Recently qualified APT Anita Hardy MAAPT gives an overview of the afternoon session at Conference 2018
On a very sunny afternoon in London we entered into the afternoon session of the 14th annual AAPT conference in London.
The afternoon session was hosted by Tarot Noble FAAPT and after a quick introduction the talks began.
DVI- OPERATION TRAPS-TUNISIAN SHOOTINGS 2015 RESPONSE
The first topic up was DVI- operation traps- Tunisian shootings 2015 response. This insightful talk was given by Dave Colvin (Hammersmith and Fulham Mortuary) with supporting info from Dave Ridgewell FAAPT.
June 26th 2015 holiday makers were enjoying a leisurely afternoon on the beach near Sousse, when Seifeddine Rezgui opened fire on random tourists. 30 British tourists were among the 38 who were killed. The nation was in shock and needed answers.
Flash forward to Dave Colvin standing in Tesco, receiving a call from the Coroner telling him that the 30 dead British citizens would be flown to RAF Brize Norton and transported to his mortuary. His mortuary is a dedicated DDM mortuary and has responded on several occasions to mass fatalities. With this in mind it would be fair to assume that there was already a plan set in stone for such an incident. However the plan that was formulated was ''there is no plan''. Through their joint explanation it became evident that each of these incidents are truly unique and no formal plan can be made to cover every eventuality.
What did come out of the talk however is the importance of communication. They pressed that if ever in these situations it is important for APTs to use lines of communication and draw on the experience of others. Contingency plans are highly important as there may be a need for other mortuaries locally to take over the day to day work of the mortuary while the investigation is underway.
They also stressed the importance of the 'pink booklet' that accompanies each body and follows them through the investigation as well as the need for being able to access extra supplies and 'police proof the mortuary' (which is no easy task). They were also able to share many photos of how their mortuary was set up to support this incident and contain people into the relevant areas. They had to create extra areas for staff to wind down and in many circumstances cool down due to the heat in the mortuary.
They ended their presentation by talking about the DVI register which is open for experienced and inexperienced APTs to join. The link can be found here: http://groupspaces.com/UKDVIAPTTeam/join/
Up next were the abstract presentations and kicking these off was Lorraine Marshall who is a senior APT. Her talk was about the SUDI (Sudden Unexpected Death in Infants) toolkit. The SUDI toolkit is a resource that is used by NHS Scotland when an infant dies suddenly. It contains information for professionals such as police, social services, GPs and other health care professionals. It provides resources and professional guidance such as body maps, PM explanations, real time explanations and demonstrates the role and responsibility of persons involved in the SUDI.
Lorraine-Jane Marshall and Dr Evans (consultant paediatric pathologist) were tasked by NHS Lothian to undertake a study into the SUDI toolkit to help determine its usefulness, how well it was being accessed and awareness of the toolkit. They sent a questionnaire out to help identify any areas where the SUDI toolkit was not being accessed etc.
The results were quite surprising; 56% of those who responded were totally unaware of the toolkit and of those that were aware only 20% were actually using it. The questionnaire also gave the opportunity for responders to suggest ideas to help increase awareness/use of the toolkit and 98% were keen on a multidisciplinary training day or compulsory CPD module.
The outcome of the questionnaire led to Lorraine-Jane and Dr Evans producing a poster which was supported by the Scottish Cot Death Trust. This was presented at the International Conference of Still Births, SIDs and Baby Survival 2018. They have also been invited to write a paper based on their findings.
The Scottish government is also going to review the findings from this study and perhaps implement training and development in the future to include all those involved in the multidisciplinary team.
The second abstract of the day was given by David Scott, Senior APT, and was an light hearted insight to every APTs biggest fear- a 'live' patient in the mortuary.
Quoting the story of Lazarus David spoke about this highly unusual situation that occured in the mortuary and the aftermath of this. In 2013 a man fell from the Kessock Bridge in Scotland. He was retrieved from the water by the RNLI's Kessock boat and attempts were made to resusitate him. After a short while he was pronounced deceased and conveyed to the mortuary by undertaker. When the staff member at the mortuary and the funeral director were booking the patient in they noticed what they considered 'signs of life'.
Immediately they phoned the Emergency Department who sent an ambulance to the mortuary. Once again resusitation was undertaken on the patient but after no signs of life occured he was pronounced deceased AGAIN. Following this incident which broke national headlines, an investigation was conducted into the circumstances which occured in the mortuary, an investigation by the Procurator Fiscal and also an investigation into the Scottish Ambulance Service.
