What Really Happens When You Die?

When I first started writing a crime novel, I realised that there were many things that I had no idea about so as I have researched them I have decided to share some of them with you. From the workings of pathologists, police and forensic scientists through to embalmers, cremators and grave diggers.

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I wish you a happy and informative read!

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It's not something we like to talk about much. We may know our local funeral parlour, but do we know what really goes on there? Or what an embalmer actually does? Or how long a cremation takes, and how it works? Rebecca Atkinson and Sarah Tavner talk to the people who handle us after death.

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Dr Clare Gerada 
General practitioner

When you die, you have to have your death certified by a doctor and a death certificate or a cremation certificate issued. If we have had contact with a patient in the previous two weeks and know the cause of death - if someone has been terminally ill, say - we can sign the death certificate immediately. If we haven't seen the patient in the two weeks before their death, or if they have died after being discharged from hospital, then we must report it to the coroner, who may request a postmortem. The coroner may also request a postmortem if drugs or alcohol are suspected, or if there's any suggestion of a violent death. It's my job to say if somebody is dead, not how they died.

What I'm essentially looking for is brainstem activity. The brainstem is the part of the brain where the body's vital functions are controlled - the breathing, the heart, the brain itself; it is the computer room of the body. If that bit of the brain is dead, then the person is essentially dead. You can still have reflex actions, so you may twitch after death.

To certify that someone is dead, you listen to the heart for one minute and feel for a pulse for one minute. You examine for signs of breathing, you look at the pupils to check there is no response to a shining light. If you're not certain, you can rub on the breastbone, which is a very painful procedure: if they are not dead, they'll quickly jump up and say, "That hurt!"

Nowadays there are machine tests for brainstem death that involve connecting up the brain and looking at the activity. Those tests would be done before organ donation.

Rigor mortis is the stiffening of the body, which begins a few hours after death and then after a while starts to reverse. A forensic scientist can estimate the time of death by whether rigor mortis has come and gone.

Most people will die in bed, but of the group that don't, the majority will die sitting on the lavatory. This is because there are some terminal events, such as an enormous heart attack or clot on the lung, where the bodily sensation is as if you want to defecate. Also, many people die on special occasions. People tend to hang on for a birthday or Christmas. I'm not saying that death is psychologically motivated, but there's a sense that people stay alive for these events and their loved ones, and then pass away, so the death rate increases on birthdays and during religious festivals.

When a death is expected, the ideal place for it is at home, in a familiar environment, surrounded by family. But that is becoming a rarer event. What is becoming more common is people being rushed into hospital for what I believe is a more undignified and worse death, in an anonymous room with nurses who are busy. In my view that is a failure of health professionals, because we should be preparing the families of terminally ill people for death, showing them that it doesn't have to be frightening and that they can do it at home. Palliative care is all about making death comfortable - you do not need to die in pain, you can die in a dignified manner. People worry that having a death at home will be horrible and traumatic for the family, but a good death is like a good birth - it is a beautiful event, not at all undignified.

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Dr Rob Jenkins 
Pathologist

Most people who come to me for a postmortem examination will have died from heart disease. In the elderly, strokes and pneumonia are also very common. The young are more likely to die from accidents, suicide or particular types of tumours one gets in youth. If a young person dies, the likelihood of them having a postmortem is high because their death is much more likely to be unexpected. Many older people who die won't have a postmortem because they are likely to have had a known illness that has led to their death.

The first part of a postmortem is an external examination that notes the condition of the patient, any unique identifiers such as tattoos, evidence of recent medical intervention or injuries. Their notes might say "found dead in bed", but you don't know whether they have fallen and banged their head the day before and have a subtle but significant injury, so you are looking out for things like that.

The internal examination starts with an incision from the sternum to the pubic bone. You go through the skin, fat and muscles to expose the rib cage. Then you cut through some of the ribs for access to the upper organs.

When removing the organs you work in three blocks. The thoracic block contains the throat, tongue, lungs, heart and aorta. Then you have the liver, stomach and pancreas in the second block. The final block includes the kidneys, the remainder of the aorta, bowels, bladder and reproductive organs.

The incision doesn't go all the way up to the chin because we don't want anything to be visible to the relatives if they view the body. So, to remove the tongue and windpipe, we work up under the skin from the chest. You loosen the skin up to the jawline, then you can work the blade to cut around the tongue, across the vessels and pull them down under the jaw.

Once you have removed all the organs, you take them to the bench and go through each of the blocks for more detailed analysis. You look for organ weight - a good indication of heart disease will be a big, heavy, often baggy, heart. You look for vessels blocked by clots or fatty deposits. As you slice through the lungs, you are looking to see if there is fluid where there shouldn't be, if there are tumours or evidence of asbestos exposure. If someone had alcoholic liver disease, one might expect a small, shrunken, scarred liver.

Using a scalpel, the mortuary technician will make an incision at the back of the head and lift up the scalp to reveal the skull. A little hand-held saw is used to cut through the skull. The technician will ask you to observe as they take off the skull in case there is something immediately obvious, such as a brain haemorrhage. They will then take out the brain for examination.

Many good things may come from a postmortem. You may find something that is relevant to subsequent generations - say, if a young mother has died and you find a coincidental breast cancer, you would suggest screening for her children.

If you can't find a cause of death from looking at the organs with the naked eye, you take tissue and fluid samples, which are examined under microscopes and submitted for toxicological analysis.

Once you have finished, everything is put back into the body and the incisions are sewn up. It is not possible to re-site the organs into the positions they held in life, but the body is reconstructed as far as possible. It is cleaned to remove traces of fluid or blood. The hair is washed. You complete the cause of death documentation and the body can be released for cremation or burial.

