National Association Of Medical Examiners Research Articles

Using counselors in a multideath disaster.

In the worst possible situation, a disaster results in multiple deaths, requiring the involvement of coroner's and medical examiner's offices. Guidelines offered by the National Association of Medical Examiners and by a national funeral directors' association suggest the use of ministers and chaplains to offer "pastoral" care to family members who have lost a loved one in a disaster. This article offers an example of a disaster protocol based upon national guidelines, but using certified and licensed professional counselors to provide preventive outreach counseling to those family members. Furthermore, this protocol uses a counselor in a key position to provide psychological care to investigative and medical personnel involved in the recovery and identification portions of a disaster.

Medical Examiners, Coroners, and Organ Recovery in the United States

To the Editor. —The article by Ms Shafer and colleagues 1 emphasizes the impact of the medical examiner's denial for organ recovery but says little of the nearly 90% consent rate for recovery in medical examiner cases. The article strongly suggests the use of compelling legislation to achieve a 100% consent rate from medical examiners. The authors discuss the lack of formal accountability for the consequences of cases not released by medical examiners. Legislation requiring 100% compliance and methods of formal accountability do not govern any other agency within the organ and tissue transplantation community. The commitment of the physicians of the National Association of Medical Examiners is clearly stated in their brochure, Policy and Guidelines on Human Organ and Tissue Procurement. These concepts were made available to the transplant community in 1988. They served to assist all medical examiners in developing standards of excellence in working with local OPOs.

Survey of Medical Examiner Office Computerization

Following a suggestion that the National Association of Medical Examiners (N.A.M.E.) develop a N.A.M.E. Information Center (NIC), N.A.M.E. conducted a survey to evaluate the current status of medical examiner office automation (computerization) in the United States. Responses were received from 80 unique reporting areas, including 75 medical examiner offices, which represent approximately 30% of the 258 medical examiner jurisdictions in the country. A total of 58 responders (65%) indicated that their office was automated. At least 38 states have one or more automated death investigation office, and electronic data exist for approximately 145,000 deaths per year, or approximately 30% of all deaths certified by medical examiners and coroners annually and approximately 6% of all deaths per year in the United States. Although computerized offices vary substantially in size and in their choice of hardware and software, a typical computerized medical examiner office (a) is in a single county with 1,000-6,000 death reports per year, (b) keeps electronic records on all cases reported, (c) uses an IBM or compatible personal computer (PC) or PC network with off-the-shelf software, (d) stores data on cause of death, manner of death, how injuries occur, and toxicology results, and (e) is interested in sharing its data. Considerable electronic death investigation data exist that can provide timely and valuable information for mortality and public health studies.

Standard Language in Death Investigation Laws

Death investigation statutes and practices vary among the 50 states. We reviewed the Model Postmortem Examinations Act, recommendations of the National Association of Medical Examiners, the College of American Pathologists' "criteria for autopsies," and the death investigation statutes and practices in each state. By consolidating the terminology from these various information sources, we developed a list of death categories for which investigation by medical examiners or coroners in the United States is either mandated, commonly performed, or recommended. The list contains specific categories of death, which fall under these three more general areas: 1) unexpected and unexplained deaths, 2) deaths from intentional and unintentional external causes, and 3) deaths that fall under specialized categories related to the decedent's age, environment, or medical conditions, or to the method of bodily disposition. To promote greater uniformity in the death investigation practices among states, we recommend that the Model Postmortem Examinations Act be modified to explicitly recommend certain types of deaths for investigation and that states modify their death investigation statues to conform to such provisions. Presently, in states where death investigation statutes lack specificity in detailing the types of deaths that should be reported for possible medico-legal investigation, our recommendations, if not in conflict with local statutes, might be used as practice guidelines for the reporting and investigation of certain types of deaths.

Can Forensic Medicine and Organ Donation Coexist for the Public Good?

