In homicide, suspected homicide, and other suspicious or obscure cases, the forensic medicine expert should visit the scene of the death before the body is removed. Local practice varies but any doctor claiming to be a forensic medicine expert should always make himself available to accompany the police to the locus of the death. This duty is often formalized and made part of a contract of service for those forensic medicine experts who are either full-time or substantially involved in assisting the police, in England and Wales, the 'Home Office Pathologists' are permanently on call for such visits and in many other jurisdictions, such as the medical examiner systems in the USA, and the European State and University Institutes of Forensic Medicine, there is usually a prearranged duty roster for attendance at scenes of death (Saukko & Knight, 2004). In many cases, the scene investigation is more important than the autopsy. A thorough and complete investigation commonly leads to the proper diagnosis of the cause and manner of death prior to an autopsy (Avis, 1993; Dix & Ernst, 1999).
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Why go to the scene? The purpose of having the forensic medicine expert attend the death scene is severalfold. By viewing the body in the context of its surroundings, the forensic medicine expert is better able to interpret certain findings at the autopsy such as a patterned imprint across the neck from collapsing onto an open vegetable drawer in a refrigerator. The forensic medicine expert is also able to advise the investigative agency about the nature of the death, whether to confirm a homicide by a specific means, evaluate the circumstances to be consistent with an apparent natural death, or interpret the blood loss from a deceased person as being more likely due to natural disease than to injury. This preliminary information helps the investigative agency to define its perimeter, structure its approach, organize its manpower, secure potentially important evidence, and streamline its efforts. Nonattendance at death scenes has been regarded as one of the classical mistakes in forensic pathology. Hospital pathologists performing forensic autopsies who are not trained to, or able to, attend death scenes should be provided with information on how, when, and where the body was found, by whom, and under what circumstances. In some deaths, the immediate environment does not contribute to death, such as in cases of metastatic breast carcinoma. In other cases, the environment plays a role although it does not cause the death; for example, consider a case in which a person with marked coronary atherosclerosis collapses with a dysrhythmia while shoveling snow. On the other hand, the scene description and scene photographs are critical in documenting that the physical circumstances and body posture are indicative of death due to positional asphyxia because the autopsy in these cases may yield very few findings. The most meticulous autopsy in all academia will provide only a speculative cause and manner of death in a 30-year-old man with a negative history, negative toxicology, and autopsy findings of visceral congestion. Yet at the scene, a screwdriver is next to an uncovered electrical outlet on a rain-soaked patio at the decedent's house, which is undergoing renovation. The cause and manner of death are provided by the scene (Lew & Matshes, 2005).
Every death scene is a potential crime scene. It is important to carefully examine the scene for evidence or unusual circumstances that may indicate the death of the person is other than by natural causes (Moldovan, 2008).
The deceased is the most valuable piece of potential evidence at any death scene. Hence, a systematic and thorough examination of the deceased should be undertaken at every death scene. Blood spillage or spatter should be noted and will remain after the removal of the body. Weather conditions, location, and poor lighting may mask some faint injuries and trace evidence on the body, therefore the death-scene investigator should document in writing, by sketch, and by photography all information about the body that can be gathered at the scene (Horswell, 2005b). The forensic medicine expert should focus on the physical condition of a body at a scene. Without a scene investigation, much initial, valuable body information can be lost. The following points will serve as a guide.
When initially notified, a forensic medicine expert should determine as much information as possible from the caller. Approximate age and gender places a subject in a certain "medical category." An attempt should be made to ascertain if there is any evidence of foul play or if any instruments are available that might have played a role in the subject's death. By gathering these data, a forensic medicine expert is able to anticipate additional infonnation that may be needed upon arrival at a scene (Dix et al., 1999). The first rule in performing a death scene investigation is to make certain that the scene is safe and secure. Usually, this requires police involvement but in some instances, it will require other professionals, such as fire department personnel or utility workers. The second rule is to not contaminate or disturb the scene. At the very least, death investigators should wear disposable examination gloves and it is also advisable to wear shoe covers and hair nets. Occasionally, full body covering is desirable. When touching items at a scene, examination gloves should always be worn and care should be taken not to sit on furniture or lean against or brush against walls or furniture (Prahlow, 2010). The death-scene investigator must seek answers to the following questions: is trace evidence at the scene consistent with the death having occurred at this location? Does the body contain any trace evidence that is unusual for this location, for example, mud on soles of shoes, grass, or seed material embedded in or found on the clothing when the deceased was located inside a building? Is the death one that can be attributed to natural causes? Are there any external signs of violence? Is there anything amiss or out of the ordinary regarding the scene? (Horswell, 2005b).
