Trauma in the Emergency Room

1. The Medical Examiner Perspective Trauma in the Emergency Room

2. Case Synopsis: David Gunby11-12-2001 @ 1030 hrs • Nurse- I’m calling to report the natural death of a patient due to renal failure. The doctor at the hospital will sign the death certificate. • Investigator- How long has this person been on dialysis? • Nurse- 35 years. • Investigator- What happened 35 years ago to require dialysis? • Nurse- Oh, he was shot and lost a kidney. • Investigator- Shot where? • Nurse- In his back.

3. Who investigates the death?

4. The Tarrant County Medical Examiner’s Office obtains it’s authority from the Texas Code of Criminal Procedure 49.25.

5. Death of a person within 24-hours of admission to a hospital Death of a person in prison or jail Any unnatural death (Homicide/Accident) Unattended or not witnessed death Unknown cause or circumstances surrounding death Suspicious deaths Suicide Unattended death (home deaths without medical staff present) All deaths of children under 6 y.o.a. Type of deaths to be investigated by the ME office

6. When should medical staff report the death? • State law CCP 49.25, section 7 states that any death falling under the previously listed circumstances “shall immediately” be reported to the ME office. • A delay in reporting the death could jeopardize the police and ME investigation. • Failure to report a death in a timely manner puts undue stress on family members.

7. Reporting the death3 things to have ready • Death has been pronounced • Preferably, next of kin is still present at the hospital to answer any additional questions • Have available the EMS run sheet, hospital admit cover sheet and your paperwork

8. Reporting the deathCalling the Medical Examiner • Call 817-920-5700, extension 1 to report a death. • Incoming calls are answered by a field investigator or investigative clerk. • The amount of time spent reporting a death depends on how well you are organized and how complex the death is.

9. Is trauma or foul play involved? • What is trauma? • What is foul play?

10. It’s all in the detailsThe Who, What, Where, When, Why & How • Who- is reporting the incident, who is dead, who is the next of kin • What- occurred • Where- did the incident take place and where is the decedent • When- did the incident occur and when was the person pronounced • Why- did they die? Diagnosis or injury details • How- were they identified, how did they arrive at the hospital, how do you get in touch with the family

11. Location in the hospital where the death occurred. Location where the original incident occurred. Location of incidentWhere is the crime scene?

12. Next of kin • Locate next of kin through prior hospital visits, personal property or friends. • Assist with identifying the decedent. • Obtain or confirm medical history. • Obtain incident details. • Explain hospital and medical examiner protocols. • Locate or provide emotional support

13. Case Direction

14. Jurisdiction Case • All cases where the Medical Examiner’s office assumes custody of the case and the decedent. • Body will be transported to the ME office for an examination which can be up to and including a full autopsy. • Prepare body by leaving all medical intervention in place and following hospital protocols. • Copy paperwork for ME review.

15. Health Insurance Portability & Accountability Act of 1996 • Commonly referred to as HIPAA • Primarily deals with insurance details • Has no bearing in death investigations & does not apply to Medical Examiner office • Sec. 1178(a),(2)(B)(b): “Public Health- Nothing in this part shall be construed to invalidate or limit the authority, power, or procedures established under any law providing for the reporting of disease or injury, child abuse, birth, or death, public health surveillance, or public health investigation or intervention.”

16. Jurisdiction Waived Case • Reportable deaths to the Medical Examiner’s office under CCP 49.25 in which jurisdiction is not retained. • Natural deaths where a physician will sign the death certificate based on medical history or diagnosis. There is no trauma or foul play suspected in the death. • The decedent is sent to a funeral home with no further action by the ME office. • The police are not normally involved.

17. Police department and crime scene officer involvement • Trauma, foul play or suspicious deaths should always be reported to the law enforcement jurisdiction where the incident occurred. • Some agencies will respond to the hospital to photograph the decedent and interview witnesses. • Homicide or gunshot victims should have their hands bagged in paper sacks to preserve evidence. • All clothing should be preserved and either turned over to the crime scene officer at the hospital or sent with the body to the ME office • Property removed by EMS or hospital staff will not be transferred to the ME office.

18. Organ / Tissue Donation • Hospitals are required to also report the death to the local organ / tissue procurement group. • Victims qualify medically and must have family approval. • The ME office must be notified of the organ / tissue request as soon as possible. In most cases requests are approved by the pathologist. An exception to the approval would be if the approval could effect pending criminal litigation. • ME investigators usually respond to the hospital to photograph the decedent prior to the donation and obtain blood/urine samples.

19. Case Synopsis: David Gunby11-12-2001 @ 1030 hrs • Nurse- I’m calling to report the natural death of a patient due to renal failure. The doctor at the hospital will sign the death certificate. • Investigator- How long has this person been on dialysis? • Nurse- 35 years. • Investigator- What happened 35 years ago to require dialysis? • Nurse- Oh, he was shot and lost a kidney. • Investigator- Shot where? • Nurse- In his back.

20. Case Synopsis: David Gunby11-12-2001 @ 1030 hrs • Investigator- No, where was he shot as in address or location? • Nurse- Oh, in Austin, TX. • Investigator- (Thinks: year 2001 minus 35 years = 1966. Victim shot in back, 1966, in Austin, TX.)

21. On August 1, 1966 Charles Whitman began a shooting spree from the UT Austin tower killing sixteen and wounding thirty-one. One of those wounded was David Gunby. David was one of the first people shot but survived his wound until 2001 when he died in Fort Worth. His death was ruled a Homicide.