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Forensic Science, Medicine and Pathology

, Volume 15, Issue 1, pp 31–40 | Cite as

U.S. Medical Examiner/Coroner capability to handle highly infectious decedents

  • Aurora B. LeEmail author
  • Erin G. Brooks
  • Lily A. McNulty
  • James R. Gill
  • Jocelyn J. Herstein
  • Janelle Rios
  • Scott J. Patlovich
  • Katelyn C. Jelden
  • Kendra K. Schmid
  • John J. Lowe
  • Shawn G. Gibbs
Original Article

Abstract

In the United States of America, Medical Examiners and Coroners (ME/Cs) investigate approximately 20% of all deaths. Unexpected deaths, such as those occurring due to a deceased person under investigation for a highly infectious disease, are likely to fall under ME/C jurisdiction, thereby placing the ME/C and other morgue personnel at increased risk of contracting an occupationally acquired infection. This survey of U.S. ME/Cs′ capabilities to address highly infectious decedents aimed to determine opportunities for improvement at ME/C facilities serving a state or metropolitan area. Data for this study was gathered via an electronic survey. Of the 177 electronic surveys that were distributed, the overall response rate was N = 108 (61%), with 99 of those 108 respondents completing all the questions within the survey. At least one ME/C responded from 47 of 50 states, and the District of Columbia. Select results were: less than half of respondents (44%) stated that their office had been involved in handling a suspected or confirmed highly infectious remains case and responses indicated medical examiners. Additionally, ME/C altered their personal protective equipment based on suspected versus confirmed highly infectious remains rather than taking an all-hazards approach. Standard operating procedures or guidelines should be updated to take an all-hazards approach, best-practices on handling highly infectious remains could be integrated into a standardized education, and evidence-based information on appropriate personal protective equipment selection could be incorporated into a widely disseminated learning module for addressing suspected or confirmed highly infectious remains, as those areas were revealed to be currently lacking.

Keywords

Coroners Medical examiners Highly infectious diseases Autopsy Personal protective equipment Forensic pathology 

Notes

Acknowledgments

We would like to extend our gratitude to the members of the National Association of Medical Examiners (NAME) Ad Hoc committee for Bioterrorism and Infectious Disease for their support of this research and distribution of the survey; these members include: second author Erin Brooks (Chair), Paul Chui, Karen Kelly, John Matthew Lacy, Micheline Lubin, Lakshmanan Sathyavagiswaran, Leah Schuppener, Suzanne Utley-Bobak, and Steven White. Additionally, we acknowledge the National Institute of Environmental Health Sciences (NIEHS) Worker Training Program (WTP) Ebola Biosafety and Infectious Disease Response Training UH4 Information, grant number UH4 5ES027055. While the grant funding did not contribute to the development and distribution of this gap analysis survey, the program did highlight the need to explore research in this area. Lastly, we also thank from the University of Nebraska Medical Center: Elizabeth Beam and at Harvard T.H. Chan School of Public Health: Paul Biddinger for their partnership and support.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest to disclose.

Ethical approval

This study was deemed exempt by Indiana University Institutional Review Board (Protocol #1711094822).

Informed consent

Survey participants were informed of potential risks and benefits prior to taking the voluntary survey. This informed consent survey was reviewed by the Institutional Review Board and approved as part of the exemption in the aforementioned protocol number.

