 Operators, please give me the MP. Military, please do us a certain tail and help us. You can please mind us who's in shock. Yes, ma'am, your name? You're in 1-1, 36-0. 1-1, 3-D, 0-1, 2-1, 2-1, 2-1. That's 31, 10-1-5, 1-2, 2-5, Verge Street, referenced possible homicide. Okay, I'll just go ahead. I'll just push this thing back to the center of the site, please. The biggest guy is dead. We're calling to the death sergeant. A man is dead. Obviously not of natural cause. It's a situation that will call for a medical legal autopsy. The essential difference between this kind of autopsy and the usual autopsy performed at a hospital is that the medical legal autopsy seeks to develop knowledge and legally sound evidence of what happened at the crime scene and who was responsible. The autopsy performed after the usual hospital death generally only seeks to determine the cause of death. For the pathologist, it is vital to be extremely thorough at every step because sometimes an item that appeared to be insignificant will later prove to be of crucial importance. That thoroughness begins in advance. The pathologist should have arrangements worked out so that he will be called to the crime scene by the CID investigator in any case involving violent death or death under suspicious circumstances. Now that's one, two, two, five, birch. And thoroughness means his notes should begin with the first call on the case. Who called? The time and the date. Items he will need at the crime scene include notebook, stethoscope, laboratory thermometer, rubber gloves, tape measure, clean forceps, and new knife blades. It's Dr. Thompson. Good evening, sir. How are you? As I mentioned earlier on the phone, the wife came home about 30 to 45 minutes ago and found her husband in this condition line on the floor. I will check him for the basic vital signs, but I'd like to see what determinations you might be able to make. There are two overriding rules that govern his actions at the crime scene. The first is, other than checking for vital signs, he must not touch or move the body or anything else at the scene until the CID investigators tell him it's okay. And the second is, the pathologist must write down everything, everything. The time he arrives, the names of the investigators, all actions he takes, everything significant he observes concerning the body. He may be called into court months from now and be expected to testify accurately about minor points that he could not possibly recall without good notes. Observe the wounds without disturbing them at this time. The principal weapons in homicide are firearms, sharp instruments, or blunt objects. If a weapon has been found, observe whether the wounds are consistent with the type and style of weapon. The pathologist pronounces the victim dead after thoroughly checking for vital signs, and both the pathologist and investigators record the date and hour. The pathologist may bring his own camera or may arrange with the investigators to get the pictures he wants from the photographer they provide. Don't assume that the investigators will obtain photos of medical value. It's up to the pathologist to decide what pictures he will need and make sure that they are obtained. Color photographs should be taken. Bear in mind that some jurisdictions do not allow color photos in court. However, pictures taken in color can be reproduced in black and white for courtroom use. It's important for the pathologist to remember that CID investigators are trained in recognizing, collecting, and preserving evidence. Any bullet holes found at the crime scene should be measured and photographed. Proper handling and documenting is essential because evidence that becomes tainted by not following the procedures may not be admitted in court. A purse inadvertently dropped by the wife when she discovered her husband's body must not be removed from the crime scene as it becomes part of the evidence. Inocuous items, a beer can, match book, a cigarette could later prove to be valuable evidence. These things should not be touched or handled. As soon as they can, the investigators will give the OK for the pathologist to continue his examination. After photographs have been taken and after conferring with the investigators the pathologist's work begins in earnest. In the absence of wounds, look for signs of natural disease or drug abuse. It is particularly important to observe and record those things which will change by the time of autopsy. Observe for rigor mortis and larvormortis. These are useful for revealing if the body was moved after death before being found. They are also helpful in estimating the time of death. It is important to remember that evidence in the vicinity and general surroundings of the victim and information based on the victim's ordinary habits, movement and day-to-day activities are sometimes more important in estimating time of death than findings in the body itself. Look closely for any trace evidence that should be collected by the investigators such as hairs or fibers on the hands, the clothes or near the body, blood or semen stains on the clothing, bed linen, floor, walls and so on. In the poor lighting of the crime scene it is often easy to overlook trace evidence on the hands. Protect them with bags until the autopsy when you will be able to do a more thorough examination. If the body is to be refrigerated prior to autopsy use paper bags to help prevent