AAPT Conference 2007

Another year and another AAPT conference! This, the third, was held at the Tulip Inn, Glasgow on Saturday 1st September.

The morning session was chaired by Council member Ishbel Gall and kicked of with a short welcome from the chairman Robert McNeil (left).

The first presentation of the day was given by Wing Commander Graham Maidment.

Wing Commander Grahame Maidment on The role of the autopsy in the investigation of fatal aircraft accidents

Wing Commander Greame Maidement is a member of the Department of Aviation Pathology based at the RAF centre of Aviation Medicine, Henlow.

As well as assisting the coroner/procurator fiscal in the identification of the deceased and establishing a cause of death the pathological findings from the autopsy of the victims of an air crash provide an essential component of the overall investigation..

In certain cases the pathological findings may identify the initial cause of the accident.
In others the study of injury patterns can assist in identifying hazards within the aircraft environment that can be altered to prevent similar injuries occurring again i.e. the modification of overhead lockers took place after it was found that many passengers had died due to head injuries received from falling baggage during an air crash.

Toxicological findings can also play an important role in the crash investigation alcohol, drugs carbon monoxide levels and even simple therapeutic doses of anti histamines can all affect the ability of the pilot when flying.

As a result of high carbon monoxide levels being found in the  crew of a plane that had veered off its flight path and hit a mountain it was found that the heater cylinders were faulty  and so they were all removed from use and replaced preventing further incidents of this kind .

It was also surprising to find out that more often than not in the case of air crashes (unless bodies have become fragmented ) it is common that the deceased can be visually identified  .Fragmentation of the bodies occurs more so in light aircraft accidents.

Wing Commander Maidment explained that when dealing with aircraft accidents involving a large quantity of personnel there are certain factors that need to be taken into consideration when it comes to the mortuary. Factors such as parking, security, storage facilities and access, the ability to facilitate x rays (if required) Is a temporary facility required and if so it needs licensing by the HTA.

Wherever the Autopsy is carried we can be sure that close co-operation between the legal authorities, air crash investigators and the aviation pathologists will only continue to improve air travel for us.

Nigel C Wright, Past President of the British Institute of Embalmers, former principal tutor of embalming

Nigel’s presentation provided us with a talk and slide show demonstrating the work of embalmers including their involvement in mass fatalities/disasters and major incidents. The Presentation was entitled 'The Embalmer his work and how our professions can help each other to help the public'.

Nigel has many years of practical and teaching embalming under his belt and his work with Kenyon’s has taken him all over the world to places such as Thailand, Iraq, Afghanistan and New Zealand and many others. Mr Wright’s slides were very informative and demonstrated the ability to correct staining and colour change present solely by adding cosmetic to the embalming fluid reducing the need for the use of external cosmetics. He explained the different techniques used in embalming to ensure the deceased looks as they did in life.

Mr Wright explained how we APT’s can assist them in preserving the deceased by leaving if possible the carotids or subclavian artery. Although more often than not these are subject to examination at post mortem so this is not always possible.
Mr Wright advocates embalming at post mortem and maybe in the future this could be incorporated into everyday mortuary practice.

Following a short break we were then given a very informative presentation by:

Professor Margaret Cox on Training for DVI and Atrocity Crime Investigations

Margaret is the Chief Executive and founder of the Inforce Foundation; a charity run foundation that has emerged from a background largely involved with the investigation of atrocity crime. It consists of a multi disciplinary team all with the same aim in mind backed by a raft of scientific and legal advisors.

Inforce provide 'hands-on' training in preparedness for DVI and atrocity work with the use of simulated mass grave excavations and mass fatality incidents and provides both training in field and mortuary environment.

Great importance is placed on making the environment as realistic as possible. The first simulated mass grave to be used was for the training of Iraqi students and so things such as the soil, water table, clothing material and artefacts all had to be taken into consideration when setting up the grave.

The bones used in the simulations are taken from teaching skeletons and tissue from pigs then added to replicate human soft tissue.

There are two main areas of training the mortuary and training within the field people are encouraged to gain an insight in to the work of both sides.

