The Department of Justice's (DOJ) Office of Justice Programs (OJP) and the Department of Health and Human Services (HHS) established this Medicolegal Death Investigation (MDI) Federal Interagency working group (MDI-WG) to coordinate Federal initiatives to strengthen the MDI system and support death investigation services practiced by medical examiner and coroner offices (ME/Cs) across the United States. The MDI-WG commenced in March 2018, is co-chaired by senior leadership from OJP and HHS, and builds upon the work of prior Federal MDI working groups.
The MDI-WG's mission is to identify both short- and long-term goals to develop and implement programmatic activities that support the MDI system, that in turn, support Federal public safety and public health national initiatives and strategies. Activities may include:
- Developing technologies/systems to facilitate information/data sharing between ME/C offices; toxicology laboratories; and Federal, State, and local entities, with specific focus on combating the opioid crisis;
- Addressing the shortage of forensic pathologists;
- Coordinating MDI research priorities;
- Strengthening drug death investigations;
- Strengthening drug death data reporting mechanisms; and
- Supporting post-mortem toxicology screening and analysis, particularly for novel synthetic drugs.
OJP: Jonathan McGrath, Ph.D., M.S.F.S., National Institute of Justice (NIJ), Senior Policy Analyst, Office of Investigative and Forensic Sciences (OIFS), (acting co-chair)
HHS: Chris Jones, PharmD., M.P.H., Senior Advisor and Director of Strategy and Innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
Jonathan McGrath, Ph.D., M.S.F.S, National Institute of Justice (NIJ), Senior Policy Analyst, Office of Investigative and Forensic Sciences (OIFS)
Margaret Warner, Ph.D., Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS)
Current Federal MDI Activities and Resources
The following Federal programs and grant-funding opportunities support MDI activities. The table of contents links to program-specific information below.
Table of Contents:
- DEPARTMENT OF JUSTICE (DOJ)
- DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
- NATIONAL TRANSPORTATION SAFETY BOARD (NTSB)
- NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY (NIST)
- U.S. CONSUMER PRODUCT SAFETY COMMISION (CPSC)
- U.S. DEPARTMENT OF TRANSPORTATION
OJP/HHS MDI-WG BACKGROUND INFORMATION
Given that several Federal agencies rely on MDI data generated by State and local agencies, the Office of Science and Technology Policy (OSTP) National Science and Technology Council (NSTC) chartered a MDI Fast-Track Action Committee (FTAC) working group in 2015. This Committee was chartered to identify and recommend strategic policy measures that could be implemented to improve the quality, uniformity, and availability of MDI data and to maximize the utility of the data for Federal purposes. The FTAC MDI-WG's work resulted in the report "Strengthening the Medicolegal Death Investigation System: Improving Data Systems (September 2016)".
A subsequent MDI working group was formed in 2016 by OSTP/NSTC in coordination with DOJ and HHS to:
- Enable broad interagency consideration of MDI recommendations for the accreditation of ME/C offices and certification of MDI personnel, and
- Consider additional ways to strengthen the MDI system based on exchange of information and discussion of MDI-related science and technology needs among the agencies.
The work of this MDI-WG resulted in the report "Strengthening the Medicolegal-Death-Investigation System: Accreditation and Certification— A Path Forward (December 2016)".
The current OJP/HHS MDI-WG includes representation from several of the Federal agencies that participated in the first two working groups.
Department of Justice
Death Investigation: A Guide for the Scene Investigation
This NIJ study, initiated in 1996 and updated in 2011, was designed to identify, describe, and assemble a set of investigative tasks that should and could be performed at every death scene. These tasks serve as the foundation of the guide for death scene investigators. The guide gathered input for national and international organizations and subject matter experts who are responsible for the investigation of death and its outcomes. Click here for access to this report.
Strengthening the Medical Examiner-Coroner System Program
The Strengthening the Medical Examiner-Coroner System program is a competitive grant program launched by NIJ in FY2017 designed to support the enhancement of MDI services and increase the supply of forensic pathologists nationwide.
Through this program, NIJ will support grants in two focus areas by:
- Supporting forensic pathology fellowships, and
- Providing resources necessary to achieve accreditation.
Paul Coverdell National Forensic Science Improvement Grants Program
The Paul Coverdell Forensic Science Improvement Grants program (the Coverdell program) awards grants to States and units of local government to improve the quality and timeliness of forensic science and medical examiner/coroners' offices services. Funds received under the Coverdell program can be used 1) to improve the quality and timeliness of forensic science and medical examiner/coroner services; 2) to eliminate a backlog in the analysis of forensic evidence; 3) to train, assist, and employ forensic laboratory personnel as needed to analyze forensic evidence; 4) to educate and train forensic pathologists; 5) to fund MDI systems to facilitate accreditation of medical examiner and coroner offices and certification of medicolegal death investigators; and 6) to address emerging forensic science issues and emerging forensic science technology.
Furthermore, the Coverdell program made funds available in FY2018 and FY2019 in both the Formula and Competitive funding opportunities to specifically target the challenges of the opioid crisis. The solicitations note: The alarming proliferation of heroin and synthetic opioids like fentanyl have had a crushing effect on many crime laboratories. Synthetic opioids in particular may be more difficult to analyze than traditional opiates, and validating methods for new drugs as they emerge may significantly slow processing of these samples. Medical examiners and forensic pathologists have also been overwhelmed with the volume of autopsies as a result of heroin and synthetic drug-related overdose deaths. To address these issues, NIJ plans to allocate approximately 57 percent of available funds to specifically target the challenges the opioid abuse crisis has brought to the forensic science community.
Research and Development in Forensic Science for Criminal Justice Purposes Program
NIJ's Research and Development in Forensic Science for Criminal Justice Purposes program directs the findings of basic scientific research; research and development in broader scientific fields applicable to forensic science; and ongoing forensic science research toward the development of highly discriminating, accurate, reliable, cost-effective, and rapid methods for the identification, analysis, and interpretation of physical evidence for criminal justice purposes. NIJ addresses this through supporting projects that will 1) increase the body of knowledge to guide and inform forensic science policy and practice, or 2) lead to the production of useful material(s), device(s), system(s), or method(s) that have the potential for forensic application.
