Coroner Talk™ | Death Investigation Training | Police and Law Enforcement

There is no greater honor than writing the last chapter of someone’s life story. As medicolegal death investigators, that is what we do and, for the most part, we do it well. With seemingly innumerable courses, electronic mailing lists, and forensic science discussion groups, there is a plethora of available information on how to investigate just about every possible death scene and circumstance. Unfortunately, there is not a major focus on the management and administration of offices and personnel in the medicolegal death investigation field. With the exception of those offices under the law enforcement umbrella, many medicolegal death investigation managers and supervisors lack basic managerial training and the “big picture” purpose and role of a Medical Examiner/Coroner (ME/C) Office is often forgotten or overlooked not only by its employees but by its administrators. The lack of managerial training and resulting substandard managerial performance; misguided managerial focus; and managerial inaction, to include the ignoring and/or avoidance of problem issues and personnel; ultimately results in the creation and maintenance of a toxic work environment and the “big picture” becomes foggy, if not completely invisible. In this environment, “cancerous” employees infect the environment to the point that good employees either leave or lose the motivation and dedication to a job well done.

The primary focus of most medicolegal death investigation managers, administrators, and supervisors is to ensure ME/C personnel properly determine jurisdiction, document deaths reported to the office, conduct scene investigations, perform death notifications, conduct postmortem examinations, certify deaths falling under its jurisdiction, and document the investigative efforts in comprehensive and factual reports, in addition to many other ancillary functions. We are fortunate to work with many outstanding death investigators and support personnel who choose to do the noblest of jobs in an underpaid, under-appreciated, and overly-stressed work environment.

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In this episode, we listen in as Anita Brooks talks with a group of team leaders about how what they do and how they do it has a great impact on the overall success of the team function.  In this segment, we play the portion of the training where Anita describes the 7 Superpowers of an Effective Leader. 

These superpowers as Anita describes them are

1. Monitor your mind’s mouth – watch your self-talk
2. Treat people as human beings, not as objects
3. Listen (to hear) twice as much as you speak
4. Practice Appreciation:  Express it, Show it, Share it
5. Choose integrity in Every Moment
6. Become an Intentional Promise-Keeper
7. Measure Your Progress with a Quarterly Leadership S.W.O.T Analysis

Have you ever wondered what being a part of CSI is really like? If so, here’s your chance to experience it…WALK inside the crime scene tape with retired Sergeant Tamara Mickelson as she shares her personal experiences of the most grueling and heartbreaking crime scenes she had ever worked. Catch a glimpse of what she saw, touched, smelled, and even tasted during an average workday. Dare to join her as she takes you through a difficult journey of memories, uncovering layers of emotional trauma left behind. Discover the ways she healed from yesterday's pain to live an emotionally balanced life today.

Get your copy by clicking the book cover below. 

Infant Loss Resources serves as a source of information and support for healthcare professionals, childcare providers, parent educators, and police and other emergency workers who are the first to respond to a family who has experienced an infant death. Ongoing educational programs are presented both to students and working professionals throughout Missouri, and in surrounding counties in IL and KS. Education enables public health and social service professionals to provide well informed, consistent services for families.

Professional education is also offered to nurses, physicians, child care providers, parent educators, and health educators on the latest recommendations to improve infant health and reduce the risk of death, which includes training on safe sleep for babies.

The definition of SIDS is the sudden, unexpected death of an apparently healthy infant, under one year of age. The death remains unexplained after a complete medical history review, autopsy and death scene investigation, all 3 of which are required by law.

While the exact cause of SIDS is unknown, researchers have been able to identify factors that are associated with infants and infant care practices that increase the risk of SIDS. As a result, risk reduction recommendations have been established. Parents and other caregivers should remember that if practiced, these risk reduction techniques will significantly reduce the risk of SIDS.

What is SUID? Sudden Unexpected Infant Death is an umbrella term used for many sleep-related infant deaths for which an exact cause may not be immediately clear or may remain undetermined.  SIDS falls under the umbrella of SUID.  Other deaths that are under the umbrella of SUID are accidental suffocation or asphyxia.  When we look at risk reduction for SIDS/SUID, the steps recommended reducing the risk are the same.

