Medicolegal Death Investigation Research Articles

Postmortem Drug Redistribution: A Compilation of Postmortem/Antemortem Drug Concentration Ratios.

Postmortem drug redistribution (PMR) is a well-known phenomenon in forensic toxicology with implications for medico-legal death investigations. Paired antemortem (AM) specimen and postmortem (PM) mortuary admission femoral blood drug concentrations from 811 coronial cases were used to construct a retrospective compilation of PM/AM drug concentration ratios for 42 parent drugs and metabolites. The median PM/AM ratios for all antidepressants were > 1 and consistent with PMR In contrast, the median PM/AM ratios of most benzodiazepines were < 1. The antipsychotics were varied (0.63-3.3) and suggest the mixed effects of PMR and drug instability. Amphetamines exhibited no trends (0.90-0.95) and are likely confounded by many factors. The PM/AM ratios of cardiovascular drugs, opioids and other drugs are also reported. This research represents an expansive retrospective compilation of paired AM and PM drug concentrations for many toxicologically relevant drugs. While the median PM/AM ratios demonstrate some drug-dependent trends, there was no obvious relationship between AM specimens and PM femoral blood taken at mortuary admission.

A Brief Review of Scanning Electron Microscopy With Energy-Dispersive X-ray Use in Forensic Medicine.

Scanning electron microscopy with energy-dispersive x-ray (SEM/EDX) analysis is an investigation whose potential has become increasingly important in the field of forensic research and diagnosis. We present the procedure to perform a well-carried-out SEM/EDX analysis on corpses affected by different types of injuries, such as blunt force trauma, ligature strangulation, electrocution, sharp force trauma, gunshot wounds, and intoxication. After the areas of forensic interest have been macroscopically identified, the sampling can be performed in 2 different ways: apposition of the double-sided graphite tape on the damaged area or performing the excision of a biological sample. In both cases, a proper negative control sample is required. In all cases, SEM/EDX analysis can detect exogenous microtraces consistent with the types of injuries involved. In blunt force trauma, microparticles of different nature deriving from the contact of the blunt instrument with the victim may be observed; in sharp force trauma, metal microtraces (Fe, Cr, Al, Ti) can be identified. In ligature strangulation, exogenous microtraces may be found in the cutaneous furrow. In electrocution, it allows to identify the pathognomonic metal pattern (Cu, Zn, Fe) of the "electric mark." In gunshot wounds, the main applications regards the detection of metal particles (Pb, Ba, Sb) of gunshot residues. Finally, in the analysis of intoxicants, it may identify traces of toxic substances. Thus, the authors conclude that SEM/EDX analysis can provide essential information to assist in the medicolegal investigation of death.

The role of the forensic anthropologist in the pediatric autopsy: Interpretations, contributions, and challenges

AbstractChild maltreatment is a growing medicolegal and social concern and forensic anthropologists in the United States are more frequently being asked to participate in pediatric autopsies to evaluate skeletal injuries. These injuries may be occult to medical imaging and the autopsy itself, but the forensic anthropologist directly evaluates the skeletal tissue which can dramatically improve the sensitivity and specificity of the analysis. The training and methods of forensic anthropologists provide them with the unique perspective of comprehending the anatomical, biomechanical, and physiological properties of human pediatric bone which informs their interpretations of time since injury and mechanism of trauma. This perspective also permits the ability to differentiate between growth and development, skeletal anomalies/variants, and traumatized bone which can be of distinct consequence to the forensic pathologist's cause and manner of death determination. This review is intended for forensic anthropologists and others in the medicolegal community who are tasked with identifying and interpreting pediatric skeletal trauma. The research and scholarly work cited herein is the most current bibliography for comprehending the role and contribution(s) of the forensic anthropologist in the pediatric autopsy, the techniques and methods available to them, and the challenges and cautions associated with this delicate work.This article is categorized under: Forensic Anthropology &gt; Trauma Analysis Forensic Medicine &gt; Imaging Modalities Forensic Medicine &gt; Medicolegal Death Investigation Systems

Sex estimation in a contemporary Spanish population: cranial and dental anthropometry.