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John Harris 
Funeral director

Once the death has been certified, we'll go to the family's home or hospital to remove the body and bring it back to the funeral parlour. Because of health and safety regulations, we have to be careful with manual handling - using stretchers enables us to slide the body rather than do heavy lifting. If someone is being collected from a hospital, they would probably be in a hospital shroud; if it's a removal from a home, they are more likely to be in nightclothes. People don't have the close family networks they used to. It's more frequent these days for someone to have died alone in their house and not be found for two or three days and sometimes two or three months. We have to go in and remove the body, which can be quite an unpleasant experience.

If a body is left untreated at room temperature, it will deteriorate quickly, so at the funeral parlour it will be put into a refrigerated unit until the death is registered. Then, with the family's permission, the body can be embalmed.

With the Muslim faith, an imam will come in and wash the body and wrap it in an unbleached cloth. Hindu and Sikh families will come and do the washing themselves. If the deceased is male, the male family members will come; if female, it will be the women. After embalming, we will dress the body before placing it in a coffin. It depends on the size of the person, but usually two or three people do the dressing. The family usually provide clothing - a favourite outfit or something apt. African families often provide full robes and headdress, and Chinese families will bring spare clothing to go with the deceased on their journey into the next life. So we dress them and put all the spare clothing around them in the coffin.

If the body has been dead for a while and the skin has deteriorated, you have to be very careful. Often, a person may have had a lot of drips and incisions and certain drugs, which can affect the skin, so the skin may be fragile, almost like paper, or weeping. If this is the case, we dress the body in a plastic bodysuit under their clothes to protect the clothes and prevent leakages. Once the body is dressed, and hair and make-up have been done, the body is placed in the coffin and put in a private viewing room. It can stay there for a day, or longer if required. The longest we've had a body in our chapel is 13 months.

A lot of my work is arranging for bodies to go back to their home abroad. About a fifth of our work is repatriation now because of the cultural diversity of the area we are based in - east London. This requires tropical embalming because the body may be kept for longer. Tropical embalming takes longer and uses stronger chemicals. Ghanaian funerals, for example, can be anything from two months to two years after death. We've had bodies here for three or four months before they've been flown home to Africa for the funeral.

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Karen Koutandos 
Embalmer

The body is brought out of the fridge and removed from the body bag or the sheets in which it has been wrapped. I gently clean the deceased with a formaldehyde or disinfectant spray. The body might be quite clamped with rigor mortis, so I massage the hands and limbs to work it out, then make an incision to raise an artery so I can inject the formaldehyde. I tend to use the brachial artery under the armpit, or the femoral artery in the groin area, to avoid incisions being seen, which can be stressful for the families when they come for a viewing. As the formaldehyde flows through the body, you begin to get colour and a more lifelike appearance. The features will plump out slightly and the deceased will look less drawn.

If a body is going abroad, the strength and amount of fluid used is increased, to ensure preservation and sanitation for a longer period.

After the formaldehyde, I drain the body of blood and fluid from the organs and chest cavity. I make an incision just under the rib cage and insert a metal suction tool, known as a trocar, attached to a suction pump. I then puncture the internal organs to drain the fluid. I remove the contents of the intestines, bowels and bladder, too, as these can give off gases and smell. I don't come into contact with the fluids. It's very clean and tidy. After I have drained the body, I distribute a litre of cavity fluid between the thoracic and abdominal cavities so that all the tissues are saturated and do not smell. Although the bowels will have already been emptied, I put an incontinence pad on the body to protect the clothing and the coffin.

We have to take out pacemakers because they can't go into the crematorium. Usually you are told that the person has a pacemaker that needs to come out, but if you are not, you can see the incision where it has gone in.

Next, I pack the throat and nose with cotton wool to stop fluid seepage. If the deceased doesn't have teeth, I put cotton around the mouth to plump it out a little; if they have dentures, I put them in place. I then stitch the mouth closed from the inside. Sometimes glue is used but I do not like the white residue it can leave after it has dried. I dry the eyes and insert plastic half-moon caps under the lids to help them hold their shape, and a touch of Vaseline helps to hold them closed. If the eyes are not dried, they can give the appearance of having a tear, which may be distressing to the family.

I will wash and style the hair, ensure that the men are shaved and any nasal and ear hair removed. Nails are cleaned and cut. It's a myth that your hair and nails keep growing after you are dead - what actually happens is that your skin retracts, so they appear longer. Even if the family are not planning to view the body, I like to make sure everything is done thoroughly in case they change their minds.

I try to make the face look peaceful because this is the last memory the family will have and I want it to be a good memory. I use very few cosmetics, just enough to take away the "waxy look" that can occur.

Of the bodies that come to the funeral homes I work in, around 90% will be embalmed. The ones that don't will be where the family have refused or the funeral is taking place very quickly. Embalming is an art. The deceased is always treated with respect and I always do the best job I can. I believe that you have to care about what you do. When you stop caring, then it is time to leave the profession.

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Michael Brown 
Crematorium technician

All coffins have a card with a number that is checked against the nameplate on the coffin before cremation. That card goes on the back of the cremator so we can keep track throughout. There is only room for one coffin per cremation chamber, so it's impossible to cremate two people at once.

I often get asked about taking the bodies out and selling the coffins and taking off the brass handles or taking out gold teeth - it's just not done. Everything goes into the cremator. Any metal will melt down and become blackened and mingled with the ashes. You have to be careful with watches, though, because the batteries will explode. The undertaker should have removed any watches before the funeral.

The cremation chamber is fuelled by gas and has to be heated to at least 750C before we can load, or "charge", the coffin. We have to adhere to strict guidelines and everything is logged automatically on the computer - time, date, duration, emissions, smoke levels, carbon monoxide, oxygen levels and the temperature in the different parts of the cremator. The computer prints out a report and every few months these are sent to environmental health.

During the cremation, the coffin burns first, then the flesh and then the organs. After 60 minutes or so, you can look through the spyhole to see how it is going. After 90 minutes, depending on the size of the person, all that is left is the glow of the ashes, no flames. A person with a lot of fat will burn hotter and for longer, up to three hours, whereas a small, frail person may take 80 or 90 minutes.