The mortuary were ultimately praised for doing the right thing and being throughough with their booking in process. It was found that there was no defibrillator near the mortuary (the nearest one located in the ED on the other side of the hospital), which has now been rectified and the crash team also now carry one with them. There was no fault found with the Scottish Ambulance Service and the death was not investigated further.
COMBINED MORTUARY AND BEREAVEMENT SERVICES- DUAL ROLE APT/BSO
The final abstract talk was taken by Michelle Lancaster FAAPT and covered the dual role of an APT and BSO. Michelle's talk focussed on her own team mainly and how they work as both APTs and Bereavment Support Officers.
They believe that this combined role allows for better person centred care for their patients and their families. Michelle explained that her staff are able to support the bereaved through the entire process of care. They deal with the family after a death occurs, are present for viewings, are able to support and advise families with the paperwork and also help with registration. As APTs also they are able to extend that care into the post mortem process and use their technical skills fully.
I myself was quite suprised that they were also involved in house searches for patients who had no next of kin, which is very unfammiliar territory as this is the duty of the police/council in our local region. Michelle very elequently described how her team work with passion and deadicaton (perhaps too much dedication in the case of the Budgie) and have the ability to be that ever present constant support for relatives. I know for myself and others that are working in large mortuarys where we deal with 6000 deaths a year this level of care and support isn't possible.
It would be nice to be able to take a step back and be more present for families, other than at viewings or down the phone, but perhaps integrated role isn't something that is possible for all of us?
MARINE POLICING UNIT- DEATH ON THE TIDAL THAMES
Lastly and perhaps the most anticipated talk of the day, was given by Sgt Jenny Hall of the Marine Policing Unit and her lecture covered Death on The Tidal Thames. I myself had never heard of the Marine Policing Unit, which seems stupid now, but I was instantly drawn into Jenny's humourous and frank discussion of how thes types of deaths are dealt with and how the Marine Policing Unit came into existance.
The Marine Policing Unit policies the 47 miles of waterways between Hampton Court in the west and Dartford Creek in the east. It was formed in order to help stop the theft of cargo from the docks of London, the Thames division was formed in 1839.
The team assists the City of London and Met Police with incidents in and around Londons waterways. The team has 22 vessels at its disposal and has 24 trained rope access officers (plus trained rope dogs) who perform search and counter demonstration operations at height.
There is also an undwerwater search team and a confined spaces search team.
Patrols of the waterway used to be conducted in rowing boats, which is a difficult task, due to the speed and flow of the Thames.In 1865 however, the steam collier Bywell Castle struck a passenger ship, the SS Princess Alice, and caused the loss of over 600 lives.
The Bywell Castle weighed three times as much as SS Princess Alice which split in two and sank in 4 minutes. The Marine Policing Unit responded by rowing out to the victims in the water to try and rescue them. At the time the ship sank, raw sewage had been pumped into that area of the Thames and is believed to have been responsible for many of the deaths that occured on the day and the subsequent weeks that follwed, due to water contamination.
The Marine Police Unit was then equipped with steam launches in order to enable them to become better at rescuing from the Thames.
Fast forward to modern times and the Marine Policing Unit are responsible for the recovery of persons in the river. Fifty plus are said to die in the Thames each year, usually through suicide, as the result of jumping off bridges.
I was fascinated to learn that bodies are not found in the floating position i had previously thought (face down, arms and legs spread), but tend to be 'bobbing' along with only head and shoulders exposed. Many have serious post mortem injuries inflicted on them through contact with boat proppellers and the river bed.
When bodies are sighted the unit launch one of their vessels from Wapping and start the process of retriving them from the water. I again was suprised to learn that the body was not pulled aboard, after some explanation and delightful photography from Sgt Hall i understood why. Many of these bodies have been in the water for a significant amount of time. Their clothing and tissues are saturated with water and therefore are very heavy, they may also have wildlife in or on them.
The bodies are actually strapped to the side of the boat in a sort of net and towed to shore. Once there they are winched into the makeshift Mortuary for further examination. Formal ID is not always possible due to the length of time in the water, damage or activity by river creatures. Bodies may also come up in unexpected places many miles from where they entered the water which can be difficult for families of the deceased to understand.
Once the death is determined to not be suspicious the bodies are transported to the local mortuary for post mortem.
Sgt Hall ended her talk by wishing us all well on our cruise down the Thames later that evening. She also reassured us that the Unit were On Call should any of us enter the water!
The conference was drawing to a close with the award of the CPD certificates for those who had acheived the 100 points required for the Diploma- Congratulations to all those who recieved the award.
Another fantastic conference has come to an end and I for one am looking forwards to Edinburgh next year!