CORONER IDIOSYNCRASY LIST
PENNSYLVANIA
Allegheny County Medical Examiner Office:
1. On all Allegheny County Medical Examiner cases draw 10 Gray Top Tubes for the Medical Examiner. Draw 1 Red Top and 1 EDTA Purple Top for CORE lab for serology testing.
2. On all Allegheny County Medical Examiner cases that are cornea/eye donors, we will obtain vitreous fluid using the following procedure.
After the cornea is removed and you have checked the lens:
· Insert an 18-gauge needle from the side towards the posterior portion of the eye
· Use two (2) separate syringes and needles
o Utilize one (1) syringe and needle on the left eye and a clean, separate syringe and needle on the right eye.
· Proceed inward and begin to aspirate on the syringe
· Obtain at least one or two cc's of clear vitreous fluid.
If you have caused the fluid to leak while recovering the first cornea and have not collected the required 1-2 cc’s of vitreous for the M.E., do not recover the second cornea. Use the second eye for obtaining vitreous fluid.
Once the vitreous is recovered, it must be placed in a glass container.
· The red top supplied in the eye case is adequate.
· If the red top is unavailable, you must place the fluid in a glass container with no preservatives.
Label glass container as vitreous fluid.
· Specify from which eye (Right/Left) fluid was obtained.
· Include appropriate information; i.e., date/time drawn, as per labeling policy, Volume IX.
· Place the tube into a biohazard bag and tape to the body along with any other specimens for the coroner.
3. Removal of Clothing Pre-Autopsy Recovery:
· Unless the Allegheny County Medical Examiner’s pathologist specifically asks that the clothing of the deceased not be disturbed, CORE staff has permission to do whatever is necessary to perform the recovery procedure.
· If the pathologist specifically asks that the clothing not be disturbed and corneas are allowed to be recovered pre-autopsy, then the recovery coordinator will recover the corneas without disturbing any of the clothing and ensure that blood for CORE serologies will be drawn by the pathologist prior to the autopsy.
4. Location Details
Parking
CORE employees can park behind the ME building in one of the open spaces
On weekends or late evening after hours, you can park in the garage
Entering the building
ACME has issued CORE an electronic key which will allow you to enter the back door of the building/glass door between the garage and access to the Tissue Recovery Suite Room
The Key is located in DRC on the shelf labeled for RC
Obtaining body/Reviewing the chart
Outside the Tissue Recovery Suite is a desk between the Tissue Recovery Suite and one of the morgue doors, pick up the phone and ask for the Supervisor on duty, give he/she the following information
o Identify yourself
o Tell them the Donors name
o Purpose of being there and what you need
The supervisor will bring the chart to you to review
The supervisor will get the body out of the morgue
The coordinator will have to sign the body, belongings etc… out by the method of bar coding, keep this receipt with CORE records
Completion of case
The Recovery Coordinator will make contact with the supervisor on duty
Once the supervisor comes to the Tissue Recovery Suite, you will then sign the body, and any belongings over to them. The supervisor will then give you a receipt that is to be kept with the CORE donor chart
If you obtain any specimens, the supervisor will bar code them and you will receive a receipt that they have signed it in, again a receipt that is to be kept with the CORE donor chart
MISC
Restrooms are located through the autopsy room, and a hallway to the left.
CORE is NOT permitted to walk the premise and will NOT have access to any area other than what is permitted
Bringing in a NON Medical Examiner body
CORE will meet the livery driver in the garage of the ACME upon arrival of the body
Once the tissue case is complete, the RC Coordinator will escort the body from the Tissue Recovery Suite to the garage where they will meet the driver of the livery service
NOTE: In cases where the driver is not yet present when the case is complete, CORE will contact the ACME Supervisor on duty and they will place the body in the morgue designated for CORE bodies. The ACME is not held responsible therefore, CORE is to wait until pick up has been made
NOTE: All biohazard is to be left outside CORE Recovery Suite
Joe Mancuso/Dr Wecht Cases:
Any cases involving autoposy with Joe Mancuso require Joe to be contacted prior to autopsy for request of blood draw. If family declines donation, Joe needs contacted in order for him to discard blood. If family consents, Joe needs notified for disposition of body, and for arrangements on how to pick up the blood.
Blair County Coroner Cases:
Do not recover iliac crest when consent is given for long bones only. Clarify which bones are permissible for recovery.
Always leave a xerox copy of the coroner/medical examiner book. The original booklet comes back to the office and is sent to the coroner with the digital CD Rom of the photos.
If permission is needed on any coroner’s case in Blair County, please provide donor information to the Administrator on Call and they will call the coroner.
CORE Form ADM-4 Last Revision: 4/08, 11/08, 7/20/09, 9/28/09, 12/23/09
Erie County:
Coroner/ME permission on organ cases, please follow steps 1 & 2 below:
1. The CORE coordinator must obtain consent from the family before asking the coroner for permission for donation.
2. Calls either to Dr. Vey or to Lyle Cook need to be elevated to Susan Stuart. She will be their primary contact person.
3. Permission may only be given for abdominal organs on certain cases. In these cases, inquire if the recovering surgeon is permitted to crack the chest. If no permission is given to crack the chest, the recovery of abdominal organs shall occur through an abdominal incision only.
If photographs or a video is requested in Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forrest, Jefferson, McKean, Mercer, Potter, Venango, or Warren Counties, contact Don Dunford at 814-452-2911 (work), 814-898-3610 (home) or pager 814-453-9353. Provide Mr. Dunford the following information:
CORE contact person
Name of the deceased
Cause of death
Hospital
Scheduled operating room time.
