photographed in the body bag.3. Description of the clothing is recorded.4. Evidence is collected from the clothing and the body.
13The Body Arrives at the Morgue or M.e.’s Office 5. If it is a homicide investigation, the hands will have been bagged at the scene. The M.E. will remove the bags and collect fingernail scrapings.6. UV radiation is used to enhance any secretions that should be collected.7. X-rays are taken.8. The body is removed from the bag and undressed in preparation for the external examination.
14The External Examination During the external examination, any wounds, bruises, scars, etc. will be examined, measured and recorded.The body is also weighed and fingerprinted during this stage of the autopsy.
15The External Examination (cont) During the external examination, the M.E. will also observe and record all of the information related to decomposition.This information is very important for the determination of time of death, body position at the time of death and location of the body at the time of death.
169 Ways of Estimating Actual Time of Death Rigor mortisAlgor mortis: Body Core TemperatureLivor mortis: (Lividity)Potassium levels in vitreous humor and the clouding of the corneaStomach ContentsEvidence of DecompositionPresence/absence of purge fluidsDrying of the tissueInsect Larval Instars
17Rigor MortisRigor Mortis- is the state of rigidity that results from release of lactic acid after death; the body’s pH changes from alkaline to acid.Rigidity begins with shorter muscles of the face and extremities, the fingers and toes; then the neck; moves down and out the long muscles of the extremities and the forearms with the legs stiffening last. The process is reversed in the same order until the body is no longer stiff.
18Approximate Time Frame of Rigor Mortis Time After Stage of RigidityDeath1-4 hours jaws & neck rigid; rest of body limpUp to 8 hrs everything down to the legs is rigidFor 12 hrs everything remains rigid24 hrs jaw is limp but everything else is rigid30-32 hrs everything but the legs are limp36 hrs no rigidity
19Circumstances that effect rigor mortis Starvation – thinner bodies stiffen fasterExtreme temperatures – cooler temperatures slow onset of rigorPhysical exertion right before death speeds the onset of rigorVictims of drowning will not show signs of rigor until removed from the water
20Algor MortisAlgor Mortis- process in which the body temperature continually cools after death until it reaches room temperature. It is also called the death chill.The body temperature will be taken at the crime scene. The temperature may be a rectal or liver reading.The body generally loses 2 degrees in the first hour and then at a rate of 1 to 11/2 degrees per hour.Once a body has reached ambient temperature, temperature will no longer aid in time of death.
21Circumstances that effect Algor Mortis Body Size – a larger body cools much slower.Clothing- the more clothing on the body the slower it cools.Body temperature at time of death – if someone has a fever when they die that must be considered when calculating rate of cooling.Ambient Temperature – if someone dies in a cold location then the body will cool off sooner.
22Rigor mortis And Algor mortis used together Temperature of Body to the touchStiffness of Majority of the BodyTime since DeathWarmNot StiffDead for less than 3 hoursStiffDead between 3 and 8 hoursColdDead between 8 and 36 hoursDead longer than 36 hours
23Livor MortisLivor mortis is the settling of the blood, causing the skin to change colors. Due to gravity, blood settles in the lowest parts of the body. However, body parts that are in contact with the floor or other objects will not develop lividity patterns.Lividity indicates the position of the body after death. When lividity becomes fixed, then the distribution of the lividity pattern will not change even if the body’s position is altered.Lividity usually becomes fixed between 10 and 15 hours after death.
24Livor Mortis Time after death when lividity patterns are visible: ½ hour - 1st seen on a fair-skinned individual4-8 hrs- lividity is fixedThe lividity patterns indicate that this person died while lying on their back.
25Importance of Livor Mortis: 1. Patterns can help to establish time of death.2. Patterns can indicate if the body has been moved.
27Stomach contentsThe stomach empties 4-6 hours after a meal. Therefore, if the stomach is empty, death likely occurred several hours after eating.If the small intestine is empty, death probably occurred 24 hours after the victim’s last meal.If the colon is empty, death likely occurred hours after last meal.The type of food eaten and the amount will affect this timeline.
28Decomposition, Purge Fluids and dry decay Decomposition begins immediately after death.The bacteria in the intestinal tract is released into the rest of the body where it begins to breakdown tissues. This process is known as putrefaction.Enzymes in the cells break down the cells and begin self-digestion throughout the body. This process is known as autolysis.Both of these processes release gas which is responsible for the smell associated with dead/decaying organisms.
29Decomposition, Purge Fluids and dry decay The breakdown of the tissues may take several days up to several years.This occurs in four stages:1. Fresh or Initial2. Putrefaction3. Black Putrefaction4. Dry Decay
30Decomposition, Purge Fluids and dry decay Fresh/Initial decay (first 24 hours)Corpse appears normal, but internal bacterial decay and autolysis has begun.Putrefaction (2-5 days)Corpse is swollen due to build up of gases and an odor is obvious. The corpse has a greenish color. Skin blisters form, eyeballs collapse, hair begins to fall out and the skin recedes from nails.The skin begins to look marbled due to blood vessels forming a web-like pattern.
31Decomposition, Purge Fluids and dry decay Black Putrefaction (5-10 days)There is a very strong odor. The flesh appears black, gases continue to escape and the corpse collapses.Purge fluids leak from the mouth and nose.Skin slippage occurs and eyeballs liquify.Dry Decay (10 days until complete)Corpse is almost dry so further decay slows from lack of moisture. Approximately one year must pass before all smell is gone from the bones.