The purpose of still photography documentation of the death scene is to provide a true and accurate pictorial record of the death scene and physical evidence present. Still photography records the initial condition of the scene. It provides investigators and others with a record that can be analyzed or examined subsequent to the scene investigation, and serves as a permanent record for legal concerns. Photography of a death scene is normally done immediately following the videography of the scene or after the preliminary scene survey. A systematic, organized method for recording the death scene and pertinent physical evidence is best achieved by proceeding from the general to specific guideline. Adherence to this guideline allows orientation of the entire death scene, orientation of the evidence within the scene, and provide; examination quality photographs of specific items of evidence that may be used for analysis away from the scene. The number of photographs that should be taken at a death scene cannot be predetermined or limited (Miller, 2003). Information such as body location and unique circumstances at the death scene may help a forensic medicine expert. It is important to keep in mind the legal implications of the photographs. Will the photographs be subpoenaed? (Dix et al., 1999). The scene and body are photographed before anything is moved or removed. Treat the body with respect. Never remove the clothing in full view of onlookers. If it is not feasible to move the body to a secure area of the scene, police officers may hold up sheets around the body, mobile panels may be used, or police vehicles may be used to block visibility from the public (Lew & Matshes, 2005).
The final task in documentation of a death scene is sketching. All of the previous tasks for documentation record the death scene without regard to the size or measurement of the scene and its physical evidence. Sketching the death scene is the assignment of units of measurement or correct perspective to the overall scene and the relevant physical evidence identified within the scene (Miller, 2003). The deceased's location relative to other objects and structures within the scene is very important. The position of the deceased is plotted: the head and groin of the deceased are good points on the body to use for plotting its position. Accurate measurements should be noted to place the items within the scene in the sketch in the same locations as they appear in the scene (Horswell, 2005b).
A systematic, thorough inspection and evaluation of the decedent should be performed by a forensic medicine expert. If he/she always begins at the top of a subject's body and moves toward the feet, the possibility of missing important injuries or evidence is lessened (Dix et al., 1999). The body should be prone (face up) during the examination, if possible. Photos of the original position of the body must be taken before the body is moved. One begins with a general assessment and progresses from head to toe, pushing clothing aside but not removing it. Some find it easier to assess rigor, livor, and algor mortis initially. The purpose of the assessment of the body at the scene is to provide some insight into the nature of the case and a working cause of death (Wagner, 2009).
abrasions. Documentation of this inspection should be made noting the presence and absence of unusual markings or abnormalities. Descriptions of the state of rigor and livor mortis as well as the body temperature of a subject helps a forensic medicine expert to estimate the time interval since death. Environmental assessment, including temperature, heating or cooling systems, moisture, and wind conditions must be made at a death scene so that the environmental influence on a decedent can be determined. The assessment should also include the types of clothing and jewelry. This information may be needed to assist in determinating the time a subject was last seen alive. Clothing should be appropriate for the weather and location found. If not, it needs to be explained. One should also determine if the clothing fits an individual. If a subject is decomposing, then clothing may appear too small due to body swelling. If the clothing is the incorrect size, one must determine why. Was the person wearing someone else's when death occurred? Or, was the decedent redressed by another person after death? Note the cleanliness of the clothing. A variance in the clothing or body cleanliness may indicate that he was handled by another individual after death (Dix et al., 1999). General uncleanliness such as lack of bathing, very dirty clothes, urine -or feces- stained clothes, long and dirty nails, and poor oral hygiene may be due to alcoholism, drug abuse, or a mental disorder (Wagner, 2009). Is the clothing worn properly? Are buttons fastened and zippers closed? It is common to find opened zippers in intoxicated males or some elderly persons living alone. If the clothing is inconsistent with normal dressing techniques, consider whether a subject had a disability contributing to this behavior. Jewelry should be carefully noted and reported as to its type, style, color and body location. All jewelry must be listed, regardless of its apparent value. Obvious "missing" jewelry should also be noted, such as only one pierced earring, or no wedding ring on a married individual. Currency and credit cards should be handled as valuable items. Currency should be counted in the presence of another and credit card details noted. If an investigator decides that these items may be given to the next-of-kin at the death scene, he must be certain that the relative has the legal right to such items. No analyses should be performed on a decedent's body at a scene, such as gunshot residue or fingerprinting, without the expressed consent of the forensic medicine expert responsible for the postmortem examination. Clothing should not be removed, a body should not be cleansed, and liquids or powders should not be placed on the deceased as these might interfere with radiographs or chemical testing. If more than one hour has elapsed since the initial body assessment and the decedent is still at the scene, a second assessment should be recorded. A thorough body visualization by a forensic medicine expert gives him/her the capability to differentiate between injuries noted at a scene and any bodily injuries sustained during conveyance to the morgue (Dix et al., 1999). 2ff7e9595c
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