People think wicker and cardboard coffins are saving the planet, but they burn very quickly instead of creating a slow, even heat like wood. That means you need more heat to cremate the body, so use more gas. It's also more hazardous for us, because they catch alight so quickly and harder on us because we can sometimes see the body through the wicker.

Once there are no more flames, you can stop the cremation and rake it out using a 15ft stainless-steel rake. There are no short cuts. We clean out the cremator every time.

All that is left are the ashes from the body, plus nails and screws from the coffin and any artificial steel joints or metal plates. There may also be some bone fragments left. It tends to be the hip and the shin bones, because they are quite large. There will be more bones if it is a large-framed or young person. Young bones are stronger and reduce less easily. The remains are raked into a steel bin at the bottom of the cremator to cool, before being transferred into a machine called a cremulator, which contains steel balls that grind down the remains into a fine ash. Your ID card goes into the cremulator, along with a plastic urn with your cremation number on it that the ashes fall into at the end. The cremulator filters any artificial joints or metal and these are buried in a deep hole at the back of the crematorium, although we are looking into ways of recycling them.

The cremulator may sound callous, but breaking down the remains is important because if you are going to have a scattering it means the remains can be dispersed as a fine ash rather than as bones, which is less distressing for the family.

We carry out the whole process of cremation and cremulation as if we were doing our own family - with the utmost dignity at all times. It's not right to be slapdash.

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Gary Burks 
Cemetery operations manager

If a person buys a grave plot, they have a choice of that grave being used for anything between one and five people. For a single grave, the law requires that the coffin be buried under at least 3ft of earth, unless the ground conditions are suitable and then the shallowest a coffin can be buried is beneath 2ft 6in of soil. The ideal is light, dry soil, not wet, heavy clay. With a grave for five people, the first person would be buried at 11ft and the next coffin would go in at 9ft 6in and so on. You have to have at least six inches between each coffin in a multiple grave.

If a body were buried illegally in a shallow grave less than 2ft deep, the decomposition rate is only 18 months to three years. That's banking on disturbance by small mammals and insects. Whereas, with a proper burial, with the coffin deep in the ground, the decomposition rate is much slower. The ground conditions affect the decomposition rate. If the coffin is sealed in a very wet, heavy clay ground, the body tends to last longer because the air is not getting to the deceased. If the ground is light, dry soil, decomposition is quicker. Generally speaking, a body takes 10 or 15 years to decompose to a skeleton.

Some of the old Victorian graves hold families of up to eight people. As those coffins decompose, the remains will gradually sink to the bottom of the grave and merge. The coffin at the bottom will often be the first to collapse and may pull down the remains above it.

Graves are dug by machine, where possible. On our new sites, where there is more room, we use a mechanical digger similar to the type you might see on the roads. We are told two days in advance what the coffin size will be. So we tailor the grave to fit.

With a reopened grave, or in a traditional area where you have had to move memorials to get to the grave, you are likely to be digging by hand. With good soil conditions, it's possible to hand-dig a grave in 1½ hours. But I've experienced it taking five hours because of roots or hard ground. A dry summer will make the ground very hard for up to 2ft. A hard frost will mean 6in of ground is frozen solid.

For £27,000 you can buy a vault grave. This is the most expensive grave we have. We excavate a big hole and concrete the sides and bottom and then put brickwork and a landing on the top. Generally, the coffin is encased in concrete - or entombed, as we call it. The coffin can be wood, but it must be sealed, usually using lead or zinc. We do this to stop noxious fumes and because we don't backfill the vault, so if you moved the landing off you could look down and see remains in the grave.

Sometimes we do exhumations. The grave owner must obtain an exhumation licence before we can do this. There have been cases of people who have moved away from the area and wanted to take their loved ones with them, or wanted to transport them back to their roots abroad. Some people have an aversion to burial and decide they would rather have a cremation after all.

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Dean Fisher 
Resomation technician

One of the biggest problems with cremation is the amount of mercury going into the atmosphere and the ecosystem. In Britain, about 16% of the mercury that goes into the atmosphere is caused by cremations. Resomation is a greener alternative to cremation. It uses water, potassium hydroxide and steam heat to dissolve the body. At the moment there are only a few resomation chambers in operation in the world, all of them in the US - ours is at Mayo Clinic, Rochester, Minnesota - but there has been interest from several UK councils and cemeteries about installing them. It does offer people a greener option.

We place the body in a basket with small holes in it and slide the body into the round resomation chamber. Once you've loaded the body, you input the temperature, body weight and duration. We calculate the amount of chemical needed by the size of the body.

Once the body is in the sealed chamber, it is immersed in around 425 to 500 litres of water mixed with around 15 to 20 litres of potassium hydroxide. A coil running though the unit generates steam, which heats all the ingredients to 150C, and then a recirculation pump creates a whirlpool effect that helps the body to dissolve. All the tissue, muscle, hair and nails inside the unit will dissolve. Resomation turns the body back into its original elements. It breaks down the body and neutralises everything, including the chemicals used to preserve the body, such as formaldehyde.

What we're doing is speeding up the natural process of being in the ground, breaking down the body in hours instead of 20 or 30 years. All that is left at the end of a resomation cycle are bone remains and liquid.

Only certain clothing fibres will dissolve during resomation, though. Cotton will not dissolve, silk and wool will. If you had on an outfit that was half wool and half cotton, you'll see cotton fibres left in the basket with the bone shadows at the end.

With cremation, only large bones will be left. With resomation, all the bones are left. Because the body lies in a basket in the resomation chamber, we can lift out the skeleton bone by bone. These are placed under a heat lamp overnight to dry. What we call the bone shadows, which are pure calcium phosphate, sterile and white, are then placed in the cremulator, which turns the bone into a fine powder similar to white flour - more aesthetic for family members than cremation ashes, which are grittier and blackish-brown.

