CORD-19:6e21cbeef3691e8702f7da5d59564a69bc597a5a JSONTXT 9 Projects

Abstract Appropriate precautions are critical to minimize damage to the body during recovery and removal from a scene and transit to the mortuary to allow for accurate interpretation of injury and the minimization of contamination. Many elements of the investigation may be affected by the way in which tasks are conducted. Members of numerous jurisdictions must all work together to ensure the best outcome both from a forensic point of view and also in preserving and respecting the dignity of the deceased. This chapter will outline the techniques necessary for preserving the body and associated evidence during transport, including specific considerations for different types of cases. The manner in which a body is retrieved from the scene of death and handled during transport to the mortuary can alter the appearance of the deceased person. This may thereby influence the subsequent evaluation of evidence or interpretation of injuries by the forensic pathologist. It is vital that the police members, the pathologist, and the body transporters work together to ensure the deceased are handled appropriately to ensure this effect is minimized. Any clothing, property, or evidence noted on the body at the scene should remain in its original position, for example, a ligature in a case of hanging. The position and integrity of all extracorporeal material should be protected while in transit to the mortuary. Furthermore, any interference with the deceased, including precautions taken to prevent evidence being destroyed, should be documented. All staff involved in recovering and transporting bodies need to be aware of procedures used to maintain the continuity of the property and evidence. All persons present must wear appropriate personal protective equipment and be trained in procedures to minimize both infectious and cross-contamination risks. It is essential that all staff are familiar with crime-scene procedures and appropriate chain of command and are well versed with protocols for dealing with media and public attention. Staff should be alert and observant and at all times prepared to maintain the necessary evidentiary chain and to minimize interference with the integrity of the deceased. Above all, staff dealing with deceased persons should at all times treat the deceased with dignity. The way in which a body is preserved prior to its removal from the scene of death will depend significantly on the circumstances of the death. In some cases crucial forensic evidence may be lost if precautions to guard against this are not taken. In many cases protecting the clothing, body, and hands of the deceased will assist with the preservation of this evidence. There are numerous means to do this. The hands may be covered with paper bags and secured around the wrists with tape, ensuring the presence of injury or evidence is not obscured nor altered. In some cases, additional measures may need to be taken to assist with the preservation of evidence. These include protecting the body parts themselves from being damaged. In cases where significant incineration or decomposition has occurred, parts of the body may be wrapped individually to prevent them from becoming detached. Any precautions such as these must always be clearly noted, performed in the presence of the pathologist or homicide detective, and commenced only after the police, pathologist, and crime-scene examiners have completed their examination. In every case, prior to the deceased being removed from the scene the following procedures should be implemented to maintain the integrity and chain of custody of the deceased: • The body is allocated a unique identifying number and labeled securely. • The body is wrapped in clean plastic or linen sheeting and placed in a body bag. Where indicated, the body and scene are photographed and examined for trace evidence. Where appropriate, the body is searched, and clothing and property are documented and removed. There are a number of different techniques employed in moving a body; however, in the majority of cases a standard procedure can be applied. After being identified and labeled, the deceased may simply be carefully lifted and placed on to a bed sheet, length of plastic, or body bag, and wrapped for transport. With particularly heavy bodies, decomposed, or fragile remains, rather than lifting, it is recommended to roll the deceased one way, placing the body bag beneath, and then roll the body the other way, pulling the body bag across underneath the body (Eitzen and Byard, 2013) . It is important for the body not to be dragged or forcibly lifted, as this may cause damage. Being mindful of the risk of physical injury, standard lifting techniques should be used, in accordance with jurisdictional work-safe practices. All equipments used should be of good quality, easily obtainable, and in adequate supply: 1. Plastic zip-lock bagsto seal and transfer property, clothing, or evidence not attached to the deceased. 2. Labelsto label property and evidence bags. They should be appropriate for use with permanent marker, waterproof, and freezer grade, suitable for long-term storage. 3. Glovesmultiple sizes and types, thin disposable gloves for ease of use, heavier duty for infectious cases, or cut resistant gloves for bodies with sharp edges such as incinerated remains, and specialized gloves for use with chemically hazardous cases. 4. Body tagsit is of utmost importance that body tags are appropriately selected based on case type. They must be strong, waterproof, and easy to label. They must be attachable to the deceased in such a way that will not interfere with the integrity of the deceased or alter the appearance of injuries or clothing. To minimize confusion it is wise to label the deceased twice, that is, one tag securely attached to the person, for example, wrist or ankle, and another tag on the outer bag area. 5. Stretcher or plastic skedto enable lifting and transfer of heavy or awkward bodies. These tools are also used in the exhumation of buried remains or the lifting of fragile skeletal cases to prevent the body from disintegrating. 