This program's goals are:
- Fundamental/Basic Research Goal: Improve the understanding of the accuracy, reliability, and measurement validity of forensic science disciplines.
- Applied Research Goal: Increase knowledge or understanding necessary to guide criminal justice policy and practice related to the forensic sciences.
- Development Goal: Produce novel and useful materials, devices, systems, or methods that have the potential for forensic application for criminal justice purposes.
Through the NIJ Forensic Science Technology Working Group (TWG), NIJ reaches out to the forensic science practitioner community to identify, discuss, and prioritize operational needs and requirements. These needs and requirements help inform NIJ's planned and ongoing research and development activities, and ensure that future research and development investments meet practitioner-driven needs. For more information and updates on identified needs and requirements, please visit: Forensic Science TWG: Operational Requirements.
Research and Evaluation in Publicly Funded Forensic Laboratories Program
The Research and Evaluation in Publicly Funded Forensic Laboratories program funds projects that direct the findings of research and evaluation toward identifying the most efficient, accurate, reliable, and cost-effective methods for the identification, analysis, and interpretation of physical evidence for criminal justice purposes. These findings can also be used to inform the forensic community of best practices through the evaluation of existing laboratory protocols and can have a direct and immediate impact on laboratory efficiency and assist in making laboratory policy decisions.
As part of this program, applicant laboratories and ME/Cs are encouraged to consider funding a postgraduate (master's or doctorate) fellowship as part of their proposal. Labs that are interested in connecting with postgraduate researchers and the anticipated lab research projects are listed here: Connecting Postgraduate Researchers with Publicly Funded Forensic Laboratories. Examples of research projects include toxicology, crime scene investigation and processing, crime scene documentation, and controlled substances. Postgraduate researchers are encouraged to reach out to these labs to express your interest, provide background information, and to assist the laboratory in preparing an application.
- FY 2018 "Research and Evaluation for the Testing and Interpretation of Physical Evidence in Publicly Funded Forensic Laboratories" solicitation and awards
- FY 2019 "Research and Evaluation for the Testing and Interpretation of Physical Evidence in Publicly Funded Forensic Laboratories" program information and awards
Forensic Technology Center of Excellence (FTCoE)
The NIJ Forensic Technology Center of Excellence (FTCoE), led by RTI International and supported through a Cooperative Agreement from NIJ, supports the implementation of new forensic technology and best practices by end users in the criminal justice community. FTCoE is dedicated to elevating the status of forensic science through advancing technology, sharing knowledge, and addressing challenges.
The FTCoE webpage, Pathology & Medicolegal Death Investigation has specific resources such as webinars, reports, and other information for disaster victim identification, medicolegal death investigation, pathology, and anthropology.
FToCE developed the "Opioid Crisis—A Public Health Enemy Webinar Series" in 2017–2018 that brings a multifaceted perspective to how diverse criminal justice disciplines are addressing these challenges; sharing their knowledge; and advancing science, technology, and law.
In 2018, NIJ and FTCOE convened a Medicolegal Death Investigation Stakeholders' Meeting, which resulted in the Strengthening the Medical Examiner–Coroner System Through NIJ-funded Programs Final Report. This meeting included a diverse group of stakeholders from across the United States to gather information on strengthening medicolegal death investigations (MDI) nationally. This meeting sought to (1) begin a formal dialogue and engage with the MDI community to better understand how NIJ can assist with high-priority needs, (2) identify solutions to help with challenges encountered by MDI stakeholders, and (3) inform NIJ's programs and initiatives based on the needs of the MDI community. The report generated from this meeting provides an overview of the meeting, its objectives, and topics discussed, including NIJ's programs to address the community's needs, NIJ's program to fund R&D in forensic science, and the National Missing and Unidentified Persons System (NamUs).
NIJ and the FTCOE hosted the 2019 National Opioid and Emerging Drug Threats Policy and Practice Forum on July 18-19, 2019 in Washington, D.C, and recording of the proceedings will be archived on the FTCOE event page. This event focused on Strengthening Forensic Response and Informing Public Safety and Health and included several panel presentations and explored ways in which government agencies and programs, law enforcement officials, forensic laboratory personnel, medical examiners and coroners, researchers, and other experts collaborate to respond to problems associated with drug abuse and misuse. This Forum discussed the impact of the opioid crisis and operational solutions to addressing: crime laboratory caseloads that are rapidly expanding; workforce shortages, safety, and resiliency programs; analytical challenges associated with fentanyl analogs and drug mixtures; laboratory quality control; surveillance systems to inform response; and issues driving policy related to stakeholder, research, and resource constraints.
"Novel Psychoactive Substances (NPS) Discovery Toolkit for Designing and Implementing Testing for New and Emerging Psychoactive Drugs" The purpose of the toolkit is to help experienced toxicologists navigate the process of deciding 1) how to update their NPS analytical scope; 2) how to design and optimize analytical methods; 3) how to validate methods efficiently and in line with recommended best practices; and finally 4) how to implement some strategies for interpretation when these drugs appear in casework.
Best Practices Guidance for Advancing Research Initiatives and Combatting the Synthetic Drug Epidemic Webinar Workshop Series (archived): The NIJ FTCOE partnered with the Center for Forensic Science Research and Education to deliver a series of three online workshops in July 2018. These workshops provided insight into the challenges forensic laboratories face with respect to analysis and interpretation of findings involving novel psychoactive substances (NPS). Each workshop runs approximately four hours long and provides resource materials, and promote a better understanding for the forensic science practitioner community about evidence-based best practices regarding the synthetic drug epidemic. The series focuses on topics such as cross-discipline information sharing, stakeholder outreach, diagnosis and treatment, and cause-of-death determinations.
The following three sessions are part of the workshop series:
- Session I: The Synthetic Drug Crisis — Identifying NPS in Forensic Casework
- Session II: Analysis of NPS — Practical Considerations and Analytical Approaches
- Session III: Interpretive Toxicology for NPS in Forensic Casework
National Missing and Unidentified Persons System (NamUs)
Funded by NIJ and managed in partnership with the University of North Texas Health Science Center's UNT Center for Human Identification, the National Missing and Unidentified Persons System (NamUs) brings together law enforcement, medical examiners, coroners, forensic experts, families, and the public to help resolve missing and unidentified person cases throughout the nation. NamUs provides criminal justice users a secure, online system to store, share, and compare sensitive case information, and a public component allows family members and other public stakeholders a mechanism to report cases and participate in the search for potential matches. As of September 2019, the NamUs database currently contains:
- Over 34,000 reported missing person cases – 18,502 cases have been resolved,
- Over 16,000 reported unidentified person cases – 3,930 cases have been resolved, and
- 6,287 cases of unclaimed decedents identified by name but whose next of kin have not been located for death notification.
