compassion fatigue

Secondary Traumatic Stress – Getting Through What You Can’t Get Over

Anita Brook-corner talk-secondary stressSecondary Traumatic Stress (STS), also known as Compassion Fatigue , is a condition characterized by a gradual lessening of compassion over time. It is common among individuals that work directly with trauma victims such as coroners, police, nurses, psychologists, and first responders.  Sufferers can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, sleeplessness or nightmares, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self-doubt. This self-doubt can cause problems at work and home, and over time will effect all relationships.

Several personal attributes place a person at risk for developing compassion fatigue. Persons who are overly conscientious, perfectionists, and self-giving are more likely to suffer from secondary traumatic stress. Those who have low levels of social support or high levels of stress in personal life or job are also more likely to develop STS. In addition, previous histories of trauma that led to negative coping skills, such as bottling up or avoiding emotions, increase the risk for developing STS.

Many organizational attributes in the fields where STS is most common, such as the healthcare field and death investigators, contribute to compassion fatigue among the workers. For example, a “culture of silence” where stressful events such as deaths in an intensive-care unit are not discussed after the event is linked to compassion fatigue. Lack of awareness of symptoms and poor training in the risks associated with high-stress jobs can also contribute to high rates of STS.

There are no known clinical treatment options for compassion trauma, but there are a number of recommended preventative measures

Personal self-care

Stress reduction practices have been shown to be effective in preventing and treating STS. Taking a break from work, participating in breathing exercises, exercising, and other recreational activities all help reduce the stress associated with STS. In addition, establishing clear, professional boundaries and accepting the fact that successful outcomes are not always achievable can limit the effects of STS.

Social self-care

Social support can help practitioners maintain a balance in their worldview. Maintaining a diverse network of social support, from colleagues to pets, promotes a positive psychological state and can protect against STS.



Screen Shot 2014-07-18 at 7.49.33Many thanks to  Anita Agers-Brooks  for her contribution  to our community and her research on this topic.  You can find more about Anita from the link in her name.  Her knew book can be found on Amazon.  





Money Plan S.O.S | Financial Coaching

Money Plan sosWe all, at times,  need to take a step back and look at our personal lives.  We are always in the mix of other people’s mess and we often neglect our own.  As public servants none of us are paid what would be considered an amazing wage. However, we can take steps to live better, live smarter, and plan for tomorrow.  In this episode I talk with Steve Stewart of Money Plan S.O.S. We talk about how to come out of financial crisis mode and into a secure financial state free from fear and worry and how Financial Coaching   can help you too.

Steve Stewart is a financial coach and podcaster and can be found at the links below.  I invite you to check out his show – subscribe to his podcast and leave a review after three shows.  His down to earth advice and information is invaluable to our financial  success.  Steve’s website has tons of resources and information free to download and use.  You can find more about Money Plan SOS and Steve Stewart at:

Podcast Link 

What Are Autoerotic Deaths – (and what they are not)

Autoerotic Death

Autoerotic deaths are accidental deaths that occur during solitary sexual activity in which some type of apparatus that was used to enhance the sexual stimulation of the deceased caused the unintentional death.

These deaths are accidental, they are not suicides as some have thought. The practitioner does not intend to die as a result of this activity, but instead, dies as a result of an overdoes of asphyxiation or a failure in the mechanism of pleasure induced by the victim.

Autoerotic deaths come in many forms and are not just from an asphyxial hanging, although asphyxia is the most common.

These deaths can also occur as a result of:

Ligature Compression of the Neck
Airway Obstruction
Chest Compression
Chemicals or Gases
Electrical Stimulation
Foreign Body Insert into Penis or Anus

By its very definition these acts are solitary. Some have proposed that when an accidental death occurs during a sexual act between two people, where the airway was obstructed or blood flow was restricted during the sexual act, should be considered an autoerotic death. However, those deaths may be accidental but not autoerotic. Auto is defined as self, one’s own, or by oneself. Although monoerotic might be a better description, auto is still the appropriate terminology.

In terms of the type of apparatus used. Some mechanism; whether ligature, mechanical, or manual has to be in use as a way to enhance the sexual stimulation and arousal of the practitioner.

Some investigators find it hard to believe that these acts are in any way sexually gratifying. This practice is very much a paraphilia act, and performed by a very slim majority of the population. It is important however to keep in mind that there are three general sources of sexual pleasure.

1. Stimulation of the genital organs .
2. Lack of oxygen to the central nervous system.Screen Shot 2015-03-01 at 08.11.32
3. The creation of a fear and anguish atmosphere.

Generally when a person first starts engaging in these acts, asphyxia or other mechanism are used in combination with masturbation or sexual intercourse. However, intercourse would rule out autoerotic by definition, but over time the need to masturbate will decrease and the asphyxia itself becomes the sexual activity.

It is important to understand that the evidence of masturbation during the fatal event is not mandatory . Quite the opposite actually, it is rare to find such evidence. It is common for the practitioner to use autoerotic stimulation as a means of sexual arousal and then masturbate to climax after having gained an erection and efficient arousal. A form of foreplay, if you will.

Autoerotic fatalities are classified as two types; typical and atypical. Typical deaths means they fit into a set of predetermined standards of accidental deaths as it relates to victimology, method, paraphilia and history. Atypical deaths do not meet these criteria. We will further explore these classifications in later chapters when victimology is addressed..

Lastly, in defining autoerotic deaths you must keep in mind that these are unintentional deaths – not suicide. But exercise extreme caution; you must rule these cases based upon the probability of available evidence.An accurate cause of death is crucial, a point of discussion later in this book. But better to rule a death suicide when a couple of scene features exist, while absolute facts cannot support a definitive

If someone dies during an autoerotic act, or sexual stimulation, as a result of heart attack, stoke, arrhythmia, etc., it is not an autoerotic death. Natural causes must be ruled

Sex and sexual activity can take a toll on the body; changing heart rate, blood pressure, respiration, and adrenaline levels. Strenuous activity can be a common cause for heart attacks and strokes.

