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and within the wound for a later search for trace evidence. The method of preservation of such samples will
depend upon what is being sought. If, for example, a body has a number of tiny puncture wounds that could
have been caused by small fragments of shrapnel, an excision of tissues around several such fragments
should be made. Some of the specimens should be preserved in 10 per cent formol saline1 for histological
examination while those for metallurgical study should be deep frozen. Should a body have what appears to
be a gun-shot wound, which could have been inflicted by a weapon fired at close quarters, it would be better
for the excised tissues around the wound to be preserved deep frozen so that there could be later analysis of
any chemical deposits on the skin. Of course, in such an instance a search for the missile deep in the tissues
would be undertaken and it would be preferable for a radiograph to be taken before this search is
commenced.
It is at this stage that the whole question of radiography must be considered. Its use will depend on the
availability of suitable apparatus and technicians. If equipment is readily available, full body radiographs
of all fatalities would be ideal. They will provide a permanent record of all major skeletal damage and detect
any unexpected metallic foreign bodies that may be present. Such foreign bodies may contribute also to
identification. In children, ossification centres in particular would be included in the radiographic survey.
1 Formol saline: a 10 per cent solution of formalin in 0.9 per cent aqueous NaCl, used as a general fixative for
histologic and histochemical preparations.
ICAO Preliminary Unedited Version — October 2008 IV-1-8
If radiography is not readily available, the pathologist may have to decide whether to press for it to be made
available for some or even all bodies. This decision can only be made on his assessment of the probability
of its value in a given instance. If sabotage were strongly suspected, radiography would be very important.
In instances where identification is difficult, or likely to be difficult, radiography is important as it might be
the only source of evidence.
At the stage when the pathologist has completed his external examination of the hands and the head, he
should allow the judicial team to proceed with finger-printing and the dentist with the examination of the
jaws and teeth. The pathologist will continue with his internal autopsy with the cranial cavity being
examined possibly as the last procedure when the dental records are finished. These minutiae are
unimportant as a team will rapidly develop a rhythm and routine of working together.
The comprehensiveness of the internal autopsy must be a matter for the pathologist to decide on the basis
of the total volume of work, the probable identity of the body (i.e. flight crew, cabin crew or passenger), and
his briefing by the Investigator-in-Charge. As a guide, the following should generally be regarded as a
minimum requirement for all casualties:
a) establishment of the cause of death;
b) discovery of major disease likely to influence life expectancy;
c) assessment of deceleration force and direction based on injury to:
1) cardiovascular system, liver and diaphragm
2) head, sternum, spine and pelvis
d) collection of specimens for carboxyhaemoglobin studies;
e) collection of lung specimens for estimation of the agonal period.
If the body is that of a member of the flight crew or could be that of a member of the flight crew,
specimens of all major organs should be taken for histological examination, including the whole heart or at
least a very large sample of myocardium from the interventricular septum and the ventricular walls. All
these samples should be preserved in 10 per cent formol saline.
Specimens of tissue should be collected for toxicological examination for drugs, alcohol and
carboxyhaemoglobin. It should be noted that carbon monoxide poisoning from exhaust fumes is unlikely
from the exhaust of gas turbine engines, whereas its concentration is much higher in the exhaust from
reciprocating engines. The possibility of a post-mortem alcohol production in tissues demands that some
thought be given to the matter of appropriate samples for this purpose. If available, urine is the best material
to preserve for alcohol estimation. If available, blood should also be collected from the heart and from deep
vessels at two peripheral sites as well. When mutilation results in blood and urine not being available, it will
often be possible to obtain a vitreous humour or bile specimen. Cerebrospinal fluid is also a suitable
material for analysis for alcohol, but it will be very rarely obtainable when the other body fluids mentioned
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Manual of Civil Aviation Medicine 2(129)
