Office of the Armed Forces Medical Examiner

Dover, DE, United States

Office of the Armed Forces Medical Examiner

Dover, DE, United States
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Wallace R.M.,Centers for Disease Control and Prevention | Griese S.,Centers for Disease Control and Prevention | Krulak D.,Naval Hospital Pensacola | Vora N.M.,Centers for Disease Control and Prevention | And 37 more authors.
Zoonoses and Public Health | Year: 2014

Summary: This article describes and contrasts the public health response to two human rabies cases: one organ recipient diagnosed within days of symptom onset and the transplant donor who was diagnosed 18 months post-symptom onset. In response to an organ-transplant-related rabies case diagnosed in 2013, organ donor and recipient investigations were conducted by multiple public health agencies. Persons with potential exposure to infectious patient materials were assessed for rabies virus exposure. An exposure investigation was conducted to determine the source of the organ donor's infection. Over 100 persons from more than 20 agencies spent over 2700 h conducting contact investigations in healthcare, military and community settings. The 564 persons assessed include 417 healthcare workers [5.8% recommended for post-exposure prophylaxis (PEP)], 96 community contacts (15.6% recommended for PEP), 30 autopsy personnel (50% recommended for PEP), and 21 other persons (4.8% recommended for PEP). Donor contacts represented 188 assessed with 20.2% recommended for PEP, compared with 5.6% of 306 recipient contacts recommended for PEP. Human rabies cases result in substantial use of public health and medical resources, especially when diagnosis is delayed. Although rare, clinicians should consider rabies in cases of encephalitis of unexplained aetiology, particularly for cases that may result in organ donation. © 2014 Blackwell Verlag GmbH618 December 2014 10.1111/zph.12105 Original Article ORIGINAL ARTICLES Published 2014. This article is a U.S. Government work and is in the public domain in the USA.


Skedros J.G.,Bone and Joint Research Laboratory | Knight A.N.,Bone and Joint Research Laboratory | Clark G.C.,Bone and Joint Research Laboratory | Crowder C.M.,Office of the Armed Forces Medical Examiner | And 8 more authors.
American Journal of Physical Anthropology | Year: 2013

Studies of secondary osteons in ribs have provided a great deal of what is known about remodeling dynamics. Compared with limb bones, ribs are metabolically more active and sensitive to hormonal changes, and receive frequent low-strain loading. Optimization for calcium exchange in rib osteons might be achieved without incurring a significant reduction in safety factor by disproportionally increasing central canal size with increased osteon size (positive allometry). By contrast, greater mechanical loads on limb bones might favor reducing deleterious consequences of intracortical porosity by decreasing osteon canal size with increased osteon size (negative allometry). Evidence of this metabolic/mechanical dichotomy between ribs and limb bones was sought by examining relationships between Haversian canal surface area (BS, osteon Haversian canal perimeter, HC.Pm) and bone volume (BV, osteonal wall area, B.Ar) in a broad size range of mature (quiescent) osteons from adult human limb bones and ribs (modern and medieval) and various adult and subadult non-human limb bones and ribs. Reduced major axis (RMA) and least-squares (LS) regressions of HC.Pm/B.Ar data show that rib and limb osteons cannot be distinguished by dimensional allometry of these parameters. Although four of the five rib groups showed positive allometry in terms of the RMA slopes, nearly 50% of the adult limb bone groups also showed positive allometry when negative allometry was expected. Consequently, our results fail to provide clear evidence that BS/BV scaling reflects a rib versus limb bone dichotomy whereby calcium exchange might be preferentially enhanced in rib osteons. © 2013 Wiley Periodicals, Inc. Copyright © 2013 Wiley Periodicals, Inc.