Remember, an autoerotic death must result in accidental death caused from the apparatus used to increase sexual pleasure. If a person dies as the result of a heart attack during the act of normal masturbation, normal meaning without the use of any aids other than one’s hand, the cause of death would be heart attack. The autoerotic factor would never come into play. The same would be true regardless of dress, activity, or scene features present. Further, if someone dies during a sexual game with a partner, that may very well be an accident, but by its very definition cannot be ruled autoerotic in nature because there was no intent of a solitary act.

Case example. A man in his mid 60’s was found by his wife sitting in a chair wearing only women’s shoes and a bra. A vacuum cleaner was nearby and in operation. The man’s penis was still inside the vacuum hose as it was apparent he was using it to aid in his masturbation. The medical examiner found the cause of death to be heart attack. So even though some of the scene features present are common with autoerotic deaths, and it was obvious that autoerotic activity was taking place, this was a natural causes death because the apparatus used, vacuum cleaner, did not cause the death due to a malfunction of its intended use for sexual pleasure.

Trophy Kill

This first hand true account of one of the most horrific  murders in Canadian history gives us an insight rarely gained into the mind of a murderer  and the forensics and documentation that goes into the prosecution of a murder of this caliber.  Dan Zupanksy was a prime witness in this case because of his relationship and correspondence  with the killer.  In this conversation we talk about the details of the murder and how it was prosecuted.   Below you will see actual drawings the suspect sent to Zupansaky during their correspondence .  This book is one of the few books that actual helps investigators understand the dynamics of a criminal investigation.  Actual court documents and testimony along with real correspondence

Dan Zupansky is a podcast producer and author living in Canada.  His podcast True Murder is  widely popular and an  iTunes classic.  Rated best show in genre.  You can find links to his show and Trophy Kill TV  below…..

Listen to the audio version or podcast for the full story.

Links and Contact for Dan Zupansky


True Murder Podcast


Actual Drawings By the Suspect Used in Prosecution



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Determining Time of Death

Garry RodgersDefining Time of Death   
There are several times of death. Let me repeat that—there are several times of death. Time of death seems to be a simple and straightforward term that obviously means the exact time that the victim drew his last breath. Unfortunately, it’s not quite that simple.

There are actually three different times of death:

  • The physiologic time of death, when the victim’s vital functions actually ceased.
  • The legal time of death, the time recorded on the death certificate.
  • The estimated time of death, the time the medical examiner estimates that death occurred.

It is important to note that the estimated time of death can vary greatly from the legal time of death and the physiologic time of death.

The only absolutely accurate determination of the time of death is the uncommon circumstance in which a person died with a physician or other skilled medical professional present. The doctor could make the determination and mark the time, and even this is assuming his watch or the clock on the wall was accurate. But that little inaccuracy aside, a death witnessed in this fashion is the only time that the three above times of death would correlate with one another.

Otherwise, it is impossible to determine the exact time of death. But what if someone witnessed the fatal blow or gunshot or what if the event was recorded on a timed surveillance camera, wouldn’t that accurately mark the time of death? The answer is a qualified yes. If the witnessed event led to immediate death, then the witness would have seen the actual death. If not, the witnessed event is simply the trauma that led to death but not the actual moment of death. People can survive massive and apparently lethal injuries for hours, even days or years.

But most deaths are not witnessed. Natural death may come during sleep, and accidental and suicidal deaths often occur when the victim is alone. In homicides, the perpetrator is typically the only witness and he rarely checks his watch, and even if he did, he’s not likely to talk about it. This means that when the medical examiner must determine the time of death he can only estimate the approximate time.

These times of death may differ by days, weeks, even months, if the body is not found until well after physiologic death has occurred. For example, if a serial killer killed a victim in July, but the body was not discovered until October, the physiologic death took place in July, but the legal death is marked as October, since that is when the corpse was discovered and the death was legally noted. The medical examiner estimated that the time of death could be July, or it could be June or August. It is only an estimate and many factors can conspire to confuse this determination. But, it is critically important for the medical examiner to be as accurate as possible.

The Importance of the Time of Death
An accurate estimation of the time of death can lead to discovering the identity of the assailant. In criminal cases, it can eliminate some suspects while focusing attention on others. For example, a husband says that he left for a business meeting at 2 P.M. and returned at 8 P.M. to find his wife dead. He says that he was home all morning and that she was alive and well when he left. If the ME determines the time of death was between 10 A.M. and noon, the husband has a great deal of explaining to do. On the other hand, if the estimation reveals that the death occurred between 4 and 6 P.M., and the husband has a reliable alibi for that time period, the investigation will move in a different direction.

Notice that in the above example the ME gave a range rather than an exact time for his estimated time of death. He didn’t say 4:30 P.M. but rather said between 4 and 6 P.M. Simply put, that’s the best he can do and that’s why it’s called the estimated time of death. It’s a best guess.

The time of death is not confined to criminal investigations; it can also come into play in civil situations. Insurance payments may depend upon whether the insured individual were alive at the time the policy went into effect or if he died before the policy expired. Even a single day can be important. Likewise, property inheritance can hinge on when the deceased actually died. Suppose two business partners die near the same time. Their contract may read that the company assets go the survivor if one of them dies. In this case, the heirs of the one that died last would own the company assets. Similarly, the dispersal of property under a will might be affected by which partner died first.

Determination of the Time of Death
Determining the time of death is both an art and a science and requires that the medical examiner use several techniques and observations to make his estimate. As a general rule, the sooner after death the body is examined, the more accurate this estimate will be.

Unfortunately, the changes that a body undergoes after death occur in widely variable ways and with unpredictable time frames. There is no single factor that will accurately indicate the time of physiological death. It is always a best guess. But when the principles are properly applied, the medical examiner can often estimate the physiologic time of death with some degree of accuracy.

