Trauma in the Emergency Room

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Trauma in the Emergency Room

• The Medical Examiner Perspective

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Case Synopsis David Gunby11-12-2001 _at_ 1030 hrs

• Nurse- Im 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.

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Who investigates the death?
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The Tarrant County Medical Examiners Office
obtains its authority from the Texas Code of
Criminal Procedure 49.25.
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Type of deaths to be investigated by the ME office

• 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.

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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.

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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

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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.

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Is trauma or foul play involved?

• What is trauma?
• What is foul play?

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Its 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

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Location of incidentWhere is the crime scene?

• Location in the hospital where the death
  occurred.
• Location where the original incident occurred.

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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

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Case Direction
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Jurisdiction Case

• All cases where the Medical Examiners 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.

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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.

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Jurisdiction Waived Case

• Reportable deaths to the Medical Examiners
  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.

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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.

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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.

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Case Synopsis David Gunby11-12-2001 _at_ 1030 hrs

• Nurse- Im 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.

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Case Synopsis David Gunby11-12-2001 _at_ 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.)

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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.