Sex estimation of skeletal remains is an essential step in the reconstruction of the biological profile of unknown individuals in medico-legal death investigations and archaeological contexts. However, the skeletons are often incomplete. When the pelvis is absent, the skull is widely considered to be the second-best indicator of sex. However, debate persists, and there is evidence that postcranial bones have more discriminatory power than the cranium. The present study was undertaken to determine the accuracy and reliability of a combination of skull and dental measurements for sex estimation in comparison with the cranial and dental methods separately, and to provide evidence as to whether the combination of these cranial measurements is more effective than postcranial bones alone for estimating sex when the pelvis is not available. The study sample comprised 70 individuals from the San José cemetery in Granada (Spain). Thirty cranial measurements and 44 dental measurements were examined using logistic regression analyses. These data showed that the combination of neurocranial and maxillary canine measurements provide the key dimensions as significant predictors of sex in this sample. For the pooled sexes, the overall correct sex allocation accuracies ranged from 76.0% to 92.3%. The present study shows that when using metric data, there is no evidence that the skull measures are better than those of the postcranial bones to estimate the sex. Only the combination of skull and maxillary canine measures provide similar sex discriminatory power to those of the postcranial skeleton.

An Illustrative Case of Suicidal Hanging Versus Accidental Hanging Associated With Autoerotic Activity

The majority of hanging deaths are relatively straightforward when opining the manner of death, typically determined to be suicide. However, there are rare hanging deaths that require the forensic pathologist to seek additional information. Forensic pathologists commonly consider an accidental manner of death when the hanging death scene includes evidence of solitary sexual activity consistent with autoerotic asphyxia. Here, the authors present a case of an initially apparent suicidal hanging where important death scene details photographed by the medical examiner investigator and history provided by family members during subsequent conversations ultimately helped the forensic pathologist conclude an opinion that the hanging was accidental, likely due to autoerotic activity. The decedent, who hanged himself in the closet of his bedroom, was wearing shorts that were initially believed to be inadvertently torn; however, further investigation revealed his shorts were intentionally modified to expose his genitalia. Additional evidence documented from the death scene photographs and conversations with his mother revealed items and activities consistent with autoerotic behavior. Before opining a manner of death in hanging deaths, forensic pathologists are encouraged to consider details beyond that obtained from the initial death scene investigation and postmortem examination. A thorough medicolegal death investigation should not be viewed as introducing cognitive bias, but rather as necessary information needed to determine the most accurate cause and manner of death.

Flualprazolam Blood Concentrations in 197 Forensic Investigation Cases.

Flualprazolam is a designer benzodiazepine and novel psychoactive substance that is increasing in prevalence and appearing in forensic investigations. Flualprazolam was quantitatively confirmed in 197 blood samples from medicolegal death investigations and human performance cases reported between August 2019 and February 2020. Drug screening was performed using liquid chromatography-time-of-flight mass spectrometry and quantitative confirmation was performed using liquid chromatography-tandem mass spectrometry. A three-point standard addition protocol was implemented for quantitation in the absence of an available traditionally validated assay. In postmortem cases with quantitative results (n=167), the mean (±standard deviation [SD]) flualprazolam concentration was 20 (±63) ng/mL, the median concentration was 8.2ng/mL and the range of concentrations was 2.0-620ng/mL. Four additional postmortem cases were reported positive (<2.0ng/mL). In drug impaired driving cases (n=22), the mean (±SD) flualprazolam concentration was 22 (±18) ng/mL, the median concentration was 14ng/mL and the range of concentrations was 4.4 to 68ng/mL. The four remaining cases were of unknown circumstances. This report details the most extensive dataset of flualprazolam intoxication cases reported to date. There was significant overlap in concentrations of flualprazolam between postmortem and DUID cases. Flualprazolam was commonly (83% of the time) found in combination with opioids (e.g. fentanyl). Toxicologists should consider quantitative flualprazolam results in the context of case history, observations, and/or other toxicological findings. Addition of flualprazolam to the scope of drug testing should be considered by all laboratories.

Telemedicine during Covid-19 pandemic: Advantage or critical issue?

Telemedicine offers a support to traditional medicine, delivering clinical services when distance is a critical factor. Although this tool does not replace a medical examination, during Covid-19 pandemic, it reduces the spread of infection and avoids the need for a patient's visit. It is useful in the management of chronic disorders or for patients undergoing palliative treatment. The University Hospital of Palermo has applied this in cases of chronic illness caring for patients who cannot stop their treatment, such as Department of Onco-Haematology, Internal Medicine, Dermatology, etc. The Department of Legal Medicine of Palermo, in particular, is also using telemedicine to manage medico-legal sudden natural death investigations and dealing with the Public Prosecutor's office of Palermo. Even after the Covid-19 emergency, telemedicine will be essential to streamline outpatient visits, while at the same time limiting costs, with significant benefits for the Italian National Public Health Service budget. In conclusion, telemedicine can offer a valuable support to the doctor's activity by streamlining and facilitating their work. In this sense, the Covid-19 pandemic represents a positive input for the acceleration and enhancement of these tools.

