Forensic Science, Medicine and Pathology

, Volume 15, Issue 1, pp 31–40 | Cite as

U.S. Medical Examiner/Coroner capability to handle highly infectious decedents

  • Aurora B. LeEmail author
  • Erin G. Brooks
  • Lily A. McNulty
  • James R. Gill
  • Jocelyn J. Herstein
  • Janelle Rios
  • Scott J. Patlovich
  • Katelyn C. Jelden
  • Kendra K. Schmid
  • John J. Lowe
  • Shawn G. Gibbs
Original Article


In the United States of America, Medical Examiners and Coroners (ME/Cs) investigate approximately 20% of all deaths. Unexpected deaths, such as those occurring due to a deceased person under investigation for a highly infectious disease, are likely to fall under ME/C jurisdiction, thereby placing the ME/C and other morgue personnel at increased risk of contracting an occupationally acquired infection. This survey of U.S. ME/Cs′ capabilities to address highly infectious decedents aimed to determine opportunities for improvement at ME/C facilities serving a state or metropolitan area. Data for this study was gathered via an electronic survey. Of the 177 electronic surveys that were distributed, the overall response rate was N = 108 (61%), with 99 of those 108 respondents completing all the questions within the survey. At least one ME/C responded from 47 of 50 states, and the District of Columbia. Select results were: less than half of respondents (44%) stated that their office had been involved in handling a suspected or confirmed highly infectious remains case and responses indicated medical examiners. Additionally, ME/C altered their personal protective equipment based on suspected versus confirmed highly infectious remains rather than taking an all-hazards approach. Standard operating procedures or guidelines should be updated to take an all-hazards approach, best-practices on handling highly infectious remains could be integrated into a standardized education, and evidence-based information on appropriate personal protective equipment selection could be incorporated into a widely disseminated learning module for addressing suspected or confirmed highly infectious remains, as those areas were revealed to be currently lacking.


Coroners Medical examiners Highly infectious diseases Autopsy Personal protective equipment Forensic pathology 



We would like to extend our gratitude to the members of the National Association of Medical Examiners (NAME) Ad Hoc committee for Bioterrorism and Infectious Disease for their support of this research and distribution of the survey; these members include: second author Erin Brooks (Chair), Paul Chui, Karen Kelly, John Matthew Lacy, Micheline Lubin, Lakshmanan Sathyavagiswaran, Leah Schuppener, Suzanne Utley-Bobak, and Steven White. Additionally, we acknowledge the National Institute of Environmental Health Sciences (NIEHS) Worker Training Program (WTP) Ebola Biosafety and Infectious Disease Response Training UH4 Information, grant number UH4 5ES027055. While the grant funding did not contribute to the development and distribution of this gap analysis survey, the program did highlight the need to explore research in this area. Lastly, we also thank from the University of Nebraska Medical Center: Elizabeth Beam and at Harvard T.H. Chan School of Public Health: Paul Biddinger for their partnership and support.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest to disclose.

Ethical approval

This study was deemed exempt by Indiana University Institutional Review Board (Protocol #1711094822).

Informed consent

Survey participants were informed of potential risks and benefits prior to taking the voluntary survey. This informed consent survey was reviewed by the Institutional Review Board and approved as part of the exemption in the aforementioned protocol number.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Aurora B. Le
    • 1
    • 2
    Email author
  • Erin G. Brooks
    • 3
    • 4
  • Lily A. McNulty
    • 2
  • James R. Gill
    • 4
    • 5
  • Jocelyn J. Herstein
    • 6
    • 7
  • Janelle Rios
    • 8
  • Scott J. Patlovich
    • 8
    • 9
  • Katelyn C. Jelden
    • 10
  • Kendra K. Schmid
    • 11
  • John J. Lowe
    • 6
    • 7
    • 12
  • Shawn G. Gibbs
    • 1
  1. 1.Department of Environmental and Occupational HealthIndiana University School of Public HealthBloomingtonUSA
  2. 2.Department of Applied Health ScienceIndiana University School of Public HealthBloomingtonUSA
  3. 3.Department of Pathology and Laboratory MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  4. 4.National Association of Medical Examiners (NAME) Ad Hoc Committee for Bioterrorism and Infectious DiseaseWalnut ShadeUSA
  5. 5.Department of PathologyYale School of MedicineNew HavenUSA
  6. 6.Department of Environmental, Agricultural & Occupational Health, College of Public HealthUniversity of Nebraska Medical CenterOmahaUSA
  7. 7.Global Center for Health SecurityUniversity of Nebraska Medical CenterOmahaUSA
  8. 8.School of Public HealthThe University of Texas Health Science Center at Houston (UTHealth)HoustonUSA
  9. 9.Office of Safety, Health, Environment and Risk ManagementThe University of Texas Health Science Center at Houston (UTHealth)HoustonUSA
  10. 10.College of MedicineUniversity of Nebraska Medical CenterOmahaUSA
  11. 11.Department of Biostatistics, College of Public HealthUniversity of Nebraska Medical CenterOmahaUSA
  12. 12.Nebraska Biocontainment UnitOmahaUSA

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