The collapse of premiership footballer Fabrice Muamba on a cold March night in 2012 during a FA cup quarter final between Bolton Wanderers and Tottenham Hotspurs was watched by millions. Despite ultimately spelling the end of a successful career as a professional footballer, thanks to the quick responses of the team doctors, the assistance of consultant cardiologist Dr Andrew Deaner (a Tottenham fan who ran on to the pitch to help), as well as the quick response of the ambulance service and emergency medicine crews, Fabrice Muamba was successfully resuscitated and made a slow but almost full recovery. Although the cause of his cardiac arrest was never revealed, it is thought that he may suffer from hypertrophic cardiomyopathy (HCM) which, coupled with the extreme physical exertions of premiership football, led to his cardiac arrest.
Other high profile cases in football include the deaths of Marc-Vivien Foé whilst representing Cameroon in the 2003 FIFA Confederation Cup during a game against Columbia, Antonia Puerta who collapsed and died whilst playing for Sevilla in a Spanish league game against Getafe in 2007 and Motherwell’s Phil O’Donnell who collapsed during a Scottish league game against Dundee United in 2009 and died later in hospital. Such cases receive a significant amount of media attention due to the nature of the death of a seemingly fit and well known individual in such a public forum, but thankfully such events are rare. A 2003 study by Corrado et al suggests an increased risk of sudden cardiac death of almost three times for athletes compared to their non-athletic counterparts[i] whilst more recent data suggests the opposite i.e. that athletes have a lower incidence of sudden cardiac death.[ii],[iii]
Overall there are around 60,000 cases of sudden cardiac death a year in the UK.[iv] However this figure includes all deaths, not just those of young athletes. A large and comprehensive 27-year registry of US athletes recorded 1866 sudden deaths in athletes between 1980 and 2006, 1049 of which were deemed to be cardiac in origin.[v] In this registry the most common cause of death was HCM (36%), followed by anomalous coronary arteries (17%). Other less common causes included myocarditis, arrhythmogenic right ventricular cardiomyopathy (ARVC), ion chanellopathies (such as Long QT syndrome) and premature coronary artery disease. Around 80% of the deaths occurred during or just after exercise, be it during a sporting event or practice session. Overall the incidence of sudden death was estimated at around 0.6 per 100,000 per year in this study. A recent comprehensive review by Sharma et al quotes a range of between 0.4-0.8 deaths per 100,000 per year in athletes when analysing only the studies with robust methodologies.[vi] Other studies of young individuals put the figure higher. An incidence of 1.8 deaths per 100,000 per year in the young (age < 35) was reported by the UK Office of National Statistics[vii] and in Italy, the figure was calculated at 2.1 deaths per 100,000 per year.1
Despite the relatively low incidence of sudden cardiac deaths, there is a strong body of opinion that believes more effort should be made to identify athletes with predisposing cardiac conditions prior to engagement in high level activities such as football. Following on from the case of Fabrice Muamba, strong voices from within football, the media and the medical profession at the time of his collapse were heard bemoaning the fact that such an event could have been prevented if more stringent screening measures were in place to identify cardiac diseases that increase the risk of sudden cardiac death.
Taking a broader perspective of competitive sport as a whole, there is considerable heterogeneity between different sports, the competitive level of the sport and the country in which the sport is taking place as to the nature, if any, of the screening programme on offer. Many point to the Italian system of screening for all competitive sport as a model to aspire to. Physician led ECG screening programmes in association with detailed medical histories and examinations have seen an absolute reduction in sudden cardiac death of 89% in competitive athletes since the programme was initiated over 30 years ago.3,[viii] Indeed the Italian system has influenced European Society of Cardiology (ESC) and International Olympic Committee (IOC) guidelines for competitive athletes which recommends an ECG as a minimum for anyone taking part in competitive sport.[ix],[x] In football, FIFA and UEFA drew up guidelines in 2008 that stipulate that every footballer involved in first team activity must have at least an ECG and one echocardiogram in their medical notes.
