Office of Justice Programs (OJP) / Centers for Disease Control (CDC) Federal Medicolegal Death Investigation Interagency Working Group (MDI-IWG) Resource Page

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 be performed at every death scene. These tasks serve as the foundation of the guide for death scene investigators. The guide gathered input from national and international organizations and subject matter experts who are responsible for the investigation of deaths and their outcomes. Click here for for access to this report. 

The Death Investigation Guide is currently being updated for a second time. NIJ has the final edits for the guide back from the working group and anticipates publication in the Summer of 2023.

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 to support ME/C agency accreditation and to increase the supply of forensic pathologists nationwide through forensic pathology fellowship opportunities. This program transitioned to BJA in FY2020.

• For information on the Strengthening Medical Examiner-Coroner System program, click here.

Paul Coverdell National Forensic Science Improvement Grants Program 
The Paul Coverdell Forensic Science Improvement Grants program (the Coverdell program) was administered by NIJ from FY 2001 to FY 2019 and transitioned to BJA in FY 2020. 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.

• For information on the Coverdell program, click here.

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: 

1. Foundational/Basic Research Goal: Improve the understanding of the accuracy, reliability, and measurement validity of forensic science disciplines.
2. Applied Research Goal: Increase knowledge or understanding necessary to guide criminal justice policy and practice related to the forensic sciences.
3. Development Goal: Produce novel and useful materials, devices, systems, or methods that have the potential for forensic application for criminal justice purposes.

NIJ’s Forensic Science Strategic Research Plan and Forensic Science Research and Development Technology Working Group (TWG) identify current research priorities and technology challenges encountered in operational forensic science laboratories and help inform NIJ's planned and ongoing research and development activities ensuring that future research and development investments meet practitioner-driven needs. Research-based knowledge and newly developed tools that work towards addressing these priorities and resolving these challenges facilitate the criminal justice community to enforce the law, promote public safety, prevent and reduce crime, and ensure fair and impartial administration of justice.

• NIJ FY24 Research and Development in Forensic Science for Criminal Justice Purposes | National Institute of Justice (ojp.gov)

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. 

• NIJ FY24 Research and Evaluation for the Testing and Interpretation of Physical Evidence in Publicly Funded Forensic Laboratories | National Institute of Justice (ojp.gov)

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 forensic technologies and best practices by end users in the criminal justice community. The 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 white papers, landscape studies, webinars, best practice reports, and other information for disaster victim identification, medicolegal death investigation, forensic pathology, and forensic anthropology. 

In 2022, the FTCoE published “A Landscape Study of Electronic Case Management Systems (CMS) for Medical Examiners and Coroners”. This report provides: background information on electronic CMS and their integration into the death investigation process, including both commercial off-the-shelf (COTS) products and internally developed CMS; product details in the form of a landscape of representative COTS CMS products; considerations for implementing a CMS, and case studies illustrating best practices and lessons learned from incorporation of CMS into the death investigation workflow. 

The FTCoE has developed several webinar and podcast series of interest to the MDI communities:

• MDI Webinar Series (2020-2021)
  1. Deaths in Custody: A Comprehensive Review
  2. The Importance of Data to the MDI Community and Stakeholders
  3. MDI Considerations for Prescription Drug Monitoring Programs
  4. Data Systems Imperative in 21st Century Forensic Services
  5. Death Certification by the Medical Examiner/Coroner in Drug-Related Deaths
  6. Harnessing Data to Implement Real-Time Data-Driven Overdose Response Strategies
• Post-Mortem Computed Tomography Webinar Series (2021)
  1. PMCT Basics: Facility and Technical Aspects
  2. Overview of PMCT for Pathologist Triage
  3. PMCT of Gunshot Wounds
  4. PMCT of Natural Disease
  5. PMCT Potpourri of Unnatural Deaths
• The New Mexico Decedent Image Database Webinar Series (2020)
  1. Overview of Accessing the NMDID Database and Searching
  2. Accessing and Utilizing Metadata from NMDID
  3. Opening and Viewing NMDID Image Data
  4. Taking 3D Measurements with NMDID Images
• Webinar: Overdose Fatality Investigation Techniques: Lessons Learned from Project ECHO (2021)
• Webinar: Handling Difficult and Disturbing Forensic Cases for Coroners and Medical Examiners (2019)
• Just Science Podcast Series
  1. Just Workforce Resiliency for MDIs
  2. Just Forensic Anthropology and Forensic Pathology Portfolio
  3. Just Partnerships To Enhance Overdose Fatality Review
  4. Just the NIJ Needs Assessment of Forensic Laboratories and Medical Examiner/Coroner Offices

In 2021, the FTCOE hosted a “Working Group on Data Exchange in Medicolegal Death Investigation”, in coordination with CDC's National Center for Health Statistics. The goals of this working group were to: 1) document the types of data that are commonly exchanged with public health and public safety partners and determine collective usage points, 2) provide suggestions on how to improve the naming process for emerging drugs, 3) guide the drug mapping/classification process, and 4) recommend needed enhancements to the operation of exchanging forensic data with other organizations. Reports from this working group were published in December 2022. 