To help with his estimation, the ME / Coroner utilizes various observations and tests, including:

Body temperature
Rigor mortis
Livor mortis (lividity)
Degree of putrefaction
Stomach contents
Corneal cloudiness
Vitreous potassium level
Insect activity
Scene markers

The most important and most commonly used of these are body temperature, rigor mortis, and lividity. French physician Dr. Alexandre Lacassagne (1843–1924), director of Legal Medicine in Lyon, France, wrote extensively on algor mortis (the temperature of death), rigor mortis (the stiffness of death), and livor mortis (the color of death).

Body Temperature
Normal body temperature is 98.6 degrees Fahrenheit. After death, the body loses or gains heat progressively until it equilibrates with that of the surrounding medium. Since corpse temperature can be easily and quickly obtained (see page XX), the search for a formula that uses this parameter to define the time of death has been sought for years. As early as 1839, English physician John Davey undertook the study of corpse heat loss in London, and as late as 1962, T.K. Marshall and F.E. Hoare attempted to standardize this analysis when they established a computerized mathematical formula known as the Standard Cooling Curve. In the intervening years, and even since Marshall and Hoare, many others have attempted to devise similar schemes. Unfortunately, none of these have proven to be any more accurate than the current formula for heat loss of 1.5 degree per hour.

The formula is:

Hours since death = 98.6 – corpse core temperature / 1.5

This approximate rate of heat loss continues until the environmental temperature is attained, after which it remains stable. That sounds simple enough.

Unfortunately, it’s not quite that straight forward. The 1.5-degree-per-hour factor varies, depending upon the environment surrounding the body, the size of the corpse, clothing, and other factors. For example, a body in a temperate room will lose heat much more slowly than will one in an icy, flowing stream. And a body in a hot environment, such as an enclosed garage in Phoenix, Arizona, in August, where the ambient temperature could be 125 degrees Fahrenheit or more, will gain heat. The key is that the corpse will lose or gain heat until it reaches equilibrium with its environment.

The coroner’s technician who processes the corpse at the scene takes a body temperature, and also measures the temperature of the surrounding medium—air, water, snow, or soil (if the body is buried). Ideally, the body temperature is taken either rectally or by measuring the liver temperature, which may be a more accurate reflection of the true core body temperature. This requires making a small incision in the upper right abdomen and passing the thermometer into the tissue of the liver. This should only be done by a trained individual and under the direction of the medical examiner. Care should be taken not to alter or destroy any existing wounds on the body. Some people have suggested measuring the core temperature by inserting the thermometer into a knife wound or gunshot injury to negate the need to make a new incision. This should never be done because the introduction of any foreign object may contaminate or alter the wound, which can be key evidence in the case. For practical reasons, the rectal temperature is usually taken.

The sooner after death the body is found, the more accurately time of death can be assessed by this method. Once the body reaches ambient temperature, all bets are off. But even if done correctly and soon after death, body temperature determination is subject to several sources of inaccuracy.

One assumption made in the calculations is the initial body temperature. The normal 98.6 degrees Fahrenheit is an average and varies from person to person. Some people have higher normal temperatures than others. Women tend to run higher temperatures than do men. Illnesses associated with fevers can markedly elevate the temperature of the person at the time of death, while chronic illness, dehydration, or the presence of prolonged shock may lower initial body temperature. There is also some diurnal (basically morning versus evening) variation in body temperature in most people. All this means that the calculation begins with some degree of error.

A dead body looses heat passively by three distinct mechanisms: radiation (heat lost as infrared heat rays), conduction (heat passed on to any object that contacts the body), and convection (heat lost into the moving air). The state of the corpse and the environmental conditions greatly affect the rate of heat loss.

Obesity, heavy clothing, warm still air, exposure to direct sunlight, and an enclosed environment slow heat loss. Fat and clothing make good insulators, so an obese person in a sweater will lose heat much more slowly than would a thin, unclothed corpse exposed to cold or moving air, water, or shade. Children and the elderly tend to lose heat faster, as do those who are chronically ill or emaciated. If the body is in contact with cold surfaces such as marble or cool concrete, heat loss will be greater.

There’s still one more curve ball: Several days after death, as fly maggots begin to feed on the corpse, their activity and internal metabolic processes can at times raise the temperature of the corpse. This should not be a problem for the forensic investigator, though, because once this insect activity is that far advanced body temperature is no longer of use.

As you can see, heat loss is fraught with inaccuracies. Still, with early and careful measurement of the core body temperature and consideration for the conditions surrounding the corpse, a reasonably accurate estimate can often be made.

Let’s say two people are murdered in a home in Houston, Texas, during late summer. The bodies are discovered four hours after death. One body is left in the garage where the ambient temperature is 110 degrees Fahrenheit, while the other is in the living room where air conditioning holds the temperature at 72. The corpse inside would lose heat at about 1.5 degrees per hour, so that if the medical examiner had evidence that the death had occurred four hours earlier, he would expect to find a core body temperature of approximately 92 to 93 degrees.

1.5 degrees / hour x 4 hours = 6 degrees
98.6 – 6 = 92.6

If he found a different core temperature, he would revise his estimate. But what if the victim were very old or young, thin, unclothed, or lying on a cold tile floor near an air conditioning vent? Under these circumstances, the heat loss would be more rapid. The core temperature could be 88 to 90 degrees, perhaps even less. If the medical examiner failed to consider these mitigating factors, an erroneous estimate of the time of death could result. For example, if the core temperature was 88 degrees and he failed to adjust for the environmental conditions around the body, he could estimate that approximately seven hours had elapsed since death.

98.6 – 88 = 10.6 / 1.5 = 7.1 hours

An estimate of six to eight hours is quite different from an estimate of three to five hours. The killer may have an iron clad alibi for the former time period, and easily could since he hadn’t arrived at the crime scene at that time. He could have been having lunch with twenty people. But only four hours later, he might not have such an alibi.

