Cognitive Interviews for 2023 Census of Medical Examiner and Coroner Offices

Cognitive Interview Protocol

Participant Number______

Date of Interview ______________

Interviewer______________

[ASK PARTICIPANT IF THEY WERE ABLE TO REVIEW THE INFORMED CONSENT SENT TO THEM PRIOR TO THE INTERVIEW, AND IF THEY HAVE ANY QUESTIONS. CONFIRM THAT THE PARTICIPANT CONSENTS TO INTERVIEW AND RECORDING. THEN READ/PARAPHRASE THE FOLLOWING TO THE PARTICIPANT]:

On behalf of the Bureau of Justice Statistics and the project team at RTI, thank you again for participating in the testing of the 2023 Census of Medical Examiner and Coroner Offices (CMEC). We’re talking today because we want to see how well people understand these questions and how they might answer them. This interview is voluntary; you can skip any question or stop the interview at any point. The answers you provide will not be shared outside the RTI/BJS team.

During this process, you and I will go through the survey items together to so that I can understand how you would answer them. I will ask that you read certain questions aloud. Please tell me anything that comes to mind as you read the question. You do not need to provide specific answers or numbers at this point. For those questions for which you would need to do additional research, please tell me whether you would be able to answer the question and, if so, how long it would take to get the answer. However, please let me know if you would not be able to provide exact numbers when we are actually collecting these data next year.

As you are reviewing the questionnaire, please read/think aloud so that I can better follow where you are in the survey. After reviewing a question, I may stop you and ask how you came up with your answer, or what specifically you were thinking about. These questions will help me understand your thought process when answering, which will help us determine if any changes need to be made to the question. If there is a question that you’d like to provide feedback on that I do not ask about, please let me know.

There are no right or wrong answers to the questions I ask. Our goal is to make sure that the questions make sense and that people like yourself can answer them and follow the questionnaire instructions easily. You can help us by pointing out anything you find confusing or unclear. If something doesn't make sense, please tell let me know. Or, if you're not sure about your response, please tell me that too.

Do you have any questions? [ANSWER ANY QUESTIONS]

Ok, let’s begin. First, I have a few general questions about you.

1. What is your job title?

2. How long have you been in this position? (If needed) How long have you been at your agency?

[LET THE PARTICIPANT KNOW THAT YOU’D LIKE TO SHARE THE INSTRUMENT ON THE SCREEN. CONFIRM IF THEY CAN VIEW THEIR SCREEN AND/OR IF THEY HAVE THE COPY SENT TO THEM AVAILABLE TO REFERENCE DURING THE INTERVIEW. BEGIN SCREEN SHARE TO DISPLAY THE INSTRUMENT.]

[INTERVIEWER: IF JP CASE, ONLY ADMINISTER THE FOLLOWING PROBE THROUGHOUT PROTOCOL TO ASSESS ABILITY TO RESPOND: Would you be able to answer this/these question(s)? Why/why not?]

SURVEY INTRODUCTION

This survey is intended to collect information about your office’s death investigation functions. If your office is embedded within another department or type of office (e.g. law enforcement agency, mortuary), please only report details about the resources and practices related to death investigation functions.

1. What does the term “death investigation functions” mean to you? (If needed) Can you provide examples of “death investigation functions”?

ADMINISTRATION

A1. What is the title of the head position in your office (e.g., Chief Medical Examiner, Coroner) and who holds that title?

Title: ______________

First Name: ____________________ Last Name: ____________________

A2. Which of the following best describes your death investigation office?

1. Coroner office

2. Medical examiner officer

3. Law enforcement coroner office (e.g., Sheriff-coroner)

4. District attorney or prosecutor office

5. Justice of the peace

6. My office does not investigate deaths  Skip to the end of the survey and return in the enclosed envelope

7. Other medicolegal death investigation office (please specify):

1. Is anything missing from the list of responses?

2. Are there other types of death investigation offices that should be included?

A3. What level of government best describes your office?

1. City office

2. County office

3. District/regional office

4. State office

A4. Which, if any, of the following provides administrative oversight of your office?

1. Public health agency (e.g., department or division of public health)

2. Law enforcement agency (e.g., department or division of public safety)

3. Government attorney’s office (e.g., district attorney, attorney general)

4. Department or division of forensic science

5. Court system

6. My office does not report to another agency

7. Other (please specify):

1. In your own words, what is this question asking?

2. What does the phrase “provides administrative oversight” mean to you?

3. (If Justice of the Peace Office) What option would you select for this question? Why?

4. Is anything missing from the list of response options?

A5. Is your office located within another business, such as a funeral home?

¡ Yes

¡ No

A6. What jurisdictions does your office serve (e.g., County, State, or Judicial District)? If you serve multiple jurisdictions, enter a comma between each jurisdiction.