The innocuous fluid left at the end of the process contains what the body is ultimately comprised of - nitrogen, phosphate, proteins, amino acids, salts and sugars. It's got a greenish-brown tint and it flows just like water. This liquid contains no DNA so has no detectable link with the original body. It can be safely disposed of or used on land as a fertiliser if requested.

I don't think resomation will necessarily replace cremation or burial, but I think it will grow in popularity.

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Rebecca Atkinson and Sarah Tavner

First published on Sat 16 Feb 2008 00.12 GMT​ in The Guardian

Post Mortem from Start to Finish

The purpose of the post-mortem is to establish the cause of death, the extent of the victim’s injuries, the presence of any natural disease and to make a factual record of the findings. Furthermore, the pathologist can offer opinions concerning what may have happened at the scene and when death may have occurred.

This enables the investigator to:

• Identify the victim;
• Determine the cause of death and where possible the mode and time of death; • Determine the nature and size of the weapon used and the amount of force used; • Determine the approximate height and stature of the offender.

The pathologist must record full details of the autopsy and document both his or her own actions and those of others that may be significant to the pathologist’s examination.

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Post-Mortem Attendance

Key Roles, the SIO will also need to decide whether any additional persons should attend. While formal identification of the body is normally undertaken by a member of the deceased’s family, the family have no legal right to attend the post-mortem or have other access to the body until it is released by the coroner. A representative of the family may be allowed to attend the post-mortem at the coroner’s discretion.

Finally, the SIO will need to consider whether or not they will attend the post- mortem. In the majority of cases the SIO will wish to be present at the post-mortem examination. This will ensure that the SIO is always involved where there are interpretational issues or findings that could significantly alter the course of the investigation. In some cases the SIO may wish to send their deputy who must be comprehensively briefed regarding their role and the evidential issues. This decision must be weighed against the other strategic issues that the SIO will inevitably be engaged in. The SIO may wish to attend at the start of the post-mortem and then at the end to be briefed by the pathologist.

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Sample Types

The SIO, following discussion with the pathologist and SOCO, determines the exact requirements for obtaining forensic samples, based on the initial crime scene assessment. Routine samples, except when the circumstances of the case demand otherwise or samples have already been taken at the scene, may include:

• Anal, vaginal, oral, penile swabs; • Fingernails;
• Head and pubic hair;
• Blood, urine, stomach contents; • Pre-transfusion blood.

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In circumstances where the initial information is limited, it would be sensible to adopt the maxim ‘if any doubt, obtain all samples’.

When appropriate, the pathologist should try to ascertain whether or not the victim had been sexually assaulted. This includes looking for evidence of buggery. Vaginal or anal swabs should be taken with a proctor-scope or a speculum to prevent challenges to the integrity of the sample. In cases of possible oral sexual contact, mouth swabs and drainage onto the neck or clothing are likely to be more helpful than analysis of the stomach. In the stomach the acid contents are likely to destroy the DNA in semen or dilute it too much for analysis. Mouth swabs should be taken in all cases irrespective of the absence of evidence of sexual activity as this may only come to light at a later stage. It is as important to look for elimination factors as implication factors.

One of the purposes of the post-mortem is to obtain samples for analysis to detect the presence of drugs and poisons, and to ascertain the blood alcohol level. Routine samples obtained during a post-mortem may also include blood, stomach contents, hair, urine, ocular fluid, bile, liver and lungs as well as a visual inspection of the organs. 

The pathologist should make a histological examination of the major organs (assuming that they are not heavily decomposed) in all suspicious deaths. Histology is of value in confirming, evaluating and revising the course of natural disease processes that may have contributed to the cause of the death. Other samples should be taken for histological examination, depending on the circumstances of the case, eg, for the purposes of determining the age of injuries. The reasons for not conducting a histological examination must be fully recorded so that the pathologist is in a position to defend this decision if necessary.

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Recording the Post-Mortem

The SIO, in consultation with the pathologist and other experts, must make a record of all injuries and assess their significance.

While the use of sound-recording is not envisaged, video recording might be useful, depending on the coroner’s wishes and the views of the pathologist. Video recording can be of value to:

• Create as near a complete record of the processes as possible;

• Facilitate further examination of the body in its original state;

• Assist the process of a second autopsy, if one is needed;

• Assist the SIO and the investigation team in understanding crucial elements of

  the post-mortem in specific cases;

• Record the removal of ligatures and other devices from the body, where

  possible. These might be best captured by some form of hand-held camera, either video or still, that can be manoeuvred manually to show precisely how a particular device was applied to the body. Such a video might also assist a virtual reconstruction, where this is subsequently deemed appropriate.

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PATHOLOGY

When still photographs are taken, it is essential to obtain detailed photographic evidence of external and internal injuries. The following general principles apply:

• Photographs, including something to indicate measurement (ie, a scale), should be taken of each injury or group of injuries;

• Photographs should be taken at an angle of ninety degrees to the injury or group of injuries;

• SIOs must ask for specific photographs, the pathologist will certainly do so;

• Where the identity of victim is unknown, consider photographing the victim’s clothing, tattoos, marks and unusual scars. Care must be taken when photographing clothing in the mortuary because of the dangers of contamination; clothing can always be described in detail at the post-mortem

  and photographed after the examination.

  External examination of the body may reveal surface fragments of material that may be trace evidence, such as flakes of paint, glass fragments, fibre, blood, semen or hairs embedded in wounds. Foreign material may also be present under the fingernails and may include hairs, fibres, skin fragments and blood from the attacker. It is essential that these items are correctly photographed, seized, packaged, labelled and retained. Consideration should be given to using the body as an exhibit and sub-exhibiting all samples taken from it in accordance with the process set out in ACPO (2005) Guidance on Major Incident Room Standardised Administrative Procedures (MIRSAP).