What of the body in the garage? The ME would expect the corpse to gain heat at the same rate of 1.5 degrees per hour. Thus, the core temperature should be approximately 104 degrees Fahrenheit, or perhaps even higher.

  Time since death: …. Changes observed

1-2 hours: ………Early signs of lividity.

2-5 hours: ………Clear signs of lividity throughout body. Fixed in 6-10 hours

5-7 hours: ………Rigor mortis begins in face.

8-12 hours: …….Rigor mortis established throughout the body, extending to arms and legs

12 hours: ……….Body has cooled to about 25°C internally.

20-24 hours: …..Body has cooled to surrounding temperature.

24 hours: ……….Rigor mortis begins to disappear from the body in  roughly the same order as it appeared.

36 hours: ……….Rigor mortis has completely disappeared.

48 hours: ……….Body discoloration shows that decomposition is beginning.

Sandbox Wars – End of Life Battles

Stephanie PayneStephanie Payne, author of The Sandbox Wars, talks about the battles that can occur when end of life planning is not completed. As Coroners, Medical Examiners, and death investigators we can be faced with families unprepared for a death of a loved one.  You may also be faced with the “long lost” family member that suddenly appears and wants to control the investigation and the family.    

For thirty years Stephanie Payne has been a practicing RN with special interest in Home Health and Hospice.  Her education is varied and diverse:  St. Louis Community College, Webster University and Landmark Education.  As a talented artist Stephanie has stretched her skills by writing about her passion: Helping people.  Next Stephanie Payne and Michael Keune have produced a documentary:   Legacy Decisions.  Stephanie has been presenting this for radio, Senior Groups, Community Organizations, Business Forums, Attorneys and Financial Planners. 

The Sandbox Wars

End of Life Decisions The Most Important Gift to Your Family

Learn about the end of your life with real life stories about how families behave during your last days.  There is a solution to our lives and The Sandbox Wars address some of the most important aspects of achieving a successful resolution to a life well lived.  There is wonderful artwork in the book by Chuck Ridler which adds humor and character to the stories.  Leland’s Road song, Whispers in My Ear, augments the experience of the book.

Visit to listen to the music and enjoy more stories by Stephanie Payne.

Crime Scene Tech | Stefanie Elliott CST

3340 Elliott, Stefanie

Forensics is the study of the past as it relates to the present.  Criminal forensic is applying  science  to the law. In short it’s the study of known science and relating it to a crime scene for the determination and prosecution of a crime.  Many men and women are specially trained to collect evidence and in some cases even apply the science to this collected evidence and provide answers to investigators.

On this episode of Coroner Talk™  I talk with Crime Scene Technician and college professor – Stefanie Elliott of the St. Johns, FL Sheriff’s office.   Our discussion centers around what crime scene technicians  do for investigators, how science is applied to criminal cases, unique circumstances where forensics saved a case, and much more.

Listen to the audio of this conversation to learn more

You can contact Stefanie


Critical Roles Managing ME & Coroner Offices

Critical Role of Managers and Administrators in a Medical Examiner/Coroner Office

Paul ParkerPaul R. Parker III, B.S., D-ABMDI


There is no greater honor than writing the last chapter of someone’s life story. As medicolegal death investigators, that is what we do and, for the most part, we do it well. With seemingly innumerable courses, electronic mailing lists, and forensic science discussion groups, there is a plethora of available information on how to investigate just about every possible death scene and circumstance. Unfortunately, there is not a major focus on the management and administration of offices and personnel in the medicolegal death investigation field. With the exception of those offices under the law enforcement umbrella, many medicolegal death investigation managers and supervisors lack basic managerial training and the “big picture” purpose and role of a Medical Examiner/Coroner (ME/C) Office is often forgotten or overlooked not only by its employees, but by its administrators. The lack of managerial training and resulting substandard managerial performance; misguided managerial focus; and managerial inaction, to include the ignoring and/or avoidance of problem issues and personnel; ultimately results in the creation and maintenance of a toxic work environment and the “big picture” becomes foggy, if not completely invisible. In this environment, “cancerous” employees infect the environment to the point that good employees either leave or lose the motivation and dedication to a job well done.

The primary focus of most medicolegal death investigation managers, administrators, and supervisors is to ensure ME/C personnel properly determine jurisdiction, document deaths reported to the office, conduct scene investigations, perform death notifications, conduct postmortem examinations, certify deaths falling under its jurisdiction, and document the investigative efforts in comprehensive and factual reports, in addition to many other ancillary functions. We are fortunate to work with many outstanding death investigators and support personnel who choose to do the most noble of jobs in an under-paid, under-appreciated, and overly-stressed work environment.

  • How much of their great work is being undermined everyday by inefficient and ineffective Division/Office management or frontline supervisors?
  • How many employees would say that their managers/supervisors care about them, effectively communicate, set expectations, hold problem employees accountable, and actually treat employees as humans, not just a name or number covering a shift?
  • How many front-line supervisors and managers lose more sleep over the performance, or lack thereof, of a problem employee than over investigating traumatic deaths and performing death notifications?
  • Do the employees care about the job they do and the office’s role and how it is perceived by the public and its customers?

Despite the existence of these issues, job satisfaction surveys of ME/C employees almost universally reveal that the employee’s actual job brings high levels of satisfaction. It is, in part, the above-listed issues that undermine true job satisfaction on par or even more so than low pay and inadequate staffing levels.

In addition to an emphasis on managerial competency, there needs to be a focus on improving interpersonal relationships among co-workers, emotional well-being in the workplace, and the importance of communication, expectations, accountability, and rewarding performance. In addition, it is critical that all death investigation employees are constantly reminded about the “big picture,” which is centered upon the interactions we have with everyone, especially families and next-of-kin, how we present ourselves to and in the public, how our reports reflect our level of competence, and how we have many customers, not just the pathologists. The painting of the “big picture” starts “at the top” of every organization and is filtered down through the managers and frontline supervisors.