Proposal of the Autopsy Guideline for Infectious Diseases: Preparation for the Post-COVID-19 Era

With the rapidly spreading coronavirus disease 2019 (COVID-19) pandemic over the past few months, the world is facing an unprecedented crisis. Innumerable lives have been lost to this novel infectious disease, the nature of which supersedes conventional medical understanding. People around the world are sacrificing their daily lives and enduring the crisis regardless of national boundaries and cultural backgrounds. The COVID-19 pandemic is not just a global health crisis, several aspects of life in the post-COVID-19 era are also being contemplated. Experts in unison are warning that the upcoming changes in all areas of life could potentially be far more drastic than ever experienced in the entire human civilization. The medical community is no exception, and therefore, personnel involved in forensic medicine also need to be adequately prepared for the future. Forensic medicine is a branch of medicine dedicated to one of the most important stages of the human lifecycle and has always been at the forefront in times of unprecedented social change. We present new autopsy guidelines in forensic medicine, formulated based on the various infectious diseases that we presently live with and may encounter in the future. In formulation of these guidelines several considerations have been taken into account, namely, the role forensic pathologists should play in the post-COVID-19 era and the necessary preparations as well as the support needed from society to fulfill that role. The present COVID-19 outbreak should be a starting point for formulating improvements in current practices in forensic science, including autopsy biosafety practices and the medicolegal death investigation system. Key Words: Autopsy · Infectious disease · Guideline · COVID-19 · Forensic medicine

Fatal intentional drowning in Australia: A systematic literature review of rates and risk factors.

Unintentional drowning deaths are only part of the drowning profile, with little attention being paid to intentional drowning in Australia. Strategies for the prevention of intentional drowning deaths are likely to be different from unintentional. Quality documentation, analysis and dissemination of intentional deaths data is crucial for developing appropriate strategies for prevention. To conduct a systematic literature review to investigate the mortality rates and risk factors of intentional drowning deaths in Australia. A systematic search guided by PRISMA was performed using Ovid MEDLINE, CINAHL, PsycINFO (ProQuest), Scopus, Google Scholar, and BioMed Central databases to locate relevant original research articles published between 2007 and 2018. Ten papers reporting the mortality rates and risk factors of intentional drowning deaths in Australia published between 2007 and 2018, with study periods of the included articles spanning from 1907 to 2012, were reviewed. Most studies investigated suicidal drowning deaths in Australia, none reported homicidal drowning deaths. The downward trend of fatal suicide drowning was identified in Australia. The annual rate of intentional drowning between 1994 and 2012 can be inferred from eight studies, ranging from 0.06 to 0.21 for nation-wide mortality rates. The highest annual state-wide mortality rate was identified in the state of Queensland, ranging from 0.02 to 0.11 per 100,000 individuals. Of four studies examining the risk factors of fatal intentional drowning in Australia, being of older age groups, being female, and the presence of substance use were identified as important factors for suicidal drowning deaths. The national-scale proportion of suicide drowning in Australia, ranging from 2% to 3% of all intentional self-harm deaths, was also identified. Limited publications reporting the mortality rates and risk factors of intentional drowning deaths in Australia were identified. Being of older age groups and being female were recognised as factors for suicide drowning deaths, and psychoactive substances were widely identified amongst cases. Future research on improving death reporting systems and the legal framework for medico-legal death investigation, along with the investigation of the risk factors of intentional drowning, are required to inform the planning, implementation, and evaluation of prevention interventions for intentional drowning deaths in Australia.

