AAPT Conference 2010
The 6th Annual AAPT conference was held for the second time in Manchester at the Manchester Conference Centre. This year accommodation was secured at the Conference Centre which made everything a lot simpler for those he stayed!
After registration and a welcome cup of coffee the Conference started with a brief introduction from James Lowell the AAPT Chair and then Alison Anderson took over as session chair for the morning.
James was the first speaker with a very frank update on where we stand as a profession at the moment and what we, as a professional body and as individuals need to do to continue to progress. A lot of people were I think given a bit of a wakeup call as they realised where we are and what needs to be done to get where we should be. Voluntary Registration is a key part of the future and we need to embrace it now before the opportunity is taken away. Modernising Scientific Careers (MSC) is high priority for AAPT over the next few months and is something that will affect everyone employed by the NHS (ultimately the Department of Health) as well as then having an effect on the profession as a whole.
James was followed by a presentation from Emyr Harries a Regulation Manager with the Human Tissue Authority. Most people have heard of Serious Untoward Incidents or (SUI) but probably less aware of when these events are reportable to the HTA. Since 1st May 2010 it has become mandatory to report actual incidents and near misses to the HTA. This replaced the voluntary system previously in place which had resulted in approximately 20 incidents being reported. SUI fall into fourteen main groups and most are to do with errors in disposal of tissue or post mortem errors although there are other more specific instances including serious equipment failure. Incidents are reported using a form on the HTA website and are submitted electronically to the HTA. Each incident is given a unique reference number and assigned to a regulation manager.
The incident and any actions will be reviewed and then the centre will be advised of an internal investigation review which will hopefully lead to and action plan and closure of the incident. Up to 31st August 2010 20 incidents had been reported, 15 SUI, 3 near misses and 2 non-reportable incidents. Four incidences of releasing the wrong deceased occurred as well as three deceased being released without all organs being returned. In one case a post mortem examination was carried out on the wrong body. Most of the SUI could have been avoided by clearer SOP’s and better staff training although major equipment failure often cannot be. It is clear that if 20 incidents have been reported in the first 4 months of mandatory reporting then many incidents were previously not being reported under the voluntary scheme. It is hoped that by sharing information from these incidents at conferences and by HTA presentations as well as in newsletters and publications everyone can learn from SUI reported. There will be a six month review of the system and an audit of feedback received by the HTA.
After a break for coffee the second morning session resumed with Dr. Isaac Zambrano from the Manchester eye bank. Many of us have been to Manchester on the enucleation course which allows us as trained healthcare professionals to remove corneas for donation so this talk gave some insight into how the service has evolved over the years since the Corneal Transplant Service began in 1983. Manchester and Bristol both store their donated corneas between 31-37*C in culture media whereas many other centres cold store tissue. The advantages of storing corneoscleral discs in culture medium is that they are available for elective surgery as well as being available for emergency surgery too. Prior to use samples are taken for microbiology and the endothelial cells assessed for suitability.
At this stage a few will be rejected as the cells will not be of high enough quality. Providing that the background information is completed and serological and microbiological tests clear, corneas are ready for the final assessment. Dr Zambrano gave a very informative talk about the work carried out in Manchester and how it has evolved into the service they so successfully provide today. This talk was probably of more significance than most people realised as currently there is a drive to encourage corneal donation and it will in many instances be APT staff who will have to carry out the tissue retrieval in their mortuaries. Corneal retrieval can be carried out under a third party agreement with the eye bank so an HTA licence is not required by the retrieving centre. Age is no barrier to corneal donation but obviously with age the suitability of corneas for grafting decreases.
Our final morning presentation was an insight into the world of Odontology. Dr Catherine Adams from the Forensic Centre in Wales gave us an idea of what she does apart from dental charts! The world of teeth certainly became more interesting and you could imagine all the tongues in the auditorium having a quick run over any dental work to check the quality of workmanship. It transpired that having a bad dentist may help get you identified but that’s probably not what most people visit the dentist for! As well as identification forensic Odontologists are used to analyse bite marks linking perpetrators to victims, and facial reconstruction.
The CBRN training programme has included Odontologists but in many cases the APT is the one holding the camera while the Odontologists sits at a safe distance asking for different camera angles…..very smart! It is important that the Odontologists is contacted to examine any bite marks prior to the post mortem examination being started as this will give a much better chance of identifying peculiarities of the bite as any incisions can distort the marks. Being aware of what the Odontologists is doing whilst in the mortuary, or sitting at a safe distance, means the APT can be of greater assistance and is another useful skill we can add to our portfolio.
After lunch the afternoon restarted with Ishbel taking over as chair for the afternoon session. Probably best I apologise now for the over-run in the afternoon but the first speaker was giving such an emotive talk it would have been rude to interrupt. Alison Anderson had agreed to step into the breach as one of the original speakers had to withdraw but due to a gallant bit of volunteering we started the afternoon with a talk from APT member Steve Jary. Steve’s presentation on Post Traumatic Stress Disorder (PTSD) was based on a well researched personal journey after the Falklands War in 1983. Most of us have little idea about PTSD and it was very interesting having a speaker with whom we could all identify as APTs but who had gone through such extreme life changing experiences and come out the other side. It was a privilege that Steve was so willing to share so much of his personal journey with what effectively was a roomful of strangers. Lots of questions followed and Ishbel let the afternoon get further behind schedule……
Marc Smith followed Steve with a much lighter but no less interesting talk on photography at post mortem. Maybe I’m just a really bad photographer but I also learnt a lot about photography in general! Some of the points made were fairly obvious, after they had been pointed out but really the bottom line is “no clutter” and “keep it clean”. Often we have spent time balancing on tip-toe or standing on a step holding up a white sheet as best we can but when you see that really it is worth it then it makes sense. Marc has a special interest in photography for court where the jury have a depersonalised set of photos rather than the post mortem photo which would no doubt upset many people. I’m sure many of us will be now producing David Bailey standard photographs in our own mortuaries after the really useful tips we picked up!