An administrator/manager/supervisor must ALWAYS:


  • with the exception of what is already documented in personnel files, start with a “clean slate”
    • this is more difficult when promoted from “inside” as opposed to being brought in from outside of the agency.
  • have a willingness to immediately identify and handle performance or interpersonal issues
    • never “look the other way”
    • “back the play” of personnel without jumping to conclusions
    • “toxic” or “cancerous” employees
    • “toxic” interpersonal relationships that negatively impact the work environment
  • be able to effectively communicate, communicate, communicate
    • via various means, e.g., in person, email, etc.
      • use caution with email (keep it short)
    • clear (and documented) expectations
    • vision
    • upcoming changes and the rationale for the changes
    • “No Surprises”
      • keep employees in the loop, whenever possible, and be kept in the loop
    • be committed to continuous improvement
      • of the manager
      • of the employee
    • be consistent
    • be responsive
    • be dedicated to the mandate that everyone is accountable, all the time
    • believe in the importance of documentation
      • If it’s not documented, it did not occur
    • understand the perception that reports/documentation are a direct reflection of an employee’s competence
    • believe that the emotional well-being of medicolegal death investigation employees is paramount
      • truly care about the employee, even if the employee doesn’t want you to
        • acknowledge the difficulties of shift work
        • understand need for work/life balance
          • family emergencies, etc.
        • acknowledge birthdays, accomplishments, jobs well done, etc.
      • be available when on-duty and off-duty, when applicable
      • be willing to:
        • “roll up the sleeves” and jump in, whether that means assisting at scenes, counting medications, communicating with next-of-kin, or even covering shifts, if need be.
          • This action results in the highest levels of credibility and respect, as people trust and believe in someone who is willing to not just “talk the talk” but also “walk the walk” by coming out of the office and getting down in the trenches, so to speak.


An administrator/manager/supervisor must NEVER:


  • compromise on integrity issues, e.g., lying, falsification of reports, timecards, etc.
  • show favoritism
  • gossip
  • bully
  • violate an employee’s confidence
  • take credit for the work of others
  • act in a way that contributes to or creates a hostile work environment
  • micromanage


Additional Management Priorities


Upon hire/promotion, a new manager must hold a mandatory meeting attended by all persons reporting to the new manager. During the meeting, the new manager should provide an overview of the following:

  • manager’s background
  • manager’s core beliefs
  • plan of action (0-60 days, 61-90 days, 90+ days) to include:
    • meeting/riding with/shadowing each employee
    • assess procedures, operations, staffing and personnel allocation
    • solicit feedback (after all, the people doing the job usually know what’s working and what isn’t)
    • building relationships with all applicable parties


Management personnel must be committed to:


  • ensuring the office and its personnel are viewed as professionals, not merely “body snatchers” or a transport company
  • justifying appropriate staffing levels
  • implementing an appropriate employee selection process
    • recruit
      • to include written and emotional well-being components
    • train
      • remedial training
    • maintain
  • using an employee’s probationary period to assess the employee but also allowing the employee to assess the office and his/her role in it
    • we want to identify those folks that do not or cannot do the job during this period
    • we also want them to assess whether we have created an environment in which they’d like to work
  • fostering positive and productive relationships with:
    • Human Resources representative
    • other Department/Division head
  • implementing and maintaining:
    • current and comprehensive policies and procedures
    • training manuals/guidelines
      • new employees, e.g., field training program, etc.
      • current employees, e.g., report guidelines, feedback/review of every report, training bulletins, external training opportunities, ABMDI certification, etc.
    • providing timely performance appraisals and appropriate goal setting
      • the content of an employee’s appraisal should never be a surprise and unveiled for the first time when reviewing the appraisal
        • constant communication during the rating period is essential and fair to the employee
      • establishing a work environment that exhibits and is built upon consistent practices
      • conducting outreach efforts to law enforcement, health care providers, mortuaries, etc.
      • implementing and monitoring workplace safety programs (physical and emotional well-being)


Chief Medical Examiners, Deputy Medical Examiners, Directors, and Administrators must be proactive and establish lines of communications and continual educational opportunities for and with:


  • appointing authorities, i.e., Boards of Supervisors, State Legislators, etc.
  • other Department Heads within the same entity, i.e., State or County level
  • media representatives.
    • Yes, media representatives.
      • Who better to present positive, proactive stories about the office and its real mission and duties, as opposed to the public perceptions promulgated by the CSI Effect?
      • If outreach is conducted with the media, when a “problem” arises, allegations of misconduct are made, or if the office actually “drops the ball” on an issue, having fostered relationships with the media and your entities media liaison will “soften the blow”


Managers and employees are equally responsible for the success of employees and the office

Employers must ensure that the employee is provided the skills, knowledge, resources, guidelines, and tools to successfully perform the job; employees must ensure they are dedicated to using them with the ultimate goal of providing the best possible service in conjunction with continuous personal and professional growth. It is easy for employees to blame management for whatever ails them but it is helpful for truly dedicated employees to consider and act upon the following issues:


Each employee must place an emphasis on value, specifically how to add value in every interaction while on-duty and representing the office.

  • What is employee’s value to other office personnel?  To next-of-kin?  To law enforcement?  To hospitals?   To funeral homes?
  • How does the employee highlight, capitalize, and increase his/her value to co-workers and customers?
  • How does the employee minimize his/her personal biases and treat all customers professionally and with respect?  If s/he does not, what needs to be done to do so?

Dedication to continuous improvement

Each employee must be dedicated to this concept. Truly successful people embrace continuous improvement and are always educating/improving themselves, however possible, as opposed to maintaining the status quo.

  • What does an employee do to continually improve his/her investigative and customer interaction skills?
  • If the employee does not, when will s/he start, as there is no choice but to do so!

Dedication of office’s roles/responsibilities/mission/vision

Each team member must be dedicated to these issues.