Prior to Muamba’s cardiac arrest, the English Premier League followed the ESC and IOC guidelines but in the wake of the events of 2012 and the backlash by media, the public and prominent voices within football, more recent guidelines have been introduced by the premier league requiring all players to have bi-annual screening with at the very least and ECG and an echocardiogram if deemed necessary by a consulting physician. Such screening programmes are costly however and there is considerable debate as to the best way to implement them. Wheeler et al analysed the economics of screening programmes and determined that screening with an ECG in combination with a history and medical examination was both reasonable and cost and effective at reducing mortality.[xi]
However screening in isolation is not fool proof. Indeed evidence suggests that the use of ECG and echocardiographic screening, as is standard practice now in the Premiership, can only pick up around 70% of conditions that may lead to sudden cardiac death.[xii],[xiii]Further difficulties can arise in this group when trying to distinguish the natural hypertrophied athlete’s heart to pathological conditions such as HCM.[xiv],[xv] Other such diagnostic grey areas can arise, and these pose problems for medical staff as to how to advise players and clubs, as well as posing problems with regard to future applications for life insurance and mortgages. Some conditions pose a slightly increased risk of sudden cardiac death and such screening tools may lead to exclusion of individuals from sports whose career risk of sudden cardiac death is only minimally increased.
A separate issue highlighted by the collapse of Fabrice Muamba is the availability automatic external defibrillators (AEDs) at football matches as well a proper training for staff to use the devices. At the 2014 FIFA congress, it was revealed that in the last 5 years, 84 reported cases of sudden cardiac arrest had occurred in football matches and training grounds. In 80% of these arrest no AED was available in the stadium and less than a quarter of those individuals were revived. The medical experts that presented this data called for an AED and appropriate medical staff to be available in every football stadium, a message echoed by Professor Jiri Dvorak, FIFA’s Chief Medical Officer who stated that ‘It is required at FIFA competitions to have appropriate medical staff around the pitch and a defibrillator in the stadium’.[xvi] Indeed in England a joint venture between the FA and the British Heart Foundation has led to £1.2 million being made available to provide over 900 AEDs to clubs in tiers 1 – 6 of the National League System and clubs in the Women’s Super League as well as providing training for two representatives from the club in their use.[xvii]
Whilst awareness of sudden cardiac death in football and in young athletes in general grows, the multitude and variety of conditions that can lead to sudden cardiac death, and the difficulty in diagnosis as well as risk stratification means that there will never be a perfect system that will completely eliminate such events as occurred in March 2012. However as both screening tools and our understanding of the disease processes develop, coupled with wider access to AEDs and trained medical staff, one hopes that the incidence of sudden cardiac death in football diminishes.
You may also like to visit Cardiac Risk in the Young (CRY) at: http://www.c-r-y.org.uk/about-us/
[i] Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G. Does sport activity enhance the risk of sudden death in adolescents and young athletes? J Am Coll Cardiol 2003;42:1959–63
[ii] Van Camp SP, Bloor CM, Mueller FO, Cantu RC, Olsen HG. Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc. 1995;27:641– 647.
[iii] Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296(13):1593–601
[iv] National Institute for Health and Clinical Excellence (NICE). Implantable cardioverter defibrillators for arrhythmias. Review of technology appraisal 11. http ://www.nice.org.uk/nicemedia/pdf/TA095guidance.pdf
[v] Maron BJ. Hypertrophic cardiomyopathy and other causes of sudden cardiac death in young competitive athletes, with considerations for preparticipation screening and criteria for disqualification. Cardiol Clin.2007;25(3):399–414
[vi] Harmon KG, Drezner JA, Wilson M, Sharma S.Br J Sports Med. Incidence of sudden cardiac death in athletes: a state-of-the-art review. 2014 Aug;48(15):1185-92.
[viii] Italian Ministry of Health, editor. Gazzetta Ufficiale della Repubblica Italiana: Serie generale 1982:63. 1982. Norme per la tutela sanitaria dell’attività sportiva agonistica (Rules concerning the medical protection of athletic activity) pp. 1715–19
[ix] Corrado D, Pelliccia A, Bjornstad HH, Vanhees L, Biffi A, Borjesson M, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26(5):516–24. [PubMed]
[x]InternationalOlympic Committee Medical Commission . Sudden cardiovascular death in sport: Lausanne Recommendations: Preparticipation cardiovascular screening. Vol. 2008. Lausanne; Switzerland: 2004
[xi] Wheeler MT, Heidenreich PA, Froelicher VF, Hlatky MA, Ashley EA. Cost effectiveness of pre-participation screening for prevention of sudden cardiac death in young athletes. Ann Intern Med. Mar 2, 2010; 152(5): 276–286.