Research and Evaluation on Drugs and Crime Program
NIJ supports the Administration's efforts to combat drug trafficking, markets, and use of illegal drugs―including prescription drug diversion― through research and capacity building for law enforcement, forensic laboratories, medical examiners and coroners, prosecutors, and other public safety and public health stakeholders. NIJ's Drugs and Crime Research Portfolio furthers DOJ's priorities, such as to combat the Nation's opioid epidemic, and reduce violent and other drug-related crime, through research that promotes effective law enforcement, court, and corrections responses to illegal drug markets. This includes research on ways to deter, investigate, and disrupt drug markets, as well as to prevent or reduce drug-related crime and violence. Projects range from policy analyses of the impact of marijuana and other drug legislation on the criminal justice system, to prosecutor led diversion programs, and veterans and other problem solving courts, designed to reduce relapse and recidivism with cost savings.
FY 2017 awards issued under the Drugs and Crime program include the following:
- Cuyahoga County, Ohio, Heroin and Crime Initiative: Informing the Investigation and Prosecution of Heroin-Related Overdose. Evaluates a Heroin-Involved Drug Investigation protocol (HIDI) that guides medical examiners and law enforcement in evidence collection and preservation to improve manslaughter prosecutions of drug dealers after an overdose death. The purpose is to improve the HIDIs ability to secure faster indictments and successful manslaughter prosecutions of drug dealers after an overdose death.
- Toxicological Time Travel: Retrospective Datamining of Analytical Time-of-Flight Mass Spectrometry Data for Evaluating the Rise and Fall of Novel Opioid and Fentanyl Analog Use in the United States. Uses data mining project to examine archived toxicology results from suspected drug-related deaths and drug-impaired driving cases originating from 40 states since January 2016, producing time-course trend reports and geographic distribution heat maps that detect emerging opioids and other drug combinations.
- This project, conducted by the Center for Forensic Science Research and Education, began documenting the first known reports of novel psychoactive substances (NPS) in the United States through analysis of biological fluids in May 2018. Reports are intended to assist the forensic science community in the rapid identification of NPS in casework and complement a project for NPS discovery from seized materials, supported by the DOJ Organized Crime Drug Enforcement Task Force.
- Reports and updates from The Center for Forensic Science Research and Education (CFSRE). CFSRE has developed emerging drug reports and interactive tools to provide forensic practitioners, researchers, public health officials, and other notable stakeholders with real-time actionable data pertaining to the identification and proliferation of NPS.
- Delaware Opiate Metric Intelligence Project. Addresses the need for timely drug intelligence and community surveillance capabilities required by law enforcement, medical examiners, and other agencies by developing a platform that integrates Prescription Drug Monitoring Program data with drug-related crime, drug overdose, and other potential drugs and crime indicators.
- Identifying and Informing Strategies for Disrupting Drug Distribution Networks: An Application to Opiate Flows in Pennsylvania. Studies heroin, fentanyl, and other drug distribution networks in urban and rural Pennsylvania counties to maximize law enforcement and community efforts to disrupt the supply of illegal opioids.
FY2018 awards issued under the Drugs and Crime program include the following:
- Building Drug Intelligence Networks to Combat the Opioid Crisis in Rural Communities: A Collaborative Intelligence-Led Policing Strategy - Develops a data driven sampling mechanism for mentoring collaborations between narcotics law enforcement agencies that promote innovative opioid drug market intelligence models through locally-controlled initiatives in jurisdictions that lack surveillance and interdiction technologies or advanced intelligence analytics.
- Novel Quantitation Workflow for Improved Drug Surveillance - Builds a protocol for collection of actionable, real-time quantitative forensic drug chemistry information that may be used to support investigations and prosecution strategies, connect related cases, project drug use trajectories, and identify potential overdose spikes with medical examiner's office.
- Illegal Marijuana and Drug Related Violent Crime in North Texas - Explores illegal marijuana markets and violent crime from the perspective of a Southwest Border jurisdiction, where high-potency marijuana products are increasingly trafficked compared to Mexican marijuana, and law enforcement need actionable data-driven research to conduct targeted interdiction and develop evidence-based intelligence via the U.S. Postal Service, online cryptocurrency and darknet websites.
- Using Artificial Intelligence Technologies to Expose Darknet Opioid Traffickers - Addresses the growing online participation of drug traffickers by designing and developing an intelligent system (AlphaDetective) that leverages artificial intelligence technologies to automate data analysis and participant linking between the darknet and the surface net (e.g., social media) for timely investigative leads to law enforcement.
Census of Medical Examiner and Coroner Offices (CMEC)
The Census of Medical Examiner and Coroner Offices (CMEC) is a census of all publicly funded offices conducting medicolegal death investigation (MDI) in the United States. The first CMEC was conducted in 2004. NIJ is coordinating with BJS and OJP/HHS MDI working group members to ensure the survey instrument accurately reflects current activities and initiatives in the MDI and forensic sciences since the 2009 National Academy of Sciences report. The CMEC data collection began in June 2019 and is currently active. It gathers information on staffing, budgets, caseloads, resources, policies, and procedures of medical examiner and coroners' offices. BJS made the award to the Research Triangle Institute (RTI) in October 2017.
Prescription Drug Monitoring Program Training and Technical Assistance Center (PDMP-TTAC)
The Prescription Drug Monitoring Program (PDMP) Training and Technical Assistance Center (TTAC) provides an array of services, support, resources, and strategies to PMDPs, Federal partners, and other stakeholder to further PDMP efforts and effectiveness in combating the misuse, abuse, and diversion of prescription drugs. TTAC maintains a website with extensive information concerning PDMPs around the country. The website contains detailed profiles on each State PDMP; training and technical guides; presentations from TTAC-hosted conferences and webinars; profiles on BJA grantees; and information about interstate data sharing, including the RxCheck Hub. In addition, TTAC maintains a database of PDMP information detailing the contacts, policies, technological capabilities, and links to each State's laws and regulations.