Mabry R.L.,U.S. Army | Edens J.W.,U.S. Army | Pearse L.,Office of the Armed Forces Medical Examiner | Kelly J.F.,U.S. Army | Harke H.,Office of the Armed Forces Medical Examiner
Prehospital Emergency Care | Year: 2010

Introduction. Airway compromise is the third leading cause of potentially preventable death on the battlefield. An understanding of the injuries associated with fatal airway compromise is necessary to develop improvements in equipment, training, and prehospital management strategies in order to maximize survival. Objective. To determine injury patters resulting in airway compromise in the combat setting. Methods. This was a subgroup analysis of cases previously examined by Kelly and colleagues, who reviewed autopsies of military personnel who died in combat in Iraq and Afghanistan between 2003 and 2006. Casualties with potentially survivable (PS) injuries and deaths related to airway compromise previously identified by Kelly et al. were reviewed in depth by a second panel of military physicians. Results. There were 982 cases that met the inclusion criteria. Of these, 232 cases had PS injuries. Eighteen (1.8) cases were found to have airway compromise as the likely cause of primary death. All had penetrating injuries to the face or neck. Twelve deaths (67) were caused by gunshot wounds, while six deaths (33) were caused by explosions. Nine cases had concomitant injury to major vascular structures, and eight had significant airway hemorrhage. Cricothyroidotomy was attempted in five cases; all were unsuccessful. Conclusion. Airway compromise from battlefield trauma results in a small number of PS fatalities. Penetrating trauma to the face or neck may be accompanied by significant hemorrhage, severe and multiple facial fractures, and airway disruption, leading to death from airway compromise. Cricothyroidotomy may be required to salvage these patients, but the procedure failed in all instances in this series of cases. Further studies are warranted to determine the appropriate algorithm of airway management in combat casualties sustaining traumatic airway injuries. © 2010 Informa Healthcare USA, Inc.


Eastridge B.J.,U.S. Army | Hardin M.,U.S. Army | Cantrell J.,Office of the Armed Forces Medical Examiner | Oetjen-Gerdes L.,Office of the Armed Forces Medical Examiner | And 8 more authors.
Journal of Trauma - Injury, Infection and Critical Care | Year: 2011

Background: Understanding the epidemiology of death after battlefield injury is vital to combat casualty care performance improvement. The current analysis was undertaken to develop a comprehensive perspective of deaths that occurred after casualties reached a medical treatment facility. Methods: Battle injury died of wounds (DOW) deaths that occurred after casualties reached a medical treatment facility from October 2001 to June 2009 were evaluated by reviewing autopsy and other postmortem records at the Office of the Armed Forces Medical Examiners (OAFME). A panel of military trauma experts classified the injuries as nonsurvivable (NS) or potentially survivable (PS), in consultation with an OAFME forensic pathologist. Data including demographics, mechanism of injury, physiologic and laboratory variables, and cause of death were obtained from the Joint Theater Trauma Registry and the OAFME Mortality Trauma Registry. Results: DOW casualties (n = 558) accounted for 4.56% of the nonreturn to duty battle injuries over the study period. DOW casualties were classified as NS in 271 (48.6%) cases and PS in 287 (51.4%) cases. Traumatic brain injury was the predominant injury leading to death in 225 of 271 (83%) NS cases, whereas hemorrhage from major trauma was the predominant mechanism of death in 230 of 287 (80%) PS cases. In the hemorrhage mechanism PS cases, the major body region bleeding focus accounting for mortality were torso (48%), extremity (31%), and junctional (neck, axilla, and groin) (21%). Fifty-one percent of DOW casualties presented in extremis with cardiopulmonary resuscitation upon presentation. Conclusions: Hemorrhage is a major mechanism of death in PS combat injuries, underscoring the necessity for initiatives to mitigate bleeding, particularly in the prehospital environment. Copyright © 2011 by Lippincott Williams & Wilkins.


