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What is a Coroner? No specific training required No specific training required Must be at least 25 years old Must be at least 25 years old Live in the same county Live in the same county Elected position Elected position Never convicted of a felony Never convicted of a felony There are 159 counties in Georgia – The GBI Medical Examiners handle 153 counties There are 159 counties in Georgia – The GBI Medical Examiners handle 153 counties
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Cobb County Medical Cobb County Medical Examiner’s OfficeExaminer’s Office
Presented by Presented by Michael GerhardMichael Gerhard
Operations ManagerOperations Manager
What is a Medical What is a Medical Examiner?Examiner?
A medical doctorA medical doctor Board Certified Forensic PathologistBoard Certified Forensic Pathologist 13 years of school…after high school!13 years of school…after high school! Appointed position by county Appointed position by county
CommissionCommission 4 Counties in Georgia have Medical 4 Counties in Georgia have Medical
Examiners - Cobb, Gwinnett, Dekalb, Examiners - Cobb, Gwinnett, Dekalb, FultonFulton
What is a Coroner?What is a Coroner? No specific training requiredNo specific training required Must be at least 25 years oldMust be at least 25 years old Live in the same countyLive in the same county Elected positionElected position Never convicted of a felonyNever convicted of a felony There are 159 counties in Georgia – There are 159 counties in Georgia –
The GBI Medical Examiners handle The GBI Medical Examiners handle 153 counties153 counties
Georgia Death Georgia Death Investigation Act Investigation Act
(O.C.G.A. 45-16-20)(O.C.G.A. 45-16-20)
When are Deaths reported?When are Deaths reported? Caused by violenceCaused by violence Suddenly when in Suddenly when in
good healthgood health Unattended by a Unattended by a
doctordoctor Suspicious or Suspicious or
unusual, particularly unusual, particularly to those 16 years to those 16 years old and youngerold and younger
After birth but After birth but before age of 7before age of 7
In custody of state, In custody of state, county, or city penal county, or city penal institution / Policeinstitution / Police
When unconscious When unconscious upon arriving to the upon arriving to the hospital or dying hospital or dying within 24 hours of within 24 hours of admissionadmission
As a result State As a result State execution / death execution / death penalty (Butts penalty (Butts County)County)
Who works at the Who works at the Medical Examiner’s Medical Examiner’s
Office?Office?
The current Chief Medical The current Chief Medical Examiner isExaminer is
Dr. Brian Frist.Dr. Brian Frist.
He was an associate M.E. with He was an associate M.E. with Dr. Burton for Cobb, Dekalb, and Dr. Burton for Cobb, Dekalb, and Gwinnett Co. from 1989 to 1999.Gwinnett Co. from 1989 to 1999.
Forensic InvestigatorsForensic Investigators Currently 4 on staffCurrently 4 on staff Representative of the Medical ExaminerRepresentative of the Medical Examiner Trained in death investigation, previous Trained in death investigation, previous
law enforcement backgroundlaw enforcement background Liaise with police, hospitals, families, Liaise with police, hospitals, families,
media, etc.media, etc. Can provide official time of deathCan provide official time of death Testify in court proceedingsTestify in court proceedings
Forensic TechniciansForensic Technicians Currently 2 on staffCurrently 2 on staff Background in funeral or health servicesBackground in funeral or health services Assistant to the Medical Examiner in the Assistant to the Medical Examiner in the
lablab Removes organsRemoves organs Documents all findings (ie: photos, Documents all findings (ie: photos,
drawings)drawings) Collects evidenceCollects evidence Takes x-raysTakes x-rays
Manners of DeathManners of Death NaturalNatural – death by natural physiological – death by natural physiological
changes (i.e. cancer, diabetes, hypertension)changes (i.e. cancer, diabetes, hypertension) AccidentAccident – death due to negligence, – death due to negligence,
disaster, or the elements (i.e.: traffic disaster, or the elements (i.e.: traffic accidents, overdoses, falls, exposure, accidents, overdoses, falls, exposure, storms,)storms,)
SuicideSuicide – death caused by self – death caused by self HomicideHomicide – death caused by another– death caused by another UndeterminedUndetermined – death when a manner is – death when a manner is
not readily apparent even after a thorough not readily apparent even after a thorough examination and investigationexamination and investigation
Manner, Cause, MechanismManner, Cause, Mechanism Person accidently shoots a man Person accidently shoots a man
during hunting.during hunting. Hiker dies from hypothermia.Hiker dies from hypothermia. Person overdoses on heroin.Person overdoses on heroin. Person overdoses on prescription Person overdoses on prescription
under doctor care.under doctor care. Person drowns.Person drowns. Person dies of meningitis. Person dies of meningitis.