References

  1. 1.
    National Institute of Allergy and Infectious Diseases. NIAID emerging infectious diseases/pathogens. 2016. https://www.niaid.nih.gov/research/emerging-infectious-diseases-pathogens. Accessed 20 Jun 2018.
  2. 2.
    World Health Organization. List of blueprint priority diseases. 2018. http://www.who.int/blueprint/priority-diseases/en/. Accessed 29 May 2018.
  3. 3.
    Brouqui P, Puro V, Fusco FM, Bannister B, Schilling S, Follin P, et al. Infection control in the management of highly pathogenic infectious diseases: consensus of the European network of infectious disease. Lancet Infect Dis. 2009;9:301–11.CrossRefGoogle Scholar
  4. 4.
    Lyon GM, Mehta AK, Varkey JB, Brantly K, Plyler L, McElroy AK, et al. Clinical care of two patients with Ebola virus disease in the United States. N Engl J Med. 2014;371:2402–9.CrossRefGoogle Scholar
  5. 5.
    Chevalier MS, Chung W, Smith J, Weil LM, Hughes SM, Joyner SN, et al. Ebola virus disease cluster in the United States--Dallas County, Texas, 2014. MMWR Morb Mortal Wkly Rep. 2014;63:1087–8.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Hewlett AL, Varkey JB, Smith PW, Ribner BS. Ebola virus disease: preparedness and infection control lessons learned from two biocontainment units. Curr Opin Infect Dis. 2015;28:343–8.CrossRefGoogle Scholar
  7. 7.
    Kortepeter MG, Smith PW, Hewlett A, Cieslak TJ. Caring for patients with Ebola: a challenge in any care facility. Ann Intern Med. 2015;162:68–9.CrossRefGoogle Scholar
  8. 8.
    Johnson DW, Sullivan JN, Piquette CA, Hewlett AL, Bailey KL, Smith PW, et al. Lessons learned: critical care management of patients with Ebola in the United States. Crit Care Med. 2015;43:1157–64.CrossRefGoogle Scholar
  9. 9.
    Schwedhelm S, Beam EL, Morris RD, Sebastian JG. Reflections on interprofessional team-based clinical care in the ebola epidemic: the Nebraska medicine experience. Nurs Outlook. 2015;63:27–9.CrossRefGoogle Scholar
  10. 10.
    Herstein JJ, Biddinger PD, Kraft CS, Saiman L, Gibbs SG, Le AB, et al. Current capabilities and capacity of ebola treatment centers in the United States. Infect Control Hosp Epidemiol. 2016;37:313–8.CrossRefGoogle Scholar
  11. 11.
    Isakov A, Jamison A, Miles W, Ribner B. Safe management of patients with serious communicable diseases: recent experience with Ebola virus. Ann Intern Med. 2014;161:829–30.CrossRefGoogle Scholar
  12. 12.
    Uyeki TM, Mehta AK, Davey RT Jr, Liddell AM, Wolf T, Vetter P, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016;374:636–46.CrossRefGoogle Scholar
  13. 13.
    Lowe JJ, Gibbs SG, Schwedhelm SS, Nguyen J, Smith PW. Nebraska biocontainment unit perspective on disposal of Ebola medical waste. Am J Infect Control. 2014;42:1256–7.CrossRefGoogle Scholar
  14. 14.
    Lowe JJ, Jelden KC, Schenarts PJ, Rupp LE, Hawes KJ, Tysor BM, et al. Considerations for safe EMS transport of patients infected with Ebola virus. Prehosp Emerg Care. 2015;19:179–83.CrossRefGoogle Scholar
  15. 15.
    Isakov A, Miles W, Gibbs S, Lowe J, Jamison A, Swansiger R. Transport and management of patients with confirmed or suspected Ebola virus disease. Emerg Med. 2015;66:297–305.Google Scholar
  16. 16.
    Jelden KC, Iwen PC, Herstein JJ, Biddinger PD, Kraft CS, Saiman L, et al. US Ebola treatment center clinical laboratory support. J Clin Microbiol. 2016;54:1031–5.CrossRefGoogle Scholar
  17. 17.
    Jelden KC, Gibbs SG, Smith PW, Schwedhelm MM, Iwen PC, Beam EL, et al. Nebraska biocontainment unit patient discharge and environmental decontamination after Ebola care. Am J Infect Control. 2015;43:203–5.CrossRefGoogle Scholar
  18. 18.