Franco D.M.,Office of the Armed Forces Medical Examiner | Ali Z.,Office of the Chief Medical Examiner | Levine B.,Office of the Chief Medical Examiner | Middleberg R.A.,Grove Labs | Fowler D.R.,Office of the Armed Forces Medical Examiner
American Journal of Forensic Medicine and Pathology | Year: 2014

Tapentadol (Nucynta) is a centrally acting opioid analgesic prescribed for the treatment of moderate to severe acute pain. Its efficacy is believed to be due to μ-opioid receptor agonist activity and inhibition of norepinephrine reuptake resulting in increased norepinephrine concentrations. There is only one other case in the literature relating to the toxicity of this agent or report of a fatality. This case report documents a case in which tapentadol was identified as the cause of death. The tapentadol concentration found in the heart blood submitted in this case was more than 20 times the upper limit of the therapeutic range. Possible mechanisms of death include respiratory depression, central nervous system depression, and serotonin syndrome. Based on the scene investigation and autopsy findings in this case, the medical examiner determined that the cause of death was narcotic (Nucynta) intoxication and the manner of death was undetermined. Copyright © 2014 by Lippincott Williams & Wilkins.


PubMed | Office of the Armed Forces Medical Examiner, Armed Forces Medical Examiner System and U.S. Navy
Type: Journal Article | Journal: Journal of analytical toxicology | Year: 2016

It is reasonable to expect the presence of multiple drugs to present a complicated picture of toxicity. We report a fatal case involving a young man who purchased illicit drugs and knowingly consumed them. After consuming these drugs and going to sleep in his friends car, he was found unresponsive the next morning with no signs of physical violence. Drugs found in the peripheral blood at autopsy were oxymorphone, methylone and ethanol at concentrations of 0.106, 0.50 and 130 mg/dL, respectively. The levels of oxymorphone and methylone in peripheral blood were comparable to those observed in other reported fatalities. Cocaine and benzoylecgonine were detected in the urine but not in the blood. Measureable concentrations were also observed for oxymorphone and methylone in urine, liver, kidney and bile. The physical findings at autopsy included pulmonary edema. This is the only reported fatal case involving this combination of drugs encountered in our laboratory.


Pasquale-Styles M.A.,Fulton County Medical Examiner Center | Crowder C.M.,Office of the Armed Forces Medical Examiner | Fridie J.,Office of Chief Medical Examiner | Milla S.S.,New York University
Journal of Forensic Sciences | Year: 2014

Bilateral symmetric bone nodules were observed in the anterolateral first ribs of an infant with shaking injuries at autopsy. The location prompted diagnostic considerations of healing fractures versus anomalous articulations with pseudarthroses. The forensic pathologist worked with forensic anthropologists and pediatric radiologists to evaluate autopsy findings and compare premortem and postmortem X-rays. Gross examination of the bones by the pathologist and anthropologists confirmed bilateral, callus-like bone nodules in first-rib locations associated with pseudarthroses. Histologic examination of one of the bones further showed features most consistent with pseudarthrosis, not a healing fracture. Radiologists then compared multiple premortem and postmortem radiographs that showed no remodeling of the bone over a 2-week interval between the time of injury and death, which would be unexpected for a healing fracture in an infant. This multidisciplinary approach resulted in the appropriate diagnosis of pseudarthroses due to anomalous articulations, an uncommon finding in forensic pathology. © 2014 American Academy of Forensic Sciences.


PubMed | U.S. National Institute on Drug Abuse and Office of the Armed Forces Medical Examiner
Type: Journal Article | Journal: Drug discovery today. Technologies | Year: 2014

Consequences to individuals convicted of abusing prohibited drugs or doping agents can be severe, including loss of employment, child custody, driving privileges, right to compete in international sports and ultimately freedom, when mandatory confinement occurs. In view of these penalties, laboratories charged with providing evidence must maximize testing accuracy. False positive and false negative tests are prevented by combining sensitive immunoassays and specific chromatographic-mass spectrometric detection. In addition, testing different biological matrices offers unique information about the drug-use history of an individual.:

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