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If the term "medical examiner" happens to come up in conversation, for many people, crime scene investigation television shows come to mind. Investigating deaths is a large part of what those experts do, but when it comes to the Armed Forces Medical Examiner System, the various jobs carried out by its experts encompass so much more than that. Turret Lathe
AFMES is the only comprehensive forensic investigative service supporting the Defense Department and the federal government. Its services include forensic pathology and toxicology, as well as DNA testing to identify current and long-ago service members. AFMES' work also includes an extensive counternarcotics program, improving military readiness by studying post-mortem injuries and preparing drug-sniffing military working dogs for training.
Armed Forces Medical Examiner System Insignias for the Armed Forces Medical Examiner System’s Forensic Pathology Investigations division and its Forensic Toxicology division. Share: × Share Copy Link Email Facebook X LinkedIn WhatsApp Download: Full Size (1.03 MB ) Photo By: DOD graphic by Katie Lange VIRIN: 230830-D-D0439-037
AFMES has three divisions to cover all of this: Forensic Pathology Investigations, the Division of Forensic Toxicology and DNA Operations. We'll focus on the first two in this article.
AFMES investigates combat-related deaths as well as those from injuries, accidents and illnesses, even when a service member isn't on duty. The work starts at AFMES' Forensic Pathology Investigations division, which enlists the help of several types of experts.
First and foremost, there are the forensic pathologists — commonly known as medical examiners — who do autopsies to determine a person's cause and manner of death. Army soldiers with mortuary affairs training also work in the division to assist, while medicolegal death investigators collect evidence to help the pathologists determine if the death was natural, accidental, a homicide or a suicide.
Medical Personnel Armed Forces Medical Examiner System personnel pose for a photo in the AFMES autopsy suite at Dover Air Force Base, Del., Sept. 10, 2015. AFMES personnel includes board certified forensic pathologists, forensic anthropologists, medical-legal death investigators, photographers and mortuary affairs specialists. Share: × Share Copy Link Email Facebook X LinkedIn WhatsApp Download: Full Size (1.74 MB ) Photo By: Navy Petty Officer 2nd Class Samantha Thorpe VIRIN: 150910-N-PI709-001C
"The medicolegal death investigators are responsible to be the eyes and ears of the forensic pathologist," explained Army Sgt. 1st Class Earnie Williams, the FPI division's morgue supervisor. "They will go to the scenes and get all the circumstances of the death to better inform that pathologist on what they found."
According to AFMES, 75% of active-duty deaths occur in areas that are handled by medicolegal authorities outside of military jurisdiction, including some that occur on military bases. So, while AFMES might not be in charge of those cases, they are still notified about them within a day or two. The MDI's make the call on whether or not AFMES investigates.
"All the investigations that we conduct are based on jurisdiction at bases. Some bases are exclusively federal, and some bases are covered by a [memorandum of agreement] with the local county," Williams explained.
Other members of the pathology division include forensic anthropologists, who analyze bone and hard tissue; photographers, who document the cases; and histotechnicians, who process the tissue to be examined at a molecular level by the forensic pathologist.
Medical Microscope Navy Petty Officer 2nd Class Tyler Wiedmeyer, an Armed Forces Medical Examiner System histotechnician, looks at slides of tissues under a microscope before handing them off to a medical examiner, June 6, 2019. The stained tissues help medical examiners see down to the cellular level for a diagnosis of cause of death. Share: × Share Copy Link Email Facebook X LinkedIn WhatsApp Download: Full Size (2.13 MB ) Photo By: Air Force Staff Sgt. Nicole Leidholm VIRIN: 190606-F-BH656-1201C Processing Samples Navy Petty Officer 2nd Class Tyler Wiedmeyer, an Armed Forces Medical Examiner System histotechnician, prepares a tissue sample, May 30, 2019. It is Wiedmeyer’s job to ensure tissue samples are processed, cut and stained for diagnosis of cause of death for AFMES and medical examiners around the world. Share: × Share Copy Link Email Facebook X LinkedIn WhatsApp Download: Full Size (1.9 MB ) Photo By: Air Force Staff Sgt. Nicole Leidholm VIRIN: 190530-F-BH656-1122C
During an autopsy, there's a range of evidence that investigators may look for to make a determination.