6. Body bagsall bags should exhibit the following characteristics: a. constructed of tough waterproof material, b. have strong zips with covers to prevent leakage, c. be generous in size to allow for bodies in rigor mortis, or showing extensive decomposition, and d. have at least four (ideally six) sturdy handles. 7. Additional equipment may include plastic and linen sheeting and towels; various types of indelible markers; heavy-duty tape for sealing and securing bags; cotton wool and superglue; disinfectant spray and cleaning equipment; plastic aprons and safety equipment such as respirators, face masks, and protective eyewear; and a change of clothes and protective footwear. It is vital that all property and clothing are handled according to strict protocols. While systems for handling such material will vary between jurisdictions, it is good practice (for routine cases) that all clothing and property not integral to the investigation is left at the home of the deceased. In such instances, once the police and forensic pathologist are satisfied the case is routine in nature, the clothing and property are removed and clearly recorded. In the description of such items, generic terms should be used at all times; for example, a gold ring with rubies should be described as a gold-colored ring with redcolored stones. It is recommended that the removal of clothing and property be done in the presence of two independent parties such as a police officer and the body transporter. Both parties will then sign the accompanying documentation in order to maintain a clear chain of custody of the items. On occasion it is inappropriate to remove the clothing and property at the scene, for example, when the death occurs somewhere other than at the person's home, or for cases that are nonroutine in nature. In this instance any clothing, property, and extracorporeal material will be removed on arrival at the mortuary or after examination by the pathologist. Again an independent person should witness the forensic technician removing the clothing and property and sign the appropriate property documentation. It should always be assumed that the family would like the clothing and property returned, regardless of the state. When this occurs, whether it is via the funeral director or the family directly, custody details should be recorded on the property sheet and cosigned by the two parties. The preservation of evidence during victim recovery is of utmost importance for suspicious deaths. The body should only be touched or moved in consultation with the police, forensic scientists, and the forensic pathologist (Geberth, 1996) . Prior to removal, the body should be carefully placed on a sheet of plastic and then into a body bag, which is sealed in the presence of investigating police members. The reasons for this process are twofold: 1. to ensure no fibers or trace evidence are lost; and 2. to maintain an appropriate chain of custody of the deceased, all clothing and property, and any evidentiary material present. In the majority of these cases, it is important that the deceased person remains absolutely undisturbed before examination by the forensic pathologist. This ensures accurate interpretation of evident disturbances to the deceased, his/her clothing, and property. For example, in cases of sexual assault the disarray of clothing may provide the pathologist with an indication of such an assault, and might highlight the possibility of injury. In addition, the clothing folds may contain evidence such as semen, hairs, or fibers that would otherwise be disturbed in removing the clothing or transporting the body. Alternatively, folds or patterns in clothing where it is bunched about the deceased may be causative of certain injuries, the interpretation of which is best performed in conjunction with viewing the clothing in situ. However, in certain circumstances it may be advantageous to remove clothing or evidence at the scene, for example, to preserve blood-spatter evidence. This should only occur at the direction of the investigating police members and after specific consultation with the forensic pathologist. All personnel involved with a suspicious death should be trained in dealing with continuity of evidence and associated procedures. In such cases, a police officer should accompany the deceased to the mortuary and oversee the transfer of the body. The training of staff in these procedures, and specific advice regarding requirements given to hospital staff, ensures there is consistency between cases. In some cases, funeral directors and hospital staff may have 'prepared' the body before its removal from the ward to the mortuary. This preparation includes the body being laid in the anatomical position with the hands and feet tied and cotton wool being placed in all body orifices. These procedures should not occur in forensic cases as they may produce postmortem artefact or injury, which is sometimes difficult to interpret at a later stage. Occasionally, a case which initially seems straightforward and will evolve under further investigation to be more complex and as such may require more detailed forensic examination. Hence these procedures are important in every case. All treatment and resuscitation equipments such as intravenous lines, cardiac resuscitation pads, or wound dressings must be left in situ to be assessed as part of the autopsy examination (Burton and Rutty, 2010) . The peripheral parts of severely incinerated bodies, particularly small bones and teeth of the deceased, may be fragile, and at risk of being damaged or lost. Care should be taken both in preparing for and during transport. When stabilizing stretchers and bodies in bags or in vehicles, care must be taken not to crush the fragile tissue. Elastic ties or 'seatbelts' may be used in place of more rigid-type stabilizers. In any case where the deceased is unrecognizable visually, establishing identity will be an important part of the investigation, and the incineration of bodies makes the