# Unknown Cause of Death



## emtsteve87 (Nov 18, 2008)

Today both crews get toned for a cardiac/respiratory arrest, PD already dispatched. Upon arrival, LEO is standing outside the door awaiting us. We ask him why he isn't doing CPR, he replies, "Your call, guys." We ask where the patient is, find out he is in the bathroom, the medic and I get in there and see the patient laying in a large pool of blood, most is already coagulating.  The medic calls obvious death and asks for a coroner to get there. The LEO goes to get paperwork and a camera as this is a possible crime scene. He gets back to the room and asks a few of us to assist him in moving the patient so he can get a picture of his face. We do and while doing so, we check for any signs of serious trauma, the only thing we find is a lac above the right eye, about 3cm x 1cm. The bathroom is only about 5ft x 3ft, and the floor was covered, part of the tub was covered, the pts shirt was soaked, and a floor mat was soaked with blood, most of which is coagulated. Pt is in rigor, we try to check the oral cavity to see if he vomited the blood, no blood in the mouth, none around the anal region. The head lac was only a few layers of skin deep. No signs of suicide, no information other than name, and a few meds-mainly acid reflux, arthritis; no cardiac or antidepressants or diabetic meds. So my question is, how could he have died, causing that much blood?


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## Sapphyre (Nov 18, 2008)

Aspirin bottles?  Alcoholic?  No warfarin or coumadin. What arthritis meds exactly?  Sounds like some sort of blood thinners were involved.


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## mycrofft (Nov 18, 2008)

*Wound penetrating to a intracerebral artery or Circle of Willis?*

Pt heart would have continued to pump out lots of blood unless the cardiac or respiratory regulatory centers were hit. Any signs of struggle, bullet holes in window walls etc., GSR on pt or surroundings? Splatter? 
Maybe fell headlong into plumbing or other fixture?

Tell us more about this 1 X 3 (1/2 by 1.5 inch approx) "lac".


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## reaper (Nov 18, 2008)

Also, Never let the LEO move the body! Once you confirm death, nothing else should be touched, until the coroner gets there to investigate. I would guess that the officer knew that and had you move pt, so he could deny touching him!!

As far as COD, we could all speculate, but that is what the ME is for!


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## mycrofft (Nov 18, 2008)

*And how exacly is one to restrain the LEO from moving a corpus?*

...but document, and insist (even if impotently) that he document, that EMS did not move that body. Make a statement into the radio mike to be recorded when it occurs despite your strong suggestion.

The crime scene is the LEO's, and once life is no longer in jeopardy (or the EMS life IS), you have lost whatever degree of input you had into her/his absolute control of the scene. Although wrong, if he sits the decedent up with a teacup in one hand and the pinkie raised, interference can get you handcuffed on the spot (although later vidicated, albeit not if you physically impede the officer).

(I'm taking a sheriff's dept course right now and happend to review that workbook. Knew it would come in handy here!).


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## reaper (Nov 19, 2008)

It is very different here. Even at a crime scene with a death, if EMS is called to confirm death, they control the scene. EMS is responsible for the body till the coroner shows up. We do have the authority to tell the LEO's to stay out.

Usually I will confirm death, with LEO as a witness. Then we both back out of the house and wait for the coroner to come. Most LEO know the rules. Sometimes you have to piss off a rookie that wants to snoop around the scene.

Here the coroner investigators have the authority to arrest any LEO, that contaminates a scene.


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## EMERG2011 (Nov 19, 2008)

Probably either on thinners or was a hemophiliac. Based on location, my only guess is that he tore the frontal branch of the facial artery all to h-e- double L.


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## emtsteve87 (Nov 19, 2008)

The arthritis meds he was on were Enbrel, Aspirin, and Relafen. Other than those, nothing else that we could find. No gunshot holes in windows or walls or splatter that would indicate a GSW. The head lac we didn't really delve into because thats all it was, a small head lac with dried deep red blood on it that looked as if it had bled at some point. We did take into account blood thinners when we found the aspirin, but as far as hemophilia, we didn't think about it. The LEO needed the body moved so that he could at least try to get a picture of the pt's face for a possible ID to get age and family. Again, we had found NO information about the pt except for the pill bottles.


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## mycrofft (Nov 20, 2008)

*Silly LEO. Sounds like a layperson, not a cop.*


Actually any way it's served he is a dumbunny. The ME will take pictures for ID. 
And , once again, the old "Who's in charge" deal.