[xii] de Noronha SV, Sharma S, Papadakis M, Desai S, Whyte G, Sheppard MN. Aetiology of sudden cardiac death in athletes in the United Kingdom: a pathological study. Heart 2009;95:1409-1414
[xiii] de Noronha SV, Behr ER, Papadakis M, Ohta-Ogo K, Banya W, Wells J, Cox S, Cox A, Sharma S, Sheppard MN. The importance of specialist cardiac histopathological examination in the investigation of young sudden cardiac deaths. Europace (2014) 16 (6): 899-907
[xiv] Pellicia A, Maron B J, Spataro A. et al The upper limit of physiological hypertrophy in highly trained elite athletes. N Engl J Med 1991. 324295–301.301
[xv] Maron B J, Pellicia A, Spirito P. Cardiac disease in young trained athletes. Insights into methods for distinguishing athletes heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation 1995. 911596–1601.1601
It has recently been reported that there has been a reduction in violent crime (1) this could be a result of major changes in society, such as better and improved policing along with the increasing price of alcohol over the years. According to a study by Professor Jonathan Shepherd of Cardiff University, data examined from the NHS has shown a drastic reduction of around 12% in violent crime within England and Wales over the last five years (1). Professor Shepherd further stated that “violence is falling in many Western countries and we do not know all the reasons why”. Could this be the result of major changes in society, such as better and improved policing, along with sharp increases in the cost of alcohol over recent years?
However, many believe that the published figure is not a true representation of the actual number of crimes committed as a result of many criminal offences not being recorded. Surveys that were undertaken by the Crime Survey for England and Wales (CSEW) across the country (face- to –face) showed a significant difference from the number of crimes apparently reported by the police. Both the police and CSEW use different definitions for violent crime therefore this creates a large discrepancy in numbers. Crime such as robbery might be described as “an offence in which violence or the threat of violence is used during a theft”. This will not be classified as violence against a person within the police report but will be interpreted by the CSEW as a violent crime.
A recent release by the Office of National Statistics showed that between 1995 and
2001/02 there was a significant drop in violent crime from 4.2 million to 2.7 million. Since then, this decreasing trend has continued by 13% between the 2007/08 and 2012/13 survey (2), which is very similar to the figures published by the NHS. The Home Office report of 2009/10 compared data from the British Crime Survey (BCS) and police recorded crime showed a consistent fall in overall crime when compared to 2008/09, both by 9% and 8% respectively (3). They then went on to conclude that the recent period of economic recession did not have any effect on the increase in crime between the periods as expected.
These violent crimes are broken down into four major categories: (i) assault without injury (ii) assault with minor injury, (iii) wounding and (iv) robbery; it wasn’t startling to discover that those who are single and aged between 16-24 are twice as likely to be the victims of violent crime. As mentioned earlier, some particular violent crimes such as homicide and sexual assault are not fully covered within the BCS, although these are covered by the police (3).
The reduction within the size of the police force throughout the country also led many to believe there would be a drastic increase in violent crime, in particular property crime during the recession. Surprisingly, that was not the outcome and could be a result of improved policing according to Prof Shepherd. According to the BCS, their report has been regarded as controversial by many; some critics are saying the public does not believe that the crime statistics are right, even though, the BCS report from local areas confirmed that a larger proportion of people (51%) believed that crime had fallen and they’re living in a lower than average crime area (2). This they believed to be a more realistic view of crime within their local area. The UK Statistics Authority was not happy with the negative commentary by these critics and went on to release a statement quoting that they had “not seen any evidence of political interference in the production of the aggregate National Statistics on crime and we are satisfied that the Home Office statisticians responsible for this work are fully committed to maintaining that integrity”.
Max Chambers, Head of Crime and Justice Policy Exchange was also quick to point out and comment that the implementation of “Sensible policies balancing enforcement and prevention can have, and are having, an impact,” on crime reduction within society. The use of neighbourhood policing teams which are more visible within the local areas, particular in high risk crime communities, has shown to be more effective in preventing crime and help in speeding up the rehabilitation process of offenders more successfully.
The steady increase in alcohol prices which is one of the major factors fuelling violent crime within society, means there would be less people getting drunk. According to the study by Prof Shepherd, alcohol “has become less affordable” combined with a fall in the income of those between 18-30 years old. Many pubs and clubs also went out of business throughout the recession, thus forcing many drinkers to stay at home and drink, therefore reducing the risk of them getting into fights with other intoxicated revellers.
According to ‘The Guardian’ newspaper, there was a combined drop of violent crime, which has seen a 5% fall within the police recorded figures. Over the 2011/12 period, the amount of murders reported by the police dropped by 10%, gun crime 17% and an 11% drop in knife crime (4). No one entity can take the credit for this downward trend in crime, however Mark Bangs from the Office for National Statistics deputy head of crime, said…“after levels have crime peaked in the mid-90s, there were then substantial falls through to the 2004-05 survey, after which crime continued to fall at a slower rate, resulting in levels of crime being flat since 2009-10.”. With the crime figures being this low, this created an opportunity for then Crime Prevention Minister Jeremy Browne to announce that this was “the lowest level since the crime survey began in 1981 and in spite of working with a reduced budget many have achieved a significant reduction in crime”(4) .