The training is done through varying and realistic simulations and role play this is called experimental education which ensures the trainees are engaged intellectually, emotionally and physically and provides trainees with the ability to make and learn from their mistakes in a safe environment with out any knock on effect.

The mortuary simulations help develop the skills and confidence to set up and work in any environment with limited or often no equipment and help build the knowledge of what is required in relation to health & safety, law, scientific requirements, logistics etc within the mortuary environment.

For further information on the work carried out and the training provided by Inforce visit www.inforce.org.

Health Protection Agency and CBR Fatalities project, presented by Professor Virginia Murray, Health Protection Agency

This very informative presentation introduced us to the Health Protection Agency and their recent Home Office sponsored research project on the safe handling of bodies contaminated with chemical, biological and radiological agents.

On April 1st 2003 the HPA was born, driven by both the events of 9/11 and the ongoing threat of pandemics and disease.

The HPA carry out exercises at both local and national level with the NHS, emergency services and local authorities to improve national preparedness in the event of major bioterrorist attacks.

Professor Murray explained the role of the HPA in incidents such as the Buncefield incident and the most famous LItvenvnyenko incident. The HPA were also very heavily involved in the events following 7/7 where they were responsible for carrying out extensive environmental testing.

Whilst developing the contingencies for ongoing CBR events it came to light that there are provisions for dealing with contaminated casualties but none at present for dealing with fatalities

New documentation to be launched in October  will aim to provide guidance in such areas an has been produced in conjunction with the AAPT , Police, Coroners office, Fire & Rescue Services Paramedic & Ambulance services , dept of emergency medicine , Forensic Pathology and the royal college of pathologists . For further information on the HPA and the work they do visit www.hpa.org.uk

Lunch was followed by the AGM with reports on the progress of the AAPT given by from left to right (see image) Christian Burt (Secretary of AAPT), David Scott (Treasurer), Robert McNeil (Chairman) and Ishbel Gall (website and Council member).

AAPT Vice-Chair James Lowell chaired the afternoon session that began with a presentation by Amanda Ranson.

Amanda Ranson Bsc (Hons) the NHSBT tissue bank manager on Tissue Donation after Death – Saving Lives. Changing Lives

Tissue transplantation offers huge benefits to many people, pain relief, helping individuals to see or walk again and does even save lives. Tissue donation also helps bereaved families take comfort in the knowledge that their loved one has helped in this way

NHSTB Tissue services teams are based in two centres Liverpool and London and supports tissue donation through out England and Wales.

Tissues that are currently donated within the NHSBT include bone, skin, tendons,
cardiovascular tissue (heart valves) eyes (corneal transplant) and cartilage.

Any one can be considered for donation although certain medical conditions and age can exclude certain types of donation .The consent process and obtaining medical history is all done by a highly trained Nurse Practitioner and documented in accordance with The Human Tissue Act 2004 & The Human Tissue Authority (HTA) Codes of Practice 2006.

The donation process is carried out by skilled scientific donation teams.

Following donation the tissue is quarantined until the donor has been fully reviewed.
If the donor has been refrigerated within 6 hours following death the retrieval can take place within 48 hours if not refrigerated within the 6 hour time scale the retrieval must be carried out within 12 hours. A blood sample must always be obtained within 24 hours of death.

Liverpool commissioned the first dedicated donation suite in autumn 2006. This enables donors to be transferred to the suite for the donation to take place  which helps prevent staff having to travel to other sites currently it is only donors from the Liverpool area that are transferred there. A total of 10 donations have been carried out in the new facility between April and July this year and hopefully this will continue to increase.

Federation for Healthcare Science (FHCS) – what does it do by Hedley Glencross, Executive Head of Membership IBMS

The FHCS was formed in 2002 and is the umbrella body for all health care scientists and represents over 50,000 it provides a collective voice for healthcare scientists.
It was established to enhance the profile of healthcare science professions helping to shape and influence policies at a national level .the federation provide support for both emerging and changing disciplines.

They develop and promote the need for research and development relating to patient benefits and also contribute to workforce planning.

The Federation is divided into 3 areas Life Science, Physiological Sciences and Physical Sciences & clinical engineering .The FHCS executive is made up of 4 representatives from each of the three sections, AAPT is currently one of the non-professionally registered organisations.