Prescription Monitoring Program Center of Excellence at Brandeis, Notes from the Field: "Drug-Related Deaths in Virginia: Medical Examiner Use of PMP Data"
Recommendations for Building Collaborations with Prescription Drug Monitoring Programs and Medical Examiners/Coroners (2019). In August 2018, the Prescription Drug Monitoring Program Training and Technical Assistance Center (TTAC) and the Institute for Intergovernmental Research (IIR), with support from the U.S. Bureau of Justice Assistance (BJA), hosted a national meeting bringing together ME/C and PDMP administrators as well as representatives from national ME/C organizations and several federal agencies to better understand state and local needs. An increasing number of ME/Cs use decedents' PDMP data to assist in determining whether and to what extent prescription drugs caused or contributed to an individual's death. The experience of ME/Cs with PDMPs indicates that PDMP data can assist in many phases of forensic investigations, both in the lab and in the field. PDMPs also can play a valuable role in assisting ME/Cs in tracking and mitigating the drug abuse epidemic. In addition, ME/C data can help PDMPs identify decedents and provide critical information to identify trends in both licit and illicit drug use.
Comprehensive Opioid Abuse Program (COAP)
The purpose of the Comprehensive Opioid Abuse Program (COAP) is to provide financial and technical assistance to States, units of local government, and Indian tribal governments to plan, develop, and implement comprehensive efforts to identify, respond to, treat, and support those impacted by the opioid epidemic. There were six application categories in the FY 2018 COAP solicitation with Category 6 supporting information-sharing partnerships for access to timely and accurate data. Category 6 provides funding to form multidisciplinary action groups that include law enforcement representatives, State or local health departments, State medical and pharmacy boards, prosecutors, medical examiner/coroner offices, forensic science laboratories, probation and parole officers, drug court representatives, child welfare representatives, local drug treatment providers, and community organizations. These action groups should leverage information from a variety of public health and public safety data sources to analyze substance abuse issues and identify potential solutions from public health, treatment, and public safety perspectives.
Included in the allowable uses of funding in the FY 2018 solicitation:
- Support the timely collection of data from medical examiner and coroner offices, forensic science laboratories (including seized drug analysis and toxicology analysis), and crime scenes and combine these data with other data sets, including fatal and non-fatal overdoses and PDMP records.
There are three application categories in the FY 2019 COAP solicitation, with Category 1 supporting Locally Driven Responses to the Opioid Epidemic and Category 2 supporting Statewide Implementation, Enhancement, and Evaluation Projects.
Included in the allowable uses of funding in the FY 2019 solicitation is the following:
- Implement an overdose fatality review team (that includes representation from medical examiner or coroner offices) and/or support multidisciplinary intervention models such as New York City's RxStat Program to bring together stakeholders with different perspectives and different data sets.
- Support the timely collection of data and/or data integration with other data sets (such as PDMP records) to provide an understanding of drug trends, support program evaluation, inform clinical decision making, identify at-risk individuals or populations, or support investigations. Examples of data sources may include medical examiner and coroner offices, forensic science laboratories, crime scene units (such as data related to the analysis of suspected controlled substances and toxicology analysis), or other novel sources of information such as testing used needles from syringe exchange programs to understand the current local drug supply. Grant funds may be used to upgrade, lease, or purchase equipment or case/information management systems only to the extent the applicant clearly articulates how the equipment or case/information management systems will expedite access to data or data integration that will be used as part of a comprehensive strategy. Applications must clearly articulate how the proposed collection of data or data integration efforts are part of a larger collaborative effort with multiple project partners. Applications solely for equipment or case/information management system upgrades, leases, or purchases will not be considered
Vicarious Trauma Toolkit
The Vicarious Trauma Toolkit (VTT) was developed on the premise that exposure to the traumatic experiences of other people—known as vicarious trauma—is an inevitable occupational challenge for the fields of victim services, emergency medical services, fire services, law enforcement, and other allied professionals; however, organizations can mitigate the potentially negative effects of trauma exposure by becoming vicarious trauma-informed.
The VTT includes tools and resources tailored specifically to these fields that provide the knowledge and skills necessary for organizations to address the vicarious trauma needs of their staff. To begin exploring the VTT, select one of the disciplines below and visit the comprehensive Compendium of Resources.
The Vicarious Trauma—Organizational Readiness Guide (VT–ORG) is the starting point for organizations that want to become vicarious trauma-informed and proactively address the impact of exposure to the trauma experiences of others. VT-ORG can be used to assess agency's current capacity as a vicarious trauma-informed organization and prioritize your needs, then used to locate resources in the toolkit to take important next steps to address gaps.
Although VTT content can be applied to a broader range of disciplines, there is some concern that the publication excludes a broader scope of victim-serving professionals, volunteers, and community groups (e.g., medical examiners, school staff, court personnel, faith-based organization workers). In response, in 2019, OVC posted a solicitation for the FY 2019 Vicarious Trauma Response Initiative: National Scope Training and Technical Assistance. This solicitation will award a cooperative agreement to develop and provide training and technical assistance for the highly collaborative and multifaceted strategy outlined in the solicitation. The recipient is expected to integrate and apply perspectives and expertise from a variety of victim-serving disciplines, organizations, experts, and local communities to buffer and mitigate the impact of vicarious trauma. The project's purpose is to improve public safety; support local communities; strengthen responses to crime victims; and support victim service providers, first responders (e.g., law enforcement, fire and emergency medical services), and other allied professionals and volunteers. "Other allied professionals" is a term that refers to all others who work to support crime victims, including, but not limited to: community-based volunteers; faith-based providers; interpreters and translators; health providers; prosecutors, judges, and court staff; school personnel; and crime scene investigators and medical examiners.