    Centers for Disease Control and Prevention. Guidance for safe handling of human remains of ebola patients in U. S. hospitals and mortuaries. 2015. https://www.cdc.gov/vhf/ebola/clinicians/evd/handling-human-remains.html. Accessed 29 May 2018.
  19. 19.
    Fitzpatrick G, Vogt F, Moi Gbabai OB, Decroo T, Keane M, De Clerck H, et al. The contribution of Ebola viral load at admission and other patient characteristics to mortality in a Medecins sans Frontieres Ebola case management Centre, Kailahun, Sierra Leone, June–October 2014. J Infect Dis. 2015;212:1752–8.CrossRefGoogle Scholar
  20. 20.
    Lehmann C, Kochanek M, Abdulla D, Becker S, Böll B, Bunte A, et al. Control measures following a case of imported Lassa fever from Togo, North Rhine Westphalia, Germany, 2016. Eur Secur. 2017;22:17–00088.Google Scholar
  21. 21.
    Le AB, Witter L, Herstein JJ, Jelden KC, Beam EL, Gibbs SG, et al. A gap analysis of the United States death care sector to determine training and education needs pertaining to highly infectious disease mitigation and management. J Occup Environ Hyg. 2017;14:674–80.CrossRefGoogle Scholar
  22. 22.
    World Health Organization. Ebola Situation reports: Democractic Republic of the Congo. 2018. http://www.who.int/ebola/situation-reports/drc-2018/en/. Accessed 6 Jul 2018.
  23. 23.
    Blau DM, Clark SC, Nolte KB. Infectious disease surveillance by medical examiners and coroners. Emerg Infect Dis. 2013;19:821.PubMedPubMedCentralGoogle Scholar
  24. 24.
    The National Academics: Foresnic Science Needs Committee. Overview of Medical Examiner/Coroner Systems in the United States: Development, Current Status, Issues and Needs. n.d. https://sites.nationalacademies.org/cs/groups/pgasite/documents/webpage/pga_049924.pdf. Accessed 29 May 2018.
  25. 25.
    Sampson BA, Ambrosi C, Charlot A, Reiber K, Veress JF, Armbrustmacher V. The pathology of human West Nile virus infection. Hum Pathol. 2000;31:527–31.CrossRefGoogle Scholar
  26. 26.
    Nolte KB, Feddersen RM, Foucar K, Zaki SR, Koster FT, Madar D, et al. Hantavirus pulmonary syndrome in the United States: a pathological description of a disease caused by a new agent. Hum Pathol. 1995;26:110–20.CrossRefGoogle Scholar
  27. 27.
    Li L, Gu J, Shi X, Gong E, Li X, Shao H, et al. Biosafety level 3 laboratory for autopsies of patients with severe acute respiratory syndrome: principles, practices, and prospects. Clin Infect Dis. 2005;41:815–21.CrossRefGoogle Scholar
  28. 28.
    National Institute of Allergy and Infectious Diseases. Three Decades of Responding to Infectious Disease Outbreaks. 2017. https://www.niaid.nih.gov/news-events/three-decades-responding-infectious-disease-outbreaks. Accessed 29 May 2018.
  29. 29.
    Fitzpatrick G, Decroo T, Draguez B, Crestani R, Ronsse A, Van den Bergh R, et al. Operational research during the Ebola emergency. Emerg Infect Dis. 2017;23:1057–62.CrossRefGoogle Scholar
  30. 30.
    Singh VD, Lathrop SL. Role of the medical examiner in zika virus and other emerging infections. Arch Pathol Lab Med. 2016;141:82–4.CrossRefGoogle Scholar
  31. 31.
    Zaki S, Blau DM, Hughes JM, Nolte KB, Lynfield R, Carr W, et al. CDC grand rounds: discovering new diseases via enhanced partnership between public health and pathology experts. MMWR Morb Mortal Wkly Rep. 2014;63:121–6.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Nolte KB, Shieh W, Zaki SR. Emerging infectious diseases and the medical examiner. 2nd ed. Northfield: CAP Press; 2003.Google Scholar
  33. 33.
    Nolte KB, Hanzlick RL, Pyan DC, Kroger AT, Oliver WR, Baker AM, et al. Medical examiners, coroners, and biologic terrorism. MMWR Morb Mortal Wkly Rep. 2004;53:1–27.Google Scholar
  34. 34.