In 2019, the FTCOE published a NIJ Success Story: Uncovering Key Details of Skeletal Remains through 3D-ID Software. To drive the application of geometric morphometric (GM) analysis in forensic anthropology, the 3D-ID software was developed to enable the forensic anthropologists to estimate sex and ancestry for unknown crania using GM methods. The reference set has been expanded to more than 2,300 individual crania, demonstrating that large variations exist within geographic regions. This no-cost software is accessible to the public on the 3D-ID website. 

NIJ and the FTCOE hosted the 2019 National Opioid and Emerging Drug Threats Policy and Practice Forum in Washington, D.C, and recording of the proceedings are 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.

National Missing and Unidentified Persons System (NamUs) 
Funded by NIJ and managed in contract with RTI International, 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 January 2022, the NamUs database currently contains: 

• Over 54,000 reported missing person cases – 32,000 cases have been resolved,
• Over 20,000 reported unidentified person cases – 6,000 cases have been resolved, and
• Over 16,000 cases of unclaimed decedents identified by name but whose next of kin have not been located for death notification – 1,500 cases have been claimed.

In response to the COVID-19 pandemic NamUs has included a checkbox for COVID-19 in the Unclaimed Persons and Unidentified Persons databases to help manage the influx of information, collect data regarding cases in ME/C offices, and track COVID-19 deaths. This information is not visible to the public.

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. 

Drugs and Crime Research Awards

National Center on Forensics  
The NIJ National Center on Forensics was charged with establishing collaborations and/or partnerships with agencies including, but not limited to, institutions of higher learning with affiliate medical and law schools, publicly funded forensic science laboratories, and statewide district attorneys' associations to provide medicolegal learning opportunities for medical students to train as deputy medical examiners/coroners in underserved rural areas; ; provide forensic science and legal training to district attorneys, judges, law enforcement, and others with an appropriate background; and develop opportunities as appropriate, amongst the designated partners to benefit current and future practitioners in the field, such as forensic pathologists/medical examiners, ,forensic scientists, district attorneys, and law enforcement, or others as approved by NIJ. 

FY20 NIJ National Center on Forensics Award Information 
FY21 NIJ National Center on Forensics Award Information 
 

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. The CMEC gathers information on staffing, budgets, caseloads, resources, policies, and procedures of medical examiner and coroners' offices. BJS released the latest report in November 2021. For more information on the methodology, past data collections, or to view the questionnaires, see “Data Collection: Census of Medical Examiner and Coroner (ME/C) Offices.”

Forensics Training and Technical Assistance Program 
The Training and Assistance (TTA) program is a competitive grant program launched in FY2022 by BJA to support and enhance program outcomes of BJA's various forensic programs through a range of TTA services, including:

• Training and educational sessions developed by Subject Matter Experts (SMEs), such as national conferences and regional meetings
• On-site or remote guidance on forensics-related issues
• Assistance in developing strategies that enhance site capacity and effective use of multiple funding streams
• Translation of lessons learned by practitioners and guidance for sustainable processes to improve case outcomes

RTI International administers BJA’s Forensics TTA program, leading a multi-disciplinary team composed of researchers, former practitioners, and professionals with expertise supporting criminal justice outcomes through the creation and delivery of TTA resources for the forensics and criminal justice communities. Forensics TTA, in consultation with BJA, utilizes SMEs, an Advisory Board, and program communication strategies to address grantee TTA needs and respond to emerging priorities. The Forensics TTA model is designed to assist BJA grantees with establishing a multi-disciplinary approach to case resolution.

Strengthening the Medical Examiner-Coroner System Program

• BJA Strengthening the ME/C System Program Overview

Paul Coverdell National Forensic Science Improvement Grants Program 
The Paul Coverdell Forensic Science Improvement Grants program (the Coverdell program) was administered by NIJ from FY 2001 to FY 2019 and transitioned to BJA in FY 2020. 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 and medicolegal death investigators, as needed to eliminate such a backlog; 4) to address emerging forensic science issues and emerging forensic science technology; 5) to educate and train forensic pathologists; and 6) to fund MDI systems to facilitate accreditation of medical examiner and coroner offices and certification of medicolegal death investigators.