identification very difficult. A commonly used method is for a forensic odontologist to compare the antemortem dental records with the teeth of the deceased person. The teeth and bones are often very brittle and fragile and often teeth may be broken or lost during transportation to the mortuary. To prevent this, the head may be photographed in situ and then wrapped in cotton wool or bubble wrap, and supported by a plastic bag or container which is secured around the neck of the deceased. Thus if the teeth are dislodged they remain contained within the bag. It is important that any body part found at the scene and not attached to the deceased is not assumed to belong to the deceased, and as such is bagged separately from the body and clearly labeled both in regards to its physical description and the specific location in which it was found, for example, 'tooth found in the vicinity of body X.' After the body is moved, the ash and debris on the floor or ground in the immediate vicinity should be carefully searched and sifted to screen for teeth, small bones, or other matter important to the case. This sifting is most appropriately done at the mortuary where lighting is optimal and suitable equipment readily available. The debris should be bagged and labeled according to the section of body immediately above it, and should be transferred to the mortuary with the deceased. It is recommended that the odontologist assists at the scene investigation to ensure the integrity and safety of the deceased person (Bassed, 2003) . In many cases of suspected suicide, items contributing to the death are found on or near the body. In some cases this evidence may be the only indication of what may have occurred. It is thus important that anything attached to the body remains as such and its position preserved as best as possible. This is to ensure the items can be examined with specific relation to their position on the deceased, in connection to additional devices, and any injury it/they may have caused. In rare cases this technique can help rule out the involvement of any other person in the death. In addition, as mentioned previously, if the evidence is removed before the pathologist's examination the mode of death may be unclear. On occasion the item may have been removed on discovery of the deceased to assist with resuscitation. In this instance, care should be taken to ensure the items are bagged individually and clearly labeled for transportation. For example, in a case of hanging, the ligature should remain intact and in situ. Where the deceased is suspended, the rope should be cut away from the suspension point, leaving the knots/attachments intact. If the ligature has been removed from the neck to facilitate resuscitation, the section of the ligature originally in contact with the deceased should be reconstructed, the ends tied together with string, then bagged, labeled, and transported with the body. Where there is evidence that has legal requirements for transport, such as firearms, drugs, or volatile substances, the chain of custody of these items should be documented clearly and completely. The police or ballistics expert experienced in safe handling procedures usually transports or may offer advice in the handling of firearms and other dangerous weapons. Case study 1: Police attended the premises of a residential unit and observed an 82-year-old female deceased in her bed. Her family had discovered she had passed away and phoned emergency services. Resuscitation was not attempted. On further investigation, it was discovered the female had no relevant medical history and death was not expected. She had been treated for depression following the death of her husband some 5 years previously. On learning of the necessity for autopsy, the next of kin informed police members that the deceased had initially been found with a plastic bag covering her head. This had been removed and concealed prior to their attendance. When a gun is fired, gunshot residues (GSR) are ejected from the weapon onto the hands and clothing of the person firing the weapon and, to a lesser degree, any persons in the immediate vicinity. Assessment of the presence and distribution of GSR on the individuals present at the scene of death can assist police with the inclusion or exclusion of suspects and assist them in determining the appropriate position of other people present at the time of the event. Ideally, this assessment should be performed as soon as possible after the incident and before the transport of the deceased (Dodd and Byrne, 2006) . In some instances this is neither practical nor timely, and it is recommended this procedure be done after the deceased is transported to the mortuary. In this situation any GSR on the deceased person must be preserved during transit. To do this, the deceased is transported in a sealed body bag, and the clothing of the deceased should remain undisturbed. In addition, paper bags are placed securely over the hands. It is essential that paper bags be used rather than plastic as the hands may sweat if contained in plastic, which can alter the presence of the GSR. MSCT scanning has proven useful in early identification of the location and number of projectiles or foreign bodies in particular where cases are visually unrecognizable due to trauma (Drummer and Cordner, 2011) . The body transporters must be aware of this as a projectile may be on the surface of the skin or in the clothing and as such there is a risk of disturbance when the body is initially moved. After the deceased is transferred on to a stretcher and removed from the scene, the immediate vicinity of the deceased is searched carefully for projectiles or spent cartridges. Case study 2: A deceased man argued with his wife for many years. He had a well-documented social history of violent, abusive behavior, and a familiarity with guns. He locked himself in a spare bedroom when his wife stormed out after a particularly heated argument. She returned home some hours later to find him deceased on the bed with a gunshot wound to the head. The body was described and