Could the reduction of lead from car fuel cause a reduction of crime? According to the chief biological criminologist, lead which is highly toxic can cause aggressive or dysfunctional behaviour, resulting in poor decision making and aggressive behaviour within individuals(5). A range of biological studies was carried out on criminals by Dr Bernard Gesch, a physiologist at Oxford University, which included their type of diet combined with various other environmental factors. He further states that “lead is a very potent neurotoxin…..” which causes alteration in the brain. The first real statistical data to support this theory was collected by a housing consultant and economist Rick Nevin, when he calculated the rise and fall of the presence of lead in petrol and compared his results to the history of crime. His results were quite startling. As the amount of lead increased, this showed a corresponding rise in violent crime two decades later. Dr Gesch’s studies support this data and he clearly believed that “the lead could account for as much as 90% of the changing crime rate during the 20th century”.(5)
The total exclusion of lead from petrol or the replacement of all petrol cars with electrical or hydrogen powered vehicles would result in a steady drop in violent crime might only be ambitious thinking at the moment, as the theory is not accepted by everyone. Professor of Criminology, Roger Matthews of the University of Kent clearly rejects this theory. He states, “biological criminologists completely misses the point and he doesn’t see a link”. He believes criminals offend because of the different things that push them into crime and not in the nature of their brain tissue (5).
The events of August 6, 2011, called the “BlackBerry riots”, resulted in the Prime Minister David Cameron promise to rid the streets of the UK of all gangs; guilty culprits would be fast-tracked through the courts and sentenced quickly. This can be interpreted as a fear-driving procedure that would help to drive potential perpetrators of violent crime to reconsider their actions before committing a crime.
Even though there are calls for an increase in the number of police officers, since the last report by the Home Office where it showed the number of police officers had fallen below 130,000. Prime Minister David Cameron welcomed the results as “good news”. He further applauded them citing that “we have asked them to do more with less resources ….and they have performed magnificently”.
The number of full-time equivalent police officers in England and Wales was 129,584 in March 2013 – a 4,516 drop from the previous year.
The continual reduction of violent crime within the UK will always be a priority for the government and local authority with the help of the communities to achieve this goal. In a recent report from the Home Office, Home Secretary Theresa May, praised the value of the numerous amount of Special Constables and police volunteers who worked within the communities combatting crimes and re-emphasised the 10% reduction of crime under the present government due to the hard work by both the police and local residents, which would help to continue the downward trend (6).
Shepherd J. BBC NEWS UK. BBC. [Online] 1 August 2014. http://www.bbc.co.uk/news/uk-27119689.
Flatley J. Crime, Regional and Data Access Division. Office of National Statistics. [Online] 13 February 2014. [Cited: 4 August 2014.] www.ons.gov.uk.
Flately J, et al. UK Statistics Authority. Home Office Research, Development and Statistics .[Online] July 2010. [Cited: 20 July 2014.] www.homeoffice.gov.uk/rds.
Travis A.Surpise 8% fall in crime. London : The Guardian, (day and month) 2013 .
Casciani D.Did removing lead from petrol spark a decline in crime? London : BBC News Magazine (day, month) , 2014.
The Rt Hon Theresa May, Secretary of State. GOV.UK. [Online] 25 June 2013. [Cited: 10 August 2014.] www.gov.uk/government.
A spate of deaths at the end of 2013 sparked a huge uproar against the cycle lanes (mostly the
superhighways) and the risk of cycling in the city. This led to a widespread analysis by the public, media and politicians in to what can be done to prevent such occurrences in the future.