____________________________

1. (If needed) How would you answer this question?

The following section collects information about staff that support death investigation functions at your office and includes questions about Autopsy Pathologists, Coroners/non-physician Medical Examiners/non-autopsy physicians, Death Investigators, other scientific support staff (e.g., Forensic Toxicologists, Forensic Analysts), ancillary staff (e.g., drivers, photographers, evidence technicians), and administrative staff (e.g., administrative assistants, record clerks, secretaries).

If an employee fills more than one role, please include them in their primary role.

1. Is there anything confusing or unclear about these instructions?

2. What do you think we mean by the term “ancillary staff”? What about “administrative staff”? Who might you include under these categories?

For questions in this section, please consider the following definitions:

• Full-time employees: Staff directly employed by your office who have regularly scheduled hours and work on average 30 hours or more per week on death investigation functions.

• Part-time employees: Staff directly employed by your office who have regularly scheduled hours and work on average fewer than 30 hours per week on death investigation functions.

• Consultants/Contractors: Those who work for another company or as a consultant and are hired to work for your office, including locums tenens.

• On-call employees: Those who do not have regularly scheduled hours and only work on an as needed basis.

• Vacancies: Positions for which your office has funds to staff but remain unfilled or open.

1. Is there anything confusing or unclear about these definitions?

2. Are any employee/staff types missing from the list of definitions that you think should be included?

3. In your own words, what is the difference between “on-call employees” and “part-time employees”?

4. What does the term “locums tenens” mean to you? Which category of employees would a locums tenens fit beneath at your office, if applicable?

Autopsy Pathologists

A7. Did your office employ/contract any Autopsy Pathologists during the pay period that included December 31, 2023? Please include all full-time, part-time, consultants/contractors/locum tenens, and on-call Autopsy Pathologists.

¡ Yes

¡ No à Skip to A13

1. Is there anything confusing or unclear about this question?

A8. How many Autopsy Pathologists did your office employ/contract in the following categories during the pay period that included December 31, 2023? Enter 0 if your office does not have staff in given category.

1. Full-time employees:

2. Part-time employees:

3. Consultant/contractors/locum tenens:

4. On-call employees:

1. What would be involved in obtaining these numbers for your office?

2. How long do you think it would take to get these numbers?

3. Are there any employee or staff types for which your office would have trouble providing counts?

4. Are there any scenarios here where you would not know where to put an employee (e.g., fits in multiple types, missing type)?

A9. How many full-time and part-time Autopsy Pathologists directly employed by your office in the pay period that included December 31,2023 were certified in forensic pathology by the American Board of Pathology (ABP)? Do not count contractors, consultants, or locum tenens. If none, enter 0.

Number of full-time autopsy pathologists certified by ABP in forensic pathology: ______

Number of part-time autopsy pathologists certified by ABP in forensic pathology: ______

A10. How were Autopsy Pathologists that performed autopsies for your office paid in 2023? Please include full-time and part-time employees and consultants/contractors/locums tenens. Select all that apply.

¨ Hourly

¨ Salary

¨ Stipend

¨ Fee-for-service (paid by case, call, day or other fee structure) àSkip to Question A12

1. What does the term “stipend” mean to you? (If needed) Can you think of any examples?)

2. What does the term “fee-for-service” mean to you? (If needed) Can you think of any examples?)

3. What do you think we mean by “paid by case, call, day, or other structure”?

4. When answering this question, which staff would you include?

A11. What was the average annual salary (or annual salary equivalent if paid hourly or by stipend) for full-time and part-time Autopsy Pathologists employed by your office as of December 31, 2023?

	Annual Salary or Equivalent	Not Applicable
a. Average annual full-time salary (or salary equivalent if paid hourly or by stipend)		¨
b. Average annual salary part-time (or salary equivalent if paid hourly or by stipend)		¨

1. When answering this question, which staff would you include?

2. What do you think we mean by the phrase “annual salary or equivalent”?

3. What would be involved in providing these annual salary or equivalent figures for your office?

4. (If hourly or stipend pay type selected) Could you describe how you might respond or come up with these figures for staff paid hourly/by stipend?

A12. Did your office employ/contract any certified Pathologists Assistants to perform autopsies, separate from assisting in an Autopsy Technician role, during the pay period that included December 31, 2023?

¡ Yes

¡ No

Coroners/non-physician Medical Examiners/non-autopsy physicians

A13. Did your office employ/contract any Coroners/non-physician Medical Examiners/non-autopsy physicians during the pay period that included December 31, 2023? Please include all full-time, part-time, consultants/contractors, and on-call employees. If an employee fills more than one role, please put them in their primary role.

¡ Yes

¡ No à Skip to Question A17

1. Is there anything confusing or unclear about this question?

2. In this question we use the term “Coroners/non-physician Medical Examiners/non-autopsy physicians.” Who would you include in this question?

