As a forensic pathologist, how often do you make scene visits? When you do visit a scene, what do you generally do?
scene visits
- Thread starter jena2lsu
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i think it depends on the individual office you're practicing. many large offices have forensic investigators who gather information, photograph the scene, and bring the body back to the ME's office. The offices i've been at (Phoenix, Philadelphia, NYC) all do it this way. We get the sheets that the investigators filled out with the file that comes with the case. Information gathered includes, but is not limited to: witness/family member statements, medical history, anything of note found at the scene (drugs, etc), state of body (rigor, livor, signs of decomp), and a description of the scene with photographs.
i would imagine if you (as a FP) were required to go to the scene, you would do pretty much the same kinds of things
i would imagine if you (as a FP) were required to go to the scene, you would do pretty much the same kinds of things
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In the coroner system the deputy coroners would do the scene investigation but the pathologist can always go to the scene if there are unanswered questions in a difficult case. It is different in the medical examiner system but I don't have experience there. I believe in some M.E. systems the medical examiner (pathologist) would do the scene investigation. I do know that in Dade county the forensic fellows go on every homicide scene.
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Work up a good rapport with the detectives working the scene. This will perhaps be the only time in your life that you will ever be able to give orders to The Man. Which, seeing how terrible a job the police can do on scene investigations, might actually help the case.
Also, resist the urge to yell out "PWNED!"
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I agree it's pretty variable. I attended some scenes as a fellow, but primarily just observed the forensic investigator and answered a few minor questions -- my job was to learn how scenes generally are handled, from "simple" natural/drug deaths on up.
Where I work now, we go to the scene on pretty much all homicides/suspicious deaths and baby deaths, where I make sure the forensic investigator gets all the photos I want, I examine the general scene, and I do a limited external examination of the body (brief review of clothing, body front, back, under the shirt, eyes, mouth, hands; assess body temp (general warm/cool, not measured temps, which is another discussion entirely), rigor, lividity, etc.) in its dirty state. I'll also assist in collecting evidence from the body for the police at the scene, when indicated. Sometimes I feel comfortable enough to say the story, scene, & body are consistent and I'm not suspicious. Usually I point out some of the trauma, shrug, and say I'll know more after the autopsy. On baby deaths we do a doll re-enactment as soon as practical, and so far I've been present for the ones that were my cases; it also lets me ask a few more questions and ensure the timeframes I'm interested in were covered.
In my travels and discussions over the years (not that I've been out very long -- hardly), it seems to me that smaller jurisdictions with fewer cases tend to have their pathologists go to scenes more regularly, while in larger offices pathologists less commonly to essentially never go to scenes. I certainly understand how it can be a problem to send a pathologist to every homicide when you're getting +/-3 homicides every day at various times during the day, have 10+ total cases every day, and still need people on-site doing autopsies or going to court, and, oh yeah, giving someone vacation or just a paper day every now and then.
Where I work now, we go to the scene on pretty much all homicides/suspicious deaths and baby deaths, where I make sure the forensic investigator gets all the photos I want, I examine the general scene, and I do a limited external examination of the body (brief review of clothing, body front, back, under the shirt, eyes, mouth, hands; assess body temp (general warm/cool, not measured temps, which is another discussion entirely), rigor, lividity, etc.) in its dirty state. I'll also assist in collecting evidence from the body for the police at the scene, when indicated. Sometimes I feel comfortable enough to say the story, scene, & body are consistent and I'm not suspicious. Usually I point out some of the trauma, shrug, and say I'll know more after the autopsy. On baby deaths we do a doll re-enactment as soon as practical, and so far I've been present for the ones that were my cases; it also lets me ask a few more questions and ensure the timeframes I'm interested in were covered.
In my travels and discussions over the years (not that I've been out very long -- hardly), it seems to me that smaller jurisdictions with fewer cases tend to have their pathologists go to scenes more regularly, while in larger offices pathologists less commonly to essentially never go to scenes. I certainly understand how it can be a problem to send a pathologist to every homicide when you're getting +/-3 homicides every day at various times during the day, have 10+ total cases every day, and still need people on-site doing autopsies or going to court, and, oh yeah, giving someone vacation or just a paper day every now and then.
are you in an ME system? large or small office? just curious. not a lot of forensic types round these parts...
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So far I've always worked in an ME system; fellowship in a larger office (on the order of ~4500 autopsies/year), currently working in a smaller office (on the order of ~750 autopsies/year). And most of the places I interviewed were also ME systems, as I recall off the top of my head.
I suppose technically the systems I experienced as a medical student were primarily coronial, but at that point in time all I was doing was observing autopsies, and really didn't pay attention to the goings on above that level or what happened before or after the cases were cut. I wouldn't consider myself to have real working experience of coroner systems, beyond what I see & hear from the outside.
I suppose technically the systems I experienced as a medical student were primarily coronial, but at that point in time all I was doing was observing autopsies, and really didn't pay attention to the goings on above that level or what happened before or after the cases were cut. I wouldn't consider myself to have real working experience of coroner systems, beyond what I see & hear from the outside.