    Centers for Disease Control and Prevention. Death investigation systems. 2016. https://www.cdc.gov/phlp/publications/coroner/death.html. Accssed 29 May 2018.
  35. 35.
    U.S. Department of Health & human services. Regional Offices. 2015. http://www.hhs.gov/about/agencies/regional-offices/. Accessed 29 May 2018.
  36. 36.
    Centers for Disease Control and Prevention. Recognizing the Biosafety Levels. n.d. https://www.cdc.gov/training/QuickLearns/biosafety/. Accessed 8 Oct 2018.
  37. 37.
    Occupational Safety and Health Administration. Hospital Respiratory Protection Program Toolkit: Resources for Respirator Program Administrators. 2015. https://www.osha.gov/Publications/OSHA3767.pdf. Accessed 29 May 2018.
  38. 38.
    Wenner L, Pauli U, Summermatter K, Gantenbein H, Vidondo B, Posthaus H. Aerosol generation during bone-sawing procedures in veterinary autopsies. Vet Pathol. 2017;54:425–36.CrossRefGoogle Scholar
  39. 39.
    Nolte KB, Taylor DG, Richmond JY. Biosafety considerations for autopsy. Am J Forensic Med Pathol. 2002;23:107–22.CrossRefGoogle Scholar
  40. 40.
    Lindsley WG, Noti JD, Blachere FM, Szalajda JV, Beezhold DH. Efficacy of face shields against cough aerosol droplets from a cough simulator. J Occup Environ Hyg. 2014;11:509–18.CrossRefGoogle Scholar
  41. 41.
    Hon CY, Gamage B, Bryce EA, LoChang J, Yassi A, Maultsaid D, et al. Personal protective equipment in health care: can online infection control courses transfer knowledge and improve proper selection and use? Am J Infect Control. 2008;36:e33–e7.CrossRefGoogle Scholar
  42. 42.
    Miller MJ, Astles R, Baszler T, Chapin K, Carey R, Garcia L, et al. Guidelines for safe work practices in human and animal medical diagnostic laboratories. MMWR Surveill Summ. 2012;6:1–102.Google Scholar
  43. 43.
    Li J, Duan HJ, Chen HY, Ji YJ, Zhang X, Rong YH, et al. Age and Ebola viral load correlate with mortality and survival time in 288 Ebola virus disease patients. Int J Infect Dis. 2016;42:34–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Aurora B. Le
    • 1
    • 2
    Email author
  • Erin G. Brooks
    • 3
    • 4
  • Lily A. McNulty
    • 2
  • James R. Gill
    • 4
    • 5
  • Jocelyn J. Herstein
    • 6
    • 7
  • Janelle Rios
    • 8
  • Scott J. Patlovich
    • 8
    • 9
  • Katelyn C. Jelden
    • 10
  • Kendra K. Schmid
    • 11
  • John J. Lowe
    • 6
    • 7
    • 12
  • Shawn G. Gibbs
    • 1
  1. 1.Department of Environmental and Occupational HealthIndiana University School of Public HealthBloomingtonUSA
  2. 2.Department of Applied Health ScienceIndiana University School of Public HealthBloomingtonUSA
  3. 3.Department of Pathology and Laboratory MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  4. 4.National Association of Medical Examiners (NAME) Ad Hoc Committee for Bioterrorism and Infectious DiseaseWalnut ShadeUSA
  5. 5.Department of PathologyYale School of MedicineNew HavenUSA
  6. 6.Department of Environmental, Agricultural & Occupational Health, College of Public HealthUniversity of Nebraska Medical CenterOmahaUSA
  7. 7.Global Center for Health SecurityUniversity of Nebraska Medical CenterOmahaUSA
  8. 8.School of Public HealthThe University of Texas Health Science Center at Houston (UTHealth)HoustonUSA
  9. 9.Office of Safety, Health, Environment and Risk ManagementThe University of Texas Health Science Center at Houston (UTHealth)HoustonUSA
  10. 10.College of MedicineUniversity of Nebraska Medical CenterOmahaUSA
  11. 11.Department of Biostatistics, College of Public HealthUniversity of Nebraska Medical CenterOmahaUSA
  12. 12.Nebraska Biocontainment UnitOmahaUSA

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