condensation. Investigators should make note that fingerprints of the victim are to be taken at the autopsy, not at the crime scene. Before moving the victim the position of the body must be outlined do not move anything until all necessary photographs have been taken. All evidence recorded and collected and a thorough investigation has been made at the crime scene. Next, rectal temperature. If the body must be turned over it is a good idea to spread a clean sheet. This protects against the loss of any object that might fall from the pockets of the clothing or out of the body. The pathologist records the temperature of the environment in which the body was found with the laboratory thermometer before taking the rectal temperature. An investigator upon arriving at the crime scene will record overall weather conditions and temperature. Approximate room temperature is also recorded at this time. After the body is turned the pathologist examines the body for exit wounds. Not uncommonly, the projectile is found immediately beneath the skin because it did not have sufficient energy to create an exit wound. Rectal temperature is another factor in estimating time of death but must be taken before the body is placed in the cold temperature of the morgue. Restore the clothing after taking the temperature. That completes the steps at the crime scene. One investigator will accompany the body to the morgue and oversee that the morgue is secured to adhere to evidentiary requirements. Dr. Thompson, I have some photographs here which were taken at the scene last night by the... A pre-autopsy conference should always be held to ensure a mutual understanding between the pathologist and the CID investigator. This is especially important if the pathologist was not present at the crime scene. Together, the two review all the facts known to the time. If you maintain good communications with the photo lab they will often be able to print the crime scene pictures overnight a big help at the pre-autopsy conference. The pathologist should ensure that the investigator plans to be present at the autopsy and the two should coordinate plans for having a photographer there. A principal aim of the medical legal autopsy is to arrive at findings on the cause of death. Mechanism of death, such as gunshot wounds, blunt force wounds, sharp force wounds, asphyxia, and a matter of death. The circumstances surrounding the death. Homicide, suicide, accident, natural, or undetermined. Note the important distinction between the meanings of these terms, cause, and manner. Note that the body is still clothed. You need to be sure that emergency room and morgue personnel know to leave clothing intact. Remember that a CID investigator must be present to ensure the proper handling and custody of evidence. Note, here again, the clean sheet under the body to preserve evidence while removing the clothes. When photographing the body, each picture must have an identification or case number and a scale within the field of view. Be sure to take identification photos of the victim showing this case number. Photography is time consuming, but it is well worth it, both for documentation and for refreshing your memory before the trial. Work closely with the photographer to get the pictures you need. Besides these initial photos, you will also need shots of the wounds later with the clothes off, before cleaning, and after cleaning. For a gunshot victim, before you begin, take a close look at places where bullets have pierced the clothing. The direction of fibers can help distinguish between an entrance and exit wound. Presence or absence of powder residue can help establish the distance of fire. Removing the clothing is arduous, because you do not do it in the usual way, simply cutting it off. The clothes have to be removed intact, so that they remain usable as evidence if needed. Let the investigator take charge of any evidence to be sent to the crime lab. The investigator takes possession of the clothing and preserves it as evidence. The clothes should be allowed to dry before they're sent to the crime lab to prevent mildew and possible destruction of evidence. In gunshot and stab wound cases, obtained x-rays of body regions involved. These may show projectiles lodged in the body, or pieces of the weapon broken off internally. If the body is unidentified, get full body x-rays to reveal any abnormalities that may later aid in identification. Measure and record the weight and height of the victim. Whether visible or not, a sample of powder residue should be collected for examination by the crime lab. It is important to identify evidence of therapy, as pointed out here, such as needle marks or cut downs. With clothing removed, another set of photos must be taken. Make sure that the photographer doesn't take pictures that will have a distorted perspective. A shot from there isn't going to do much good. This angle shows the wound in the correct perspective. The wound should be photographed before they're cleaned and after they are cleaned. A step ladder should be available to get photos from above the body. Describe for the record the sex, race, development and state of nutrition. The investigator should make his own notes throughout the autopsy, so he can proceed with his work on the case, without having to wait for the pathologist to complete his protocol. Provide a complete external description, recording all abnormalities. Some special points to