AAPT Council member Tarot Noble-Harris FAAPT reports on the morning presentations from the AEE 2021
Due to the pandemic preventing any social events over 2020, I was really looking forward to finally attending the AEE and getting back to some sense of normality as well as catching up with other APTs from across the UK.
After such an intense year working on the front lines of the pandemic, this gave those of us in attendance a chance to check in with each other.
After registration, everyone had a chance to see the commercial exhibition before the talks began. We value greatly the support of our Company Members, it gave everyone a chance to catch up with those that we hadn’t spoken to in a while and get to grips with the latest mortuary equipment and products.
AAPT Chair John Pitchers gave the introduction, ensuring to remind us all of the importance of looking after each other after the struggles we had all faced over the last year and a half. He spoke about registration with the science council, registering with the UKDVI and highlighted some upcoming webinar sessions that will be of great benefit to APTs.
Lydia Judge-Kronis, AAPT Vice-Chair, was the morning session Chair.
She introduced the first speaker of the day; Dr Sarah Pitt CSci FIBMS on how microbiology can be used in Post Mortem investigations. Sarah used this time to explain how microbiology can help to determine the cause of death in some cases.
Dr Pitt said they can use it to help determine if a crime has taken place, where they died and even where they lived. I found this prospect fascinating as my usual dealings with microbiology have been with either paediatric cases or obvious infections.
Sarah showed photos of various bacteria and malaria and what they look for when testing these. She explained that everyone has “normal flora” which is acquired at birth and will stay with you for life, and transient flora which is what you get throughout life, such as from contact transfer, etc.
These are used to help determine where someone was originally from which can help with unidentified patients. A study was carried out in Japan which determined that those who were born in Northern Japan had the MY group and Southern Japan has the CY group of bacteria. This information can give the police a start on where to look for missing persons records if an unknown person is found deceased.
Sarah gave several case studies highlighting the use and importance of microbiology. The first case study highlighted the possibilities of false positive blood alcohol levels as bacteria and fungi will use almost anything for energy and the resultant waste product is alcohol. This was something that I had not considered before.
One of the questions at the end asked how you could be sure if the levels were accurate or not, and Sarah explained that this fermentation does not occur in the vitreous, so taking vitreous to obtain alcohol levels would be the most accurate.
The second case study involved a deceased person found in a river. By looking for diatoms, it can determine if the person was in the water at death. Diatoms found in the lungs means the water was aspirated and in the stomach means the water was swallowed. As there are over 5600 species of diatoms, comparing those found within the patient and those from the water source can determine if the person died where they were found. Sarah used a final case study to highlight how microbiology was used to trace anthrax that had contaminated drugs back to the source. This talk gave a broad and fascinating insight into the uses of microbiology in our line of work.
The next speaker of the day was Dr Dominic Chambers, a Pathologist giving a lecture about agricultural deaths.
The talk gave a snapshot of agriculture associated fatalities in Kent. This location has an abundance of orchards and there are links here with dockyards, paper mills and power stations. Because of this there are a high number of mesothelioma cases, and agriculture related deaths. He explained that although fundamental, health and safety does not work well in this field. It is most likely due to lone working an unwise risk-taking.
If there is a fatality then the Health and Safety Executive is involved to help determine whether there was a genuine accident and how to prevent it from reoccurring. Dominic then went on to explain the most common causes of death in agriculture, the most common being transport and falling objects, but also a high number of animal related injuries, most of which involve cows.
One of the elements that I was surprised to see on this list was work related stress and suicide. In comparison with other careers, fatalities are much, much higher in agriculture. He then went on to mention RIDDOR and the risks that come with working in agriculture including the machinery, lone working, old and decrepit buildings and structures and access to firearms.
Dominic then focussed on three different case studies around agricultural deaths. He explained what happened in each one and the condition of the patient when they arrived in the Mortuary. He explained the importance of being able to check the patients. They can arrive completely covered in mud and they need to work around this to be able to determine the injuries.
The conclusion of this lecture was that farms are dangerous, accidents tend to be catastrophic, and that health and safety should be of paramount importance in this field.
There was a little extra time after the second talk and Lydia used this as an opportunity for delegates to talk about their experiences during the pandemic. She highlighted the lone working aspect which most APTs are familiar with, and asked “Is that ok now?”
Health and safety is integral to our work, and although a few years ago, APTs would just get on with it and get things done alone, this should not be the case anymore. Hopefully the issues around the pandemic can highlight this and prevent unnecessary risks to Mortuary staff.
People used this time to talk about their experiences. Dr Mike Osborn used this opportunity to clear up any concerns around the use of body bags with covid patients, highlighting the importance of using sound judgement in each case. This time also gave people the chance to highlight their issues around reporting of spaces throughout the pandemic and how complicated it became.
After a break and a chance to visit the trade stands, it was time for the selected abstract presentations.
Dr Imogen Jones was first up, discussing collaboration and care: APTs and the social sciences. Imogen explained that she works in law, medicine, and death studies. Her presentation talked about her research and how APTs can collaborate with other roles such as social sciences in research.