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" 

Comprehensive Opioid, Stimulant, and Substance Use Site-based Program (COSSUP)
The purpose of the  Comprehensive Opioid, Stimulant, and Substance Use Site-based Program (COSSUP) is to provide financial and technical assistance to States, units of local government, and Indian tribal governments to develop, implement, or expand comprehensive efforts to identify, respond to, treat, and support those impacted by opioids, stimulants, and other drugs. Since 2017, through its leadership of COAP/COSSUP, BJA has supported innovative work—from coast to coast, in large cities and rural America, in tribal lands and United States territories—by over 500 site-based projects and demonstration sites.

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.

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 analyses conducted by local, State, Federal, and private forensic laboratories across the country. Initially focusing on drug chemistry (NFLIS-Drug) to provide detailed analytical results of drugs seized by law enforcement, the NFLIS program expanded to include drug testing results from toxicology laboratories (NFLIS-Tox). In addition, the program will collect drug-related mortality data from medical examiner and coroner offices (NFLIS-MEC).
  
NFLIS Synth-Opioids 
NFLIS and the Synth-Opioids Real-Time Communication Network (Synth-Opioids) have partnered to create NFLIS Synth-Opioids. This is an interactive platform that bridges multiple disciplines and multiple jurisdictions in forensic sciences for the rapid sharing of emerging psychoactive substances in the United States. By sharing scientific data to assist in detecting and identifying unknown synthetic substances and opioids, DEA has been expanding the Nation's collective scientific expertise and breaking silos of information, not only across the Nation, but also globally.
  
DEA Toxicology Testing Program (DEA TOX)
The Drug Enforcement Administration (DEA)’s Toxicology Testing Program (DEA TOX) began in May 2019 as a surveillance program aimed at detecting new psychoactive substances within the United States. In response to the ongoing synthetic drug epidemic, DEA awarded a contract with the University of California at San Francisco (UCSF) to analyze biological samples generated from overdose victims of synthetic drugs. The goal of DEA TOX is to connect symptom causation to the abuse of newly emerging synthetic drugs (e.g. synthetic cannabinoids, synthetic cathinones, new synthetic opioids, other hallucinogens, etc.). More information can be found at: https://www.deadiversion.usdoj.gov/dea_tox/.

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

Investigation & Certification of Drug Toxicity Deaths - Online Training Course. Free, and Continuing Education (CE) Credits are available. 

The goal of this 4-module course is to promote the use of current evidence-based practices for investigation, evaluation, and certification of drug toxicity deaths. 

Course Objectives 

1. Identify the key investigative stages that teams use for conducting a necessary and appropriate death investigation when there is a suspected drug-related death. 
2. Describe best practices and challenges related to performing autopsies when there is a suspected drug related death.
3. Describe the best practices and challenges associated with using toxicological testing for establishing cause of death. Explain the essential components for consideration when determining the cause and manner of drug-related deaths.

Module 1: Overview of Medicolegal Death Investigation
Module 2: Introduction to Scene Investigation
Module 3: Autopsy & Postmortem Toxicology
Module 4: Death Certification for Drug Toxicity Deaths

Corona Virus 2019 (COVID-19) - FAQs for Medicolegal Death Investigators 

Overdose Data to Action (OD2A)
Overdose Data to Action is a 4-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. 

On March 7, 2023, CDC’s National Center for Injury Prevention and Control (NCIPC) announced two distinct, new Notice of Funding Opportunities (NOFOs) for drug overdose surveillance and prevention efforts: 

• Overdose Data to Action in States (OD2A-S), to support state health departments to conduct overdose-related surveillance and prevention activities to decrease fatal and non-fatal overdoses and related harms. All states, as well as D.C. are eligible to apply for this 5-year funding announcement, including currently unfunded states.
   
• Overdose Data to Action: Limiting Overdose through Collaborative Actions in Localities (OD2A: LOCAL), to support local city and county health departments and territories to develop overdose-related surveillance infrastructure and implement prevention activities to decrease fatal and non-fatal overdoses and related harms. All local health departments, special district health departments, and territories are eligible to apply.

These two funding opportunities, one designed for states and one designed specifically for localities and territories, help ensure broad resources and support to combat the evolving overdose crisis at all levels of government based on the latest epidemiology and prevention science. Both awards will support a 5-year cooperative agreement to expand and strengthen overdose surveillance and prevention efforts to reduce fatal and non-fatal overdoses involving opioids and/or stimulants and polysubstance use. Applications are due May 8, 2023. 