"For instance, if there was a slip and fall, and somebody passed away from that, then [pathologists] would be looking for any fractures — anything in the neck or head that would indicate the result of how they died from the fall," Williams explained. "Then they would also look through the different organs that we recovered in order to determine why they fell in the first place."
Aside from Dover, AFMES has five regional medical examiner labs in the U.S., as well as one in Germany and one in South Korea.
Forensic Tools Tools that forensic pathologists use during an autopsy are prepared on a table inside the autopsy suite at the Armed Forces Medical Examiner System on Dover Air Force Base, Del., Aug. 30, 2023. Share: × Share Copy Link Email Facebook X LinkedIn WhatsApp Download: Full Size (5.16 MB ) Photo By: David Johnston, DOD VIRIN: 230830-D-D0439-076
Within the pathology division is a section for mortality surveillance, which looks at injury trends within the military using autopsies and other forensics. AFMES can report these findings to military leaders to help with readiness and force protection.
Take, for instance, operations in Iraq and Afghanistan. According to Dr. Tim McMahon, the director of DNA Operations at AFMES, injuries that pathology division personnel found and reported during that time led to changes in armor used in combat. One example he gave pertained to the redesign of blast plates on Humvees.
"There were plates underneath the vehicle, and the way the plates were situated, the blast would go straight up into the bottom of the vehicle. That was causing some foot injuries and other things," McMahon said. "So, my understanding is that by looking at the wounds or looking at the deaths, [experts] were able to restructure the plates such that it focused the blast energy or shockwave — instead of it coming straight up, it was focused away from the vehicle."
Rough Terrain Army Reserve Sgt. Sam Gordon drives a Humvee through the Rough Terrain Driving Course at Fort McCoy, Wis., Aug. 19, 2023. The course consists of log rolls, hills, mud pits and a rock crawl and is intended for soldiers to familiarize themselves with navigating off-roading obstacles in tactical vehicles. Share: × Share Copy Link Email Facebook X LinkedIn WhatsApp Download: Full Size (4.32 MB ) Photo By: Army Spc. Addison Shinn, Army Reserve VIRIN: 230819-A-AE781-1045
As AFMES pathologists investigate deaths, a team of toxicologists works alongside them by testing autopsy samples to see what drugs, alcohol or other chemicals may have been in the deceased person's system that may have caused acute toxicity.
AFMES' Division of Forensic Toxicology also serves as a crime lab of sorts for the military. It supports the Navy Criminal Investigative Service, Army's Criminal Investigation Division and the Air Force Office of Special Investigations. AFMES toxicologists are often called on to help with sexual assault and DUI cases, or, for example, determining if someone accused of showing up to work intoxicated had drugs or alcohol in their system.
Toxicology Lab Tiara Evans, an Armed Forces Medical Examiner System Division of Forensic Toxicology analytical toxicologist, places a vial into a Turbovap, Oct. 31, 2019, at the AFMES Forensic Toxicology Lab. A Turbovap dries the liquid being tested, leaving any potential drug behind. Share: × Share Copy Link Email Facebook X LinkedIn WhatsApp Download: Full Size (819.2 KB ) Photo By: Air Force Staff Sgt. Nicole Leidholm VIRIN: 191031-F-BH656-1008C
Aside from Dover, AFMES supports five other DOD-certified drug testing labs in the U.S. that cover workplace drug testing for each military service. Those labs look for about 20 different kinds of drugs, said Dr. Jeff Walterscheid, AFMES' chief toxicologist. However, if a service member is suspected of abusing a substance for which he or she doesn't have a prescription — particularly if that drug falls outside the scope of the DOD's workplace drug testing program — those samples are often directly sent to the flagship lab in Dover to take a closer look.
"[For example] sometimes the spouse might have a prescription. [The test subject] doesn't have any drugs, but he takes supplements or Ibuprofen, and it just so happens that it looks just like one of those other pills," Walterscheid explained. "Did an inadvertent swap happen at home? Did the pharmacy make a mistake in filling the prescription? It's these things that we have to work through and use our detective skills to say, 'What are all the other possibilities?' without immediately assuming somebody's nefariously taking drugs."
To do their work, toxicologists use immunoassays, which are quick, efficient tests that use antibodies to look for various classes of drugs. For newer drugs that don't yet have antibody tests created for them, Walterscheid said they rely on what's called time-of-flight mass spectrometry — which, in a nutshell, measures the mass of different molecules and how quickly they travel to reveal what substances might be in a sample.