Helping Victims of Mass Violence & Terrorism: Planning, Response, Recovery and Resources – Toolkit
Previous experiences with mass violence and terrorism indicate that advanced planning, preparation and developing, and maintaining multidisciplinary partnerships better prepare communities to respond to victims in the most timely, effective, and compassionate manner possible. In recognition of this need, OVC, in coordination with the Federal Bureau of Investigation's Office of Victim Assistance, and DOJ's Office of Justice for Victims of Overseas Terrorism, has developed a toolkit, Helping Victims of Mass Violence & Terrorism: Planning, Response, Recovery, and Resources – Toolkit, that supplies victim service providers with the framework, strategies, and resources to conduct planning and preparation ahead of an incident and mitigate the impact of future acts on victims. Additionally, this toolkit provides resources to aid communities' response to victims even if they have not planned for an incident. The toolkit has four sections: Partnerships & Planning, Response, Recovery, and Tools. The Partnerships & Planning section reviews how to create and maintain partnerships, address resource gaps, and develop victim assistance protocols. The Response and Recovery sections cover how to use the protocols after an incident of mass violence or terrorism. The Tools section includes checklists, samples, a glossary, and a compendium of victim assistance resources.
National Forensic Laboratory Information System (NFLIS)
The National Forensic Laboratory Information System (NFLIS) collects results from drug chemistry analyses conducted by State, local, and Federal forensic laboratories across the country and provides timely and detailed analytical results of drugs seized by law enforcement. The NFLIS program is expanding to include two additional continuous drug surveillance programs; one that collects drug-related mortality data from medical examiner and coroner offices (NFLIS-MEC), and one that collects drug testing results from toxicology laboratories (NFLIS-Tox). This data will be used to supplement and complement the current information from drug cases submitted to and analyzed by the Nation's forensic drug laboratories (NFLIS-Drug).
Synthetic Opioids Real-Time Communication Network ([email protected])
The DEA Synthetic Opioids Real-Time Communication Network administered by the Southeast Laboratory connects forensic chemists, toxicologists, coroners, medical examiners, and other stakeholders to address the analytical challenges associated with emerging and novel synthetic opioids. Through this growing network of members from across the United States and internationally, scientific data and analytical approaches are being shared for the detection and identification of synthetic opioids many of which are structurally similar substances. The collective scientific expertise across the various disciplines is a powerful tool in overcoming the analytical difficulties associated with new emerging compounds as they are being analyzed.
Seized-drugs chemists, medical examiners, coroners, and toxicologists are able to quickly communicate questions and tap into an abundance of existing forensic knowledge regarding the analysis of synthetic opioids in overdose deaths and DUI cases. For example, a toxicologist or a seized-drugs chemist in an area where fentanyl analogues are just emerging may ask for information in how to address analytical challenges with the instrumentation and equipment available in their respective laboratories. Network members (possibly another toxicologist or a seized- drugs chemist) respond to the query, thus providing recommendations and sharing their own experiences in real-time.
The assistance provided in this network helps laboratories (federal, state, local, and private) rapidly identify unknown substances, highlight challenges associated with low level and under-reported substances, and facilitate a collaborative effort in combating the opioid crisis. For access and participation in this network, please send your request to [email protected].
In December 2019, NIJ published a Report to Congress on the DOJ Needs Assessment of Forensic Laboratories and Medical Examiner/Coroner Offices, which examined the workload, backlog, personnel and equipment needs of public crime laboratories and medical examiner and coroner offices and provided an overview of academic forensic science the resources and needs. The Department operationalized the needs assessment by holding a series of listening sessions with stakeholders from fall 2017 to early 2018 and conducted special topic listening sessions to address topics including the opioid crisis, medicolegal death investigation, and system-based approaches to increasing efficiencies and capacities. In addition to the listening sessions, the Department reviewed data collected through various instruments and ongoing research projects. The report to Congress is available on the DOJ Forensics Webpage.
Needs Assessment Report: https://www.justice.gov/olp/page/file/1228306/download
DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
Overdose Data to Action (OD2A)
Overdose Data to Action is a 3-year cooperative agreement that began in September 2019 and focuses on the complex and changing nature of the opioid overdose epidemic and highlights the need for an interdisciplinary, comprehensive, and cohesive public health approach. Funds awarded as part of this agreement will support state, territorial, and select county, city, or township health departments in obtaining high quality, more comprehensive, and timelier data on overdose morbidity and mortality and using those data to inform prevention and response efforts.
Recipients will be able to do a number of surveillance activities to monitor and gather data about the scope and nature of the overdose problem under the new cooperative agreement:
- Collect and disseminate emergency department data on suspected overdoses categorized as "all drug," "all opioid," "heroin," and "all stimulant"
- Collect and disseminate descriptions of drug overdose death circumstances using death certificates and medical examiner/coroner data
- Implement innovative surveillance activities to support interventions. These activities help increase comprehensiveness and timeliness of surveillance data.
The prevention component of this cooperative agreement will position recipients to strengthen prescription drug monitoring programs, improve state-local integration, establish linkages to care, and improve provider and health system support. Optional strategies that recipients may implement include improving partnerships with public safety and first responders; empowering individuals to make safer choices; and providing jurisdictions opportunities for innovative prevention approaches.
Applied Research to Address Emerging Public Health Priorities
In 2017, CDC awarded more than $400,000 in seed funding, under Applied Research to Address Emerging Public Health Priorities, to support pilot projects that help strengthen death investigation and surveillance systems. For example: 1) develop data standards and data access mechanisms to help medical examiners and coroners (ME/Cs) share critical information for deaths of public health importance; 2) expand adoption of standards-based, scalable, and software-as-a-service electronic case management systems for ME/Cs; 3) identify ways existing ME/C case management systems can be enhanced to help promote interoperability—automated, meaningful, and multi-directional exchange and use of data—and enable a coordinated response to multistate, high-priority threats; and 4) integrate electronic ME/C case management systems with State-based Electronic Death Registration systems and other electronic public health systems. Please note the funding for this program has ended.
National Violent Death Reporting System (NVDRS)
The National Violent Death Reporting System (NVDRS) is now in all 50 states, the District of Columbia and Puerto Rico. It is an ongoing surveillance (reporting) system that pools data on violent deaths from multiple sources into a usable, anonymous database. These sources are coroner/medical examiner reports (including toxicology), law enforcement reports, and death certificates.
NVDRS covers all types of violent deaths in all settings and for all age groups. Data elements collected provide valuable context about violent deaths, such as relationship problems; mental health conditions and treatment; toxicology results; and life stressors, including recent money- or work-related problems or physical health problems. Such data are far more comprehensive than what is available elsewhere and decision-makers and program planners can use this information to develop, inform, and tailor violence prevention efforts.