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## Level one trauma (Nov 28, 2008)

emtsteve87 said:


> Today both crews get toned for a cardiac/respiratory arrest, PD already dispatched. Upon arrival, LEO is standing outside the door awaiting us. We ask him why he isn't doing CPR, he replies, "Your call, guys." We ask where the patient is, find out he is in the bathroom, the medic and I get in there and see the patient laying in a large pool of blood, most is already coagulating.  The medic calls obvious death and asks for a coroner to get there. The LEO goes to get paperwork and a camera as this is a possible crime scene. He gets back to the room and asks a few of us to assist him in moving the patient so he can get a picture of his face. We do and while doing so, we check for any signs of serious trauma, the only thing we find is a lac above the right eye, about 3cm x 1cm. The bathroom is only about 5ft x 3ft, and the floor was covered, part of the tub was covered, the pts shirt was soaked, and a floor mat was soaked with blood, most of which is coagulated. Pt is in rigor, we try to check the oral cavity to see if he vomited the blood, no blood in the mouth, none around the anal region. The head lac was only a few layers of skin deep. No signs of suicide, no information other than name, and a few meds-mainly acid reflux, arthritis; no cardiac or antidepressants or diabetic meds. So my question is, how could he have died, causing that much blood?


In region XI (Chicago), once the patient has been deemed a D.O.A. (per region XI Policy and Procedures) no further examine of patient or scene is necessary. EMS crew could be sited with obstruction, and or contamination of a potential crime scene. Any further investigation of the body or scene would be ill advised and at the crew's own discretion.
As for the C.O.D. of this patient, there was no mention of the complete exposure of the patient's body; there could have been trauma to the body that went un-noticed in the initial exam of the patient. You made no mention of a rapid trauma assessment having been performed, therefore C.O.D. could only be based on those injuries actually seen.


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## Sasha (Nov 29, 2008)

MAYBE it wasn't his blood and someone bled all over the place and left? :O I don't know.. Just throwing it out there, sounds like he was on blood thinners or asprin


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## Ridryder911 (Nov 29, 2008)

In my area most EMS are not even called or definitely cancelled while enroute. LEO are taught to declare death (check carotid) and EMS is not needed on obvious D.O.A. therefore less people to pollute the potential crime scene. 

R/r911


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## BossyCow (Nov 29, 2008)

I had a call similar to this except the guy wasn't dead yet. Family found him in bed in the morning laying in about a 2 foot diameter pool of clotting blood. Seriously.. looked like the guy's head was resting on a big pile of raw liver. Turns out a minor lac to his head and coumadin combined to create the mess.


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## ttoude (Dec 25, 2008)

anything in the toilet?


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## DR_KSIDE (Dec 29, 2008)

reaper said:


> Also, Never let the LEO move the body! Once you confirm death, nothing else should be touched, until the coroner gets there to investigate. I would guess that the officer knew that and had you move pt, so he could deny touching him!!
> 
> As far as COD, we could all speculate, but that is what the ME is for!



For all of those non LEO people, the ME or Coroner is NOT LE, the LEO has every right to move or adjust the vic, it is HIS or HER crime scene, as long as he or she took photos prior to any adjustment and the adjustment was minor. He or She should wait before adjusting, but it can be done. The only thing that the ME does is make note on the cause, and unless it is obvious from the scene, they won't find out the cause until autopsy.


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## reaper (Dec 29, 2008)

DR_KSIDE said:


> For all of those non LEO people, the ME or Coroner is NOT LE, the LEO has every right to move or adjust the vic, it is HIS or HER crime scene, as long as he or she took photos prior to any adjustment and the adjustment was minor. He or She should wait before adjusting, but it can be done. The only thing that the ME does is make note on the cause, and unless it is obvious from the scene, they won't find out the cause until autopsy.



You need to check state laws where you live.

In our state, the coroner and the deputy coroners have ultimate control over a death scene. They are the first to investigate it. Once they are done, then they will allow the forensic team to collect evidence and have the BTS take the body.

They also have full authority over any and all LEO. They have the power to arrest any LEO that compromises a death scene and yes, they have arrested an LEO for doing just that.

If it is a natural death, then the Paramedic handles it. We fill out the coroners report and confirm death on scene. If we call the family MD and they are willing to sign the death certificate, then we have family call the funeral home to pick up the body. If the family MD doesn't want to sign, then we call the coroner and let them know what is up. They will then release the body for pick up.

So, the best thing you can and should do is know your state and local laws on this. I have worked states where the LEO does all of the death scenes and have worked ones set up like this one. You just need to know the chain of command for this.


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## BossyCow (Dec 29, 2008)

The lines on this are blurred in our area. There is a deputy sheriff who serves as coroner. The ME conducts the actual autopsies and determines cause of death. Our ME is never on scene and the coroner must be called on all in home deaths other than those with a previously recorded notice of impending death or where Medical Personel are present (ie doc or hospice nurse)


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## mycrofft (Dec 30, 2008)

*Bossy, you mean the CSI guys and gals don't make arrests!?*

Say it isn't so!:sad:


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## daedalus (Dec 30, 2008)

Murder scenes are traditionally the purview of Law Enforcement. In my area, and as I thought everywhere, local police department detectives have ABSOLUTE control over the scene. They get the first look at the body and CSI teams employed by the same department photograph it. The coroner is just a meat wagon to pick the body up and bring it to the ME. They have no authority.

It just doesn't even make sense any other way. Cops deal with murders, no any one else. Dead bodies are a police matter.


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