++
KEY POINTS IN THIS CHAPTER
Deaths that are sudden and unexpected or deaths that result from complications of injuries, drug toxicity, or chemical exposure must be reported to the medicolegal authority.
Clothing should accompany the body to the medicolegal death investigation agency.
There are exceptions under HIPAA that allow for the release of information after death.
Be cautious of how you interpret postmortem changes; describe what you observe and palpitate using descriptive terms.
If a patient with a remote history of trauma dies, the death should be reported to the medicolegal death investigation agency.
++
According to the Centers for Disease Control and Prevention (CDC, 2014a), the leading cause of death for adolescents and young adults is unintentional injury. This includes car crashes, drug overdoses that are not suicidal in nature, and drowning. Homicide and suicide rank high in this age group also (CDC, 2014a). In older adults, death is usually caused by a disease process such as heart disease, cancer, stroke, or Alzheimer’s disease (CDC, 2014a). However, falls are the leading cause of elderly traumatic deaths.
++
On a daily basis, nurses provide care to patients who die. The cause may be the result of traumatic injuries or a natural disease process. In addition to caring for families who experience the death of a loved one, legal responsibilities must be considered after someone dies. Depending on jurisdiction, nurses may be required to report the death to the medical examiner or coroner. Nurses should be familiar with the laws and the types of deaths that require medical examiner or coroner notification.
++
Death investigation is a subspecialty of forensic nursing. Although there are few forensic nurse death investigators, they fulfill an important role. The death investigation process gathers health and other medical information to determine the circumstances surrounding the death. Many agencies use information about death as part of their daily duties. For example, the prosecutor’s office uses injuries and medical treatment documented in murder trials and other types of court cases. The health department uses stats to track and trend death and how it occurs, such as from overdoses. Product improvement comes from studying deaths or injuries related to consumer products. Forensic nurse death investigators gather information, assess scenes, and assist the medical examiner or coroner with determining the cause and manner of death. Although it may seem tedious to gather the information needed to report a death, this information serves of vital importance for family and communities. The purpose of this chapter is to describe the field of death investigation and the roles of healthcare workers.
+++
DEATH INVESTIGATION SYSTEMS
++
The first thing nurses must determine is the type of death investigation system that operates in their area. The United States has three types of death investigation systems:
++