ABMDI Board (F-ABMDI) cheat sheet

Medical examiner offices are headed by a physician, typically a forensic pathologist; coroner offices are headed by an elected or appointed official who may be lay or a physician, and some states operate mixed systems.

Common statutory jurisdiction triggers: death unattended by a physician, death shortly after hospital admission, violent or suspected criminal death, suicide, death in custody, death at work, and death of a person in apparent good health.

Cause of death = the injury or disease that initiates the lethal sequence; mechanism = the physiologic derangement (e.g., exsanguination, arrhythmia); manner = natural, accident, homicide, suicide, or undetermined.

HIPAA (45 CFR 164.512(g)) permits a covered entity to disclose protected health information to a medical examiner or coroner for identification of a decedent or to carry out the official's lawful duties.

Chain of custody rule: every transfer records date, time, item description, releasing party, and receiving party; an undocumented gap weakens evidentiary reliability and admissibility.

Role division at a scene: law enforcement secures the scene and conducts the criminal investigation; the ME/coroner takes custody of the body and the property on the body.

Jurisdiction is generally geographic (county or district) and fixed by statute; an investigator acts outside it only through formal request, waiver, or mutual aid.

The ME/coroner may delegate scene response to a medicolegal death investigator, but legal authority to take jurisdiction, order autopsy, and certify death remains with the office.

Where death falls within statutory jurisdiction, most states authorize ME/coroner autopsy without family consent; religious objection may delay but generally does not bar the examination.

Documentation order: overall views, then midrange, then close-up with a scale; photograph the body as found, before and after turning, and evidence in place and after recovery.

Photograph the decedent before any movement and include the body's relationship to fixed landmarks so position can be reconstructed.

Place paper bags (not plastic) over the hands to preserve trace evidence and permit drying; package biological evidence in paper and air-dry wet items before sealing.

Positions are triangulated from two or more fixed permanent reference points; a sketch carries scale, legend, orientation, and the investigator's name and date.

Record an environmental baseline: indoor and outdoor temperature, thermostat setting, window and door status, HVAC operation, and weather.

Livor distribution and rigor state are documented at the scene because both change with time and are altered by movement of the body.

Record times for dispatch, arrival, pronouncement, law enforcement arrival, and notification of the medical examiner or coroner.

Do not remove the body, clean the scene, or release the premises until photography, measurement, and law enforcement release are complete.

Scene type drives documentation priorities: residence, outdoor or remote, vehicle, workplace, healthcare facility, and custody settings each raise distinct evidence concerns.

Primary identifiers: fingerprint comparison, dental comparison, DNA analysis, and radiographic comparison; visual recognition is secondary and unreliable after trauma, decomposition, or fire.

Postmortem printing technique: massage, rehydrate, or inject the fingers to restore ridge detail, then record all ten prints and palms when feasible.

Dental identification requires antemortem records (charting, radiographs, restorations, missing teeth) compared by a forensic odontologist.

DNA reference samples come from relatives (buccal swab) or antemortem personal items; postmortem samples include blood cards, muscle, bone, and teeth.

Property handling rule: itemize every item, describe condition, photograph valuables, obtain a receipt, store under chain of custody, and release only to persons authorized by statute or policy.

External examination minimum data set: sex, apparent age, height, weight, hair color and length, eye color, scars, tattoos, marks, and visible injuries.

Postmortem indicators recorded at examination: livor, rigor, algor, decomposition stage, and evidence of medical intervention.

Medical devices and implants (pacemakers, orthopedic hardware with serial numbers) are documented before removal because they can support identification.

Rigor mortis: onset about 1–4 hours, complete in about 6–12 hours, resolution over about 24–36 hours; accelerated by heat and antemortem exertion, slowed by cold.

Livor mortis: onset about 20 minutes to 2 hours, blanching before fixation, non-blanching after fixation at roughly 8–12 hours; distribution reflects final body position.

Algor mortis: roughly 1–1.5 °F (0.5–1 °C) per hour under temperate conditions, modified by clothing, body habitus, air movement, and immersion.

Sharp force injury categories are incised, stab, and chop wounds; the skin defect of a stab wound may be shorter than the blade due to elastic recoil, so depth is determined at autopsy.

Blunt force injury produces contusions, abrasions, and lacerations; lacerations show intact tissue bridging, which distinguishes them from sharp force wounds.

Gunshot entrance wounds typically show an abrasion collar and may show soot, tattooing, or a muzzle imprint; exit wounds are usually larger, irregular, and lack an abrasion collar.

Asphyxia indicators include conjunctival and facial petechiae, cyanosis, congestion, and patterned ligature or hand marks.

Postmortem redistribution can raise or lower drug concentrations after death; interpretation uses multiple specimens (peripheral blood, vitreous, liver, urine) plus scene and medical history.

Thermal injury produces pugilistic attitude, charring, heat fracture of the skull, and epidural heat hematoma, all of which are postmortem and can mimic antemortem trauma.

Cause-of-death sequence on the certificate: immediate cause, conditions leading to it, underlying cause that initiated the sequence, and other significant contributing conditions.

Manner must be one of five categories: natural, accident, homicide, suicide, undetermined; 'pending' is a certification status, not a manner category.

Hold the cause as pending only while studies are outstanding; document the reason and expected time frame in the case record and amend when results return.

Report writing rule: separate objective findings from interpretation, use qualified language such as 'consistent with,' and avoid opinions on criminal responsibility or intent.

Record release follows statute and agency policy; photographs and medical records are commonly restricted even when the report itself is a public record.

Testimony rule: opinions must fall within documented education, training, and experience and must be supported by the case file.

Disclose any personal, financial, or professional relationship involving a case and withdraw when impartiality could reasonably be questioned.

Ethical duties in practice: confidentiality, accuracy, impartiality, honesty about the limits of one's knowledge, and truthful documentation of all case actions.