She talked about how her research is exploratory to help understand what future research needs to be going forward. Imogen carried out her research using semi-structured interviews to talk to Coronial Pathologists, Forensic Pathologists, APTs and other related professions. Dr Jones then used NVIVO analysis technology to analyse the data obtained.
One of the main findings that Imogen noted was that APTs really care.
She said this is because of humanisation where we ensure the patients names are written on the fridge doors, take time to clean them, placing toys with children; all things that any APT or Mortuary staff will have been involved with, and comes naturally to us.
Imogen then explained why social sciences are ideal to collaborate with. Social sciences ask different questions, brings researched together to think in new ways, and working with APTs, Scientists can shed light on what is important. She finished by explaining the next steps; what are the issues, what policies can be developed and what opportunities are there? She demonstrated real enthusiasm for her work and highlighted the care that we put into our work with our patients.
The second abstract presentation was given by Meritxell Miret and Laura McMinn on virtual viewings and what could go wrong.
I had heard about virtual viewings being set up but had not been involved in any so this abstract was of interest to me as a possibility for the future. They outlined the historical context of viewings and the importance of families having the opportunity to say goodbye to their loved ones.
Throughout the covid pandemic, viewings were restricted or stopped altogether in most places throughout the UK. Meritxell explained that they hated having to do this, so liaised with IT to get virtual viewings set up using the Attend Anywhere appointments. They showed a video on how this process works, then explained what the relatives would see; going through to a virtual waiting area before being linked to the viewing.
They explained how there are options for chat features so APTs can message with the relatives to confirm details. They will then have a video call with the APT to confirm ID checks and ensure the relatives are in a private place before proceeding. There is a lot of communication that needs to happen to ensure that this is done effectively. Laura explained the safety and information governance aspects; cameras must be on for identification checks; the whole system is encrypted and secure and if anything doesn’t feel right then the APT can cancel the viewing.
If the relatives attempt to record the viewing then the call can be terminated. They then compared virtual against physical viewings discussing the positives and limitations of each.
There is definitely a place for this going forward, especially in cases where relatives may live far away, or the patient is high risk so the relatives might not be able to go directly into the room with them. Laura finished this abstract explaining what could go wrong and how this is tackled. Possible privacy issues such as relatives trying to record the viewing can be handled by terminating the call.
ID confirmation may pose tricky but ensuring that the link is not shared and the relative gives the patients name and their name. There may be connection issues from either end, in which case the viewing can be rearranged for another time.
The final issue that Laura highlighted was that the relatives have diminished support when not there in person, but they can be contacted to ensure they have the support they need. So far this process seems to have worked well for the Mortuary and is something that I feel will continue into the future.
The final talk of the morning was given by AAPT President Dr Mike Osborn on the role of the autopsy in the 21st century.
Mike began by defining what an autopsy is; “examination of the body to determine a cause of death and underlying pathology”. He mentioned that covid is here to stay and the guidelines that are in place to ensure that we work safely.
This was emphasised with a photo of the PPE that was used for a Covid Post Mortem, including the Jupiter hoods. He explained that to determine the cause of death and extent of changes due to disease would depend on the case, giving examples. He explained aspects that I have never considered; these results can provide data which can increase finding and improve care and services for the living.
Mike then gave case study examples with photos. The first case study was of a patient who had fallen from a chair that was placed on a table. He had a massive basal skull fracture, but on examining the heart, it was noted that he also had a completely occluded vessel which demonstrated that he had an aneurysm and then fell. In other case studies, Mike demonstrated CT images against the Post Mortem photos.
This was to demonstrate how Post Mortem compares with the clinical impression, which helps the medical team determine whether they took the right steps or not and how to proceed in the future. One particular example was a patient who had a subdural haemorrhage which they should have survived. It was determined at Post Mortem that the patient had a clot within the cavernous sinus, preventing venous drainage.
This allows the clinical team to know to check for that in the future, potentially saving their lives. He explained how since the 1960s there has been very little improvement in the death certification but conducting Post Mortems can give accurate data on the cause of death.
Mike then talked a little about his research into the Covid cases and the results they found. Everything they gained from this came from Post Mortem data. He explained how the Post Mortem examination can yield a lot of information about diseases and can be utilised to compare and learn about them. There have been Post Mortem pathways that have been developed to aid research as these examinations are so valuable.
Dr Osborn then finished his lecture by explaining the different types of Post Mortems that are available now, including biopsy post mortems and the benefits and digital Post Mortems using cross sectional imaging.
He highlighted the definition of an autopsy again, and explained that we are still achieving this, but in new and different ways. This talk gave a really good overview of how our work helps so many other people and can benefit different teams for research funding to understand diseases and helping future patients.
After this final morning talk it was time for lunch and another chance to catch up with others. The talks given were really interesting and I felt I learned a lot from each of the speakers. I would like to take this opportunity to thank the organisers of the AEE 2021 for all the time and effort they put in to getting this together and giving us a chance to see each other after such a long and difficult year and a half!