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KC -
what are your thoughts on the tendency for EMS to often "scoop and run" practically anyone who's not in full rigor or early decomp? i'm told that's becoming more common in many locations around the country, thus making scene examation less common and valuable? i understand the reasoning behind it, but it obviously is a hindrance to the coroner/ME who's later performing a medicolegal death investigation.
what are your thoughts on the tendency for EMS to often "scoop and run" practically anyone who's not in full rigor or early decomp? i'm told that's becoming more common in many locations around the country, thus making scene examation less common and valuable? i understand the reasoning behind it, but it obviously is a hindrance to the coroner/ME who's later performing a medicolegal death investigation.
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It definitely limits certain things, and we become more dependent on witnesses trying to accurately remember details on what is probably the worst day of their life. We occasionally track down EMS providers as well, whether they scooped & ran or were just there helping to determine death; they're not always focused on what we want, but they're usually better about remembering things than most witnesses. Often we have an investigator discuss the scene with the police who were there. When there's an important question that isn't being answered, we'll still sometimes send someone to the original scene.
But, with the exception of babies or rare "unusual" homicides, I haven't found it to be a "problem" per se. With babies, they're generally moved by family or witnesses, regardless of what EMS does anyway -- in those cases I think it's generally more likely to confuse the question of positional asphyxia than anything else. With -most- homicides, really, I don't think I've seen it be a serious problem. In theory, "weird" homicides with attempts at covering it up, misleading investigators, etc. could be compromised, but it's probably more likely to affect the police investigation than ours (neglecting for a moment just how intertwined the two really are).
Personally, so far I've found it bemusing but not seriously problematic when EMS haul in the obviously dead, or even leave them there with fresh defib & ECG pads falling off decomposed bodies. This, because someone somewhere wasn't dead when EMS said they were, so now in some jurisdictions they are mandated to run an ECG trace. (Whatever happened to just telling someone they screwed up?) Police, here at least, are allowed to determine death in "obvious" cases, and occasionally call off EMS before they arrive at the scene. The bigger complicating factor, to me, is when EMS/hospital partially succeeds but the patient dies days-years later: the scene is hopelessly contaminated, hospital admission samples are gone, witnesses are suddenly scarce, and even the autopsy itself is complicated by all the intervening anatomic-physiologic changes of surgery, healing, multiple arrests, etc.
So.. yeah, EMS in general complicate the process, but rarely in a major irrecoverable way. And yeah, they have a job to do too, and with the exception of re-instituting common sense/faith in EMS by elimination of running ECG traces on decomps or other obviously-dead individuals, I don't have a great alternative. To me the trend is somewhat like the trend away from simply doing a good history & physical; that art is being slowly replaced by imaging & laboratory tests, in part because those technologies are so much improved and in part, I think, because it -is- an art...not always easy to reproduce and open to a tremendous amount of interpretation. Interpretation of scenes & witnesses can be like that, while autopsies are relatively standard and descriptive.
But.. that's getting a bit too philosophical.
-k
But, with the exception of babies or rare "unusual" homicides, I haven't found it to be a "problem" per se. With babies, they're generally moved by family or witnesses, regardless of what EMS does anyway -- in those cases I think it's generally more likely to confuse the question of positional asphyxia than anything else. With -most- homicides, really, I don't think I've seen it be a serious problem. In theory, "weird" homicides with attempts at covering it up, misleading investigators, etc. could be compromised, but it's probably more likely to affect the police investigation than ours (neglecting for a moment just how intertwined the two really are).
Personally, so far I've found it bemusing but not seriously problematic when EMS haul in the obviously dead, or even leave them there with fresh defib & ECG pads falling off decomposed bodies. This, because someone somewhere wasn't dead when EMS said they were, so now in some jurisdictions they are mandated to run an ECG trace. (Whatever happened to just telling someone they screwed up?) Police, here at least, are allowed to determine death in "obvious" cases, and occasionally call off EMS before they arrive at the scene. The bigger complicating factor, to me, is when EMS/hospital partially succeeds but the patient dies days-years later: the scene is hopelessly contaminated, hospital admission samples are gone, witnesses are suddenly scarce, and even the autopsy itself is complicated by all the intervening anatomic-physiologic changes of surgery, healing, multiple arrests, etc.
So.. yeah, EMS in general complicate the process, but rarely in a major irrecoverable way. And yeah, they have a job to do too, and with the exception of re-instituting common sense/faith in EMS by elimination of running ECG traces on decomps or other obviously-dead individuals, I don't have a great alternative. To me the trend is somewhat like the trend away from simply doing a good history & physical; that art is being slowly replaced by imaging & laboratory tests, in part because those technologies are so much improved and in part, I think, because it -is- an art...not always easy to reproduce and open to a tremendous amount of interpretation. Interpretation of scenes & witnesses can be like that, while autopsies are relatively standard and descriptive.
But.. that's getting a bit too philosophical.
-k