Age Distribution:

90% of all SIDS/SUID deaths occur in infants less than 6 months of age. 70% of deaths occur in infants between 2 and 4 months of age.

Seasonal Distribution: More deaths occur in the winter and fall months;  most likely due to babies sleeping with too many layers of clothing or blankets in the winter

Population Distribution: Approximately 3,000 – 3,500 babies die of sudden infant death in the U.S. each year. Annually in the state of Missouri, approximately 90 – 95 babies succumb to SUID. There is a gender difference in that 60% male vs. 40% female babies are affected.  SIDS/SUID affects babies of all races, religions and ethnic groups; however the statistics show us that the incidence of SIDS/SUID is greater for:

• African American and Native American babies
• low birth weight babies (< 2,500 grams)
• babies born prematurely
• babies whose mothers smoke during and after pregnancy
• babies of multiple births (twins or triplets)
• babies born within 18 months of one another and babies of younger mothers

Infant Loss Resouces:   http://infantlossresources.org/ 

Evidence in infant and child death cases is many times very different than in older children and adult deaths, infants die differently than adults, in most cases; so the evidence surrounding their death will be different. Understanding what potential evidence is is critical as well as knowing how and what to collect. Remember – If you think it might be evidence or lead you to a reason for the death – take it, you can always give it back.

Personal Property v. Evidence

• Personal Property

Is the property on or near the body that belongs to the baby (or decedent) and can be returned to next-of-kin.

• Evidence

Is any material that may contribute to the cause and manner of death and is considered important in supporting facts of the case. What is determined evidence depends on the type and manner of death being investigated.

Chain of Custody 

Every item secured from the scene, whether it is personal property or evidence to be processed – must be accounted for at every moment while in the custody of the investigative agency.  Until such time that it is returned to the family or destroyed following court order when the evidence is no longer needed. Use a property log and ensure that every person handling or receiving the item(s) signs for it and can testify as to its integrity or secured storage.

Photograph – EVERYTHING  FIRST!

Be sure that you have photographed and documented in your notes, anything you might be taking as evidence.  Its placement will become critical in your final report.If the items had been moved by police, EMS, or family document the place you found it and note the move is you know it.

Collecting Evidence

Every item and material of evidence collected;  must be identified, collect, and stored using proper methods. Different evidence has different containers it is important to store and transport correctly. Not doing so can cause evidence to become contaminated, chain of custody to be broken, or samples to be degraded beyond use

Some Evidence in Infants Deaths  to Consider

• Bedding, Bed, and Sleeping area
• Any OTC or Rx  Medications for baby – Or in the baby area
• Bottles – those with milk and those in sink or floor empty
• Baby food  – or whatever the child has been eating
• Diapers – toxicology testing
• Clothing – recent, might have changed child after finding
• Items used as weapons
• Anything that looks like it could be involved- in and around the infant area – you can always  give it back later

These topics and more are discussed in this week’s episode.

Check out online eLearning options by 

https://www.ditacademyonline.org

Death Investigation is all we do !  Many training agencies are well rounded and can fulfill the training needs in nearly every category of public policing and investigation.  At DITA we concentrate on death investigation and everything surrounding those investigations.  By becoming hyper-focused in this field we are better able to provide intense and specific training you and your investigators need.

All infant and child deaths need to be investigated in a systematic and standardized method.  The SUDI forms provided by the CDC is the national standard approach to investigating these deaths. Frequently, a cause of death is determined after a thorough investigation and autopsy by a medical examiner and coroner. The deaths that remain unexplained are defined as SIDS. Therefore, SIDS is a type of Sudden Unexpected Infant Death.

The U.S. Centers for Disease Control has developed the Sudden and Unexplained Infant Death (SUID) Investigation Reporting Form. The Reporting Form, a guide for its use and a training curriculum for infant death scene investigation are available online. The form will guide and standardize the work and practices of EMS professionals, law enforcement, death scene investigators, medical examiners and coroners, death certifiers and child death review (CDR) team members.  Information obtained by using the form in infant death investigations can also be used to guide the development of strategies for the prevention of infant deaths.