  • Is the employee dedicated to positively impacting where the office’s direction and service?  If not, the supervisor must meet with the employee immediately!
    • Remember, not everyone is cut out to work in the medicolegal death investigation field. I am always dedicated to helping people find jobs for which they are most suited; if that’s not in the medicolegal death investigation field, so be it. We need to ensure that only people who want to positively impact the office continue to work at the office, as co-workers and the family members of the decedents will either reap the benefits of a dedicated employee or suffer the consequences of an employee who should not be in our line of work (in the case of family members, those negative consequences may last a lifetime).
  • How does the employee demonstrate dedication to the office?  To co-workers?  To law enforcement?  To next-of-kin?  To hospitals?  To funeral homes?
  • Does the employee do anything that may demonstrate s/he is not dedicated to where the office is going, what it is supposed to be doing, its mission, or its vision?


Performance competence/skills/knowledge

Each employee must display competence in his/her respective area.


  • Does the employee strive to be best the (job title) s/he can be?
  • What is s/he doing to attempt to attain that goal?
  • Is the employee flexible in thought and conduct?  Is his/her way the only correct way?


Documentation competence/skills

Each employee must be willing and able to document, in writing, what it is they do pursuant to the guidelines/instructions provided.


  • Does the Investigator document every death reported to him/her?
  • Does the Investigator document the deaths in a timely fashion?
  • Does the Investigator thoroughly document the deaths pursuant to standardized guidelines?
  • Does the documentation make sense? Does it tell a legible, coherent story? Are pertinent negatives addressed, etc.?
  • Is the documentation complete before going off-duty?
  • Are Investigative Narrative Report Performance Measures in place and, if so, does the Investigator meet those measures?


Investigative scene response

Each Investigator must appropriately triage and respond to scenes and, upon arrival, act in a professional, appropriate, and confident manner.


  • Does the Investigator respond to scenes in an expeditious, yet safe, manner?
  • Does the Investigator prioritize/triage multiple scene responses appropriately?
  • Does the Investigator “think outside of the box” when confronted with competing interests?
  • While on scene, does the Investigator conduct himself/herself in a professional manner?
  • Does the Investigator view himself/herself as the expert in medicolegal death investigation or does s/he allow others to dictate how to conduct himself/herself and/or the investigation?


Interaction with customers

Each employee must act in a compassionate, professional, competent, and appropriate manner when interacting with an office’s various customers.


  • Does the employee model professional conduct during every interaction with every customer?
  • Does the employee provide accurate information to customers?
  • How does the employee “come off” to co-workers?  To next-of-kin?  To law enforcement?  To funeral homes?
  • Does the employee sound compassionate, professional, competent, and appropriate during telephone conversations with various customers?
  • Does the employee allow biases to “bleed through” and become obvious to those with whom s/he is talking to or interacting?

Maintain a Focus on the “Big Picture”

 While it is true that ineffective management results in ME/C personnel losing sight of the “big picture,” as the focus is ultimately placed on those problem areas/personnel not being addressed but left to create the “toxic” environment in a workplace already made stressful enough by the basic responsibilities of the job, it’s possible to lose sight of the “big picture” even under the most ideal of circumstances and best management practices due to the inherent nature of the job. With a focus on professional appearance, interaction with next-of-kin, professionally authored reports and an understanding that they are obtained and read by numerous entities not just the pathologist, and emotional well-being, the “big picture” should remain clear.


 One of the most important “big picture” ME/C issues is the appearance of those employees who interact with the public (primarily the Investigators but also employees who work at the front counter, property clerks, chaplains, etc.)

  • Do they look sharp or like they just rolled out of bed?
  • Do they walk with confidence or slouched over dragging their feet?
  • Are their verbal public interactions and over the phone with all customers professional and respectful or do they come off as uncaring, inflexible, dispassionate know-it-alls (or maybe even worse, crass or vulgar)?

 My training and experience revolves around a concept called command presence, which is basically presenting oneself as a confident and competent authority that can be trusted and respected.  Physical appearance, body language, and verbal skills contribute to this command presence and people are oftentimes viewed, positively or negatively, based upon one’s overall grasp and control of those attributes.

 Investigators are the visible representation of an ME/C office and are the basis for the public’s, law enforcement’s, and hospital’s perceptions or beliefs about the office. Investigators must exude command presence, confidence, and pride when observed (and heard) in public at all times, whether that is at a scene, re-fueling a vehicle, walking into a convenience store, etc.

 We are responsible for investigating the death and subsequently taking custody of a decedent.  When you look professional, you tend to act professional, and are subsequently treated as a professional.  I’ve found that wearing professional or uniform attire appropriately, i.e., tucked in, clean, pressed/shined, etc., not only results in increasing both the level of respect shown to ME/C personnel and positive thoughts of their professionalism before saying one word to an officer or family, but it also results in ME/C personnel being more respectful to customers and the decedent.  I know it may be difficult to keep clothing in that condition after a scene call or two but that doesn’t mean personnel should begin the shift looking as if they have already been to several scenes.  Dedicated ME/C personnel must be provided the opportunity to shine in the eyes of the families, officers, hospitals, and the general public without the automatic formation of a less-than-ideal opinion of them as soon as they are seen or heard.  First impressions are very hard, if not impossible, to change.

Interaction with Next-of-Kin

 The next-of-kin and families of decedents are probably the most important ME/C customer.  ME/C personnel should be the primary contact with next-of-kin and meet with them at scenes—to obtain information tending to assist in the thorough documentation of that “last chapter” and to provide them information about “the next steps” and making them aware of the appropriate resources, grief or otherwise—or immediately call them if they were not at the scene (after they are notified, of course, but being able to effectively and compassionately interact with them if they happen to call the ME/C office “cold”).  As the “point” people and the sole external face of the Office, Investigators primarily experience this oftentimes stressful interaction.