Until November, 2013 had been a ‘normal’ year for cyclists in London, with the appointment of Andrew Gilligan as London’s first Cycling Commissioner in January highlighting the increasing influence cycling is having on transport in London. This resulted in the release of ‘The Mayor’s Vision for Cycling in London’, an article which included an outline for a ‘Crossrail for bikes’, providing a fully segregated route across London from east to west. (1)
Whilst all was looking on the up for cyclists and their safety on London’s roads, the shocking events of November led to drastic statements and criticism of the system. Six cyclists were killed in less than a fortnight, taking the cycle related deaths to 14 for the 2013. The six deaths occurred in Mile End, Whitechapel, Bow, Holborn, Croydon and Camberwell. Three of these fall directly on or on roads adjoining cycle superhighway two, one of four active cycle superhighways in the city. Eight more are scheduled to be introduced by 2015. Cycle superhighway two covers a large stretch or road in East London, including: Whitechapel High Street, Whitechapel Road, Mile End Road, Bow Road, and the recently added section on Stratford High Street. (2)
Various investigations and research papers on the topic highlighted some common factors which are present in cycle fatalities. One of the most frequent incidences was that of a Heavy Goods Vehicle (HGV) turning left at a junction, with cyclists coming from the inside cycle lane with the intention of continuing straight on. A paper in the Emergency Medicine Journal highlighted that the most common accidents took place during the peak commuting time of 08:00 – 09:00 and within 20 m of a junction, generally on roads with a 30mph speed limit. (3)
A further study conducted at the Royal London Hospital found that over a six year period, the number of cyclist admissions gradually increased (assumed to be due to the increase in cyclists in London), with 82% being due to injury following a collision with a motor vehicle. Collision with HGV’s displayed characteristic patterns although traumatic brain injury was seen to be more commonly associated with collisions with cars. The majority of cyclists admitted after collisions with cars survived, with a small percentage needing longer term medical care. The individuals involved in collisions with HGV’s generally showed sever torso injuries, along with sever haemorrhaging. It was shown that the main cause of death was not necessarily due to the head injury, with the analysis of the non-survivor cases pointing to the surgical control of haemorrhaging being the vital factor. Another frequent method of death found with HGV collisions was exsanguination. The study at the Royal London Hospital showed that over 90% of all admitted for cycle accidents survived after treatment, but it was unable to link survival to the quality of life in the long term. (3)
In response to the deaths the cycling charity CTC stated that they were ‘sickened by the continuing failure to protect cyclists’ with British Cycling demanding and ‘urgent investigation’. The Mayor of London, Boris Johnson, stated:
“There’s no question of blame or finger-pointing. That doesn’t work in these circumstances. But unless people obey the laws of the road and people actively take account of the signals that we put in, there’s no amount of traffic engineering that we invest in that is going to save people’s lives.” He also stated that the riders had “…taken decisions that really did put their lives in danger.” (4)
He also followed these comments up in another interview, stating that cyclists were endangering their lives when not following road traffic laws, making it “very difficult for the traffic engineers to second-guess [their actions]“.
These comments were greatly condemned by both the public and the media, with politicians also criticising the Mayor for deflecting blame and insulting the victims of fatal collisions. Although the Mayor was quick to blame the cyclists for the deaths, it is important to note that statistic from TfL showed that cyclists breaking the law was only identified as a factor in only 6% of cases where there was a fatality or serious injury. (5)
The events of November 2013 also resulted in Operation Safeway, in which around 650 police officers were deployed at 60 junctions in central London during the morning and evening rush hours in order to ‘enforce’ and ‘educate’ the public on the laws and dangers of the road. This was also seen by riders as an attempt to blame riders irrespective of the circumstances as they operation was shown to mainly target cyclists with regard to helmets and high visibility clothing. An article in The Independent showed that studies had found helmets to reduce head, minor and severe brain injuries for cyclists of all ages by up to 58%. Although this shows they are visibly useful, other studies have shown that it is not head injuries that need to be prevented as they are very rarely fatal. When compared with the Netherlands (often cited as one of the safest countries for cyclists), it can be seen that helmets are not the most important factor. There is no mandatory law for cyclists to wear helmets. In fact, it is not uncommon to see moped/scooter riders without helmets. The Dutch have achieved their high standards of safety by providing well directed cycle lanes with their own dedicated rules using lights and signals. They also emphasise the awareness of cyclists to drivers and stress that cyclists must be given way when necessary. (6)
It seems that the most obvious was to improve the safety of cyclists on the road would be to separate them from the motor vehicles. Deputy Prime Minister Nick Clegg has called for the cycle superhighways to “physically separate the cyclists from roads”, which would in turn greatly reduce the number of cyclists hit by a HGV turning left at a junction for example. There have been calls for HGVs to be banned from the city during rush hours but Mr Johnson has refused to allow this, stating that it risks damaging London companies and creating a “serious influx as soon as the ban is over”. He also mentioned the fact that a ban would result in the HGVs having to operate during the night, leading to disruption in residential areas. This was backed up by the fact that only two of the 14 deaths last year could have been affected by the ban (the other 12 happened outside the rush hour, or did not involve lorries.) He did however, state that he is considering a ban on cyclists wearing headphones; a statement that drew criticism once again from cyclists due to the fact that the Metropolitan Police traffic division were unable to identify any serious cycling incidents in which headphone use could be identified as a contributing factor. According to a BBC poll taken in December 2013, the events had resulted in one fifth of regular cycle commuters giving up cycling to work (7), with 68% stating that they felt London’s roads were unsafe to cycle on. It is apparent that there is much to be done to improve safety, but the onus must be shifted from the cyclists to the drivers of both cars and HGVs to adhere to the rules and regulations laid out in order to allow the cyclists to ride safely. (8)
Mayor’s Vision for Cycling in London. Greater London Authority, London Assembly; 2013.