National Vital Statistics System (NVSS)
The National Vital Statistics System (NVSS) is the oldest and most successful example of intergovernmental data sharing in Public Health and is the mechanism by which the National Center for Health Statistics (NCHS) collects and disseminates the Nation's official vital statistics. These data are provided through contracts between NCHS and vital registration systems operated in the various jurisdictions legally responsible for the registration of vital events—births, deaths, marriages, divorces, and fetal deaths.
Sudden Unexpected Infant Death (SUID) and Sudden Death in the Young (SDY)
The Sudden Unexpected Infant Death (SUID) and Sudden Death in the Young Case Registry (SDY) builds on the National Center for Fatality Review and System and brings together information about the circumstances associated with SUID and SDY cases as well as information about investigations into these deaths. Participating States and jurisdictions use data about SUID and SDY trends and circumstances to develop strategies to reduce future deaths.
CDC and the National Institutes of Health collaborate on the SDY Component of the Case Registry which expands the population of the SUID Case Registry to include children and adolescents. The SDY component of the Case Registry was created to increase the understanding of the prevalence, causes, and risk factors for infants, children, and young adults who die suddenly and unexpectedly.
For more information on SDY from CDC’s Data Coordinating Center: https://www.sdyregistry.org/
For more information on Sudden Unexplained Infant Death Investigations: https://www.cdc.gov/sids/TrainingMaterial.htm
Infectious Diseases Pathology Branch (IDPB)
The Infectious Diseases Pathology Branch (IDPB) is the primary unit within CDC responsible for conducting laboratory studies and investigations of infectious diseases of unknown cause or origin, and has tests that can identify more than 150 infectious agents (including bacterial, viruses, parasites, and fungi) in formalin-fixed tissue specimens. Medical examiners/coroners (ME/C) and forensic pathologists are often among the first healthcare workers to encounter infectious disease outbreaks and also can identify unexplained deaths of possible infectious etiology. These can be challenging cases to investigate, especially for sudden deaths, when pre-mortem specimens are unavailable, and when traditional laboratory assays have been unsuccessful in identifying a specific agent. For cases with gross or histopathologic features suggestive of an infectious process, ME/C can submit tissue specimens to IDPB in collaboration with state and local health departments. Specific immunohistochemical, molecular, or other assays can be pursued using clinical and epidemiologic information provided by the submitter and the histopathologic features identified in the submitted tissue specimens. IDPB has had a strong partnership with ME/C and forensic pathologists for many years. This partnership, coupled with the use of state-of-the-art technologies, has facilitated explanation of many otherwise unexplained deaths. IDPB evaluates hundreds of cases each year from across the US. Identified diseases have included those of public health importance, such as reportable conditions, vaccine-preventable diseases, and emerging infectious diseases.
If you are a physician or are associated with a government health agency, please see Specimen Submission Guidelines for information on how to submit cases to IDPB for testing.
Disaster Preparedness and Disaster-related Deaths Program
The Center for Preparedness and Response's Division of State and Local Readiness funds preparedness activities to state and local public health systems through the Public Health Emergency Preparedness (PHEP) cooperative agreement and other funding. In 2011, CDC established the Public Health Preparedness Capabilities: National Standards for State and Local Planning, a set of 15 distinct, yet interrelated, capability standards designed to advance the emergency preparedness and response capacity of state and local public health systems. Since then, these capability standards have served as a vital framework for state, local, tribal, and territorial preparedness programs as they plan, operationalize, and evaluate their ability to prepare for, respond to, and recover from public health emergencies include mass fatality incidents.
The National Center for Environmental Health's (NCEH) Health Studies program conducts rapid epidemiologic investigations in response to outbreaks that are believed to have environmental causes and responds to natural and technologic disasters including radiologic emergencies. In addition, NCEH conducts mortality and morbidity research studies to more accurately define the relation between human health and environmental exposures. When requested, NCEH provides technical assistance and expertise to state or local public health agencies. Depending on the scale of the radiation emergency, an event could result in radioactively contaminated decedents, through surface contamination, internal contamination, or shrapnel on or in decedents' bodies. Assisting in fatality management operations would include coordinating proper and safe recovery and handling of contaminated decedents. https://www.cdc.gov/nceh/radiation/emergencies/publichealthpreparedness.htm
Public Health Preparedness and Response Capabilities Document includes Capability 5 "Fatality Management"
CDC's Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health is a guide that state and local jurisdictions can use to better organize their work, plan their priorities, and decide which capabilities they have the resources to build or sustain. The capabilities also help ensure that federal preparedness funds are directed to priority areas within individual jurisdictions.
Disaster Death Scene Investigation Toolkit
CDC's Death Scene Investigation after Natural Disasters or other Weather -Related Events (Print only) (Espanol/Spanish toolkit) features checklists, forms, and other resources for death scene investigators to use when collecting data at death scenes during and after a natural disaster or weather-related event.
To use refillable forms specific to certain disasters, see these links:
- Heat / Español (Spanish)
- Winter / Español (Spanish)
- Tornado / Español (Spanish)
- Hurricane / Español (Spanish)
- Thunder/Lightening / Español (Spanish)
- Earthquake / Español (Spanish)
A literature review to examine how death scene data are collected and how such data are used to determine disaster relatedness informed the new toolkit. More information about the literature review can be found in the article, Medicolegal Death Scene Investigations After Natural Disaster- and Weather-Related Events: A Review of the Literature.
Reference Guide and Training for Disaster-related Death Certification
Disaster-related mortality data collected from death certificates are used to assess the scope of a disaster, identify common risk factors for these deaths, and develop evidence-based public health interventions. The key to more accurate reporting of disaster-related deaths is to promote a common framework and decision-making process for determining disaster relatedness. CDC's A Reference Guide for Certification of Deaths in the Event of a Natural, Human-induced, or Chemical/Radiological Disaster provides examples and recommendations for recording the name and type of disaster on the death certificate to ensure that disaster relatedness is reflected appropriately on the death certificate.
