The World Trade Center attacks on September 11, 2001; the CIA’s discovery of biological testing by Al Qaeda; and the recent terrorist bombings in London have certainly changed our perspective not only on disaster preparedness and planning but also on the threat of biological terrorism.

We no longer consider a biological terrorist attack on U.S. soil a remote possibility, rather a reality. For our sake, we hope that is years away, because we have a lot to do to be prepared for minimizing the consequence of such anevent.

Medical examiners will once again play a key role in responding to the next attack, whether involving a threat biologic agent or otherwise. Accordingly, your capacity to respond against potentially biohazardous risks is critical in protecting your life and the lives around you. While preparing for biological terrorism involves addressing some complex issues, the focus of this article is only on biological containment in medical examiner facilities.

Current published biological containment design guidelines relate primarily to research laboratories working with known pathological hazards within highly controlled environments. Researchers in academic, corporate, and government facilities across the county are safely working in well designed biological containment environments with known agents. But what about “unknown” dangers possibly present in medical examiner facilities? Every medical examiner’s office faces the challenge of discovering the unknown threat from mass causalities or a single entity. To do that in most of today’s autopsy/morgue facilities is absurd. This should give you pause to consider how your facility can better prepare you to deal with unknown threats.

How well do biocontainment and biosafety guidelines written for research facilities apply to medical examiners?

The mission of medical examiners and the procedures they use present significantly different challenges. Major differences between medical examiner and research operations with respect to biocontainment and biosafety include:

Hazards are unknown – Probably the biggest differentiator between medical examiners and researchers involves working with unknowns. In research settings, the biological challenges are almost always known or predictable. Medical examiners conduct investigations to determine potential infectious agents.

Human bodies are large – Another difference between medical examiners and most researchers is the physical size of the infectious item. Research often involves procedures that can be contained inside a biological safety cabinet. Medical examiners can’t perform required functions inside a biological safety cabinet.

Human bodies arrive contaminated – Research samples arrive clean, under controlled environments, and then infected in high containment areas. Bodies arrive infected and need to be moved into containment, vehicles delivering bodies need to be disinfected, and the disposal (or disinfection) of bodies is a challenge.