All infant and child deaths need to be investigated in a systematic and standardized method.  The SUDI forms provided by the CDC is the national standard approach to investigating these deaths.

Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant under 1 year of age, which remains unexplained after a thorough investigation including a complete autopsy, examination of the death scene and review of the clinical history.

In the United States, SIDS is the major cause of death in infants from 1 month to 1 year. Most deaths occur between 2-4 months of age. Typically, a seemingly healthy infant dies suddenly and unexpectedly, usually during a period of sleep. A diagnosis is made after all the possible causes of death have been excluded. SIDS can occur in families of any race, socio-economic status, religion or nationality.

Causes of SIDS remain unexplained. However, SIDS is not caused by suffocation, child abuse, immunizations, vomiting, choking or by minor illnesses such as a cold or infection. SIDS is not contagious.

As talked about in this episode all child death investigations need to include scene reenactment photos of the position and place the child was last seen alive and the position and place they were found unresponsive.  Using placed/found signs will help everyone viewing the photos to understand the reenactment.

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Chief Forensic Investigator

St Louis Medical Examiner's Office

About 4,300 US infants die suddenly and unexpectedly each year. We often refer to these deaths as sudden unexpected infant deaths (SUID). Although the causes of death in many of these children can’t be explained, most occur while the infant is sleeping in an unsafe sleeping environment.

Researchers can’t be sure how often these deaths happen because of accidental suffocation from soft bedding or overlay (another person rolling on top of or against the infant while sleeping). Often, no one sees these deaths, and there are no tests to tell sudden infant death syndrome (SIDS) apart from suffocation.

To complicate matters, people who investigate SUIDs may report the cause of death in different ways and may not include enough information about the circumstances of the event from the death scene.

Law enforcement, first responders, death scene investigators, medical examiners, coroners, and forensic pathologists all play a role in carrying out the case investigation.

A thorough case investigation includes

• An examination of the death scene.
• An autopsy (medical examination of the body after death).
• A review of the infant’s medical history.

Most SUIDs are reported as one of three types of infant deaths.

Types of SUID

1. Sudden Infant Death Syndrome (SIDS) SIDS is defined as the sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, the examination of the death scene, and a review of the clinical history. About 1,500 infants died of SIDS in 2014. SIDS is the leading cause of death in infants 1 to 12 months old.
2. Unknown Cause The sudden death of an infant less than 1 year of age cannot be explained because a thorough investigation was not conducted and cause of death could not be determined.
3. Accidental Suffocation and Strangulation in Bed Mechanisms that lead to accidental suffocation include:  
   • Suffocation by soft bedding—for example, when a pillow or waterbed mattress covers an infant’s nose and mouth.
   • Overlay—for example, when another person rolls on top of or against the infant while sleeping.
   • Wedging or entrapment—for example, when an infant is wedged between two objects such as a mattress and wall, bed frame, or furniture.
   • Strangulation—for example, when an infant’s head and neck become caught between crib railings.

Even after a thorough investigation, it is hard to tell SIDS apart from other sleep-related infant deaths such as overlay or suffocation in soft bedding. While an observed overlay may be considered an explained infant death, no autopsy tests can tell for certain that suffocation was the cause of death.

It is important an investigator take some immediate action upon first arriving on the scene. Unlike most death investigations, the decedent in an infant death has almost always been moved since discovery. Therefore, it is essential that the investigator uses this first opportunity to locate and evaluate the location(s) within the scene where the infant was reported to have been moved between placement and discovery. While also noting existing environmental conditions that may have affected the infant.