The FHCS is currently undergoing a review, and the findings will be presented in November at the AGM along with recommendations for the future of the FHCS. For further information on the FHCS visit www.fedhcs.net

Terry Johnson, Mortuary Manager Hull and East Riding Public Mortuary, Council member, Chairman VRC , with a presentation on Training and Education for APT’s

Training and education  for APT’s is currently and has been for some time a significant area of weakness .This more often than not is due to the lack of investment in mortuaries and the people working in them. The result is the training and development of APT’s has suffered.

Recently the AAPT has managed to convince organisations such as the Royal College of Pathologists that technologists have been overlooked for far too long. This resulted in the Workforce Review Group and it is the body that identified the principal drivers for change that include:

• The need to develop additional, extended and advanced roles for APT’s
• The Implementation of Knowledge and Skills Framework
• The need for statutory regulation
• The licensing of mortuaries via the HTA

The AAPT Training and Education Committee is working with Skills for Health to develop training, education and up to date qualifications for APT staff. The current qualifications, the Certificate and Diploma in Anatomical Pathology, have been in place for over 50 yrs and these now need bringing in line with the work we do and in line with other healthcare scientists.

An evaluation of the current training and qualifications has highlighted the need for a change we need training and a qualification that will permits the development of additional, extended and advanced practitioner roles.

The AAPT Education and Training Committee are producing a draft learning pack which will hopefully be completed by the end of October with a consultation period until January 2008 .Hopefully resulting in the introduction of a new qualification being developed for 2009.

Following Terry we were then given an interesting presentation by;

Jon O’Shaugnessy on The Role of the Consular Officer (When Britons die overseas)

Jon is the desk officer for the Middle East in consular Directorate of the foreign and common wealth office. He explained to us how the FCO organises its consular network through its embassies, High Commissions and Consulates around the globe.

The Consular Office deal with approximately 4000 deaths overseas each annum and around 70 of these being murders.

One of the main questions asked of the office is “will you repatriate the body?” – under normal circumstances they will not thus stressing the importance of insurance when travelling abroad. There are often many obstacles that are faced by families when a death occurs over seas the officers try to help the families overcome these by assisting in such things as identification liaising with local authorities on behalf of the family.

In the event of crisis management, disaster or terrorist attack as park of an aftercare package they will arrange and cover the cost of repatriation of British nationals. They will also where possible provide identification of the deceased o request the assistance of a DVI team if necessary and liaise with international undertakers to arrange storage.

In all cases wherever possible they will try to notify families of a death prior to media announcements.  The officers work very hard to ensure all assistance is given and manage to overcome obstacles such as language barriers and although some of the tales are very sad they like us learn to handle these issues carefully but always with a little humour as a release mechanism.

The final talk of the afternoon was given by;

Muhidin Tabakovic -Trainee Mortuary Technician From ICTY to AAPT –a Bosnians Progress between the titles

Muhidin is currently employed as a trainee technician by the University of Glasgow. Muhidin lived in Bosnia and when the war broke out in 1992 he was forced to live as a refugee with another family.

In 1997 he took his first steps into the Mortuary in Visoko. In 1998 he began work there for ICTY as a cleaner but Muhidin had developed a keen interest in the work carried out and wanted to gain further experience and so became involved with the pathology , anthropology and evidence gathering. I myself can remember standing around a table scrubbing bones with him as I am sure can many others who worked there.

Muhidin then went on to work for The International Commission on Missing Persons for the former Yugoslavia as a Mortuary Technician here he gained experience on exhumations from mass graves . His role involved preparation of remains for anthropological examination, assisting in the identification of those killed and the successful return of their remains to families.

Muhidin has come a long way in twelve years and gained vast experience in all aspects of mortuary work and now holds the role of trainee technician in a busy forensic mortuary in Glasgow where every day brings a new challenge. 

Andrea Mellor
AAPT Council member

The AAPT Conference 2007 took place at the Tulip Inn, Glasgow on Saturday 1st September 2007. The AAPT Conference is an annual opportunity for delegates to update their knowledge of scientific, technological, legal & social issues relating to anatomical pathology technology.

The conference also offers a unique platform for exhibitors to present their latest products and services.

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