32Insect larval InstarsThis will be a factor if the body was located so that insects had access to the body.Flies will lay eggs on the body. Maggots hatch from the eggs within 24 hours. The maggots mature through three different instar stages. The length of the maggot will indicate which instar stage and aid the M.E. to estimate time of death.
33Internal ExaminationAfter the external examination and decomposition analysis is complete and all information is recorded, the M.E. will prepare the body for the internal examination.A body block will be placed under the back of the body to cause the arms and neck to fall backwards and the chest to protrude forward. The makes it easier to make the Y-incision on the torso.
34Internal ExaminationThe V-part of the Y incision is cut from the left shoulder, down under the nipples and over to the right shoulder. Then the scalpel is placed in the pit of the abdomen, below the sternum and cut straight down and left of the belly button to form the rest of the Y incision.Shears are used to open the chest cavity.A saw is used to cut through the ribs and sternum. The entire chest plate is removed.
35Internal ExaminationNext, the organs will be removed from the body. There are two Methods for Organ Removal. Each method was designed by and named for German pathologists.The Rokitansky procedure: organs are removed all at once and then examined.The Virchow procedure: each organ is removed separately and immediately examined.
36Internal ExaminationNo matter how they are removed from the body, each organ is weighed and examined.Small slivers may be cut from an organ for microscopic examination.
37Internal Examination The organs will be inspected for the following: Heart- trauma damage; stenosis; ventricular fibrillationLungs- trauma; toxic gases, vapors and dusts; fire; CO, heroin overdose; lung diseaseLiver; cirrhosis; trauma damage
38Internal Examination Stomach- drug overdose; stomach contents Bowel- sliced and stripped; trauma and disease; drug packagesHead- brain removed, weighed, sectioned and checked for internal traumaKidneys- failure; jaudice; BUN test ( urea nitrogen in blood)
39Internal Examination Next, the brain is examined. The M.E. makes a cut from ear to ear on the back of the head.The scalp is peeled forward to expose the skull. The skull is examined for any contusions.A skull saw is used to cut off the top halve of the skull and expose the brain.
40Internal ExaminationThe brain is observed while in the skull and then removed.If the brain needs to be preserved for later inspection it is placed in formalin.
41The Final stepsAll of the organs are placed in a plastic bag to prevent leakage. The bag is placed inside the body cavity.The chest plate and skull cap are replaced.The chest flaps and scalp are sewn back together.The body is then returned to the family and disposed.
42m.e.’s reportThe M.E. uses all of the information from the autopsy to determine the cause, manner and mechanism of death.These will be listed on the Death Certificate.These findings also determine if the death was due to a crime.
43The Cause of deathThe cause of death is the illness or injury that actually begins the dying process. Examples include:Gunshot woundDrowningBlunt Force TraumaStrangulationStab Wound
44The Mechanism of DeathThe mechanism of death is the physiological reason that a person dies.Examples include:Lack of oxygenLoss of BloodShockSepsis
45The Manner of death There are five manners of death: Accident Homicide Natural CausesSuicideUndeterminedThe manner of death may be changed once on a death certificate. An undetermined manner is only used until a final decision is made.
46Cause, manner and mechanism of death One can die of a massive hemorrhage (the mechanism of death) due to a gun shot wound through the head (cause of death) as a result of being shot (homicide), shooting yourself (suicide), dropping a gun and it discharging (accident), or not being able to tell which (undetermined). All of which are manners of death.
47Medical Examiner vs Coroner Many areas of the United States do not have the demand or budget to support a Medical Examiner’s office. In this case, a coroner will investigate the death and complete the death certificate.However, a coroner cannot perform an autopsy. So they will have to have the nearest M.E. perform the autopsy.
48Medical Examiner vs Coroner A medical examiner is a medical doctor, usually a pathologist and is appointed by the governing body of the area. There are 400 forensic pathologists throughout the U.S.A coroner is an elected official who usually has no special medical training. Many coroners have only a high school education.Sometimes the local funeral director will also be the coroner.
49Medical Examiner’s Report And Death Certificate (next slide) for Brendon lee
52Body Disposal BurialAfter death, most families use the services of a funeral home.A funeral home, funeral parlor or mortuary, is a business that provides burial and funeral services for the deceased and their families.The funeral home will embalm the body and help with burial arrangements.The word burial comes from the word birgan which means to conceal.
53The Process of Embalming Embalming is done to delay decomposition and allow time for the funeral.Blood and body fluids are removed and replaced with embalming fluid.
54Body Disposal BurialTom M Wages Funeral Services, LLC located in Lawrenceville, Georgia
55Body Disposal BurialA coffin is the general term for the container in which a corpse is buried.Coffins have been made of clay, stone, papier-mache, turtle shells, baskets, fabrics, and metals.Coffins are sculpted to the body shape.
56Body Disposal BurialFor many years, coffins were a symbol of social status.The poor were buried in a shroud.However, the poor were transported to the cemetery in a slip-coffin.A slip-coffin had a hinged bottom to allow the body to drop into the grave.The coffin was then returned to the church for reuse.