Upon arrival an investigator should:

• Identify the lead investigator at the scene and present your identification
• Identify other essential officials at the scene (e.g., EMS, emergency department personnel, childcare providers, social/child protective services).
• Explain your role in the investigation.
• Identify and document the first essential official(s) to the scene for identification for future follow up.
• Determine if the scene is safe to enter

To establish scene parameters and become familiar with the environment, the investigator should:

• Locate the first responder and/or lead investigator.
• Determine the location where the infant was discovered dead or unresponsive.
• Determine the location where the infant was last known alive.
• Determine the location where the infant was placed.
• Identify visible physical and fragile evidence.
• Document and photograph fragile evidence immediately and collect, if appropriate.
• Observe the physical living environment.
• Locate and view the decedent, if possible.

In August 1997, sixteen-year-old William Jenkins was on his second day of work at a fast-food restaurant in suburban Richmond, Virginia when the restaurant was robbed at closing time.

While cooperating fully with the robber, William was shot and died instantly. His father, Bill Jenkins, quickly found that there were virtually no readily available resources that could answer his many questions as a survivor of a traumatic loss.

He began looking for help and found it, after a fashion, scattered in the bookstores, on the

Internet, and in support groups and agencies. But nowhere was there a single, concise, practical, and eminently useful resource for bereaved families written by victims for victims containing the advice and guidance that he and his family needed following their loss. Several months later, using the information he had collected for his own personal well-being, this experienced teacher and speaker sat down to write the book that he should have received the night he was notified of his son’s death, What to do When the Police Leave: A Guide to the First Days of Traumatic Loss.

This landmark book on grief and bereavement quickly became an important resource for families dealing with the sudden or traumatic death of a loved one and the caregivers who work with them. Now, a recognized expert on victims and trauma, Bill has served on the boards of directors for Murder Victims for Human Rights, the National Coalition of Victims in Action, and is the founder, along with his wife, Jennifer Bishop, of IllinoisVictims.org, a statewide victim rights watchdog group. He is also active in many other victims’ rights and support activities and organizations, has been an instructor with the Virginia Institute of Forensic Science and Medicine, leads seminars on victims’ perspectives for national organizations such as the National Center for Victims of Crime, the National Organization of Victim Assistance, and Parents of Murdered Children and also addresses local and regional conferences for law enforcement and victim advocates. He and his wife also speak at victim impact panels for youthful offenders and in support of funding for programs for children and young

people that are proven to decrease crime.

In 2006, Bill received the Edith Surgan Victim Activist of the Year award from the National

Organization of Victim Assistance, a singular honor that recognizes to his expertise in the field and his commitment to making society more sensitive to victims’ rights and needs. In 2019, he was awarded the prestigious John Gillis Leadership Award by Parents of Murdered Children.

Bill has also written a full-length play, Hearts Full of Tears, that has been produced by two

professional theatre companies so far. It deals with the emotional struggle of a family dealing with the shooting death of their teen-aged son. Critical and audience reviews have been very positive.

Returning to his educational roots and love of biology, his latest research is in the

neurobiology of trauma and stress, how our brains respond to traumatic experiences, and what

treatments are most helpful to victims and their families. He hopes that his own personal perspective and unique voice using the latest authoritative scientific discoveries will help victims understand how their brains respond to crisis and inform caregivers how best to help trauma victims in their work. Bill is a professional artist and educator at the college level for over 25 years, he currently teaches and designs for the theatre program at Dominican University near Chicago, IL.

You can buy the book What to do When the Police Leave: A Guide to the First Days of Traumatic Loss. By clicking on the title link.

In this episode, I have a conversation with Anita Brooks about the real human side of grief and death notification. As investigators, we can become hardened and not see the real grief associated with the news we are delivering. We try to sound like we care and have compassion, but is it really coming out the way it should?

The 5 stages of grief and loss are: 1. Denial and isolation; 2. Anger; 3. Bargaining; 4. Depression; 5. Acceptance. People who are grieving do not necessarily go through the stages in the same order or experience all of them

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Learn more about online and classroom training at the links below.

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Her son died in a car accident. The highway patrol came to her house to notify her and her husband of the accident and the death of their child. She states, "I remember them telling me like it was yesterday, but it has been 16 years".

In this episode, I speak to a mother about the night her son died and what went right and what went wrong with the notification process. This conversation gets very real and raw at times and this mother has some great advice for you as to how best to make notification to a loved one.