"We can also use something called tandem mass spectrometry," Walterscheid said, while pointing at the machine pictured below. "It has a series of magnetic chambers that can trap an ion, smash it up and give us fragments that are very diagnostic for what this drug is. We can also measure how much."
Forensic Toxicology At the Armed Forces Medical Examiner System at Dover Air Force Base, Del., a member of the Division of Forensic Toxicology works on a tandem mass spectrometry machine, which is used to test for drugs during workplace drug testing. Share: × Share Copy Link Email Facebook X LinkedIn WhatsApp Download: Full Size (327.68 KB ) Photo By: Navy Petty Officer 1st Class Reina Delgado VIRIN: 230830-D-LM581-021C
AFMES toxicologists test a wide range of people involved in accident and incident investigations. Walterscheid used a fatal aircraft crash as an example.
"The pathology group will do an autopsy, then we'll receive the samples and look for drugs and alcohol — even carbon monoxide or cyanide, because in a fire, these decomposition products can get into the air, and we can determine what all might have been attributing to toxicity," he said. "But not only that, the ground crew — the people that were involved in getting the aircraft ready for flight. Were they using drugs? Were they intoxicated? We can give this full-service investigation to the flight surgeons so they can clear it for resuming the mission or if they need to put a hold and try to sort out what really happened."
Toxicology's centralized lab is primarily staffed by contractors, along with some service members and a few government civilians. It is run by a few military officers and a corps of enlisted service members who are clinically trained for work in hospital laboratories. AFMES is a unique assignment for most of them.
"We're the only place that can do this, so a rotation through here gives [service members] this extra level of technical background … and when they get stationed at a new hospital lab, they're going to have a lot more experience," Walterscheid said.
When it comes to staying up on the latest drug-use trends, the toxicology team participates in conferences and other industry-related forums to learn about new drugs that are coming onto the scene across the country and world. They also read public journals and reports and even use social media to gauge how drugs are being used.
Little B Little B, an 86th Security Forces Squadron military working dog, sniffs lockers during detection training at Ramstein High School on Ramstein Air Base, Germany, April 24, 2020. The MWDs practice detection under multiple different scenarios such as finding specific scents in areas where the smell may be masked by other scents. Share: × Share Copy Link Email Facebook X LinkedIn WhatsApp Download: Full Size (4.1 MB ) Photo By: Air Force Airman 1st Class Taylor D. Slater VIRIN: 200424-F-PJ020-1026C
Military working dogs used by the DOD for drug detection are certified to identify cocaine, heroin, marijuana and methamphetamine. If you've ever wondered where the kennels that train them get the products they use to teach the dogs, now you know — it's AFMES' Division of Forensic Toxicology.
"It's real street drugs. It models exactly what would be encountered out in the real world," Walterscheid said. The division procures its drugs from the Drug Enforcement Administration's Special Testing and Research Lab in Dulles, Virginia, as part of its counternarcotics mission to provide the training aids to 164 service kennels.
Each kennel has a set number of training aids that it maintains. They're returned to AFMES every two years for replacement to avoid scent profile degradation.
Training Aide The Armed Forces Medical Examiner System’s Division of Forensic Toxicology prepares a training aide for drug detection K-9s at 164 service kennels. Lab techs carefully measure specified amounts of drugs and put them into “bindles,” which are filter paper that disperses the odor. They’re then sealed in tins and serialized before being securely shipped to the kennels. Share: × Share Copy Link Email Facebook X LinkedIn WhatsApp Download: Full Size (235.52 KB ) Photo By: Armed Forces Medical Examiner System VIRIN: 231207-D-D0439-071
To prepare the training aids, the toxicology lab will carefully measure specified amounts of drugs and put them into "bindles," which are filter paper that disperses the odor. They're then sealed in tins and serialized before being securely shipped. Strict guidelines are in place for proper receipt of the aids, which includes procedures for any possible discrepancies. That way, they can keep a tight control over what the DEA provides, Walterscheid said.
Whether it's providing these training aids, making sure our service members are on the straight and narrow, or finding the reason behind a person's death, AFMES has a big job to do. Thankfully, its diligent, experienced personnel take that wide-ranging mission on with pride.
"When this job opened up, it was a once in a lifetime opportunity," Walterscheid said. "I'm so glad I took it."
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