  The body should be photographed while fully clothed and particular attention paid to injuries and damage to the clothing. Care must be taken when removing clothing from the victim. The indiscriminate use of scissors to remove clothing should be avoided. Undressing the body should only take place in the presence of the pathologist.

  All clothing should be fully searched and any items found exhibited. Investigators can use body maps to identify the position of injuries, marks, scars and any other distinguishing features. Consideration should also be given to using specialist photography to highlight bruising. If there are a number of bruises or other injuries, the pathologist should give each an identifying number.

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THE POST-MORTEM REPORT

• When the post-mortem examination is complete the pathologist makes a thorough report (which becomes the property of the coroner). The report should be written as soon as possible and within an agreed timescale. The pathologist may make rough notes, sketches and body maps during an examination, although these would not ordinarily be provided to the SIO in addition to the report. Some aspects of the post- mortem, such as examination of the brain, may take up to eight weeks to complete and so delay the final report. In order to allow the MIR to use the information revealed in other aspects of the post-mortem, the SIO should ask the pathologist to provide an interim report. The SIO should, however, be aware that the results of the special tests may significantly alter the findings and hence the conclusions of the final report. In complex cases the pathologist should provide the SIO with a provisional timetable for the production of the final report.

The SIO, or whoever attends the post-mortem examination, should go through the findings with the pathologist at the time of the post-mortem. It is essential that the SIO ensures the pathologist is kept up to date with any investigative developments, even after the report has been produced. If information subsequently revealed by the investigation impacts on the conclusions contained within the post-mortem report, the pathologist should produce a supplementary report incorporating that information and drawing further conclusions.

It is good practice to supply the pathologist with a record of all the exhibits taken, with their relevant exhibit numbers, at the completion of the post-mortem so that an accurate reference can be made to them in the report.

As an overview the post-mortem report should include:

• The information the pathologist received in advance of the autopsy.

• That the data justifying decisions and actions taken at the examination of the scene and the body have been retained.

• Details of all investigations made either personally or by submission to a laboratory for report.

• Conclusions and an explanation for those conclusions. Where unusual features are found but are concluded not to be relevant, the pathologist must explain why the finding has been discounted.

  •The reasoning underlying why, where findings are open to alternative explanations, one particular explanation is favoured.

• The reasoning that supports the conclusions, detailing all the material drawn on to support that reasoning, including reference to pertinent and current literature.

• All samples that have been retained by the pathologist, whether or not these have been assigned police exhibit references.

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INTERPRETING POST-MORTEM RESULTS

• The post-mortem findings represent a vital ingredient of the crime scene assessment process. In addition to the forensic and pathology (hard science) elements to the post-mortem, the opportunity must also be used to collect the soft science elements, ie, the interpretative facts of the post-mortem, for example, by asking ‘What does this injury mean?’

  The pathologist will contribute to the interpretation of the post-mortem results by:

• Attending any conference called by the police or the CPS to discuss the pathologist’s report and/or other issues involved in the case;

• Explaining clearly all the findings and their interpretation in the context of the case;

• Considering alternative explanations, testing alternative hypotheses, drawing conclusions and giving advice based on the facts of the case and established

  scientific principles;
   

PATHOLOGY

• Stating what is required before additional conclusions can be drawn, and demanding that those requirements are fulfilled before any additional conclusions are drawn;

• Identifying, clarifying and summarising areas of agreement and disagreement;

• Requesting feedback to determine whether those involved in the investigation

  understand the outcomes of the consultations. The SIO may wish to explore the following issues:

  • Cause of Death – which injury was responsible for death? If there are multiple injuries, which was the fatal injury? Cause of death? Significance of injuries? Degree of force used?

  • Time of Death – this is vital for setting ‘Relevant Time’, for enquiry parameters. It may prove the suspect could have had access to the victim.

  • Toxicology – blood/alcohol may provide time of death. Is there evidence of victim drug abuse? Was the victim drugged or intoxicated? Stomach contents may give evidence of lifestyle or sequence of events.

  • Level of Attack – likely to give an indication of the nature of the attack, the degree of force used and over what period. Was the victim capable of ‘fight or flight’? How many attackers were there? What was the likelihood of the offender being injured? Did the offender intend to kill? Was there evidence of overkill?

  • Injury Analysis – number and type of injuries. How were the injuries caused? Evidence of defence wounds? Timing of injuries in relation to time of death? Evidence of gratuitous violence? Were injuries caused before or after attack? Are injuries consistent with accounts of witnesses? Is there evidence of bodily contact, eg, bites and scratches?

• Murder Site – evidence that the deposition site was not the murder site?

• Disguise Cause – attempts by the offender to disguise the cause of death.

• Sexual Evidence – what evidence is there of a sexual element to the offence such as rape, oral sex, shaving pubic hair, penile penetration, clothing removal and semen deposits?

  • Weapon Analysis – type of weapon used, number of weapons, weapon found at the scene?

  • Lifestyle – cleanliness of the victim, sexuality, drug user, overall state of health of victim, evidence of recent assaults.

  • Size and Physique of Victim – evidence of being controlled before death? Is it likely that the victim could have posed a threat after being injured? Is the victim right or left-handed? The position of defence wounds may assist. Is the assailant right or left-handed?

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EXHIBITS

Where instances arise of weapons and other articles being found at the scene, these will need to be taken to the mortuary or to the pathologist for inspection. The exhibit must be properly packaged to avoid contamination, but also be clearly visible. A packaged knife must allow the width and length to be measured. The pathologist must sign the exhibit label of any article examined.

Other material may be of mutual interest to the pathologist and the investigative team; it should, therefore, be preserved either at the crime scene or during the post- mortem. Examples of such articles include:

• Ballistic projectiles;
• Extraneous items such as hairs, fibres, blood or semen on the body; • Ligatures (do not cut or undo the knot).