We are not Grim Reapers swooping in to collect “a body” and then disappear back into the ether, leaving no trace of our existence.  We are professional independent medicolegal death investigators, who should be more knowledgeable in reactions to death, the grief process, and the importance of communication (as information not provided to families and unanswered questions of families will result in them filling in, on their own, with what may or may not be true).  Everyone we come into contact with should somehow be educated about the role of the ME/C office.  Whether it’s as they watch us professionally perform our legal duties or during the conversations we have with them while performing those duties, every contact matters, every time.

  • Management should strive to publicize to all personnel the positive comments received from next-of-kin. I was always amazed how many next-of-kin took time, despite all they were experiencing, to write a “Thank You” note to an Investigator or any employee who treated them (and the decedent) with compassion, dignity, and respect. To me, that spoke volumes about the level of service provided and the content of those notes were oftentimes heartfelt, touching sentiments that truly painted the “big picture” of why we do what we do.

Reports/Documentation – Direct Reflection of an Employee’s Competence and Numerous Readers

 An Investigator can be the best one in the agency but if his/her reports contain spelling errors, misused words, and grammatical errors, no one will ever know it and, worse yet, the credibility of and confidence in the medicolegal death investigation will be undermined.

Many times an Investigative report is drafted with the pathologist in mind. It is true that the pathologist will rely upon the content of the report to determine the extent of the examination and to focus it accordingly. There are, however, numerous other customers who will obtain, read, and rely upon the report to include, but not limited, to the following:


  • Toxicologists
  • Forensic anthropologists, odontologists, neuropathologists, and other forensic specialists
  • Fellow investigators and other ME/C personnel when fielding calls from next-of-kin, etc.
  • Next-of-kin (who will read it often and pass it on from one generation to the next)
  • Law enforcement
  • Prosecutors
  • Defense attorneys
  • Insurance companies
  • Health care providers
  • Medical facilities
  • Fatality review committees/teams
  • Media outlet
  • Managers must ensure there are documented expectations for report content and that reports are reviewed and feedback provided.

Emotional Well-Being

 There are only a handful of people operating under the same laws and circumstances as medicolegal death investigation personnel, and therefore, only a handful of people who can even begin to relate to this job’s stressors.  In all probability, significant others, spouses, parents, children, and friends cannot begin to comprehend what it is we do, see, hear, smell, and experience every day. Think about it…if a normal person happens to come upon just one suicidal shotgun wound to head once in their lives, they would probably be traumatized, need counseling, and never forget the image.  I would bet each of you can’t even remember how many of these you’ve seen and dealt with.  Dead infants and children…forget it.  Yet, we deal with these situations on an all too regular basis.

In addition, it’s not one thing just to see a dead body, but we are the only ones who have regular personal interaction with grieving, traumatized, and devastated families and friends.  I guess it’s possible to have some kind of detachment or desensitization when just looking at a dead body or just talking to the loved ones over the phone days after the death, but when having to also personally interact (sometimes within minutes of the death or immediately after being notified of the death) with those folks who had strong feelings (one way or the other) about the decedent, the ability to distance ourselves from their pain and grief becomes nothing less than impossible.  On top of all that, we are left to cope (or at least attempt to cope) with the pain and grief that “normal” people experience in their lives in addition to the depression, grief, and pain that comes along with the inappropriate coping mechanisms (and their consequences) many of us “learned” over time.  I learned a long time ago that what we experience will not destroy our emotional, mental, and physical well-being and ruin our family life, friendships, and social structure; how we respond to what we experience determines the extent of damage inflicted or survival attained.

Unlike our traditional first responder partners, i.e., law enforcement, fire department, EMS, many times medicolegal death investigation personnel are overlooked when it comes to debriefings and other related services.  Although we usually do not have to make split-second life-or-death decisions, we are tasked with dealing with what is arguably the most sensitive of issues—death.  For us to do our jobs someone has to die and, about half the time, those deaths are not natural or expected.  We see just about every form of death imaginable (some not even imaginable) and yet we are expected to continually perform our jobs with the same proficiency and professionalism as we did during the first days of our careers.  In addition, it is assumed that we are capable of living “normally” when outside (and even inside) of the workplace.

 Treating people like humans, and not numbers or shift coverage entities, shows employees they are actually cared about and, in turn, will help them maintain balance, well-being, and focus on providing compassionate and professional death medicolegal investigation services. Unfortunately, I have witnessed first-hand an almost “burn ‘em out, throw ‘em away, and bring in someone new” mentality. Without proper management, guidance, and nurturing, I believe medicolegal investigation personnel have an effective “shelf life” of five to seven years, depending on call volume and that may be overly generous.

  • A manager must constantly assess his/her own views and actions as it pertains to the emotional well-being of personnel.
  • Managers should model and encourage the positive responses to the incredible stress experienced in this line of work and encourage participation in debriefing events and confidential counseling sessions.



Paul R. Parker III, B.S., D-ABMDI

Parker Medicolegal Services, LLC

P.O. Box 20525

Fountain Hills, Arizona 85269


Telephone: 480-298-4981







Autoerotic Fatalities – Interpreting the Scene

Autoerotic 19The scene of an autoerotic death can hold a wide variety of problems and issues for the investigator. Filled with deceiving information and abnormal behavior, these scenes offer challenges to even the most seasoned investigator. However, it is vital that you get these scenes worked correctly. First and foremost, it is your job to get the correct answers for the family, the victim, and any insurance companies needing the information. The stigma attached to suicide and the autoerotic can have devastating affects on survivors, proper determination can only be achieved through good scene work and investigation.

Proper Scene Work

As in any investigation, you should never rely solely on what you see. Without doing a complete investigation you will never find the truth. DO NOT go in with preconceived ideas or basis. If you can not properly work a sexually charged scene then remove yourself and let someone else take lead.

The investigator must consider all aspects of the triangle of forensic investigation. There is an interdependence of all evidence, and none of these elements can be interpreted separately. Each of these elements are equally important.