photographed. Two weapons were found in the immediate vicinity of the deceased and he had many additional weapons within the household. The case was reported to the coroner as suspected suicidal gunshot wound to the head. On admission to the Forensic Institute, four gunshot wounds were noted. The case was X-rayed and found to contain no projectiles. The projectiles were later found, one having entered the neck, exited through the top of the head, and embedded in the ceiling. The other dislodged in transit and was found amongst the clothing of the deceased. On the basis of this information, the location and track of the two wounds, and the results of samples taken from the hands of the deceased for analysis of GSR, the pathologist was satisfied that this was a rare case of gunshot suicide involving two weapons fired simultaneously. A number of precautions were taken at the scene prior to transport of the deceased, which may have impacted on the outcome of the case. These included: • wrapping the head of the deceased in cotton wool to preserve the presence and situation of projectiles; • securing the hands of the deceased in paper bags to promote sampling for GSR; • photographing the deceased in situ with the two weapons in the immediate vicinity; and • demonstrating the patterns of blood spatter on the wall behind the deceased and a defect in the ceiling from one of the projectiles. Dealing with a decomposed body involves a number of associated risks. Flies and maggots are often present, as are spiders, beetles, and other insects. The decomposing body presents a difficult situation, in terms of body removal, which may be dealt with in a number of ways. The body may be very bloated or fragile, and sometimes beginning to break apart. Moving a severely decomposed body can complicate this process further and if care is not taken, may result in the removal of skin or the detachment of limbs. To overcome this, rather than lifting the body on to plastic, it should be carefully rolled on to its side, and the plastic tucked underneath the deceased. The body can then be lifted using the plastic to hold the remains intact and gently placed into a body bag. Care should be taken to avoid being bitten or stung; however, fly spray or deodorizer should not be used on the body as it may interfere with toxicological and/or microbiological testing. Fluid-filled blisters, called buboes, may rupture and splash body transporters, and appropriate safety attire should be worn. It is recommended that a multidisciplinary approach to the scene investigation of the decomposed case is taken, utilizing the experience, where necessary, of both entomologists and anthropologists (Archer et al., 2005) . The process of recovering skeletal remains is slow and meticulous as the soil and vegetation deposited after the death are removed layer by layer without disturbing the skeleton. The bones are packed in paper bags either grouped or separately depending on the case. It is recommended that the skull is wrapped in cotton wool and supported by a box or container, similar to the procedure used when recovering incinerated remains. In some circumstances where some tissue is still attached to the bones, and the deceased is not completely skeletonized it may be more beneficial to slide a large board underneath the deceased and lift the remains with the board, keeping it intact for transportation. As with incinerated bodies, the soil around the deceased should be bagged, labeled, and sifted later to search for teeth, small bones, and other evidence. The advice of the forensic anthropologist in scene recovery is critical to the retrieval of all small remains and the exclusion of nonhuman skeletal elements (Archer et al., 2005; Bassed 2003 ). The recovery of diving fatalities presents one of the more difficult situations in body removal. The equipment may provide vital information as to the cause of death or the circumstances immediately before death and thus it must all remain intact and accompany the deceased. This procedure presents a bulky and awkward body transfer. Ideally an expert should be present at the scene to examine the equipment, ensuring all valves are turned off, and settings are secure so as not to be accidentally altered during transit. In diving fatalities, radiography (X-ray or CT) for air embolism should be performed as soon as possible. In light of this, it is crucial that the body be transported as quickly as possible to the mortuary (Edmonds and Caruso, 2014) . Universal precautions to minimize the spread of infectious disease should be employed with each body removal regardless of its infectious state, and all bodies treated as potentially infectious; personal protective equipment should always be worn. However, certain cases are deemed high risk purely due to their nature. These high-risk cases include intravenous drug users, prostitutes, homosexuals, or persons recently imprisoned. If this is the situation, extra care should be taken to avoid contact with body fluids and safety glasses, surgical masks, and double gloves may be worn. Staff should always be observant for sharps and other foreign objects. To prevent splashes, a towel or absorbent material can be placed over any open wounds or the face of the deceased person. In cases where there is identified risk for an airborne biohazard such as tuberculosis or severe acute respiratory syndrome (SARS), a towel should be placed over the face to prevent the escape of sputum or other fluids, and an appropriate face mask or respirator worn by the body transporters. Chemical, Biological, Radiological, and Nuclear Hazards Before a contaminated body is recovered and transported, the contaminant must be identified and assessed to ensure the appropriate precautions are taken to maintain a safe work environment. In many instances, once the body is removed from the scene the level of contamination is low. However, each situation needs to be separately and fully assessed on an individual basis. Representatives from Environmental Protection Agency (EPA) or WorkSafe or similar occupational health