Walker P. The Guardian. [Online].; 2013 [cited 2014 February 7. Available from: http://www.theguardian.com/uk-news/2013/nov/18/sixth-london-cyclist-killed-camberwell-lorry.
Manson J, Cooper S, West A, Foster E, Cole E, Tai NRM. Major trauma and urban cyclists: physiological status and injury profile. Emergency Medicine Journal. 2012 February.
Jones S, Weaver M, Walker P, Wintour P. [The Guardian].; 2013 [cited 2014 February 7. Available from: http://www.theguardian.com/uk-news/2013/nov/14/fifth-london-bike-death-bus-superhighway.
Jones S, Walker P, Wintour P. [The Guardian].; 2013 [cited 2014 February 14. Available from: http://www.theguardian.com/uk-news/2013/nov/14/boris-johnson-london-cycling-deaths.
[BBC News London].; 2013 [cited 2014 February 7. Available from: http://www.bbc.co.uk/news/uk-england-london-25080427.
[BBC News London].; 2013 [cited 2014 February 7. Available from: http://www.bbc.co.uk/news/uk-england-london-25176031.
Brooke M. [London24 Online].; 2013 [cited 2014 February 7. Available from: http://www.london24.com/news/transport/get_rid_of_the_blue_paint_on_london_s_cycle_superhighways_if_the_lane_isn_t_segregated_1_3077254.
Most inquests in England and Wales will be completed within six months under a new code of standards for coroners which has come into effect.
The legal framework launched by the Ministry of Justice follows complaints that bereaved families in some areas have had to wait years for a hearing.
The service will be overseen by the first chief coroner Judge Peter Thornton QC.
All 96 coroners will also be subject to mandatory training requirements.
Coroners courts investigate the medical cause of death if it is not known, appears to be unnatural or resulting from violence, or if it happened in custody.
Inquests aim to establish who has died, and how, when and where the death occurred. They are not trials, and so do not determine civil or criminal liability.
The overhaul to the system follows a consultation and aims to make the inquest process more efficient.
The MoJ says it will end “past inconsistencies which led to criticisms of a postcode lottery with bereaved people in some areas facing long waits”.
Under the rules, coroners will have to complete inquests within six months of being informed of a death “or as soon as is reasonably practicable after that date”.
Inquests can be delayed by factors, such as waiting for criminal proceedings to be completed.
Any inquests that last more than a year must be reported to the newly-appointed chief coroner.
Each year more than 30,000 inquests are held in England and Wales and individual coroners have up to now been responsible for holding hearings “as soon as practicable”. Judge Thornton QC told the BBC that standards had been “a little uneven” and the new national rules would create a more “efficient, effective and modern” service for bereaved families. As chief coroner he said he would be able to “lead the service nationally and try to bring some consistency”, adding he would investigate any case where an inquest had not been carried out within 12 months of a death being reported to a coroner.
Commenting on the measures, justice minister Helen Grant said: “I want to see all coroners delivering the same efficient service across the board, and we have put these changes in law so people can be assured inquests are being conducted quickly, with adequate care and the right support available for those who lose loved ones.”
The new rules also mean coroners will have to release the body to the bereaved family as soon as they can, or inform them if it is going to take longer than 28 days.
The government’s consultation on changes noted that some faith groups – notably Muslims and Jewish people – had voiced concerns about releasing bodies for funerals.
Coroners will also have to notify the bereaved within a week of setting the date for the inquest and provide greater access to documents and evidence, such as post-mortem reports, before the inquest takes place.
The laws will also allow coroners to permit less invasive post-mortem examinations – another concern raised by faith groups.
he office of coroner dates back to 1184 and coroners are independent judicial office-holders, appointed and funded by the relevant local authority.
However, once appointed, the coroner is answerable only to the High Court for his or her judicial and administrative decisions.