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) began collecting data on violent deaths from six states in 2002, and grew progressively to include more states over several years.  In 2018, NVDRS was expanded to include data collection 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. 

NVDRS & Coroner/Medical Examiner Partners Factsheet (English) 

NVDRS & Coroner/Medical Examiner Partners Factsheet (Spanish) 

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 date, including mortality data. These data are provided through contracts between NCHS and vital registration systems operated in the various jurisdictions legally responsible for the registration of deaths. To modernize the nation’s death data and systems and promote quality and timely data, NCHS is engaging with vital registration offices and others, including medical examiners and coroners, to offer support and resources for data modernization.  

Sudden Unexpected Infant Death (SUID) and Sudden Death in the Young (SDY)  
CDC’s Division of Reproductive Health supports the Sudden Unexpected Infant Death (SUID) and Sudden Death in the Young Case Registry (SDY). The Case Registry monitors infant and child deaths in funded states and jurisdictions. The SUID and SDY Case Registry builds on child death review programs and uses the National Fatality Review Case Reporting System, bringing together information about the circumstances associated with SUID and SDY cases, as well as information about investigations into these deaths.  

CDC and the National Institutes of Health collaborate on the SDY component of the Case Registry, which includes infants, children, and adolescents. SDY tools for investigations and autopsy can be found here: https://www.sdyregistry.org/.  The SDY component was created to increase understanding of the prevalence, causes, and risk factors for those who die suddenly and unexpectedly and to inform strategies to prevent future deaths.  

The Sudden Unexpected Infant Death Investigation Reporting Form 

The Sudden Unexpected Infant Death Investigation Reporting form or SUIDI-RF  is a voluntary tool and template for death investigators to use to standardize data collection to help improve classification of sleep-related infant deaths. 

The form and accompanying training materials can be found here SUIDI Reporting Form | CDC 

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 

Key Resources:  
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.
Source: https://www.cdc.gov/cpr/readiness/capabilities.htm 

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.
Source: https://www.cdc.gov/nceh/hsb/disaster/materials-and-resources.htm 

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.
Source: https://www.cdc.gov/nchs/nvss/reporting-guidance.htm  

Training course: Guidance for Certification of Deaths in the Event of a Natural, Human-Induced, or Radiological/Chemical Disaster. 

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. 

Training for Handling Radioactive Decedents
Source: https://www.cdc.gov/nceh/radiation/emergencies/examiners-coroners.htm

Funding Opportunities and Current Activities:

• Emergency Response Funding
• 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. 
• Read the GAO Report: Disaster Response: Federal Assistance and Selected States and Territory Efforts to Identify Deaths from 2017 Hurricanes 
• 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 Centers for Disease Control and Prevention (CDC) is leading the development of Traceable Opioid Material® Kits (TOM Kits®) to support detection of emerging opioids and other drugs of concern. CDC maintains the contents of the TOM Kits® product line based on new needs identified, in part, through DEA Emerging Threat Reports. The DEA 2012 mid-year data indicate that fentanyl accounts for over 89% of their opioid identifications and is mixed with other controlled substances in over 40% of identifications. 

Five TOM Kits® products are now available, and new Emergent Drug Panel kits including the most prevalent opioids, benzodiazepines, stimulants, hallucinogens, and synthetic cannabinoids are anticipated in Spring 2023. These kits are reference materials and do not eliminate the need to meet analytical method requirement of other federal agencies. TOM Kits® products are NOT for Diagnostic Use. 

Laboratories requesting one or more kits:

• Can be from any sector – academic, public, or private.
• Must be located 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® products and how to request them, please visit  https://www.cdc.gov/nceh/dls/erb_opioid_kits.html. , TRACEABLE OPIOID MATERIAL®, and TOM Kits® are registered 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) and Fetal and Infant Mortality Review (FIMR)are processes where multidisciplinary teams at the community or state level review the circumstances around fetal, infant, and 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-seven (47) states use the CRS to enter data from CDR and 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.

Additionally, through its work with the CDC on a variety of special projects, enhanced data collection through NFR-CRS is occurring. These projects include: 1) Sudden Unexpected Infant Death (SUID) Case Registry with the Division of Reproductive Health, 2) Improving water-related death scene investigations and prevention with the Division of Injury Prevention and 3) Enhanced data collection of pediatric fatalities directly or indirectly related to natural disasters with the Children’s Preparedness Unit. All of these projects seek to gain a deeper understanding of systems gaps that inform prevention. 

