Report from Michelle Williams FAAPT
FORENSIC TOXICOLOGY AWARENESS COURSE
Provider: DR SIMON ELLIOT, CONSULTANT FORENSIC TOXICOLOGIST, MANAGING DIRECTOR of ROAR FORENSICS.
Location: COUNTESS OF CHESTER EDUCATION and TRAINING CENTRE, CHESTER.
The course was developed with the support of the AAPT and has been expanded to be suitable for HM Coroner’s Officers and Pathologists involved in casework that has a toxicological aspect.
Why did I attend?
The reason I wanted to attend this course was for probably the same reasons as quite a few of us APTs. When I was being trained 13 years ago, I was taught how to retrieve toxicological samples, shown which container they were to be decanted into, demonstrated to on packaging and told where to send or which day to expect the courier.
That was as far as my knowledge went, apart from a couple of stray bits of information picked up along the way (self taught). I wanted to know more, I wanted to know if we could improve our practices here at Gloucestershire Coroner’s Court, I wanted to know what happened at this amazing place we only knew as ROAR once our samples arrived there and I certainly wanted to learn more about the non-routine samples that are sometimes required. I wanted to know how to understand a toxicology report, and what all the numbers meant.
The course began at 9am and I was happy to see technologists I recognised. The group was made up of 10 people and it was a straight divide of Coroner’s Officer’s and APT’s.
There are Families at the end of the Results
Registration took place and Dr Elliot introduced himself to the group. He told us about his background in labs in the NHS and how he came away to start his own business, ROAR, with him himself saying “there are families at the end of results, it's like nobody cares”, so he decided to do something about it, and hasn't he just!
Dr Elliot gave us a brief run down of the agenda which included;
The basics first
The initial principles of toxicology covered the basics such as introducing any substance into the body which is capable of destroying or seriously impairing life. This covered areas such as types of poisons and toxins, and how they react to being put into the body.
This got very scientific but was explained at a pace we could all relate to and find interesting. I found fascinating the small conversation on “overdose” and how theoretical calculation using a persons weight and theoretical volume of distribution can often quote different results, and also the falsely elevated concentration of alcohol when analysing post mortem blood samples due to microbial action causing post mortem alcohol production. This is coupled with high concentrations of drugs post mortem through drug redistribution as cells ‘burst’ and distribute drugs into the blood from organs potentially providing false readings.
Psychoactive Substance Act 2016
Drugs and poisons covered legal to illegal, intentional and unintentional death from and when to consider designer drugs. A short introduction was also given on the Psychoactive Substance Act which was introduced in the UK on 26th May 2016.
Sudden death Vets…..check the toxicology
Also covered were unusual drugs and poisons and how these can sometimes be missed if they are not being looked for and are not known in the case history, such as a sudden death in a Vet for example. Vets have access to potent drugs meant only for animals. This could be an important piece of information left off the occupational history, so not something that would be readily investigated by the toxicology lab.
Helping the Coroner
Toxicological investigations covered all the things we can do to help things along. It would be like us having no PM40! The job without the tools if you like. The more history and information forensic toxicology labs have on a deceased, the more information they can give the Coroner in return.
This part was more for the Coroner’s Officer’s but was very interesting and maybe for those of us who are able to nudge our local Officers into giving more info, the better the feedback. That’s a bonus surely?
Specimen Selection and Collection
Now, the part I was most interesting in hearing about – Specimen Selection and Collection. Although I have never had any complaints (that I can remember) from our selection and collection, I have never had any sort of feedback either!
I have watched different pathologists, both routine and forensic retrieve samples from different sites with different a technique which all worked, but was there a preferred method? Dr Elliot began with confirming that the specimens of greatest toxicological use are blood and urine and that nothing else is usually required.
He followed this up with an anatomical diagram showing best collection sites (huge relief when he confirmed femoral site) and ensuring sites are labelled on vials along with time and date.
Problems and inaccuracies
He went on to tell us what can be used in the absence of blood and urine, and how, why and what to collect. Dr Elliot also answered the main problem with toxicology I encounter with pathologists, obtaining insulin readings from vitreous.
In a nut shell, this is a biochemistry process, and because of the consistency of vitreous, the readings the machines give out are highly inaccurate, hence labs don't like to process because of the inaccuracies.
Dr Elliot covered all of the last topics which included analysis and reporting, and a question and answer session was held after, although not much had been left uncovered at that point. I left feedback suggesting that information from ROAR be passed directly on to mortuaries as well as Coroner’s.
A lot of us work in separate buildings to our Officer’s and a lot of information that is passed, never reaches the mortuaries. That said, we do work in the same building and this can still be the case due to everyone being so busy.
I have come away feeling I have gained a lot of knowledge from the day, well informed and confident that we do provide a good service to ROAR forensics and know that we play a positive part in gaining results for families.
All that we do in retrieval of specimens can help, even on heavily decomposed cases. Yes, of course there are a couple of things I will take back to ‘gold standard’ our practices, along with the new knowledge to share with Gloucestershire Coroner’s Court employees and anyone else who will listen.
This course is to be repeated on a yearly (if not more) basis. I would highly recommend attending and if you need any more incentive, it comes with 4 CPD points, a very colourful certificate and won't break the training budget.