and safety authorities may be able to offer advice on specific risks. If the contaminant cannot be identified, the case should be treated as highly toxic and maximum protection should be worn by workers. In extreme cases the body is decontaminated prior to removal. To do this, it is recommended that the body be photographed in situ, and then the clothing and property removed, bagged, and labeled. Scene workers wearing selfcontained breathing apparatus should then repeatedly hose the deceased. Generally, the fire brigade controls the scene, and only personnel trained in decontamination procedures should enter. In any case where there is suspicion of chemical contamination, a safety officer should be assigned to monitor the level of toxic fumes continually and ensure that the safety of the staff is adequate. In the event of a mass disaster, body recovery can be crucial in assisting in both the final identification of the deceased person and the reconstruction of the events just prior to the incident . The international disaster victim identification (DVI) forms published by Interpol are well-recognized as the preferred method for documenting body recovery and identification in the event of a disaster. Systematic recording and accurate descriptions of deceased persons involved in a mass fatality incident are essential to facilitate adequate reconstruction of the event. The likelihood of some element of criminality being associated with the event is high. In light of this, all deceased persons should be treated as suspicious deaths irrespective of the size, location, or type of disaster. Depending on the nature, scale, and location of the incident, the mortuary to be utilized for transport may be an existing mortuary, a purpose built temporary mortuary, or a combination of both . Regardless of the destination, the recovery of the deceased persons from the scene of death should be consistent, accurate, and respectful. The DVI protocol consists of five phases: phase 1the scene phase 2the mortuary phase 3antemortem retrieval phase 4reconciliation phase 5debriefing. Once the injured have been triaged and removed from the scene, the scene should be secured. DVI scene teams are formed. These teams consist of a crime-scene examiner, a photographer, and a recorder. A pathologist and a forensic odontologist support each team. The location of each body or specimen is recorded such that it is related to a known reference point, usually a grid reference. A unique DVI number is given to each body or body part. Property not attached to a body is also recorded with reference to its location and handed to a property officer. The Interpol DVI form B is completed and the body or body part is moved to an appointed holding area. During phase 1 the pathologist certifies death and assists with the identification of body parts. The body is transported to the mortuary in a body bag. Once at the mortuary, the body is radiographed and autopsied. The autopsy involves the assistance of DVI autopsy teams. These teams consist of a recorder, an examiner, and a photographer. With the assistance of a pathologist and a forensic technician, the DVI teams record and photograph all the clothing and property. Once the body has been photographed, identifying features such as hair color, eye color, scars, and tattoos are recorded. The autopsy is performed and the recorder again documents all details that may be utilized during the identification, such as the presence of an appendix, gallbladder, or foreskin. A forensic odontologist examines the teeth of the body; and fingerprint personnel take fingerprints where appropriate. During the autopsy examination a sample of blood or tissue is retained for DNA analysis and comparison. These details are all recorded on DVI Interpol forms C1 to G. Trained police personnel interview family members of missing persons (presumed to have died in the mass disaster) to gather information regarding all identifying features of that person. This includes the color and type of clothes that the person may have worn and other identifying features such as hair color, eye color, scars, and tattoos. They are also responsible for gathering the dental and medical records, and where relevant the collection of antemortem samples for DNA comparison. Antemortem forms and postmortem forms completed during phases 1 and 2 are compared during the reconciliation phase. This comparison is achieved systematically using a reconciliation chart and grouping each set into male and female, black and white, and ages 0-15, 15-75, 75 plus. If in doubt, the deceased is placed in the 15-75 group. The final identification of each case is presented to the coroner along with an appointed identification panel for the final decision and authority to confirm identity. It is essential for all staff involved in the body recovery of a mass disaster to undergo debriefing. This process could involve a 'hot' debriefing immediately after the event and at the end of each working day, and could also involve a later debriefing which also examines the procedures utilized and ways of improving these processes. All personnel should be aware that any action in handling a deceased person prior to examination at a mortuary may impact the manner in which the case is treated in ongoing investigations. It is vital that suitably qualified medical personnel, for example, forensic pathologists, are consulted before any steps are taken to retrieve, secure, and transport the deceased. This chapter is designed to offer some instruction to those persons performing body retrieval from a scene of death. It is in no way suggesting that these persons should replace the role of the forensic pathologist. It should be emphasized that all steps taken to secure the body that may interfere with the deceased in any way should occur only after examination or observation of the deceased by a forensic pathologist and should always be appropriately and clearly documented. See also: Crime Scene Investigation and Examination: Recovery of Human Remains

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