Cause of DeathCause of Death The The process that produced process that produced the the
mechanism of death mechanism of death Ex:StabbingEx:Stabbing
Mechanism-Mechanism- actual physiological actual physiological change that causes death change that causes death
Ex: Exsanguination (bleeding out)Ex: Exsanguination (bleeding out)
Common MechanismsCommon Mechanisms Asphyxia (changes due to lack of Asphyxia (changes due to lack of
oxygen)oxygen)
Leading Causes of death Leading Causes of death U.S.U.S.1. Heart disease 1. Heart disease
2. Cancer 2. Cancer 3. Cerebrovascular diseases (stroke) 3. Cerebrovascular diseases (stroke) 4. Chronic Obstructive Pulmonary Disease (COPD; Bronchitis, 4. Chronic Obstructive Pulmonary Disease (COPD; Bronchitis,
Emphysema)Emphysema)5. Accidents (unintentional injuries) 5. Accidents (unintentional injuries) 6. Diabetes mellitus 6. Diabetes mellitus 7. Alzheimer’s disease 7. Alzheimer’s disease 8. Influenza and pneumonia 8. Influenza and pneumonia 9. Kidney disease 9. Kidney disease 10. Septicemia (Blood Infection)10. Septicemia (Blood Infection)11. Suicide 11. Suicide 12. Chronic liver disease (Cirrhosis) 12. Chronic liver disease (Cirrhosis) 13. Hypertension (High Blood Pressure)13. Hypertension (High Blood Pressure)14. Parkinson’s disease (Affects Motor skills) 14. Parkinson’s disease (Affects Motor skills) 15. Homicide 15. Homicide National Vital Statistics Reports Volume 58, Number 19 May 20, 2010: Data for 2007National Vital Statistics Reports Volume 58, Number 19 May 20, 2010: Data for 2007
Leading Causes of Death for Leading Causes of Death for U.S. Youth 15-19U.S. Youth 15-19
1. Unintentional Injury (Accidents)1. Unintentional Injury (Accidents)2. Homicide2. Homicide3. Suicide3. Suicide4. Cancer4. Cancer5. Heart Disease5. Heart DiseaseNational Center for Health Statistics National Vital Statistics Reports March 7, 2005National Center for Health Statistics National Vital Statistics Reports March 7, 2005
The Autopsy
External Exam Photographs Clothing Valuables X-rays Evidence Drawings Documents the external findings
Autopsy Forms
Autopsy
Surgical Dissection Remove and weigh each organ Dissect and examine each organ Documents the internal findings
ORGANS Heart Lungs Liver Spleen Kidneys Pancreas Gastrointestinal tract Brain
Heart
Heart
Lungs
Liver
Spleen
Kidneys
Pancreas
Brain
Post Post MortemMortem
ChangesChanges
LividityLividity Settling of blood due to gravity.Settling of blood due to gravity. Most cases becomes visible within 30 Most cases becomes visible within 30
minutes to two hours.minutes to two hours. If the body’s position is changed, two If the body’s position is changed, two
patterns of lividity could develop.patterns of lividity could develop. Helpful in determining if body has Helpful in determining if body has
been moved.been moved. Cherry red coloration in Carbon Cherry red coloration in Carbon
Monoxide (CO) deaths.Monoxide (CO) deaths.
Lividity
Rigor MortisRigor Mortis Stiffening of the muscles caused by Stiffening of the muscles caused by
chemical changes.chemical changes. Starts in smallest muscles (eyelids, face, Starts in smallest muscles (eyelids, face,
neck, fingers) neck, fingers) Peaks at 12 to 24 hoursPeaks at 12 to 24 hours Leaves after 36 hoursLeaves after 36 hours Little usefulness in determining time of Little usefulness in determining time of
death but helpful in determining position death but helpful in determining position at deathat death
DecompositionDecomposition First external signFirst external sign - Green discoloration over the - Green discoloration over the
right lower abdomen (24hrs to 2 days)right lower abdomen (24hrs to 2 days) BloatingBloating – Expansion of body cavities caused by gases – Expansion of body cavities caused by gases
and chemical release of - ammonia, hydrogen sulfide, and chemical release of - ammonia, hydrogen sulfide, mercaptans, methane, phosphoric and sulfuric acids.mercaptans, methane, phosphoric and sulfuric acids.
PurgePurge - Contents of the respiratory and GI tract exiting - Contents of the respiratory and GI tract exiting orifices as a result pressure. orifices as a result pressure.
Skin slippageSkin slippage – Epidermis separates from the dermis. – Epidermis separates from the dermis. MarblingMarbling - Pattern resulting from bacterial gases - Pattern resulting from bacterial gases
mixing with blood in the superficial blood vessels.mixing with blood in the superficial blood vessels. MummificationMummification - Extreme dehydration, occurring in a - Extreme dehydration, occurring in a
dry environment which can be warm or cold.dry environment which can be warm or cold. SaponificationSaponification - transformation of fatty tissues into - transformation of fatty tissues into
adipocere or graves wax. Not common. Seen in adipocere or graves wax. Not common. Seen in bodies immersed in water or buried. bodies immersed in water or buried.
Early Decomposition
Marbling
eMedicine
Advancing Decomposition
eMedcine
Skin Slip
Traffic AccidentsTraffic Accidents
Don’t be in a hurryDon’t be in a hurry
ALWAYSALWAYS wear your seatbelt wear your seatbelt
Driving and alcohol do not Driving and alcohol do not mixmix
Determining time of death:Determining time of death: Ocular fluid- potassium level in Ocular fluid- potassium level in
vitreous humor in eyes rises after vitreous humor in eyes rises after deathdeath
Gastrointestinal tract:Gastrointestinal tract: Stomach- contents digested and Stomach- contents digested and
emptied within 2-4 hoursemptied within 2-4 hours Small intestine- food further digested Small intestine- food further digested
and absorbed, 2-3 hours (4-8 hours and absorbed, 2-3 hours (4-8 hours total time)total time)
Large intestine-waste 12-24 hours (20-Large intestine-waste 12-24 hours (20-30+ hours total time)30+ hours total time)