The Role of the Medical Examiner: Death and Public Health. Carraugh Reilly Nowak, MFS, D-ABMDI Karen Biel Costantino, RN, BSN
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1 The Role of the Medical Examiner: Death and Public Health Carraugh Reilly Nowak, MFS, D-ABMDI Karen Biel Costantino, RN, BSN
2 About the Erie County Medical Examiner s Office Over 2600 reported deaths Around 1200 cases (autopsies/exams/etc) Tox & Histo: 50% of cases complete by 30 days 80% of cases complete by 60 days 99% of cases complete by 90 days
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4 About the Erie County Medical Examiner s Office Who works there? Administrative Admin. Coordinator Clerical Staff Forensic Pathologists Chief Medical Examiner Assoc. Chief Medical Examiners Forensic Toxicologists Chief County Toxicologist Toxicologists Investigators Medical Investigators Scene Investigators Morgue Keepers Histologist Pathological Lab Assistants Law Enforcement/DAs/Ancillary/Forensic Scientists
5 Medicolegal Death Investigation
6 Medicolegal Death Investigation: Jurisdiction Notification of Death ME Jurisdiction Not ME Jurisdiction Scene/Background Investigation Ancillary Tests Forensic Autopsy Investigation Report Certification of Death
7 Medicolegal Death Investigation The purpose of the investigation is to determine: Who? What? When? Where? Why? How?
8 Medicolegal Death Investigation: Components Scene Investigation Background Investigation Ancillary Studies Toxicology Radiology Clinical Labs Others
9 Medicolegal Death Investigation These investigations put together a story and timeline of the last years, months, days and hours of an individual s life This story is taken into consideration during the autopsy
10
11 Forensic or Medicolegal Autopsy The purpose of the autopsy is to establish the cause and manner of death through the: Documentation of internal and external injuries Collection of medical evidence such as tissues, fluids and trace evidence Reconstruction of the injuries Does this all correspond??
12 Goal of Medical Examiner s Office: Certification of Death (AKA: Death Certificate)
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14 Death Certificate Who Issues It? Physician/Doctor Medical Examiner
15 Death Certificate- What Does It Show? Identifies the individual States the Cause and Manner of death Cause what actually caused the person to die, i.e. heart attack Manner 5 types: Natural Accident Homicide Suicide Undetermined
16 Death Certificate-Why Is It Important? Closure for family Settling of estates/insurance, etc. Cause and Manner Legal criminal and civil litigation Public Health
17 Epidemiology & Disease (Death) Prevention H1N1 Myocarditis Co-Sleeping Cancer Registry DMV Reports
18 Mass Fatality And Pandemic Disease Planning Basics: Structure Flexibility All-Hazards
19 Mass Fatality Plan COOP (Continuity of Operations Plan) MERT ( Medical Examiner s Response Team) Forms Phases
20 Additions Specific to Flight 3407 COOP External Assistance MERT Designated Staff Family Office Scene External Assistance Numbering System Forms DMORT ( Disaster Mortuary Response Team) Phases III
21 Lessons Learned Updates to the ECMEO Mass Fatality Plan Family Assistance Designee MERT Office Division Additional Phase
22 Pandemic Disease Plan Jurisdiction Autopsy Reporting PPE/Employee Prophylaxis Decontamination
23 Death in medical setting Death outside medical setting Not reportable to MEO Reportable to MEO Not ME Jurisdiction Limited ME Jurisdiction* ME Jurisdiction MD/Hospital/PMD Transport* Death Certificate Issued (Cause and Manner of Death) Incident Command -Transport -Identification ME/Designee (Pandemic Cases) Forensic Autopsy or Examination Death Certificate Issued (Cause and Manner of Death) Transport* Funeral Home/ Crematory Funeral Home/ Crematory Emergency Storage Units (coolers/refer trucks/cold storage Temporary Interment Site District Registrar/Clerk s Office Burial Permit* Disposition Burial Cremation Removal/Hold(Storage) Disinternment Reinterment
24 Additions Specific to H1N1 Jurisdiction After Sentinel Cases, most not ME Confirmed /suspected cases of H1N1, not ME Autopsy 4 H1N1, 1 Influenza A Only Sentinel Cases and unconfirmed Reporting All samples sent to NYS Lab at Wadsworth PPE/Employee Prophylaxis CDC Guidelines utilized at all times Decontamination CDC Guidelines utilized at all times
25 Lessons Learned Updates to the ECMEO Pandemic Disease Plan Definition of Sentinel Case CDC Guidelines
26 QUESTIONS??????? Erie County Medical Examiner s Office 503 Kensington Ave. ( ECMC Campus)
27 How can you be involved? Interns - ECMEO offers internships to college students Volunteers - Specialized Medical Assistance Response Team (SMART)
28 THANK YOU!!!
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