Screen Shot 2015-01-17 at 08.48.20
Without this integrated approach, homicides could be missed, or suicides and natural deaths could be misinterpreted as autoerotic.It is important to look at what is present as well as what is not present. Family, spouses, parents – may sometimes alter the scene to avoid the embarrassment of what they found, or to save the embarrassment of the deceased.Be sure to interview the person who discovered the body quickly and look for indicators as to alteration

When looking at the scene keep in mind that these scenes can look like homicide or suicide. Many victims of this deadly game like to act out fantasies of torture  and rape they want to do to someone else.

Hands and feet may be bound, gag may be in the mouth, and a hood over the head. On first glance you will see evidence of a homicidal scene. But look closely and ask yourself these type of questions; could this person have done this themselves, could they have gotten out if still alive, how much struggle do you see, is there an escape mechanism. These along with history investigation will determine your manner.

Proper History Investigation

These cases are not complete unless you do a good history investigation. Areas such as medical, psychological, and sexual history. Talk with family and friends to learn sexual behavior patterns. Talk with old girlfriends about sexual acts and fantasies. You should know the victims medical history and psychological history, could this have been suicide, did he just get “bad news” from the doctor .

Computers should be seized and forensically evaluated for evidence of sexual interest and searches. Did the victim enjoy this type of sexual games, who has he talked to, what chat rooms, etc. Computers give us a really good insight into a person and their interests.

Above all you must not have found any evidence of suicide ideation, suicide notes, or anything leading you to the suicide conclusion based upon the probability of the evidence. Better not to rule it autoerotic than to rule it wrongly.

This is only a very small fraction of the information needed to investigate these cases. Please take the time to find books, and articles on the topic and become familiar. You may not work many of these in your career and you can only learn from two sources; experience and education. Education is the key here.

The podcast attached to this post goes much deeper into this topic.

Autoerotic Fatalities – Asphyxia

Autoerotic ropeAutoerotic deaths are accidental deaths that occur during solitary sexual activity in which some type of apparatus that was used to enhance the sexual stimulation of the deceased caused the unintentional death.

The prevalence of auto-erotic fatalities is difficult to calculate, since a coroner often records a verdict of accident or misadventure. It is under these labels that many auto-erotic deaths lie hidden. Sometimes, however, where uncertainty exists over whether the person intended suicide, the verdict is left open. Bereaved families usually prefer this. ‘They often find an open verdict a little easier to accept, certainly easier than misadventure which might imply unsuspected goings-on15 scene features can be encountered, in different combinations, at the scenes of autoerotic deaths.  However, it is our duty as investigators to come to ruling in every case we can.  Much is riding on your answer, so a thorough investigation is required.

15 features commonly found at scenes of autoerotic deaths.  Any combination of these may be observed.

  1. Nudity
  2. Exposed Genitals
  3. Cross-Dressing
  4. Evidence of Masturbation Activity
  5. Foreign Body Insertion in the Anus
  6. Lubricants
  7. Pornography
  8. Mirror
  9. Video Recording
  10. Covering of face ( mask, duct tape, panty hose, etc)
  11. Bondage of Genitals
  12. Other Bondage ( arms, legs, and body bound)
  13. Other Masochistic Behavior
  14. Protective Padding in Hanging
  15. Evidence of Repetitive Behavior

Commonly, the victim is found nude or with exposed genitals. This is an important clue to the possibility of autoerotic death. However, not all dead bodies found nude or with exposed genitals are victims of autoerotic death.  However,  not all victims of autoerotic deaths are found nude or with exposed genitals.


Typical victim of an autoerotic  accident is a white male average age 33.               

96% are Male     96% White

Females are rare,  as are blacks, Asian, and Native Americans .

Youngest reported case age 9   Oldest   89 

15 to 19 years old represent only 5%  to 16%  of victims

Masturabation Mandate 

It has been wrongly believed by many investigators that evidence of masturbation  (exposed genitals or presents of semen)  had to be present for the autoerotic ruling . This is NOT true.  Sexual pleasure is sometimes gained simply by the actions of the victim – and sometimes as a precursor – or sexual stimulate – prior to masturbation.

As For Semen

In hanging deaths semen can be frequently found due to  spontaneous ejaculation  caused by a nerve response. Further, it was commonly observed in the day of public hanging that the condemned would get an erection after dropping from the gallows floor.  This is believed to be a symptom of a severed spinal cord.  (this led people to believe that hanging caused sexual pleasure)

Asphyxiation most common form.

The most common form of dangerous autoerotic activity involves the use of some technique for reducing the oxygen to the brain to achieve an altered state of consciousness.It is important to note the distinction between autoerotic or sexual asphyxia on the one hand, and asphyxia as a cause of death on the other –

Autoerotic asphyxia refers to the use of asphyxia to heighten sexual arousal, more often than not with nonfatal outcome.

The practitioner  who dies, most often dies from an overdose of asphyxiation.The autoerotic practitioner who dies while engaged in such acts, most often dies from an overdose of asphyxiation when, for one reason or another,  becomes unable to terminate his means of enjoyment.

Positional such as fall, slips, etc. or if victim becomes unconscious.Sometimes however, someone engaged in autoerotic asphyxia may die a non-asphyxial death – such as heart attack, stroke, or exposure. This will change the manor of death to natural.  NOT autoerotic asphyxia.

Asphyxial Death Process

Amount of pressure to occlude the neck structures

Jugular Veins         4.5 lbs

Carotid Arteries     11 lbs

Trachea                    33 lbs

Vertebral Arteries  66 lbs

(On average the human head weighs 10 pounds)

Agonal Sequence in Hanging

Loss of Consciousness        10 +- 3s

Convulsions                         14 +- 3s

Decerebrate Rigidity           19 +- 5s     (extended)

Start of deep rhythmic abdominal respiratory movements          19 +- 5s

Decorticate Rigidity         38 +- 15s     (flexion)

Loss of muscle tone          1 min 17s  +- 25s

End of deep respiratory movements    1 min 51s  +- 30s

Last muscle movement           4 min 12s  +-  2 min 29s

Listen  to the audio version for a more complete conversation on the topic.