Determining Deaths from a Radiation Emergency Fact Sheet
Radiation emergencies—such as a nuclear detonation, dirty bomb, or nuclear reactor accident—can release radioactive materials into the environment. Exposure to radioactive materials can cause injury and death. It is important for medical certifiers such as medical examiners and coroners to understand the health effects of radiation so that they can accurately determine the illnesses or injuries that caused the death and record this information onto the death certificate.
Guidelines for Handling Decedents Contaminated with Radioactive Material
Detonation of a nuclear weapon or activation of a radiological dispersal device could cause radioactively contaminated decedents. The guidelines address both of these scenarios. They could also be applicable in other instances where decedents' bodies are contaminated with radioactive material (e.g. reactor accidents, transportation accidents involving radioactive material, etc). This resource suggests ways for medical examiners, coroners, and morticians to deal with loose surface contamination, internal contamination, or shrapnel on or in decedents' bodies.
Funding Opportunities and Current Activities:
Connect with the National Academies - Best Practices in Assessing Mortality and Significant Morbidity Following Large-Scale Disasters for more resources related to the ongoing two-year study, and sign up for email alerts
New York Times article: Tallying the Dead: Why a Storm Death in One State Might Not Count in Another
National Institute of Occupational Safety and Health (NIOSH)
The National Institute of Occupational Safety and Health (NIOSH) is a research agency focused on the study of worker safety and health, and empowering employers and workers to create safe and healthy workplaces. NIOSH is part of the U.S. Centers for Disease Control and Prevention, in the U.S. Department of Health and Human Services. It has the mandate to assure "every man and woman in the Nation safe and healthful working conditions and to preserve our human resources." NIOSH has more than 1,300 employees from a diverse set of fields including epidemiology, medicine, nursing, industrial hygiene, safety, psychology, chemistry, statistics, economics, and many branches of engineering.
NIOSH has developed an illicit drug tool-kit for first responders. The tool kit provides resources such as videos, infographics, and other information to help emergency responders understand the risks and communicate what they can do to protect themselves from exposure to illicit drugs. The toolkit can be found at: https://www.cdc.gov/niosh/topics/fentanyl/toolkit.html
Toxicology Testing, Traceable Opioid Material Kits TOM Kits
The CDC is leading the development of Traceable Opioid Material* Kits (TOM Kits*) to support detection of emerging opioids by laboratories in the US. CDC maintains the contents of the TOM Kits* based on new needs identified, in part, through DEA Emerging Threat Reports. The DEA 2019 mid-year data indicate that fentanyl and fentanyl-related compounds account for over 75% of their opioid identifications.
Two TOM Kits* are now available, and additional kits are anticipated in the spring of 2020. These kits are reference materials and do not eliminate the need for laboratories to meet analytical method requirements of other federal agencies. TOM Kits* are NOT for Diagnostic Use.
Laboratories requesting one or more kits:
- Can be from any sector – academic, public, or private.
- Must be in the United States.
- Must have current DEA registration.
- Must comply with respective state and local regulations.
- Must submit requests directly to the respective vendor.
The kits are available at no charge. For more information on the TOM Kits* and how to request them, please visit https://www.cdc.gov/nceh/dls/erb_opioid_kits.html.
*TRACEABLE OPIOID MATERIAL, TOM KITS, and the TOM KITS Logo are marks of the U.S. Department of Health and Human Services.
National Center for Fatality Review and Prevention - The National Fatality Review Case Reporting System
Child Death Review (CDR) is a process where multidisciplinary teams at the community or state level review the circumstances around child deaths to better understand why children die and to identify ways to prevent future deaths. The National Fatality Review Case Reporting System (CRS) is a standardized case reporting tool available to states through the National Center for Fatality Review and Prevention. Forty-five (45) states use the CRS to enter data from CDR and Fetal-Infant Mortality Reviews (FIMR) completed by state and local teams. These include deaths due to natural causes as well as unintentional and intentional injury, including deaths related to suicide, homicide, and substance use.
The CRS is a web-based application that allows local and State users to enter case data, findings, and review team recommendations; access and download their data; and download standardized reports. Users can add custom questions to the CRS to collect data unique to their state. With data use agreements between States, users may be able to compare their data with other States and with national compilations. In addition, researchers can access data from the CRS for research purposes.
The National Center for Fatality Review and Prevention is funded by HRSA to provide technical assistance and training to state and local CDR and FIMR teams. The Center produces data summaries, training modules, and guidance documents for reviewing specific types of deaths and hosts webinars. To join the Center’s listserv or to receive their newsletter, send your request to [email protected].
Extramural Loan Repayment Program for Clinical Researchers (LRP-CR)
The NIH Loan Repayment Programs (LRPs) are a set of programs established by Congress and designed to recruit and retain highly qualified health professionals into biomedical or biobehavioral research careers. Additional detailed information about each LRP is provided at www.lrp.nih.gov/about_the_programs/index.aspx and www.lrp.nih.gov/apply.
Applicants from Medical Examiner or Coroner offices may be eligible for the Extramural Loan Repayment Program for Clinical Researchers (LRP-CR) as long as they contractually agree to engage in NIH mission-relevant research for an average of at least 20 hours each week for at least two years and are working with human material. The Extramural LRP repays up to $50,000 annually of a researcher's qualified educational debt. The applicant does not need to work at a hospital but needs to be employed or supported by an institution described as follows: “a domestic nonprofit foundation (e.g., universities), professional nonprofit association, or other nonprofit institution, or a U.S. government agency (Federal, State, or local). A domestic foundation, professional association, or institution is considered to be nonprofit if exempt from Federal tax under the provisions of Section 501 of the Internal Revenue Code (26 U.S.C. 501).”
Click here for the link to the current funding notice (closes November 15, 2019)
Please visit the LRP website at www.lrp.nih.gov, send an email to [email protected], or call the Division of Loan Repayment Information Center toll free at (866) 849-4047. Applicants are strongly encouraged to pay attention to Institute or Center (IC) specific funding priorities, and also to discuss their career interests with an IC scientific liaison: www.lrp.nih.gov/contact-engage#ContactEngageContactListsTile
NATIONAL TRANSPORTATION SAFETY BOARD (NTSB)
The National Transportation Safety Board (NTSB) Transportation Disaster Assistance (TDA) Division coordinates Federal government resources to support local and State governments, disaster relief organizations, and transportation carriers to address concerns of survivors, families, and friends following a transportation accident investigated by the NTSB. The TDA Division serves as the primary resource for survivors, families, and friends regarding NTSB investigations. TDA Specialists provide information regarding the NTSB investigative process, and to the maximum extent practicable, updates on the status of existing investigations. TDA Specialists can also assist survivors, families, and friends with accessing available family assistance resources through appropriate organizations. Following certain air carrier and passenger rail accidents, the NTSB will coordinate federal resources to support the medicolegal jurisdiction's victim recovery and identification efforts.