CYP450-Mediated metabolism of suvorexant and investigation of metabolites in forensic case specimens

Suvorexant (Belsomra®) is a sedative hypnotic that was approved for use in 2015. It has a novel mechanism of action and was the first dual orexin receptor antagonist (DORA) to be approved for the treatment of sleep disorders. Sedative hypnotics often feature prominently in forensic investigations such as impaired driving and drug-facilitated sexual assault (DFSA) cases. As such, suvorexant is a drug of interest and its identification in forensic toxicology investigations is of significance. However, limited studies have been published to date and the disposition or importance of its metabolites has been largely uninvestigated. In this report, we investigate the enzymes responsible for metabolism and explore the prevalence of metabolites in blood from a series of thirteen forensic investigations. Recombinant cytochrome P450 enzymes (rCYPs) were used to generate phase I metabolites for suvorexant in vitro, and metabolites were identified using liquid chromatography-quadrupole/time-of-flight-mass spectrometry (LC-Q/TOF-MS). Four rCYP isoenzymes (3A4, 2C19, 2D6, and 2C9) were found to contribute to suvorexant metabolism. The only metabolite identified in blood or plasma arose from hydroxylation of the benzyl triazole moiety (M9). This metabolite was identified in seventeen blood and plasma specimens from twelve medicolegal death investigations and one impaired driving investigation. In the absence of a commercially available reference material, the metabolite was confirmed using rCYP-generated in vitro controls using high resolution mass spectrometry.

An introduction to postmortem interval estimation in medicolegal death investigations

AbstractThroughout the history of forensic medicine, the postmortem interval has been one of the most commonly and thoroughly investigated problems. The importance of an accurate PMI in the context of a medicolegal death investigation cannot be understated due to its utility and application toward investigative determinations including inclusion or exclusion of suspects, determination of time of assault versus time of death, and preliminary victim identification. However, despite its importance, the question of postmortem interval estimation is often answered with a low degree of accuracy as compared to the rates of certainty within other forensic disciplines. While there are various methods that may be utilized for answering the time of death question including both scientific and investigative techniques, the variables that affect the application of these methods to death investigations are abundant. As a result, there are numerous limitations associated with time of death determination in a medicolegal death investigation and the estimation of the postmortem interval must be done with caution and deference to the many variables that affect its accuracy.This article is categorized under: Forensic Anthropology &gt; Time Since Death Estimation Forensic Medicine &gt; Death Scene Investigation Crime Scene Investigation &gt; Education and Formation

Postmortem Computed Tomography: An Overview for Forensic Nurses Involved in Death Investigation.

The traditional invasive autopsy has been considered the "gold standard" for death investigation worldwide. However, this has now been challenged by a new minimally invasive approach that utilizes cross-sectional radiological imaging to investigate the death. Globally, postmortem computed tomography is the most commonly used modality and is becoming increasingly available throughout the world. Forensic nurses working in association with coroners and medical examiners' offices, as well as mass fatality incidents, now need to update their knowledge base to understand these innovative techniques, the advantages and disadvantages to their use, and how they impact on medicolegal death investigation and the care of the deceased and bereaved. Using the example of the coroner system of England and Wales, this article provides a comparison between the traditional invasive autopsy and postmortem radiological alternatives and presents the impact postmortem radiology is now having on death investigation.

Origins of the Armed Forces Medical Examiner System.

The Armed Forces Medical Examiner System (AFMES) is the only medicolegal death investigation system of the US federal government. Its origins can be traced to three dried tissue specimens placed on a shelf by a Civil War Surgeon General in 1862. The collections and the library of the Army Surgeon General spawned the Armed Forces Institute of Pathology (AFIP), the National Museum of Health and Medicine, the Walter Reed Army Institute of Research, and the National Library of Medicine. Pathologists of the Army Medical Museum performed the autopsies of assassinated Presidents Lincoln and Garfield and assisted with that of Kennedy. The now defunct AFIP created the first forensic pathology training program approved by the American Board of Pathology and then the AFMES. Col Ed Johnston, CAPT Charlie Stahl, and Col Dick Froede were the original pioneers of the AFMES.

Isotonitazene Quantitation and Metabolite Discovery in Authentic Forensic Casework.