Clive Coleman Legal correspondent, BBC News
Today’s overhaul of the coroners system is a huge step forward in addressing long-standing criticisms of delay and inconsistency among some of the 96 coroners in England and Wales.
However, concerns remain. Coroners are funded by local authorities and it will be challenging to maintain the new standards in an age of cuts to local services.
Also, campaigners worry that there is still no appeal to the Chief Coroner available over the decision of a coroner.
The only appeal lies to the High Court by way of judicial review, which can be both time-consuming and costly for bereaved families. The Chief Coroner, who is responsible for overseeing the reformed coroner system, has today issued a press notice which is available here:
Further information at: http://www.judiciary.gov.uk/media/media-releases/2013/ChiefCoronerImplementationOfRelevantPartsOfCoronersAndJusticeAct2009.
The statutory instruments that enable the reforms are available here: http://www.legislation.gov.uk/uksi/2013?title=coroner.
Forensic Scientists at Abertray University in Dundee have managed to unlock the key to recovering fingerprints from food which, Foods had previously proved to be difficult surfaces for obtaining fingerprints from and therefore evidence gathering in foods was overlooked. The new research has now been published in the forensic science journal: ‘Science and Justice’1, the results can now be replicated by others. will lead to a future breakthrough in gathering evidence for police investigations.
The Scientists modified an existing technique in order to obtain fingerprints from fruits and vegetables, something which has never been achieved in the UK before.
Dennis Gentles, a former crime scene examiner and forensic scientist, who has worked at Abertray University over the last 10 years stated:
Foods such as fruits and vegetables used to be in that category, because their surfaces vary so much – not just in their colour and texture, but in their porosity as well. These factors made recovering fingerprints problematic because some techniques, for example, work on porous surfaces while others only work on non-porous surfaces.
He also went to say that: “It may not seem like much, but a piece of fruit might just be the only surface that has been handled in a crime scene, so developing a trusted and tested technique to recover fingerprints from such surfaces is something to be valued by crime scene examiners.
The method of recovering fingerprints was initially designed to take prints from the sticky side of an adhesive tape. Mr Gentles finally stated:
We tried altering the formulation a bit, making it more dilute than that suggested by the Home Office, and found that it out-performed all the other methods we tested.
Although there’s still a considerable amount of research to do before we can recommend techniques for all types of foods, we’ve shown for the first time that it really is possible to recover fingerprints from them – something that was previously thought to be unachievable.
This means the police will now be able to gather even more evidence to present in court, adding more weight to their investigations.
Source: The Independent Newspaper, 26/04/2013
D. Gentles et al: A preliminary investigation into the acquisition of fingerprints on food: Science and Justice, Volume 53, Issue 1, March 2013, Pages 67–72
Mummifying Alan, the award winning documentary, which aired on Channel 4, involved a team of expert specialists attempting to mummify a specially- donated body of a man named Alan. In this documentary, we saw the successful process of mummification being carried out and this gave us a true insight into the ancient Egyptian mummification techniques.
The director of The AFMS and expert forensic pathologist, Professor Vanezis, was closely involved in the mummification process and was responsible for carrying out the autopsy on the deceased and in the extraction of the organs. As stated on the Channel 4 website:
Following ancient Egyptian procedure, he first made a small incision approximately 4 inches long on the left side of the abdomen. He then removed most of the organs through this small opening, cutting them away and removing them one by one.
The exception was the heart, which was left intact because the Egyptians believed it was the seat of intelligence and needed in the last judgement before the soul could enter the next life.
The intestines, stomach, liver and lungs were also regarded as an essential requirement for the body in the afterlife. So, after their removal, each was preserved seperately inside a ‘canopic jar’, protected by its own god whose head was represented on the jar lid.
Although the brain was often removed through the nose using a metal implement, x-ray evidence reveals that many of the best Egyptian mummies had their brains left in place. Therefore, Alan’s brain was left intact.”
Professor Vanezis gave a very detailed explanation of ‘Human Decomposition’, in relation to the work he carried out and this was posted on the main Channel 4 website:
From the moment we die our bodies start to break down. This process of decomposition involves a cascade of chemical processes involving enzymes and bacteria, which steadily digest the body.
No two humans decay in exactly the same way, as a number of factors affect both the rate and sequence of decomposition, including temperature, humidity and alkalinity. But, overall, the process follows the same key stages. Understanding these extraordinary and complex molecular events goes to the very heart of forensic science.