The Center also used HRSA and CDC funds to develop and release a Child Death Scene Investigation Learning Series. This learning series was developed in collaboration with national experts to provide high quality death scene investigation training to various professionals involved in Child Death Review (CDR) or Fetal Infant Mortality Review (FIMR) programs throughout the US. This learning series will be expanded to include modules on water-related and disaster fatalities. 

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].

The National Center for Fatality Review & Prevention: Supporting Fatality Review Teams

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/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)."

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

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
TDA offers training workshops and presentations on family assistance operations after transportation disasters. If you would like to learn more about specialized TDA training opportunities or the TDA Division’s Family Assistance Operations bi-annual course, please contact us at [email protected].

The Organization of Scientific Area Committees for Forensic Science (OSAC) strengthens the nation's use of forensic science by facilitating the development and promoting the use of high-quality, technically sound standards. These standards define minimum requirements, best practices, standard protocols and other guidance to help ensure that the results of forensic analysis are reliable and reproducible.  

OSAC was created in 2014 to address a lack of discipline-specific forensic science standards. OSAC fills this gap by drafting proposed standards and sending them to standards developing organizations (SDOs), which further develop and publish them. 

OSAC also reviews standards and posts high quality ones to the OSAC Registry. Inclusion on this registry indicates that a standard is technically sound and that laboratories should consider adopting them. Recent additions to the registry cover DNA mixture interpretation, digital evidence examination and wildlife forensics. Hundreds more are in the pipeline. 

OSAC's 450-plus members work in forensic laboratories and other institutions around the country and have expertise in 22 forensic disciplines, as well as scientific research, measurement science, statistics, law and policy. OSAC drafts and evaluates forensic science standards via a transparent, consensus-based process that allows for participation by all stakeholders. 

OSAC Medicolegal Death Investigation Subcommittee 

The OSAC Medicolegal Death Investigation Subcommittee (MDI) focuses on standards and guidelines related to sudden, unnatural, unexplained or suspicious deaths, including homicides, suicides, unintentional fatal injuries, drug-related deaths and other deaths that are sudden or unexpected; 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 "Discipline-Specific Bibliographies and Bibliographic Reference" section. On October 1, 2020 the OSAC Disaster Victim Identification (DVI) Subcommittee was transitioned to being a task group of the MDI Subcommittee.  The DVI subcommittee's documents can now be founding on the MDI Subcommittee's webpage. The MDI & DVI members now collaborate on topics of common interest on the MDI Subcommittee. There are over 10 standards on the OSAC Registry that address various MDI and DVI topics. 

In July and August 2021, the MDI Subcommittee published two documents identifying important aspects of the collection and exchange of MDI data and on research and development as noted below:

• Medicolegal Death Investigation Data Commonly Collected and Exchanged
• Principles to Promote Research in Medicolegal Death Investigation

OSAC Forensic Anthropology Subcommittee  
The OSAC Forensic 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. The Forensic Anthropology Subcommittee has approved one standard for the OSAC Registry related to facial approximation. Many of the previously produced SWGANTH documents can be found on this website under the subcommittee’s “Discipline-Specific Bibliographies and Bibliographic References” section. 

OSAC Forensic Toxicology Subcommittee  
The OSAC Forensic 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 Forensic Toxicology Subcommittee has approved several standards for listing on the OSAC Registry that address forensic toxicology report content, measurement traceability, method validation, and guidelines for opinions and testimony in forensic toxicology.

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.

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.

Fatality Analysis Reporting System (FARS)
The Fatality Analysis Reporting System (FARS) was conceived, designed, and developed by the National Center for Statistics and Analysis (NCSA) of the National Highway Traffic Safety Administration in 1975 to provide an overall measure of highway safety, to help identify traffic safety problems, to suggest solutions, and to help provide an objective basis to evaluate the effectiveness of motor vehicle safety standards and highway safety programs.

The Fatality Analysis Reporting System (FARS) contains data derived from a census of fatal traffic crashes within the 50 States, the District of Columbia, and Puerto Rico. To be included in FARS, a crash must involve a motor vehicle traveling on a trafficway customarily open to the public and must result in the death of at least one person (occupant of a vehicle or a non-motorist) within 30 days of the crash.

All NCSA published reports, data, and public tools can be found can be found at: https://cdan.nhtsa.gov/ 

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.

[This event was postponed due to the COVID-19 pandemic]

Other resources/relevant information from FAA:

1. Aerospace Medicine Technical Reports
2. The Bioaeronautical Sciences Research Laboratory
3. How to request records - Freedom of Information Act (FOIA) Requests
4. About the Civil Aerospace Medical Institute (CAMI)