The synthetic opioid landscape continues to change as non-fentanyl-related substances appear in forensic toxicology casework. Among the newest synthetic opioids to emerge is isotonitazene, an analogue of a benzimidazole class of analgesic compounds. Isotonitazene is an active and potent synthetic opioid, but the extent to which this compound is causing toxicity among drug users was previously unknown. This report describes the confirmation and quantitation of isotonitazene in blood, urine and vitreous fluid through standard addition, as well as in vivo metabolic profile determination in drug users. Quantitative analysis was performed using liquid chromatography tandem mass spectrometry (LC-MS/MS), and metabolite discovery was performed using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS). In total, 18 cases were confirmed positive for isotonitazene, nine of which were previously negative for any opioid. The average isotonitazene concentration in blood was 2.2±2.1ng/mL (median 1.75ng/mL, range 0.4-9.5ng/mL), and the average isotonitazene concentration in urine was 2.4±1.4ng/mL (median 2.7ng/mL, range 0.6-4.0ng/mL). The lowest concentration of isotonitazene in blood was 0.4ng/mL (two cases) with no other opioids present; findings in death investigations. Four metabolites of isotonitazene were detected in vivo. N- and O-dealkylation products were determined to be the most prominent urinary biomarkers, while 5-amino-isotonitazene was identified in most blood samples. The prevalence and popularity of isotonitazene continue to increase in the United States in early 2020. Toxicologists, medical examiners and coroners should be aware of novel opioids outside the standard scope of testing, especially in medicolegal death investigations. Forensic scientists should add isotonitazene to testing procedures, and public health officials should counsel about potent new drugs and the dangers of opioid use.

Forensic entomology for the investigator

AbstractForensic entomology is a discipline deeply rooted in history that is still evolving with regards to its utility in both the modern scientific community and medicolegal death investigations. While there are many applications of forensic entomology with the forensic sciences, the most common application is that of the estimation of time since death, also often known as a minimum postmortem interval, which in some instances can be equal to the time of colonization. This time estimation is based on the period of insect activity on a body, and the age of the insects collected from the remains can aid in determining a portion of the postmortem interval. For this estimation, temperature is a key element of entomological evidence collection, along with the insects themselves. Proper documentation of the scene conditions in which the body is discovered is essential for use in an entomological postmortem interval estimation. Likewise, proper documentation and collection of the insects from the body and the death scene—including a representative sample of all areas of colonization and species present—better allows the entomologist to provide a more accurate and useful estimation of time since death.This article is categorized under:Forensic Biology &gt; Interpretation of Biological EvidenceForensic Anthropology &gt; Time Since Death EstimationForensic Science in Action/Crime Scene Investigation &gt; Crime Scene Examination

A Census of Medicolegal Death Investigation in the United States: A Need to Determine the State of our Nation's Toxicology Laboratories and Their Preparedness for the Current Drug Overdose Epidemic.

In 2007, the Bureau of Justice Statistics reported on 2004 data collected from the Census of Medical Examiner and Coroner Offices (CMEC). The CMEC was one of the first comprehensive reports on the state of the medicolegal death investigation system in the United States and included information on administration, expenditure, workload, specialized death investigations, records and evidence retention, and resources. However, the report did not include responses on questions that were related to toxicology such as specimen retention and type of testing. The purpose of this publication is to provide the community with toxicology laboratory‐specific responses from nearly 2000 medical examiner and coroner (MEC) offices. Data obtained from a BJS CMEC public use dataset for any remaining information that was not reported in the 2007 BJS report were evaluated specific to the operation of toxicology laboratories within a MEC office or specific to toxicology testing. The CMEC includes information on average operating budget for MEC offices with internal or external toxicology services, budget for toxicology/microbiology services, respondents’ routine uses of toxicology analysis, toxicology specimen retention time, average turnaround times, use of computerized information management systems, and participation in federal data collections. These historical data begin to address the present state of our nation’s toxicology laboratories within the medicolegal death investigation system and their preparedness for the current drug overdose epidemic.

Evaluating the Potential for Unintentional Occupational Exposure to Fentanyl and Fentanyl Analogues Among Medicolegal Death Investigators and Autopsy Technicians.

Recent increases in deaths in the United States from synthetic opioids such as fentanyl and fentanyl analogues (fentanyls) have raised concerns about possible occupational exposures to these potent agents. Medicolegal death investigators and autopsy suite staff might perform job tasks involving exposure to fentanyls. The potential for exposure to fentanyls among medicolegal death investigators and autopsy technicians at a state medical examiner's office was evaluated through review of caseload characteristics, injury and illness logs, and procedures and policies and discussions with management and employee representatives. The evaluation showed that this medical examiner's office had low potential for work-related exposure to fentanyls; its standard operating procedures and personal protective equipment requirements should reduce the potential for occupational exposure. Medicolegal death investigation agencies can develop and implement guidance to control exposures and provide workforce education and training to reduce the potential for work-related exposure to fentanyls.