3. Is there an easier term or terms that we should consider to describe this group?

A14. How many Coroners/non-physician Medical Examiners/non-autopsy physicians did your office employ/contract in the following categories during the pay period that included December 31, 2023? Enter 0 if your office does not have staff in given category.

1. Full-time:

2. Part-time:

3. Consultant/contractors:

4. On-call employees:

[ASK FOR EACH STAFFING CATEGORY AS NEEDED (E.G., IF PROCESS IS DIFFERENT, MORE DIFFICULT ETC.)]

1. What would be involved in obtaining these numbers for your office?

2. How long do you think it would take to get these numbers?

3. Are there any employee or staff types for which your office would have trouble providing counts?

4. Are there any scenarios here where you would not know where to put an employee (e.g., fits in multiple types, missing type)?

If your office did not employ/contract any Coroners/non-physician Medical Examiners/non-autopsy physicians during the pay period that included December 31, 2023 à Skip to Question A20

A15. How were Coroners/non-physician Medical Examiners/non-autopsy physicians at your office paid in 2023? Please select all that apply.

¨ Hourly

¨ Salary

¨ Stipend

¨ Fee-for-service (paid by case, call, day or other fee structure) à Skip to Question A17

[IF NOT ASKED PREVIOUSLY]

1. What does the term “stipend” mean to you? (If needed) Can you think of any examples?)

2. What does the term “fee-for-service” mean to you? (If needed) Can you think of any examples?)

3. What do you think we mean by “paid by case, call, day, or other structure”?

4. When answering this question, which staff would you include?

A16. What was the average annual salary (or annual salary equivalent if paid hourly or by stipend) for full-time and part-time Coroners/non-physician Medical Examiners/non-autopsy physicians employed by your office as of December 31, 2023?

	Annual Salary or Equivalent	Not Applicable
a. Average annual full-time salary (or salary equivalent if paid hourly or by stipend)		¨
b. Average annual salary part-time (or salary equivalent if paid hourly or by stipend)		¨

1. (If not previously asked) What do you think we mean by the phrase “annual salary or equivalent”?

[ASK FOR EACH STAFFING CATEGORY AS NEEDED (E.G., IF PROCESS IS DIFFERENT, MORE DIFFICULT ETC.)]

2. What would be involved in providing these annual salary or equivalent figures for your office?

3. (If hourly or stipend pay type selected) Could you describe how you might respond or come up with these figures for staff paid hourly/by stipend?

Death Investigators

A17. Did your office employ/contract any Death Investigators during the pay period that included December 31, 2023? Please include full-time, part-time, consultants/contractors, and on call employees. If an employee fills more than one role, please put them in their primary role.

¡ Yes

¡ No à Skip to Question A22

1. Is there anything confusing or unclear about this question?

A18. How many Death Investigators did your office employ/contract in the following categories during the pay period that included December 31, 2023? Enter 0 if your office does not have staff in given category.

1. Full-time:

2. Part-time:

3. Consultant/contractors:

4. On-call employees:

[ASK FOR EACH STAFFING CATEGORY AS NEEDED (E.G., IF PROCESS IS DIFFERENT, MORE DIFFICULT ETC.)]

1. What would be involved in obtaining these numbers for your office?

2. How long do you think it would take to get these numbers?

3. Are there any employee or staff types for which your office would have trouble providing counts?

4. Are there any scenarios here where you would not know where to put an employee (e.g., fits in multiple types, missing type)?

A19. How many Death Investigators directly employed by your office during the pay period that included December 31, 2023 are certified by the American Board of Medicolegal Death Investigators (ABMDI)?

Full-time Death Investigators certified by ABMDI:

Part-time Death Investigators certified by ABMDI:

A20. How were Death Investigators directly employed by your office paid in 2023?

¨ Hourly

¨ Salary

¨ Stipend

¨ Fee-for-service (paid by case, call, day, or other fee structure) à Skip to Question A22

[IF NOT ASKED PREVIOUSLY]

1. What does the term “stipend” mean to you? (If needed) Can you think of any examples?)

2. What does the term “fee-for-service” mean to you? (If needed) Can you think of any examples?)

3. What do you think we mean by “paid by case, call, day, or other structure”?

4. When answering this question, which staff would you include?

A21. What was the average annual salary (or annual salary equivalent if paid hourly or by stipend) for full-time and part-time Death Investigators employed by your office as of December 31, 2023?

	Annual Salary or Equivalent	Not Applicable
a. Average annual full-time salary (or salary equivalent if paid hourly or by stipend)		¨
b. Average annual salary part-time (or salary equivalent if paid hourly or by stipend)		¨

1. (If not previously asked) What do you think we mean by the phrase “annual salary or equivalent”?