Follow OPC Protocol on all potential organ cases in Erie County.
Fayette County Coroner’s Office:
An additional lock will be attached to the body bag on Franklin County Coroner cases. Following a recovery, ensure that this lock is placed on the bag prior to taking the patient back to the morgue. After the lock is attached, a photograph should be taken, confirming that the CORE staff followed procedure.
Franklin County Coroner's Office:
Mr. Jeff Conner receives a copy of the autopsy on all coroner cases in his area.
ORGAN DONORS
- The coroner would like for the coordinators to alert him when they are evaluating a potential donor as soon as they arrive at the hospital so that the coroner’s office has time to conduct an investigation. (both situations should be within the times of 8am and 11pm, unless the situation warrants otherwise) Even if you do not believe the patient is a Coroner’s case, you still need to call.
- The coroner would like the coordinators to refrain from calling him between the hours of 11pm and 8am if possible, unless the situation warrants otherwise - example would be a family wanting to withdraw or a patient that is coding.
- A coordinator should not approach a family for consent until the coroner’s office has completed their investigation and have stated their intentions. If after hours, please check with AOC for approval to approach family.
- If the coroner’s office has not been called by the hospital, the CORE coordinator should make the call to the coroner’s office when evaluating a potential organ donor.
- If the coroner’s office has been called by the hospital and it is determined to be a coroner case: 1. Do not call the coroner-he will call CORE when his investigation is complete. 2. If the coroner has not contacted CORE within 4 hours we are to call him before proceeding.
- The coordinator will fill out the Franklin County Coroner form every time they evaluate a potential organ donor at Chambersburg hospital, which will include details about the evaluation. This form will be faxed to the coroner’s office after each organ evaluation and organ donor case.
On any coroner's case, two (2) red tops along with two (2) gray tops must be obtained.
If the Franklin County Coroner leaves a specimen draw kit with the donor, the recovery staff must provide the samples requested and leave the kit with the body.
Lawrence and Mercer Counties;
Most autopsies will be done by Cyril Wecht and Joe Mancusso
Mercer County:
When evaluating the death of a patient at a Mercer County institution, establish if the death involves the county coroner. Should the coroner release the body, follow SOP. Should the death fall under the jurisdiction of the Mercer County Coroner, obtain consent and donor med/soc history. Then contact the coroner or his designee. Whatever the coroner or his designee decides, those directions/instructions are to be followed.
WEST VIRGINIA CASES:
When there is a hospital case in which CORE is interested, CORE staff will obtain the name and direct phone number of the blood bank worker to allow the FIU investigator to determine if the blood bank has ‘admission’ samples, and if so, estimated total volume, and in what blood tubes (edta, red, green etc).
When CORE needs an admission sample to qualify for submission for serology purposes, the CORE representative will call the FIU investigator and provide the FIU investigator with the information listed above, and will await our authorization prior to CORE accepting custody of case-associated hospital blood samples, or any portion thereof. Authorization for release of any autopsy case related materials must come solely from the pathologist on call, obtained through FIU consultation.
In cases where in-hospital death is suspected due to intoxication, or is unexplained, or when death is the result of a homicide: Dr Kraner asks for a minimum of 10 mls. of admit blood sample to adequately address toxicology inquery into the cause and manner, or other forensic issues.
In cases of explained in-hospital deaths, where no charges will be filed, such as clearly self-inflicted GSW: the OCME need for admit blood is to be considered relative to case particulars, CORE needs and nature of donation process – with organ donation for transplant purposes given primacy.
In cases where the pathologist, following autopsy case consultation, considers it necessary to refuse to authorize CORE utilization of admit blood samples, referral must be first made to the Chief or First Deputy Chief prior to contacting the CORE representative.
Other Notes:
CORE WILL NOT recover iliac crests on any tissue donor that is a ME/Coroner or autopsy case unless the recovery will take place post autopsy. If a donor is not a ME/Coroner or autopsy case, the iliac crest can be recovered.
DO NOT place or leave any sharp objects inside, outside, or in the immediate area of the donor body.
Notify the OR staff when an organ recovery is a ME/coroner case. A needle and sponge count must be performed on all ME/coroner cases.
If Charleston Mortuary is furnishing transportation of a body and further information needs to be relayed to the driver, contact Jim Lowery. Always do a tight closure.
Dr. Kaplan prefers speaking directly to the coordinator/administrator on call rather than obtaining information from the deputies.
Medical Photographers:
On all West Virginia Medical Examiner/Coroner cases, send CD of pictures to the West Virginia Medical Examiner’s Office.
A. Dr. Kaplan:
The Charleston Medical Examiner’s Office will forward all calls to the State Police Department Dispatch between the hours of 12:00 Midnight and 8:00 a.m. Ask to speak to the investigator-on-call.
Dr. Kaplan retains the option of coming to ICU before recovery can begin. We will make his travel arrangements and arrange the time for his convenience.
Tissue Donors: Send specimens directly to the ME office by C & H. Do not leave specimens with the body. If an insufficient amount of pre-transfusion blood is available, have it spun down and provide the ME office with 20 cc. Contact the Administrator on Call if dealing with pre-transfusion blood specimens on any organ and/or tissue donor in West Virginia.
CORE Form ADM-4 Last Revision: 4/08, 11/08, 7/20/09, 9/28/09, 12/23/09