IS GIVING 100% too much to ask? Medical examiners in some parts of the country say it may be, particularly if organ procurement organizations are doing the asking. Relationships between medical examiners and procurement agencies have been laced with tension for years. But the stress may be mounting. Some specialists in forensic medicine say procurement agency approaches have become increasingly aggressive. In a handful of states, they add, laws allow organ harvesting to supersede death investigations, potentially jeopardizing evidence in criminal cases. "Some [procurement organizations] are almost zealous," says Thomas Hegert, MD, the organ and tissue committee chair of the National Association of Medical Examiners (NAME). "They want us to give 100% of those cases for which we have received consent for organ procurement." Procurement agencies dispute that characterization. "There is a lot of misunderstanding," says Teresa Shafer, RN, president of the North American Transplant Coordinators Organization (NATCO). "We're looking

National Association of Medical Examiners Pediatric Toxicology Registry. Report 2: Phenylpropanolamine update.

The National Association of Medical Examiners (N.A.M.E.) has an ongoing project referred to as the Pediatric Toxicology (PedTox) Registry, which contains data for drugs and poisons detected in children. A recent PedTox Registry report on phenylpropanolamine (PPA) reported blood PPA concentrations in 12 dead children whose deaths were not attributed to PPA. Since that report, another article has been published describing plasma PPA concentrations in living children who were given PPA to evaluate its effect on incontinence. The 10 children in the incontinence study were older than most of the 12 deceased children whose PPA concentrations were reported in the PedTox Registry (10 of whom < or = 5 years of age). The plasma PPA levels observed in the incontinent children fell within the range of blood PPA concentrations reported in the PedTox Registry. Plasma PPA levels of up to 642 ng/ml (0.642 mg/L) were well tolerated in children > or = 6 years of age. Insufficient data exist to determine how similar blood PPA concentrations are tolerated by children < 6 years of age, although some data indicate that such levels may be well tolerated in the younger age group as well.

Forensic pathology then and now. Retrospect and reflections.

The past half-century has witnessed significant progress and multiple, meaningful changes in the day-to-day practice of forensic pathology as it has in all other branches of laboratory and clinical medicine. Associated with the welcome advancing "scientific" aspects of our work have been gratifying changes in the professional status of our much misunderstood area of medical activity, the latter most vividly and convincingly represented by American Board of Pathology certification in Forensic Pathology and the appearance of such growing, vital, national professional organizations as the American Academy of Forensic Sciences and our National Association of Medical Examiners and the creation of such highly respected periodicals as the Journal of Forensic Sciences and our American Journal of Forensic Medicine and Pathology. Objective assessment of the foregoing accomplishments leads to the inescapable conclusion that forensic pathology has emerged from its previous role as the "invisible profession" and become a respected and productive branch of laboratory medicine.

National Association of Medical Examiners 1989 Annual Meeting

National Association of Medical Examiners 1989 Annual Meeting

Human Rights Resolution Passed by the National Association of Medical Examiners, September 1987

Human Rights Resolution Passed by the National Association of Medical Examiners, September 1987

Pediatric Toxicology Registry

Drs. Hanzlick, Frost, and Bennett are members of the Pediatric Toxicology Committee established by the National Association of Medical Examiners.

Medicolegal system in Greece

At the Annual Meeting of the National Association of Medical Examiners in Chicago, Illinois, in November 1981, Dr. W. Sturner, Chief Medical Examiner of the State of Rhode Island, gave his perspectives as far as clinical forensic medicine and pathology are concerned. This topic, therefore, brought to mind the idea of writing an analysis of the medicolegal system in Greece. This article attempts to show the advantages, problems, and the perspectives of an old-style medicolegal investigation system, existing in Greece since 1910. The clinical aspects of forensic medicine and pathology is exemplified by the presentation of the preliminary results of the study of injuries in traffic accident victims, 1,600 cases examined by the author with the support of other colleagues in Athens, Greece.

National Association of Medical Examiners

National Association of Medical Examiners