Decomposition begins just minutes after death. Early changes to the body include a drop in core temperature, stiffening of the limbs known as Rigor Mortis and a pooling of the blood under the pressure of gravity known as Post Mortem Lividity.
The onset of death also triggers a process called Autolysis, or self-digestion, whereby our own enzymes literally turn against us, digesting our cells from the inside out, and causing them to rupture and release fluids. This liquefying process rapidly spreads across the whole body, with the first visible signs appearing as blisters and loosening of the skin, known as ‘skin slippage’. As the cells rupture and fluids steadily build up, the body becomes a moist environment, and ideal breeding ground for bacteria and other micro-organisms.
This next stage in the decay process is called Putrefaction. As these micro-organisms break down the soft tissue, they produce a steady build up of gases including ammonia, methane, and carbon dioxide. As these gases accumulate the body becomes increasingly bloated, particularly around the bacteria-rich area of the intestines.
Chemical processes also turn the skin a distinct greenish colour, as sulphur-containing hemoglobin settles in the blood, and bacteria enter the veins creating a visible, dark marbling effect of the skin surface.
Insects play a major role in decomposition. First on the scene are blowflies, which can detect a dead body within minutes of death – from many miles away. They lay eggs within the first hour, and the blowfly larvae will feed on the tissues and liquids, and in turn a succession of other flies and beetles will appear, collectively breaking down different parts of the soft tissue.
In the active decay phase, bacteria and insects continue to break down the body proteins and fats giving the body a deflated and wet appearance, as well as a strong odour.
The final stage of decomposition is skeletonisation, when the flesh has been completely broken down and only dry bone remains. Depending on the environmental conditions, the body may never get to this stage – but instead can become naturally mummified.
Mummification occurs most commonly in dry conditions which slow down or arrest the process of putrefaction. Typical features of a mummy include dry, leathery skin that has been completed desiccated. In Ancient Egypt, the desert conditions naturally preserved bodies in this way – before embalmers started to develop the ‘artificial’ practice using natron salt to dry out the tissues.
But, deserts are not the only place where natural mummies have been found.
Dry, cold environments have also created extraordinary mummies, the most famous being Otzi the Iceman and the ‘bog bodies’ of Northern Europe, which have been preserved predominantly through a lack of oxygen and acidic environments that tan the tissues.
Although many ancient cultures preserved their dead in various ways, the Egyptians remain the best known and arguably the most successful mummy makers of all.
Their need to preserve the dead was part of a highly complex belief system which maintained that at death an individual’s soul was reborn into another stage of existence. Here it would be judged by the gods who would weigh the individual’s heart to find out if they had led a good life. If the heart was heavy with sin it was condemned and destroyed, when a second, final death occurred. Yet if their heart was pure, their soul was allowed to pass through into the Afterlife and live forever in a perfect environment, based on the Egyptian landscape. Here the soul could travel around at will, although it still needed to return to its original body which formed its permanent home.
This explains why the Egyptians went to such great lengths to preserve the body after death. This was particularly important in the case of their rulers, the pharaohs, each of whom contained within them a divine soul regarded as the essence of Egypt itself. With this soul maintained and nurtured by special temple rituals during life, it was essential that at death every pharaohs body was perfectly preserved to house this soul, the accumulated powers of which could be accessed in magical rituals to maintain Egypt’s well being.
Yet the most perfect levels of preservation were only achieved after centuries of experimentation and a considerable amount of trial and error.
Although the earliest bodies were buried in hollows in the desert, where the hot sand dried the skin and allowed corrosive bodily fluids to drain away, there is evidence that by c.4500 BC some were also wrapped in linen and coated in various oils and resins. These early bodies were often buried facing east toward the rising sun, with their arms and legs drawn up to the body in the ‘foetal’ position suggesting an early belief in rebirth.
As society developed, the wealthier classes wanted more elaborate burial to reflect their status so began to be buried in purpose-built stone tombs. Yet no longer in direct contact with the hot dry sand, their bodies soon decomposed, leading to the need to remove the internal organs by c.2600 BC. With the previously flexed body now laid out flat to give access to the abdominal area, there is also evidence that the Egyptians had begun to use naturally occurring natron salt as a preservative, in some cases mixing it in water to use as a solution, but most often in its dry form, piled over the body to draw out the body fluids and preserve the skin.
In this way the Egyptians produced mummies for centuries until the dawn of the 18th dynasty c.1500 BC when a new regime brought in dramatic political and religious changes. These changes were even reflected in the way this new dynasty’s royal dead were mummified, the life-like results they achieved now resurrected in the mummification of Alan Billis.