Importance and Approach to Manner of Death Opinions in Opioid‐Related Deaths

The majority of opioid-related deaths are accidental. However, the number of opioid-related suicidal deaths is likely under recognized. Presented here is a case of suicide by heroin overdose. The manner of death would have likely been deemed accidental if not for critical information shared by the decedent's family during follow-up telephone interviews between the forensic pathologist and the decedent's family, which included text messages that were sent by the decedent just before his death that were not known at the time of the initial medicolegal death scene investigation. This case highlights that when a forensic pathologist establishes an engaged relationship with the decedent's family, the information elucidated can prove to be invaluable in reaching an informed opinion about the manner of death. For overdose cases, identifying an accurate manner of death allows the design of public health efforts that adequately address the health risks in the community. For aid in the determination of the manner of death for overdose cases, we propose a five-step checklist that may assist forensic pathologists and medicolegal death investigators when approaching similar cases.

Evaluation of pedestrian–train fatalities in the State of Maryland: A 5-year retrospective study

Few studies have been done on the incidences of train-related pedestrian fatalities throughout the United States, with no previous studies reported in the State of Maryland. A retrospective study was conducted at the statewide medical examiner's office in Maryland to evaluate the characteristics of train-related pedestrian fatalities from 2014 to 2018. The aim of the study was to analyze circumstances of deaths through the medicolegal death investigation and postmortem examination findings, including toxicological study, to help identify epidemiological characteristics of pedestrian–train-related fatalities. A total of 48 pedestrian-train deaths were identified. Of the 48 cases identified, 21 deaths (43.75%) were determined to be accident, 20 deaths (41.67%) were suicide, and 7 deaths (14.58%) whose manner of death could not be determined. Of the 21 accidental victims, 17 were male and 4 were female (M:F ratio = 4.3:1), 11 (52.38%) were white, 6 (28.57%) African American, and 4 Hispanic (19.05%), with age ranging from 16 to 58 years (mean age = 35). Of the 20 suicide victims, 17 were males and 3 females (M:F ratio = 5.7:1), 16 (80%) were white, 2 (10%) African American, and 2 (10%) Hispanic, with age ranging from 22 to 60 years (mean age = 40). The majority of accidents occurred during weekday evening rush hours between 4:00 pm and 7:00 pm, while the suicides showed no specific time frames. No specific peak for seasons of year was found in suicides or accidents. Postmortem toxicological studies showed that 52.38% (11/21 cases) of accidental victims were positive for alcohol and 30% (6/20 cases) of suicide victims were positive for alcohol. Manner of death could not be determined in 7 cases because of unclear circumstances of death. Thorough death scene investigation and complete postmortem examination, including comprehensive toxicological testing, is very important in all train-related pedestrian fatalities. Determining the manner of death can directly affect the outcome of civil ligation and dispersal of insurance benefits. The characteristic profiles of train-related pedestrian fatalities can also assist effective preventive measures on railway suicides and accidents.

Proposal of the Autopsy Guideline for Infectious Diseases: Preparation for the Post-COVID-19 Era (abridged translation).

With the rapidly spreading coronavirus disease 2019 (COVID-19) pandemic over the past few months, the world is facing an unprecedented crisis. Innumerable lives have been lost to this novel infectious disease, the nature of which supersedes conventional medical understanding. The COVID-19 pandemic is not just a global health crisis, several aspects of life in the post-COVID-19 era are also being contemplated. Experts in unison are warning that the upcoming changes in all areas of life could potentially be far more drastic than ever experienced in the entire human civilization. The medical community is no exception, and therefore, personnel involved in forensic medicine also need to be adequately prepared for the future. Forensic medicine is a branch of medicine dedicated to one of the most important stages of the human lifecycle and has always been at the forefront in times of unprecedented social change. The autopsy, one of the most important tools of forensic medicine, is also useful to infectious diseases because it identifies the causal relationship between death and infection, reveals medical and epidemiological knowledge, and provides objective evidence for legal disputes. We present new autopsy guidelines in forensic medicine, formulated based on the various infectious diseases that we presently live with and may encounter in the future. In formulation of these guidelines several considerations have been taken into account, namely, the role forensic pathologists should play in the post-COVID-19 era and the necessary preparations as well as the support needed from society to fulfill that role. The present COVID-19 outbreak should be a starting point for formulating improvements in current practices in forensic science, including autopsy biosafety practices and the medicolegal death investigation system.