Submission Tips & Common Problem Areas

1. FORENSIC TOXICOLOGY Submission Tips & Common Problem Areas TSgt Stephanie Washington stephanie.washington@afip.osd.mil 301-319-0100

2. MISSION Post-Mortem and Human Performance Testing Laboratory Performs testing for medical examiner autopsies, military aircraft, ground and sea mishaps, military criminal investigations, legal alcohol determinations, fitness-for-duty inquiries, special request drug testing and selected forensic cases of national interest. Toxicological Report TAT Standard - 8 days Average - 2.4 days Industry TAT can range from 2 weeks to 4 months

3. MISHAPS Includes: Aircraft, Ship and Ground Incidents • Specimens • 2 NaF blood tubes (14 mL total) • 1-2 EDTA blood tubes (7 mL total) • 50-70 mL of Urine (screw top shipping container) Testing • Carbon Monoxide • Ethanol • Drugs of Abuse

4. INVESTIGATIVE • Investigates often serve as a “catch all” category • Provide expertise as appropriate to assist agents during the collection and labeling process (CID, NCIS, OSI) • Specimens • 2-3 NaF blood tubes (14 -21 mL total) • 50-70 mL of Urine (screw top shipping container) Testing • Ethanol / Volatiles • Drugs of Abuse • Prescription Drugs (Special Testing Available Upon Request)

5. AUTOPSY / DEATH CASES Includes:Post-Mortem and Aircraft Fatalities Specimens Blood, Urine, Vitreous, Bile, Gastric Contents, Liver, Kidney, Lung, Brain, Adipose, Heart and/or Muscle Testing Volatiles Drugs of Abuse Basic Drug Screen *Acetaminophen & Salicylate **Carbon Monoxide **Cyanide ** Suicide Cases

6. QUICK FACTS • Direct urine observation during collection is recommended at the unit level • we don’t need documentation • sample would not be rejected • Tamper-resistant tape is not required; often this can obscure/hide info • Over-packaging defeats the point and serves no real purpose • Do not send separator gel or clot tubes • Specimens listed are the minimum amounts…we will work with what we get • Melendez-Diaz supreme court ruling…you could be summoned to court

7. Laboratory Basics • Provide complete identification information when labeling specimens • use full legal name and full SSN • be consistent • If possible don’t allow service member to label their own samples • potential for self-sabotage --- purposeful errors, etc • Be sure to properly mix and label specimens • Write legibly on chain-of-custody

8. Packaging Basics SINGLE CASE / PERSON • - Item 1 (blood) with absorbent material sealed in bag • Item 2 (urine) with absorbent material sealed in bag • Item 3 (chain-of-custody) sealed in bag • Package all three sealed items together in a larger bag • Send at refrigerated temperature Urine Specimen Bottles NSN 6640-00-165-5778

9. Pooled leaking urine Try to use only plastic tubes…glass vials often break during transit

10. See TOX guidelines for specifics on packaging Post-Mortem cases Lack of absorbent material 1323 custody form not packaged in separate bag

11. Package 1323 inside box with sample not under shipping label(s) - it can easily get sliced or tossed when opening package • Please send BLD & URN in the same box and use the same 1323 • sending 2 forms and 2 boxes is unnecessary and can cause confusion

12. SAMPLE 1323

13. Mailing Address Discrepancy • make sure address is • accurate and complete • if overseas be sure to use the proper APO AE / FPO AP instead of the local postal code • list requestor’s e-mail in addition to physical address for faster results

14. Sample Identification “Daniel” on 1323 and “Danny” on samples is not effective labeling • If possible: • don’t allow agents to label with only initials or evidence number • don’t hand over an unlabeled sample - use comma as directed to avoid name order confusion Example: William, Thomas vs. Thomas, William

15. Medication History - most critical in investigative cases - may apply to drug(s) found at the scene

16. Sample Receipt - Evidence List - list often left blank or mismatched • Exception to the Rule: • separate events may require multiple collections on same day • Please send BLD & URN in the same box and use the same 1323 • sending 2 forms and 2 boxes is unnecessary and can cause confusion

17. Importance of Comments • answer the “what happened?” question • provide specific details will help direct appropriate testing • please don’t leave blank #1 - too vague #2 - specification directs appropriate testing #3 - mention of UAV would omit CO testing

18. - service member should not start the custody form - it must be the person who takes control of the sample once it’s collected. - you do not need them to sign their BLD over to you • accounting for shift change is unnecessary if the sample isn’t handled • don’t line out unused lines Chain of Custody Close-up

19. CONTACT INFO Forensic Toxicology Case Submission Address Armed Forces Institute of PathologyATTN: Division of Forensic Toxicology Building 546825 16th Street, N.WWashington, DC 20306-6000 http://www.afip.org/consultation/AFMES/operations/fortox.html Email: fortox@afip.osd.mil Phone (0700-1600 EST): 301-319-0100 After Hours: 301-319-0000

20. QUESTIONS