note in the case of an unidentified body. The teeth should be charted by a dentist. Also, photographs of identifying characteristics, such as tattoos, birthmarks and scars should be taken, recorded and carefully described. The next step is a careful examination of the hands for any trace evidence overlooked earlier and for wounds or abrasions. Bear in mind that evidence of suicide is sometimes hidden before authorities are called for insurance and embarrassment reasons. In a gunshot death, the absence of a weapon may not prove homicide. The investigators should collect a sample to be tested for powder residue on all suicides involving firearms, and any time you suspect a powder residue may be present. Investigators are provided with special chemically treated swabs for this purpose. Both hands should be swabbed for a comparison of the amounts of residue present. The vial is sealed and all appropriate data recorded on the label, including the date and time and investigators name. In cases of contact violence, clean under the fingernails, collecting the scrapings from each in a separate container and marked with an identifying label. Clippings should be taken from the nails of each hand and placed in individually labeled containers. Finger printing may be done as you complete processing each hand. Evidence is gathered from the right hand in the same manner. A lesion found on the victim's right wrist indicates possible drug abuse. This should be recorded on the body diagram chart. Hair samples. At least 12 full-length hairs should be pulled from the head to compare with hairs found at the crime scene, on weapons, or on clothing. Next comes the task of measuring the wounds. All measurements should be recorded using the metric system, but be prepared to translate into inches. Measure the location from the top of the head and from the midline. This data must be recorded on a body diagram chart. In the case of multiple gunshot wounds, a letter or number designation should be assigned to each wound and noted whether entrance or exit. Exit wounds are identified by the corresponding entrance wound. Record whether the wound or wounds are contact, close range, or distant. Also, measure and record the dimensions of each wound. For entrance wounds, measure and record the size of powder residue, abrasions, or gun muzzle contact rings around them. The wounds should not be probed at this time. The probe might create a false track. After examining and measuring the entrance wounds, turn the victim. Examine and measure the exit wound. An abrasion in this case caused by the skin being compressed between the projectile and some non-yielding object on the skin's surface, such as a belt or a wall the person was leaning against. Measure from the top of the head and from the midline. Measure the length and width of the abrasion. The hematoma surrounding the abrasion is also measured. Photograph the abrasion before making the incision. Record the data on the body diagram chart. Palpate to determine the exact location of the projectile, which is directly beneath the skin. Make the incision alongside the abrasion long enough to facilitate the search and removal of the projectile. If a projectile remains in the body, describe its location. Never use a metal instrument in removing it, because this could obliterate markings needed for firearms examination. Clean the projectile with a sponge. The base of this one was deformed during penetration. The technique of identifying the projectile is important, both to avoid damaging it and to satisfy requirements for admission in court. Avoid damaging the firearm markings. Write your initials either on the nose of the projectile or preferably on the base. Never anywhere else. The investigator takes custody. Both men initial the box. Any failure to carry out the required steps for identification and custody could lead to a homicide case being thrown out of court. All ways do a complete autopsy, including head, neck, and trunk. A partial one is never enough. When you begin the internal examination, make the usual Y-shaped incision. Here are some pointers to keep in mind. The internal exam, including examination of the head, pretty much follows the procedure of any other autopsy with a few special requirements. Note any additional facts that could aid in estimating the time of death, such as decomposition and stomach contents. Even when death is by violence, watch for and gather any evidence of drug abuse or of natural disease. A blood alcohol determination should always be performed and other drug determinations, as the history and anatomic findings indicate. Blood should be obtained for toxicological analysis in all medical legal cases. On all homicides, save an additional sample of blood for typing to compare with blood found at the crime scene. All of the bile is removed from the gallbladder for toxicological analysis. Bile is extremely useful for identification of narcotic drugs. If urine is available, it should be saved for drug analysis. Additional specimens to be saved for toxicological analysis are liver, kidney, brain, lung, and gastric contents. Also, obtain specimens for microscopic examination of contusions and lacerations for possible determination of how long before death the wounds were inflicted. In your protocol, you will describe the tract of each bullet separately. That is, for each bullet, you describe the entrance wound, the internal damage caused by that one bullet, and its exit wound. Organize your examination and your notes so there won't be any confusion when you go to write the protocol about which damage was caused by which bullet. Describe the tract of the bullet in terms of anterior to posterior, inferior to superior, left to right. Record the amount of blood accumulated in body cavities traversed by the bullet. The tract of the bullet must be identified before any of the internal organs are removed. In this case, the bullet passed through the stomach and the spleen. The bullet then perforated the left side of the diaphragm and passed through the chest cavity on the left. Here, the hole can be seen where the bullet exited the posterior wall of the chest cavity. After the chest organs have been removed, the removal of the tongue with the neck organs can be performed. Fresh bite marks give support to the possibility that a seizure preceded death. Also, a good view of the upper air passage can be obtained for examination for possible foreign objects. Removal of the tongue should be performed in every medical legal autopsy. The skin of the neck is reflected up to the level of the lower jaw. The carotid arteries, as pointed out here, are identified so as to avoid cutting them. Insert the knife under the chin through the floor of the mouth. So the tip of the blade emerges under the tongue. From this point, cut along the side of the mandible back as far as the angle of the mandible. Scissors are useful for cutting along the angle of the mandible. Care should be used to avoid severing the carotid artery. If you should damage the carotid artery, tie a section of polyethylene tubing firmly into the vessel to facilitate embalming later on. The tissue on the other side of the mandible is cut in the same manner. Both the fingers and scissors can be used to free the tissue under the mandibular arch. The esophagus and trachea are freed from the tissue posteriorly. Examination of the tongue reveals no bite marks. There is no obstruction of the air passage. In this case, a portion of a denture can be observed. Through this approach, the entire mouth posterior to the teeth can be examined. Here, the intact carotid arteries can be seen after removal of the tongue and neck organs. After removal of the neck organs, excess soft tissue must be removed so that evidence of injury can be identified. The hyoid bone, the thyroid cartilage, and the cricoid cartilage are areas of possible injury in cases of strangulation. Looking at the neck organs from the anterior view reveals the inferior side of the tongue. The hyoid bone, the thyroid cartilage, the cricoid cartilage, and the trachea. Viewing the neck organs from the posterior side reveals the superior surface of the tongue. The greater horn of the hyoid bone, the epiglottis, the superior horn of the thyroid cartilage, the cricoid cartilage, and the trachea. In any medical legal case in which there is a possibility of neck injury, the posterior neck should be examined. This is usually done after all other areas of the body have been examined. Any hemorrhage observed, as noted in this case, is evidence of neck injury. The soft tissue is separated from the vertebral spines. Checking for any unusual movement of the vertebral column gives indication of the presence or absence of a fracture. That completes the procedures for the medical legal autopsy, except for the head, which is done in the usual manner. The pathologist first drafts the provisional protocol. As mentioned earlier, you describe each gunshot wound as two entrants, track, and exit, under a heading entitled Evidence of Injury, rather than grouping them under external and internal examination headings, as you would for the usual protocol. All injuries in addition to the gunshot wound should be placed under the heading of Evidence of Injury. To avoid possible confusion in the courtroom, it is much better to give the cause of death as, for example, gunshot wounds, head, chest, and left upper arm, as illustrated in this completed protocol, rather than something like hemorrhage due to gunshot wounds. Likewise, for a man who has been attacked with a blunt instrument and later dies in the hospital of pneumonia, as shown in this protocol, list the injuries as the cause of death, giving the full explanation elsewhere in the protocol. Another point concerns the summary or opinion section. It should be written in language that laymen can understand, like this. This 40-year-old black male died of a gunshot wound of the abdomen with hemorrhage from the spleen. The manner of death is homicide. Finally, keep in mind that any mistakes you make in the protocol, or even a small typographical error, may be picked up in court by the defense attorney and used in an attempt to embarrass or discredit you. Now, Doctor, on page 2, line 8 of this document, I find a reference to the utter abdomen, U-D-D-E-R. Yes, that should be upper abdomen. It's a typographical error. I see. Doctor, did you proofread this document before you signed it? Yes, I did. But Doctor, if you can overlook an obvious mistake like that, how are we to know you didn't overlook something more obvious in the autopsy? That may sound funny, but not when you're the man in the witness chair. In every medical legal case, you must take extra care to be sure your work is complete and thorough. The outcome of trials, insurance settlements, and personal reputations will sometimes depend on it.