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Commentary: Medicolegal death investigations from a federal viewpoint

A view of the Armed Forces Medical Examiner System facility is shown July 21, 2017, on Dover Air Force Base, Delaware. Pursuant to a Base Relocation and Closure, the new AFMES facility was constructed adjoined with the Charles C. Carson Center for Mortuary Affairs. Prior to the BRAC, AFMES called Rockville, Maryland, home. (U.S. Air Force photo by Senior Airman Ashlin Federick) A view of the Armed Forces Medical Examiner System facility is shown July 21, 2017, on Dover Air Force Base, Delaware. Pursuant to a Base Relocation and Closure, the new AFMES facility was constructed adjoined with the Charles C. Carson Center for Mortuary Affairs. Prior to the BRAC, AFMES called Rockville, Maryland, home. (U.S. Air Force photo by Senior Airman Ashlin Federick)

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DOVER AIR FORCE BASE, Del. – As many professionals in the industry know, the medicolegal profession can be quite diverse. Some offices are structured as a Medical Examiner system while others operate as a Coroner system or a combination Coroner/Medical Examiner system. Jurisdictions can be confined to a county or extend throughout the state. Most of us have never considered the jurisdiction that reaches beyond the state-level. At the Armed Forces Medical Examiner System, jurisdiction transcends state and even country borders. Operating under title 10 of the United States Code, AFMES conducts forensic medicolegal investigations worldwide. Teams of medical examiners, medicolegal investigators, and photographers are available to respond anywhere in the world at any time.

A view of the autopsy suite is shown August 30, 2017, at the Armed Forces Medical Examiner System on Dover Air Force Base, Delaware. Consistent with the capability of accommodating large numbers of fatalities, the main autopsy suite was designed to provide optimal conditions, whether there is only one examination or more than 20. (Courtesy photo)A view of the autopsy suite is shown August 30, 2017, at the Armed Forces Medical Examiner System on Dover Air Force Base, Delaware. Consistent with the capability of accommodating large numbers of fatalities, the main autopsy suite was designed to provide optimal conditions, whether there is only one examination or more than 20. (Courtesy photo)

AFMES roots go back over 150 years, as an offspring of the Armed Forces Institute of Pathology. Evolving as a tri-service entity, AFIP was originally branded the Army Institute of Pathology, established in 1862 as a repository for “specimens of morbid anatomy.” Essentially a database of diseases, AIP and eventually AFIP, played a vital role in military and civilian medicine through research, education, and consultation.   AFIP functioned as the subject   matter expert for the proper diagnosis and management of infectious diseases and biological toxins. In 1988, the Office of the Armed Forces Medical Examiner was established to augment the AFIP mission by providing scientific forensic investigation into the cause and manner of death of military personnel and some civilians, nationally and globally. Eventually, the Department of Defense DNA Operations and Division of Forensic Toxicology emerged in support of the mission. By 2011, the AFIP was disestablished, leaving OAFME, along with DoD DNA Operations and Forensic Toxicology, a combined entity now known as AFMES. No longer an arm of AFIP, the organization transitioned under the U.S. Army Military Research and Material Command and relocated from Rockville, Maryland, to its new home on Dover Air Force Base, Delaware. In 2015, the organization would undergo more changes as it was ultimately transferred under the Defense Health Agency, a combat support agency serving all branches of the military, where it remains to date.

While AFMES is tasked with and adept at providing multifaceted investigations and recovery for all deaths falling within its jurisdiction, the organization is the subject matter expert for aerospace pathology and military aircraft mishaps. Teams of photographers, investigators, anthropologists, and pathologists are available to deploy at a moment’s notice. In addition to the more traditional aspects of investigation, AFMES conducts mortality surveillance of all military deaths. Tracking and analysis of these deaths uncovers modifiable risk factors and seeks to provide prevention input.  Whether it is identifying a growing trend of a particular death type or analyzing the effectiveness of armor worn by soldiers in combat, AFMES plays a vital role.

Every civilian Medical Examiner or Coroner has its own history to include its own lore surrounding the unsolved or unidentified cases. At AFMES, that tradition looks a little different. Remains are still being recovered and identifications processed in the deaths of those who died in such incidents as the 1941 attack on Pearl Harbor, the 1952 Mount Gannett C-124 Crash, the Vietnam War,  Korean War, World War II, and the Mexican-American War, just to name a few. AFMES has played a critical role in a number of historically significantly incidents in the country, such as the American Airlines Flight 77 crash into the Pentagon. The unique nature of the organization provides its medicolegal investigators with the opportunity to gain knowledge and skill in the investigation of deaths that are rarely, if ever, seen within the civilian sector.

Despite the enormity and gravity of the incidents that AFMES investigates, its medicolegal investigations component is relatively small, especially when compared with its vast jurisdictional territory. There are less than ten medicolegal investigators assigned to AFMES, all of whom hold Diplomat or Fellow status with the   American Board of Medicolegal Death Investigation and possess a combined total of over 80 years of death investigative experience. In addition to keeping active ABMDI status, AFMES investigators must also undergo rigorous and stringent background processes and clearances.

The investigators at AFMES face unique challenges inherent to the military structure and area of responsibility. Perhaps the biggest challenge these investigators face daily is one of logistics. While investigators in other Medical Examiner or Coroner’s offices may drive a few minutes to a few hours to reach their scene, AFMES investigators are tasked with responding globally. Response times range anywhere from a few hours of driving to over a day in an airplane, which demands an enormous amount of coordination from the outset. When a service member dies in a combat theater of operations or even in another country of friendly affiliation, that coordination is compounded. From minor challenges such as time zone differences to more complex issues such as release of jurisdiction from a host nation, the investigators are responsible for ensuring that jurisdiction is properly invoked, that all involved persons are receiving the same communication, and that all necessary parties are present at the appropriate time for AFMES operations, in addition to the typical responsibilities shouldered by investigators in the civilian sector.

While some of these challenges are unique to the investigators at AFMES, many are the same challenges and rewards experienced by medicolegal death investigators nationwide. They are still facing death daily, still speaking with grieving families and still trying to put the puzzle pieces together.

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