Mary H. Dudley, M.D. Death and Accident Investigation Protocols Death and Accident Investigation Protocols Mary H. Dudley, M.D. Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2013 by Mary H. Dudley, M.D. CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20130507 International Standard Book Number-13: 978-1-4665-5689-8 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents The Author vii Introduction ix Death and Accident Investigation Protocols 1 Death and Accidents 1 Form 1.1 Aircraft accident report 1 Form 1.2 Alcohol-related death report 3 Form 1.3 Blunt-force injury report 5 Body Examination 6 Form 1.4 Case label 6 Form 1.5 Case communications log 7 Form 1.6 Report on child fatality—abuse or neglect 8 Form 1.7 Child/infant death—investigation checklist 14 Form 1.8 Natural death, motor vehicle accident, suicide 17 Form 1.9 Death report—general 19 Death Reporting Form 23 Form 1.10 Investigator information form 23 Form 1.11 Drowning report 24 Form 1.12 Drug overdose report 27 Form 1.13 Report of death from electrocution 30 Form 1.14 Evidence release form 33 Form 1.15 Report on death from exposure 34 Form 1.16 Report on death from a fall 36 Form 1.17 Report on death from fire 41 Gunshot 44 Form 1.18 Report on death from gunshot/shotgun 44 Form 1.19 Wound key for description of injury 53 Hanging Strangulation 54 Form 1.20 Report on death by hanging 54 Form 1.21 Report on death by hanging/description chart 58 Homicide 59 Form 1.22 Report on death from homicide 59 Hospice/Hospital 64 Form 1.23 Hospice report of death 64 Form 1.24 Report on hospital death—natural 66 Form 1.25 Report on hospital death—surgical 68 Heat/Cold Death 72 Form 1.26 Report on potential heat-related death 72 Form 1.27 Heat death report—final 74 Form 1.28 Report on potential cold-related death 75 In Custody Death/Infectious Diseases/Lightning Strikes 76 Form 1.29 Report on in-custody death 76 Form 1.30 Report on death from infectious disease 77 Form 1.31 Infectious disease—reportable conditions 78 v © 2010 Taylor & Francis Group, LLC vi Contents Form 1.32 Inquiries report 80 Form 1.33 Report on death from lightning strike 81 Medication List 83 Form 1.34 Decedent’s medication list 83 Form 1.35 Medications, chemical agents, drugs, and paraphernalia list 84 Motor Vehicle Accident—Driver/Passenger 85 Form 1.36 Motor vehicle accident death report 85 Form 1.37 Motor vehicle accident death report—pedestrian 88 Natural and Nursing Home Death 91 Form 1.38 Report on natural death 91 Form 1.39 Nursing home report of death 93 Occupational Exposure 95 Form 1.40 Occupational exposure report 95 Form 1.41 Occupational fatality report 97 Organ and Tissue Donor 98 Form 1.42 Organ and tissue donor information report form 98 Form 1.43 Organ and tissue donor referral form 101 Photo Report 102 Form 1.44 Photo report 102 Poison and Toxic Substances 103 Form 1.45 Death from poison and toxic substances 103 Form 1.46 Report on death from poison and toxic substances 105 Sexual Assault 106 Form 1.47 Sexual assault death report 106 Sharp Force Injury 108 Form 1.48 Sharp-force injury 108 Form 1.49 Report on death from sharp-force injury 110 Skeletal Remains 111 Form 1.50 Report on skeletal remains 111 Specimen Collection 114 Form 1.51 Specimen collection form 114 Suicide 115 Form 1.52 Report on death from suicide 115 Form 1.53 Suicide risk worksheet 117 Unidentified Body 118 Form 1.54 Report on unidentified body 118 Form 1.55 Unidentified body consultation request 120 Form 1.56 Unidentified body worksheet for positive ID 121 © 2010 Taylor & Francis Group, LLC The Author Mary H. Dudley, MD, MS, RN, is the chief medical examiner for Jackson County, Missouri. She is board certified in anatomic and forensic pathology by the American Board of Pathologists. She completed a 2-year fellowship in forensic pathology at the University of New Mexico following a 4-year anatomic and clinical pathology residency at Penrose Hospital in Colorado Springs, Colorado. Previously, Dr. Dudley was the chief medical examiner in Sedgwick County, Kansas, and medical examiner for Maricopa County in Phoenix, Arizona. Dr. Dudley has been active in the field of forensic medical investigation for many years. She developed the first forensic nursing program in Colorado in 1994 and the first Forensic Medical Investigation (FMI) training course in 1996. Dr. Dudley is a member of the following associations and committees: • National Association of Medical Examiners • American Academy of Forensic Sciences • International Association of Forensic Nurses • Registered diplomate of the American Board of Medicolegal Death Investigators vii © 2010 Taylor & Francis Group, LLC