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DEFENCE AND SECOND POST-MORTEMS

When informed that a person may be charged with murder, manslaughter or infanticide, a coroner may agree for a further post-mortem examination by another pathologist. In order to facilitate the early release of the body, if no suspects have been charged or arrested within twenty-eight days of the first examination, a second, independent post-mortem should be conducted in anticipation of any future defence requirements.

The coroner will not usually object to a further post-mortem examination being conducted for, or on behalf of, any person who may have a proper interest – provided that such further examinations are conducted without undue delay and after proper notice has been given to the coroner. In all cases, the coroner should explore whether a second or subsequent post-mortem may be required. The SIO should cooperate with the coroner in meeting requests from the defence for early disclosure, if this will assist the early release of the body.

Whenever a post-mortem is required on behalf of the defence, details of the pathologist acting on behalf of the defence should be given to the coroner without delay. The post-mortem and subsequent release of the body can then be considered. Defence solicitors will need to establish, for example, the nature of the wounds and cause of death. They will also need to examine the post-mortem report, photographs and any other relevant items. Investigators should ensure that this documentation is available, subject to the coroner’s prior approval.

The original pathologist should always be present and, where possible, the SIO or a representative.

Where a sexual motive is suspected, the SIO should expect the forensic pathologist to examine under the skin so as to identify any bruising. Where this has not been done, the SIO should expect a second post-mortem a few days after the original post-mortem to examine for bruising.

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PATHOLOGY

The coroner will decide whether to provide the police with a copy of the report from any secondary post-mortem examinations, but it is normally considered proper to do so. The coroner will retain the second report, and if an arrest in connection with the death is subsequently made, they will provide a copy of the second report to the defendant or their legal representatives.

In the event that significant discrepancies arise between the first and second post- mortem reports, the coroner will, without delay, consider whether to commission a third examination. It will not normally be appropriate to provide a third pathologist with either of the previous reports, or to seek to reconcile the differences between the earlier reports.

The third pathologist should again be independent of the first two pathologists, ie, from a different establishment. As soon as the coroner has decided that no further examination is necessary, the body will be released for disposal by the family or executors.

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RELEASE OF THE BODY

Home Office Circular 30/1999 relates to the release of bodies in cases involving suspicious death. This circular suggests that, subject to the interests of the criminal justice system, it is the responsibility of all agencies to treat the early release of the body as a priority. It should also be a priority for the SIO in helping the family to cope with their grief. This grief may be compounded because of religious beliefs held in certain communities, eg, Muslim and Jewish, if there is any delay in burial after death. There is also likely to be a natural resistance from some communities, in relation to performing a post-mortem examination. This is usually based on religious beliefs particularly in the Muslim community. These matters require a sensitive response from the SIO who should bring them to the attention of the coroner. Further information in respect of this is available from the Commission for Racial Equality.

The SIO should be proactive in pursuing an early resolution of all post-mortem examinations in cases where a suspect has been arrested or charged.

When the post-mortem report is expected to be delayed, the SIO should liaise with the coroner and pathologist. The SIO should consider the following issues when contemplating the early release of a body:

• Whether the identification of the victim is in dispute;

• The evidential value of retaining the body;

• The needs of the investigation;

• The need for a defence or second post-mortem when the identity of the

  offender is unknown.

  When the report is received, the coroner will provide copies of it to all those having a proper interest, including the SIO and any person who has been charged in connection with the death (and to their legal advisers). Any photographic or video recording taken at an examination will also be supplied (these will be made available by the police). The deceased’s next of kin should also be advised that the report is available, if appropriate. See also 16 Family Liaison.

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The coroner will not release the body unless all those having a proper interest confirm in writing that they have no objection to the body being released (other than those proposing to release the body). The coroner will, not less than five days before the proposed release of the body, notify his or her intention to do so in writing to all those persons who have not confirmed that they have no objection to the release of the body.

If the coroner is advised by the SIO that a person is likely to be arrested within twenty-eight days of the discovery of the homicide, they will not release the body until the person is charged, or until the expiration of that period – whichever is the shorter. The coroner will serve, on any person who is charged, a copy of the report of the initial examination and any records of it.

Where the coroner is initially informed that a person may be charged within twenty- eight days of the discovery of the homicide and it subsequently appears unlikely that any person will be so charged, the SIO should inform the coroner at the earliest opportunity.

Families will want to know details of when the deceased will be released for burial. The FLO should facilitate this request, through the coroner’s officer after consultation with the SIO. The coroner has control of the body and decides when it will be released, and the SIO should ensure that the coroner is consulted and advised about the enquiry. When the crime is unsolved, consideration should then be given to asking the coroner to authorise a second post-mortem examination by another Home Office pathologist. This should normally clear the way for the release of the body once a further independent post-mortem examination has been conducted.

In a homicide investigation the question of organ transplants may arise. In such circumstances the SIO needs to consider the implications of a transplant for the investigation, as soon as possible. They should be mindful of the following points:

• In cases of unlawful killing, removal of the organs can only be with the consent of the coroner in whose jurisdiction death occurred.

• There will be a presumption in favour of transplant provided that the coroner is satisfied the organ donation will not prejudice the investigation of an unlawful killing. The interests of justice are paramount.

• The coroner will inevitably consult the Home Office pathologist assigned to the case, to establish that their examination will not be impaired by the removal of any organs.

• The relevance of the removal of an organ should be considered in the context of a second post-mortem examination.

• If a person is charged, no organ transplant should take place without obtaining the views of the defendant or a legal representative.

• The SIO should take a leading role in gathering opinions and assessing the impact of organ removal on the investigation.

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PATHOLOGY

RETENTION OF MATERIAL AFTER AUTOPSY

In the past, unnecessary or ill-considered retention of material removed at autopsy, has caused considerable distress to bereaved relatives. The pathologist must consider very carefully whether such material needs to be retained and for what purpose. At present, in criminal cases, retention is referred to in Rule 9 of the Coroners (Amendment) Rules 2005 which states:

A pathologist shall make provision, so far as possible, for the preservation of material which in his opinion bears upon the cause of death or the identification of the deceased.

The Criminal Procedure and Investigations Act 1996 states that any material obtained in the course of a criminal investigation and which may be relevant to the investigation should be retained until the end of criminal proceedings and following completion of any appeals procedure. In general terms, this may be interpreted as the release from detention of a person convicted of homicide.

Certain organs can only be fully examined if they are retained after the autopsy is otherwise completed. A police representative (eg, a FLO), or the coroner or their officer, should explain the reason for this to the appropriate victim’s relative.

Any materials retained must be kept in secure storage and under suitable conditions. Their whereabouts must be properly recorded and indexed in order to ensure easy access, see ACPO Homicide Working Group (2006) Guidance on Police and Coroners’ Approach to Pathology.

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Information taken from Murder Investigation Manual © ACPO Centrex 2006

Initial Responses from the Police

INITIAL RESPONSE

The actions taken by the first officers attending the scene of a homicide or major incident are critical to the success of the investigation. From the outset, officers should adopt an investigative mentality and approach.

During the initial response it is sometimes difficult to determine if a death is the result of natural causes, an accident, suicide or homicide. If in doubt, investigate as homicide until the evidence proves otherwise.

Initial reports of vulnerable missing persons may also be difficult to assess. Those involved in the initial response should remember that every missing person report has the potential to become a homicide investigation.

Officers should carry out an initial assessment of the incident and send a situation report to the control room which, in turn, will coordinate the deployment of supervisors and additional resources to the incident.

Those making the initial response to an incident should be guided by the following principles which underpin all major investigations:

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Identify Suspects

The Preservation of Life

This is the first responsibility for those initially deployed to the scene. On arrival, the condition of the victim should be assessed and if there is any possibility that they may still be alive, first aid should be applied and an ambulance called.

Applying first aid and removing the victim will involve disturbance of the scene and may destroy material. The following action, can minimise the impact of such disturbance:

• A sketch or series of sketches may assist;

• Observe exact detail of scenes, particularly the location of the victim;

• Identify anything which is moved, noting original and eventual position;

• Try to effect removal with minimum disturbance of the scene;

• Establish a single route into and out of the scene;

• Make an accurate record of these facts and report them to the SIO at the

  earliest opportunity.

  When a victim is moved from the scene to the hospital, the identity of the ambulance crew and details of the hospital, should be established. Ideally, an officer should travel to the hospital with the victim to provide evidence of continuity and to coordinate investigative actions at the hospital. If it is not possible to send an officer from the scene, an officer should attend the hospital at the earliest opportunity.

  Priorities for officers at the hospital, if the victim is still alive:

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Seize the victim’s clothing and other possessions (including mobile phones) as evidence;
Establish the identity of the victim;
Obtain a pre-transfusion blood sample;

Obtain a medical opinion about the victim’s condition;
Obtain details of family, friends or associates who visit the victim, as they may be witnesses or sources of other information;
Subject to medical advice, if the victim is conscious, establish what has happened including details of any suspects (this might be admissible in a subsequent trial as a ‘dying declaration’).

A DYING DECLARATION is when:

• The person making the statement has since died or is in a settled and hopeless expectation of death;

• The statement is to be admitted in a homicide trial; • It relates to the cause of death.

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Priorities for the officers at the hospital, where the victim dies before arrival:

• Treat the victim as a scene;

• Ask the medical staff to leave the victim’s clothing on the body;

• In cases where medical treatment has been given to the victim or there have

  been attempts at resuscitation, request that all connecting tubes, needles,

  plasters and other medical items be left in place;

• If possible, obtain an opinion from medical staff treating the victim as to the

  type of injuries and the cause of death;

• Establish if the victim spoke to anyone before death and make a record of what

  was said.

  Where officers attending the scene consider the victim to be dead, a police surgeon should be called to formally pronounce life extinct. Pathologists and some paramedics can also perform this function.

  Note: There have been cases where police officers believed a victim to be dead, only for police surgeons to discover vital signs of life through medical examination. If in doubt, apply first aid and call an ambulance.

  Where a police surgeon attends prior to an SIO, they should be asked to pronounce life extinct while causing minimum disturbance to the body and the scene.

  Preserve Scenes

  Crime scenes are an important source of material for investigations. Physical evidence, however, can be very fragile and easily destroyed or contaminated. It is, therefore, essential that those involved in the initial response take effective action to maximise the chances of recovering physical evidence. To do this, officers must:

  • Identify; • Secure; • Protect.

  Identify

• The identification of the crime scene is a priority activity.

• Look beyond the obvious, as parameters of a scene may well extend beyond

  where the body is found.

• Identification of routes taken to and from the scene by the suspect and victim is of equal importance.

• Identification of other crime scenes, where there is more than one.

Secure

• Prevent entry (other than to authorised persons such as the scenes of crime officer (SOCO), SIO and police surgeon).

• Ensure that protective clothing is worn by all those who enter the scene.

• Commence a crime scene log 

• Depending on the circumstances, there will always be a wide range of methods available to secure scenes. Some of the most commonly used are:

o Tape – start with a widely defined area to allow the SIO the best chance of securing all available evidence;

o Stationing officers at entry points – beware of contamination issues that may arise if this is used;

o Blocking access by using vehicles; o Road blocks and road diversions; o Temporary fencing.

Protect

Officers should prevent further human or animal disturbance of the scene, but, leave specialist protection such as protection from the weather to the SOCO and other specialists.

 Secure Evidence

In the early stages of an investigation, witnesses are an important source of material. Focused questioning at the crime scene affords an opportunity to secure material by identifying witnesses and other scenes. This should include:

• Obtaining details of all persons at the scene;

• Identifying witnesses and obtaining an initial account from them, including

  descriptions of those they have seen at the scene;

• If they have made telephone calls from the scene, securing the numbers of the

  phones used and those called, as this will assist to verify witness accounts and

  times;

• Recording the index numbers of motor vehicles in the vicinity;

• Obtaining a description of any vehicle seen to leave the scene;

• Seizing any CCTV images that may have recorded relevant events.

  Likely sources of witnesses are:

  • Residents in the immediate vicinity;
  • Passers-by;
  • People working in the area;
  • Family and associates of the victim or suspect.

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The significance of information provided by the person reporting the suspicious death must not be underestimated.

Note: A person reporting a murder may be a significant witness or the offender

Identify Victim

The identification of victims enables investigators to instigate actions which may lead to the early identification of suspects. Those reporting the incident and witnesses found at the scene should be questioned to establish the victim’s identity as soon as possible. No attempt should be made to search the victim’s clothing for identification evidence as this may destroy other physical evidence which could identify the offender.

A record should be made of clothing being worn by the victim together with their physical description.

If the identity of the victim is unknown, a search of missing person records should be undertaken to establish if any of the descriptions match the deceased. Visible tattoos or other physical features may also be used to search local records and the PNC.

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Identify and Arrest Suspects

When homicide is suspected, the identification and arrest of the offender(s) must always be a priority.

Note: Offenders may still be at the scene or may return to it during the initial response.

Where suspects have been identified, the arrest should be made by officers who have not visited any scenes. This will avoid cross-contamination. If this is not possible, for example, if the offender is arrested at the scene by officers who are already there, arresting officers should follow normal procedures for taking suspects into custody but should try to reduce contamination of forensic evidence as much as possible. The fact that the arresting officer has been at the scene should be declared to the SIO as soon as possible.

The suspect should not be questioned in detail about the incident; anything that they say should be recorded as significant statements.

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THE SIO AND THE INITIAL RESPONSE

SIOs are generally called to the scene of an incident following a situation report from those making the initial response. Depending on the nature of the incident, a great deal of activity may have been initiated prior to the arrival of the SIO. The SIO’s first task on being informed of an incident is to review what has been done prior to their involvement and bring the investigation under their command.

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Each force will have its own arrangements for calling SIOs to the scene of an incident, together with out-of-hours cover arrangements. Whatever the nature of these arrangements, the first contact is usually by telephone and this provides the SIO with an early opportunity to review what has been done and to take control of the investigation. The SIO should speak to the person in command of the incident, apprise themselves of the situation and be satisfied that the action being taken is appropriate. They should also:

• Ensure that any instructions they give for the preservation of the scene or other fast-track actions are clear and recorded;

• Consider authorising the deployment of additional or specialist resources where they leave sufficient information to enable a judgement to be made;

•Ensure that the person in charge of the incident has a clear line of communication with them should they wish to confer before taking fast-track action as a result of information that may be received while the SIO is travelling to the scene.

In all but the most unusual of circumstances the SIO should attend the scene as soon as possible and take command of the incident.

On arrival at the scene the SIO should obtain a briefing from the officer in charge of the incident. There is usually a large amount of information to assimilate during the initial response and the SIO is likely to issue verbal actions during this period. SIOs should remember that verbal instructions are more prone to misinterpretation than written ones, particularly in the highly pressured environment of an initial response. They should, therefore, make sure that all instructions are as clear as possible. To ensure that they have accurate records of what they have been told and the actions they have raised, SIOs should consider appointing a loggist. Loggists should keep accurate records of:

• Material received by the SIO, its source and the time of receipt;
• Any observations, decisions or comments which the SIO intends to later include

in their Policy File (as directed by the SIO);
• Actions issued by the SIO, including who they were issued to and the time.

Where it is thought likely that the initial response will be lengthy or complex, SIOs should consider establishing a temporary command team using the resources that are available to them at the scene. This will enable them to manage the various strands of work that will be required to successfully complete the initial response phase of the investigation.

SIOs should review the action taken prior to their arrival. In particular they should:

• Satisfy themselves that the scene parameters are adequate and that the measures taken to protect the scene are effective;

• Assess the number and type of resources that are needed to successfully complete the initial response and initiate their acquisition;

• Instigate any necessary fast-track actions;

• Identify all the staff who have been involved in the initial response, including

  those in the control room, and ensure that they are fully debriefed before they

  go off duty;

• Secure all records made by those involved in the initial response;

• Secure the recordings of telephone messages to the police about the incident;

• Arrange for a Major Incident Room (MIR) to be opened – local force policy will

  govern the location and specification of the MIR and where possible, SIOs should site the MIR near the scene and ensure that it meets the specification outlined in ACPO (2005) Guidance on Major Incident Room Standardised Administrative Procedures (MIRSAP);

• Ensure that the victim’s family are aware of the death and allocate a family liaison officer (FLO);

• Consider issuing a preliminary press release. By informing the press that an incident has occurred and setting a time for a formal press conference in the near future, the media are less likely to seek information directly from the SIO at the scene.

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FAST-TRACK ACTIONS

Fast-track actions are: Any investigative actions which, if pursued immediately, are likely to establish important facts, preserve evidence or lead to the early resolution of the investigation.

Fast-track actions are often used during the first twenty-four hours of an investigation, but they may be required at other key stages, for example, where another scene is discovered, a significant witness is identified, or a suspect is identified.

The process of reviewing and updating fast-track actions should commence from the moment an SIO is informed of an incident, when the SIO first attends the main scenes and as the investigation unfolds.

The fast-track menu shown in Figure 4 is not exhaustive and not all items on it will be relevant in every case. It is intended as a guide to the types of strategies SIOs might want to consider early on in an investigation. Specific details of the type of action required under each item on the menu can be found in the relevant strategic section.

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Taken from Murder Investigation Manual © ACPO Centrex 2006