TDA Training Courses
The TDA Division also works closely with local, State, and Federal agencies, non-governmental and private organizations, and transportation carriers during the preparedness phase of the disaster management cycle to assist with planning an effective family assistance response following transportation accidents. TDA Specialists can collaborate with the family assistance response community to ensure key concepts and operational aspects of a family assistance operation are understood and implemented during a response.
Training courses relevant to the ME/C community include the following:
- Transportation Disaster Response – Family Assistance (TDA301): This course offers a broad overview of family assistance concept of operations, best practices, and lessons learned from recent transportation accident responses. The course focuses on family assistance operations from initial notification of an event through to long-term engagement with accident survivors and family members. The course is highly interactive, with students participating in a tabletop exercise and a mock family briefing.
- Mass Fatality Incidents for Medicolegal Professionals (TDA403): This course examines the principles of managing the medicolegal response to transportation-related mass fatality incidents. Areas addressed include managing search and recovery operations, the antemortem and postmortem data collection process, quality assurance, and interacting with family members regarding medicolegal issues.
- Managing Transportation Mass Fatality Incidents (TDA 406): This course is designed specifically for the emergency management, law enforcement, and medicolegal communities. Areas addressed include the core principles for managing the transition from first response and life safety operations into the disaster victim recovery and identification process.
NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY (NIST)
The Organization of Scientific Area Committees for Forensic Science (OSAC) was launched in 2014 and works to strengthen the nation's use of forensic science by facilitating the development of technically sound forensic science standards and by promoting the adoption of those standards by the forensic science community. OSAC is administered by NIST, but the great majority of its more than 550 members and 250 affiliates are from other government agencies, academic institutions, and the private sector. Participants have expertise in 25 specific forensic disciplines as well as general expertise in scientific research, measurement science, statistics, law, and policy.
OSAC Medicolegal Death Investigation Subcommittee
The OSAC Medicolegal Death Investigation Subcommittee focuses on standards and guidelines related to sudden, unnatural, unexplained, or suspicious deaths—including homicides, suicides, unintentional fatal injuries, drug-related deaths, and other sudden or unexpected deaths—and determination of the cause and manner of death. Many of the previously produced SWGMDI documents can be found on this website under the subcommittee's "Baseline Documents" section.
OSAC Disaster Victim Identification Subcommittee
The OSAC Disaster Victim Identification Subcommittee focuses on standards and guidelines related to fatality management of a mass fatality incident that involves the scientific identification of human remains.
OSAC Anthropology Subcommittee
The OSAC Anthropology Subcommittee focuses on standards and guidelines related to application of anthropological methods and theory, particularly those relating to the recovery and analysis of human remains. Many of the previously produced SWGANTH documents can be found on this website under the subcommittee's "Baseline Documents" section.
OSAC Toxicology Subcommittee
The OSAC Toxicology Subcommittee focuses on standards and guidelines related to the analysis of biological samples for alcohol, drugs, or poisons, and the interpretation of these results.
The Medical Examiners and Coroners Alert Project (MECAP)
The U.S. Consumer Product Safety Commission (CPSC) works to reduce the risk of injuries and deaths from consumer products. CPSC has jurisdiction over thousands of types of consumer products within the agency’s jurisdiction. CPSC conducts epidemiological studies to estimate consumer product-related deaths and analyzes factors contributing to fatalities through in-depth investigations of incidents. Reports on deaths are the most valuable data we receive to help carry out CPSC’s mission.
CPSC’s Medical Examiners and Coroners Alert Project (MECAP) is designed to collect timely information from coroners and medical examiners on product-related deaths. Timeliness is extremely important when reporting to MECAP for several reasons. It provides the opportunity for CPSC staff to investigate an incident while the details of the incident and product use are still fresh in the minds of the participants. There is also a greater chance that the CPSC staff will have an opportunity to examine the product involved as it was when the incident occurred and before it is discarded or modified. Additionally, the faster an incident is reported, the more quickly the CPSC can act to remove hazardous products from the marketplace. This can translate into injuries prevented and lives saved.
All it takes is one MECAP report to alert the CPSC to a hazardous product. Any medical examiner or coroner can participate in the MECAP program. The more participants, the better the quality of the data. The results are used by CPSC to set priorities, support banning or recalling hazardous products, support development or evaluation of product standards, and to educate the public.
For more information on MECAP visit: https://www.cpsc.gov/Research--Statistics/MECAP. To report an unsafe consumer product to CPSC online, visit: www.saferproducts.gov, or call CPSC's toll-free Hotline at: (800) 638-8095.
Federal Aviation Administration (FAA)
FAA Colloquium – Postmortem Toxicology in Aviation
The Federal Aviation Administration's (FAA's) Civil Aerospace Medical Institute is again organizing a 3rd colloquium on postmortem forensic toxicology in aviation to be held during April 7-9, 2020 at the FAA Mike Monroney Aeronautical Center in Oklahoma City, Oklahoma, USA.
The meeting will be a scientific platform for medical examiners; pathologists; coroners; forensic toxicologists, academics, and students; aerospace medicine scientists and specialists; regional flight surgeons; National Transportation Safety Board personnel and other accident investigation authorities, including employees of the FAA's Flight Standards District Offices and Office of Accident Investigation and Prevention.
With recent advances in the field, topics covered will be sample processing; importance of chain of custody of samples; analyses of samples for combustion gases, ethanol, and drugs; analytical result interpretation; significance of quality control/quality assurance; prevalence of drugs in aviation accident pilot fatalities; postmortem drug pharmacology; and litigation and expert testimony issues.
Please complete and submit this advance registration form by January 31, 2020. You will receive the final announcement and other details in February 2020. Registration information can be found at: https://cami-colloquium.eventbrite.com
Other resources/relevant information from FAA: