Why Go To The Scene?

Medical expertise is crucial in death investigations. It begins with body examination and evidence collection at the scene and proceeds through history, physical examination, laboratory tests, and diagnosis – in short, the broad ingredients of a doctor’s treatment of a living patient. The key goal is to provide objective evidence of cause, timing, and manner of death for adjudication by the criminal justice system. Death investigation has been performed for centuries in all societies, although not always by medical professionals. Although the primary goal of a death investigation is to establish the cause and manner of death, the role of the death investigation extends much further than simply answering these two questions. A common question asked is, “Why does it matter? The person is dead.” While it is true that the dead cannot benefit, the value in death investigation is to benefit the living and future generations. In a culture that values life, explaining the death in a public forum (the meaning of “forensic”) is crucial for many reasons. And this interest goes beyond simple curiosity.  In homicide, suspected homicide, and other suspicious or obscure cases, the forensic medicine expert should visit the scene of the death before the body is removed. Local practice varies but any doctor claiming to be a forensic medicine expert should always make himself available to accompany the police to the locus of the death. This duty is often formalized and made part of a contract of service for those forensic medicine experts who are either full-time or substantially involved in assisting the police. In many cases, the scene investigation is more important than the autopsy. A thorough and complete investigation commonly leads to the proper diagnosis of the cause and manner of death prior to an autopsy.

Why go to the scene?

The purpose of having the forensic medicine expert attend the death scene is several-fold. By viewing the body in the context of its surroundings, the forensic medicine expert is better able to interpret certain findings at the autopsy such as a patterned imprint across the neck from collapsing onto an open vegetable drawer in a refrigerator. The forensic medicine expert is also able to advise the investigative agency about the nature of the death, whether to confirm a homicide by a specific means, evaluate the circumstances to be consistent with an apparent natural death, or interpret the blood loss from a deceased person as being more likely due to natural disease than to injury. This preliminary information helps the investigative agency to define its perimeter, structure its approach, organize its manpower, secure potentially important evidence, and streamline its efforts. Nonattendance at death scenes has been regarded as one of the classical mistakes in forensic pathology. Hospital pathologists performing forensic autopsies who are not trained to, or able to, attend death scenes should be provided with information on how, when, and where the body was found, by whom, and under what circumstances. In some deaths, the immediate environment does not contribute to death, such as in cases of metastatic breast carcinoma. In other cases, the environment plays a role although it does not cause the death; for example, consider a case in which a person with marked coronary atherosclerosis collapses with a dysrhythmia while shoveling snow. On the other hand, the scene description and scene photographs are critical in documenting that the physical circumstances and body posture are indicative of death due to positional asphyxia because the autopsy in these cases may yield very few findings.

The examination of a death scene and subsequent collection of potential evidential material requires special skill, knowledge, aptitude, and attitude. The manner in which a death scene investigation is conducted may be a critical factor in determining the success of an investigation. The thorough examination of a death scene requires a disciplined and systematic approach to recording the various observations made and collection of potential evidential material. This must be combined with the analysis of various observations and the interrelationship of potential evidentiary material. This is particularly relevant if the body remains at the scene of death, and has not been transported to the hospital during attempts at resuscitation; however, a scene investigation can be vitally important and provide valuable information even if the body has been transported to the hospital. If a body is pronounced dead at the scene (as opposed to after transport to the hospital), many death investigation systems require a scene investigation.

The deceased is the most valuable piece of potential evidence at any death scene. Hence, a systematic and thorough examination of the deceased should be undertaken at every death scene. Blood spillage or spatter should be noted and will remain after the removal of the body. Weather conditions, location, and poor lighting may mask some faint injuries and trace evidence on the body, therefore the death-scene investigator should document in writing, by sketch, and by photography all information about the body that can be gathered at the scene. The forensic medicine expert should focus on the physical condition of a body at a scene. Without a scene investigation, much initial, valuable body information can be lost. The following points will serve as a guide. When initially notified, a forensic medicine expert should determine as much information as possible from the caller. Approximate age and gender places a subject in a certain "medical category." An attempt should be made to ascertain if there is any evidence of foul play or if any instruments are available that might have played a role in the subject's death. By gathering these data, a forensic medicine expert is able to anticipate additional information that may be needed upon arrival at a scene. The first rule in performing a death scene investigation is to make certain that the scene is safe and secure. The second rule is to not contaminate or disturb the scene. At the very least, death investigators should wear disposable examination gloves and it is also advisable to wear shoe covers and hair nets. Occasionally, full body covering is desirable. When touching items at a scene, examination gloves should always be worn and care should be taken not to sit on furniture or lean against or brush against walls or furniture. The death-scene investigator must seek answers to the following questions: is trace evidence at the scene consistent with the death having occurred at this location? Does the body contain any trace evidence that is unusual for this location, for example, mud on soles of shoes, grass, or seed material embedded in or found on the clothing when the deceased was located inside a building? Is the death one that can be attributed to natural causes? Are there any external signs of violence? Is there anything amiss or out of the ordinary regarding the scene? A successful death investigation, involving more than one individual, requires cooperation and coordination. Any potential conflicts should be worked out. The opportunity to meet at the scene initiates the collegial working relationship between the forensic medicine expert and the detective/investigator. After all, a gunshot wound is a gunshot wound: it is the circumstances behind that gunshot wound that are frequently so compelling and always so instructive about human nature.

All death scenes should be secured and recorded photographically and diagrammatically. If the information to hand, backed by the postmortem, suggests that the death was due to natural causes then the scene should not be processed any further. However, if there are signs at the scene, and other information suggests that the deceased died in suspicious circumstances, and this is reinforced by signs of a struggle or anything unusual, further processing for latent impressions and trace evidence should take place. The four major tasks of documentation are note taking, videography, photography, and sketching. All four are necessary and none is an adequate substitute for another. For example, notes are not substitutes for photography. Effective notes as part of an investigation provide a written record of all of the crime scene activities. The notes are taken as the activities are completed to prevent possible memory loss if notes are made at a later time. Accurate crime scene note taking is crucial at sider the who, what, when, why, and how. One of the most important questions that needs answering is: did death occur at this location? The position in which the deceased was discovered is of particular importance as it will provide an indication as to whether the deceased was moved or not before being discovered. The presence or absence of rigor mortis or stiffness of the body, whether absent, minimal, moderate, advanced or complete, will help the death-scene investigator determine if the person died at that locus in the position as found. Some death-scene investigators with relevant training and experience may feel they are in a position to evaluate rigor mortis and hypostasis. A pink-purple discoloration is usually present at the lowest point of the body. This is due to the settling of the blood by gravitation and the location and state of fixation should be noted and photographed. For example, unfixed livor blanches white when moderate pressure is applied, as opposed to fixed livor mortis, which remains the same color when pressure is applied. If livor mortis is noted on the deceased in areas not consistent with forming in the lowest parts of the body then the death-scene investigator should consider the possibility that the deceased was moved after death. Bodies found in awkward positions that compromise breathing can die of positional asphyxia. The chest wall must be able to rise and fall for respiration to occur. If one is wedged too tightly in a position, the chest wall cannot rise and fall. Descriptions of the state of rigor and livor mortis as well as the body temperature of a subject helps a forensic medicine expert to estimate the time interval since death. Environmental assessment, including temperature, heating or cooling systems, moisture, and wind conditions must be made at a death scene so that the environmental influence on a decedent can be determined. The assessment should also include the types of clothing and jewelry. This information may be needed to assist in determining the time a subject was last seen alive. Clothing should be appropriate for the weather and location found. If not, it needs to be explained. One should also determine if the clothing fits an individual. If a subject is decomposing, then clothing may appear too small due to body swelling. A common misconception among laypeople is that a “painful” expression on the face or a contorted position means the person suffered during the process of dying. Generally, there is no correlation between facial expressions, body positions, and suffering. Pain and suffering can be assessed before and during the dying process, but it is done carefully and generally by the forensic medicine expert after evaluating the autopsy and investigative information. A forensic medicine expert needs to know this initial information so that he can compare it with the decedent's body data and determine if there are any discrepancies. It is better to ask the question twice and get the same answer, than to accept as fact information that has been checked by one source. Any recent events that may have a bearing on the death are also important. A death investigator should always ask if a decedent had recently been involved in any potential harmful situations. This information may be extremely helpful if later attempts are made to make a prior incident a contributing factor in the death. If suicide is suspected, it is preferable to interview family members and close friends as soon as possible after the death is discovered. Death scenes may be indoors or outdoors. The death may have occurred at the scene or the body may have been “dumped.” The death scene may be untouched since the crime was committed or it may have been contaminated by the untrained or the unwary. The murderer may have intentionally altered the scene in an effort to mislead investigators or make a statement, usually a defiant one. A crime scene altered in this manner is said to have been staged. By visiting the scene and actually seeing the position of the body and the pattern of injuries to the deceased and the arrangement of objects in the surrounding areas, the forensic medicine expert can put the pieces of the puzzle together and attempt to reconstruct the circumstances that led to the event. Always be professional―remember that onlookers, including the decedent's family, and news media may be at the perimeter of the scene, so do not say or do anything that would reflect poorly on yourself and the organization you represent. Trash (discarded gloves, etc.) should be placed in bags designated for investigators' refuse, and not in the garbage cans that are part of the scene because in actuality, they are evidence. Never remove items from a scene for souvenirs. Dismemberment of the corpse allows the murderer to clear the scene of the crime to delay investigations until the body is found. It also makes it easier to transport the body even for long distances, during times of day when possible witnesses could be about, without raising suspicion.

The forensic medicine expert should visit the death scene before the autopsy if it is possible. Although, investigation and legal systems differs from country to country, there is always an opportunity to visit the death scene him/herself, he/she would check the documents (notes, sketches, photographs, etc) which crime scene investigation team prepared. Many medicolegal deaths may be resolved by death scene investigation. A forensic medicine expert should never forget: If the death scene investigation is not performed before the autopsy, that autopsy will be an imperfect autopsy.

Acknowledgements:

The Police Department;

www.politie.nl and a Chief Inspector – Mr. Erik Akerboom     ©

 Bibliography:

1.    Criminal Investigations – Crime Scene Investigation.2000

2.    Forensic Science.2006

3.    Techniques of Crime Scene Investigation.2012

4.    Forensics Pathology.2001

5.    Pathology.2005 

6.    Forensic DNA Technology (Lewis Publishers,New York, 1991).

7.    The Examination and Typing of Bloodstains in the Crime Laboratory (U.S. Department of Justice, Washington, D.C., 1971).

8.    „A Short History of the Polymerase Chain Reaction". PCR Protocols. Methods in Molecular Biology.

9.    Molecular Cloning: A Laboratory Manual (3rd ed.). Cold Spring Harbor,N.Y.: Cold Spring Harbor Laboratory Press.2001

10.   "Antibodies as Thermolabile Switches: High Temperature Triggering for the Polymerase Chain Reaction". Bio/Technology.1994

11.   Forensic Science Handbook, vol. III (Regents/Prentice Hall, Englewood Cliffs, NJ, 1993).

12.   "Thermostable DNA Polymerases for a Wide Spectrum of Applications: Comparison of a Robust Hybrid TopoTaq to other enzymes". In Kieleczawa J. DNA Sequencing II: Optimizing Preparation and Cleanup. Jones and Bartlett. 2006

13.   Nielsen B, et al., Acute and adaptive responses in humans to exercise in a warm, humid environment, Eur J Physiol 1997

14.   Molnar GW, Survival of hypothermia by men immersed in the ocean. JAMA 1946

15.   Paton BC, Accidental hypothermia. Pharmacol Ther 1983

16.   Simpson K, Exposure to cold-starvation and neglect, in Simpson K (Ed): Modem Trends in Forensic Medicine. St Louis, MO, Mosby Co, 1953.

17.   Fitzgerald FT, Hypoglycemia and accidental hypothermia in an alcoholic population. West J Med 1980

18.   Stoner HB et al., Metabolic aspects of hypothermia in the elderly. Clin Sci 1980

19.   MacGregor DC et al., The effects of ether, ethanol, propanol and butanol on tolerance to deep hypothermia. Dis Chest 1966

20.   Cooper KE, Hunter AR, and Keatinge WR, Accidental hypothermia. Int Anesthesia Clin 1964

21.   Keatinge WR. The effects of subcutaneous fat and of previous exposure to cold on the body temperature, peripheral blood flow and metabolic rate of men in cold water. J Physiol 1960

22.   Sloan REG and Keatinge WR, Cooling rates of young people swimming in cold water. J Appl Physiol 1973

23.   Keatinge WR, Role of cold and immersion accidents. In Adam JM (Ed) Hypothermia – Ashore and Afloat. 1981, Chapter 4, Aberdeen Univ. Press, GB.

24.   Keatinge WR and Evans M, The respiratory and cardiovascular responses to immersion in cold and warm water. QJ Exp Physiol 1961

25.   Keatinge WR and Nadel JA, Immediate respiratory response to sudden cooling of the skin. J Appl Physiol 1965

26.   Golden F. St C. and Hurvey GR, The “After Drop” and death after rescue from immersion in cold water. In Adam JM (Ed). Hypothermia – Ashore and Afloat, Chapter 5, Aberdeen Univ. Press, GB 1981.

27.   Burton AC and Bazett HC, Study of average temperature of tissue, of exchange of heat and vasomotor responses in man by means of bath coloremeter. Am J Physiol 1936

28.   Adam JM, Cold Weather: Its characteristics, dangers and assessment, In Adam JM (Ed). Hypothermia – Ashore and Afloat, Aberdeen Univ. Press, GB1981.

29.   Modell JH and Davis JH, Electrolyte changes in human drowning victims. Anesthesiology 1969

30.   Bolte RG, et al., The use of extracorporeal rewarming in a child submerged for 66 minutes. JAMA 1988

31.   Ornato JP, The resuscitation of near-drowning victims. JAMA 1986

32.   Conn AW and Barker CA: Fresh water drowning and near-drowning — An update.1984;

33.   Reh H, On the early postmortem course of “washerwoman’s skin at the fingertips.” Z Rechtsmed 1984;

34.   Gonzales TA, Vance M, Helpern M, Legal Medicine and Toxicology. New York, Appleton-Century Co, 1937.

35.   Peabody AJ, Diatoms and drowning – A review, Med Sci Law 1980

36.   Foged N, Diatoms and drowning — Once more.Forens Sci Int 1983

37.   "Microscale chaotic advection enables robust convective DNA replication.". Analytical Chemistry. 2013

38.   Sourcebook in Forensic Serology, Immunology, and Biochemistry (U.S. Department of Justice, National Institute of Justice, Washington, D.C.,1983).

39.   C. A. Villee et al., Biology (Saunders College Publishing, Philadelphia, 2nd ed.,1989).

40.   Molecular Biology of the Gene (Benjamin/Cummings Publishing Company, Menlo Park, CA, 4th ed., 1987).

41.   Molecular Evolutionary Genetics (Plenum Press, New York,1985).

42.   Human Physiology. An Integrate. 2016

43.   Dumas JL and Walker N, Bilateral scapular fractures secondary to electrical shock. Arch. Orthopaed & Trauma Surg, 1992; 111(5)

44.   Stueland DT, et al., Bilateral humeral fractures from electrically induced muscular spasm. J. of Emerg. Med. 1989

45.   Shaheen MA and Sabet NA, Bilateral simultaneous fracture of the femoral neck following electrical shock. Injury. 1984

46.   Rajam KH, et al., Fracture of vertebral bodies caused by accidental electric shock. J. Indian Med Assoc. 1976

47.   Wright RK, Broisz HG, and Shuman M, The investigation of electrical injuries and deaths. Presented at the meeting of the American Academy of Forensic Science, Reno, NV, February 2000.