After another coffee and a chance to wander round the trade stands we were treated to another entertaining talk this time from Professor Atholl Johnston. Although highly entertaining the presentation highlighted the importance of robust operating procedures and high standards which must be maintained in the mortuary especially when obtaining samples and labelling them correctly. Professor Johnston had been employed by Mohammed Al-Fayed after the death of his son Dodi in Paris. The chauffeur Henri Paul who had been driving the Mercedes car which crashed killing both Dodi and Princess Diana as well as seriously injuring her bodyguard was shown to be intoxicated from the samples obtained at post mortem examination. All is not quite as clear cut as it would first appear though and the evidence is maybe not quite as robust as the authorities would have us believe. What is clear though is that the conspiracy theories will no doubt continue for years to come and the mysterious white car has not been found! From the video evidence, the bar bills produced by the Ritz and the very consistent test results there is at least in my mind some dubiety over the toxicology presented as evidence.
Our final and maybe most controversial speaker was Dr Ian Roberts from The John Radcliffe Hospital in Oxford. All the talk of replacing post mortem examinations with imaging makes a few APTs a bit nervous and over the years the rumours have circulated about the end of the APT and post mortem examination as we know it. After many years the post mortem examination has remained greatly unchanged but attempts are always being made to introduce less invasive techniques. Traditional autopsy has changed little because it is a quick and reliable in the diagnosis of many common causes of death. Some studies have taken place over the years comparing imaging techniques with more traditional post mortem methods. Certain causes of death can successfully be verified using imaging but in many case it is very difficult to determine cause of death using imaging alone. Currently imaging is used to complement traditional post mortem techniques especially in traumatic deaths where there may be fractures, foreign bodies or identification issues. Much of the early work was carried out in Manchester as a result of faith groups objecting to post mortem examinations.
While Christianity encourages post mortem examination, Islam and Judaism forbid the practise which can cause issues with the legal system. In Bolton the coroner will accept the findings of a radiologist in 80-90% of cases where MRI is carried out rather than conventional post mortem examination. These examinations are all privately funded by families or religious groups and cost in the region of £900. Cause of death investigation is not part of radiology training or examination and the radiologists providing this service are working outside of all control systems that prevent bad practice. In 2006 the Department of Health funded two trials to assess the potential value for post-mortem MRI as an alternative to conventional autopsy. This Oxford-Manchester (adult) study was to look at 250 adult deaths over 4 years and the results should be published soon. From information available it would appear imaging is good at identifying certain pathologies such as tumours and other mass lesions (eg. ruptured aneurysms) fractures and intracranial pathology but not so good at identifying coronary artery atherosclerosis and myocardial lesions, pulmonary emboli, intestinal lesions such as infarcts or perforations and fluid in the lungs – oedema or pneumonia.
In Oxford they have developed a technique for imaging which involves injecting the coronary arteries to identify any disease which may provide a cause of death. If this and the imaging does not provide an acceptable cause of death then a conventional post mortem is carried out. What of the pathologist and APT? Under the Oxford way of doing the imaging the APT and pathologist are involved and the cause of death does not come from the radiologist but the pathologist. It is thought the numbers of Coroner’s autopsies would be reduced whilst the quality of the remaining autopsies would be improved. Rather than providing all the answers the imaging findings will inform dissection. “There’s an abnormality here – what is the pathology?” A high proportion of autopsies are of poor quality with no means of review or audit but imaging provides a permanent record that will expose pathologists’ errors and again improve quality. Use of routine CT scan in traumatic deaths would provide superior information to dissection about fractures and other injuries. Again this is something where APTs will have to adapt their practice and change their skill set in order to move with the times.
The conference was drawn to a close with a few words from Professor Sebastian Lucas AAPT President who had just arrived back from Africa in time for conference. Professor Lucas very kindly presented four CPD awards to APT members Katie Tomkins, London and Alison Anderson, Laura Morgan and Maria Smith all from Glasgow.
The feedback has been very good and we wait to see how the Conference Committee can top this year’s programme, and the extremely useful golf umbrellas!
As usual our thanks must go to all the trade stands for supporting this year’s conference and to MOPEC and LEEC for kindly sponsoring the Conference Dinner and the Friday Curry.
I look forward to Glasgow in 2011.
Ishbel Gall
AAPT Vice-Chair
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Images from AAPT Conference 2010
James Lowell, Chair AAPT, Delegates registering for the event
opens Conference 2010
CPD Attendance certificates in readiness for delegates
Mike Conway FAAPT in discussion with Simon Chappell of Chemsol Limited
Mopec Europe Ltd remained busy throughout the event
Emyr Harries conducting the talk "HTA: SUI Reporting" The Pulse Stand
Dr Isaac Zambrano and "The Corneal Transplant Service" Steve Jary FAAPT and
"PTSD in the Workplace"
Catherine Adams and Marc Smith conducting their talks "An Odontologist in the
Mortuary" & "Photography in the Mortuary - How Help from the APT can be Invaluable"
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