[ASK FOR EACH STAFFING CATEGORY AS NEEDED (E.G., IF PROCESS IS DIFFERENT, MORE DIFFICULT ETC.)]

2. What would be involved in providing these annual salary or equivalent figures for your office?

3. (If hourly or stipend pay type selected) Could you describe how you might respond or come up with these figures for staff paid hourly/by stipend?

4. When answering this question, which staff would you include?

A22. Did your office have volunteer Death Investigators in 2023?

¡ Yes

¡ No à Skip to Question A24

A23. How many volunteer Death Investigators did your office have in 2023?

1. What does the term “volunteer” mean to you in this question? Can you think of any examples? Who might you include here?

Scientific Support and Ancillary Staff

A24. During the pay period that included December 31, 2023, did your office employ/contract scientific support staff (e.g., Forensic Toxicologists, Forensic Analysts or Chemists, other scientific investigative support staff) or ancillary staff (e.g., drivers, photographers, evidence technicians) with roles specific to death investigation functions? Include full-time, part-time, consultants/contractors, and on call employees.

¡ Yes

¡ No à Skip to Question A26

1. Is there anything confusing or unclear about this question?

A25. How many scientific support or ancillary staff with roles specific to death investigation functions did your office employ in the following categories during the pay period that included December 31, 2023?

1. Full-time:

2. Part-time:

3. Consultant/contractors:

4. On-call employees:

[ASK FOR EACH STAFFING CATEGORY AS NEEDED (E.G., IF PROCESS IS DIFFERENT, MORE DIFFICULT ETC.)]

1. What would be involved in obtaining these numbers for your office?

2. How long do you think it would take to get these numbers?

3. Are there any employee or staff types for which your office would have trouble providing counts?

4. Are there any scenarios here where you would not know where to put an employee (e.g., fits in multiple types, missing type)?

Administrative Staff

A26. During the pay period that included December 31, 2023, did your office employ/contract any Administrative Staff (e.g., administrative assistants, records clerks, secretaries) that directly supported death investigation functions? Please include full-time, part-time, consultants/contractors, and on call employees.

¡ Yes

¡ No à Skip to Question A28

1. Is there anything confusing or unclear about this question?

A27. How many Administrative Staff (e.g., administrative assistants, records clerks, secretaries) did your office employ/contract in the following categories during the pay period that included December 31, 2023?

1. Full-time:

2. Part-time:

3. Consultant/contractors:

4. On-call employees:

ASK FOR EACH STAFFING CATEGORY AS NEEDED (E.G., IF PROCESS IS DIFFERENT, MORE DIFFICULT ETC.)]

1. What would be involved in obtaining these numbers for your office?

2. How long do you think it would take to get these numbers?

3. Are there any employee or staff types for which your office would have trouble providing counts?

4. Are there any scenarios here where you would not know where to put an employee (e.g., fits in multiple types, missing type)?

A28. How many vacant or unfilled positions did your office have for each of the following roles during the pay period that included December 31, 2023? If none, enter 0

Role	Vacant Positions
Autopsy Pathologists:
Coroners/non-physician Medical Examiners/non-autopsy physicians:
Death Investigators:

Section Debrief:

For all the questions in section A, did you have to refer back to the definitions of the different staff types?

EXPENDITURES AND FUNDS

B1. On what month and day does your office’s fiscal year begin (e.g., 01/01, 07/01, 10/01)?

/

Day Month

B2. How much did your office spend on death investigation functions in the most recently completed fiscal year?

• If your office is part of a larger organization (e.g., sheriff-coroner), only include expenses related to death investigation functions. If your office only functions as an MDI office, include your total expenses.

• Include expenses paid by your office, such as, for autopsies, personnel, supplies and equipment, training, transportation, toxicology/ancillary testing, indigent burial, and body storage expenses related to MEC functions

Total expenditures:

¡ If estimate, check here

1. In this question, what do you think we mean by the instruction “If your office is part of a larger organization (e.g., sheriff-coroner), only include expenses related to death investigation functions”?

2. What expenses would you include in this question?

3. How easy or difficult will it be for your office to come up with this number? How would you come up with your answer to this question?

4. (If office is part of larger organization) How easy or difficult would it be for your office to separate out death investigation expenses from larger budgets/expenditures?

5. (If difficult for respondent to answer) Did you notice the estimate check box? Would you use it? Why or why not?

B3. Which of the following functions of your office are included in the total expenditures reported in B2? Please select all that apply.

Expense	Yes	No
Autopsies
Personnel
Supplies and equipment
Training
Transportation
Toxicology
Indigent Burial
Body storage
Other (please specify)

B4. In your most recently completed fiscal year did your office receive funding from any of the following? Select one for each row.

Funding/revenue source	Yes	No	Don’t Know	My office is not permitted to collect funds from this source
American Rescue Plan Act/Coronavirus State and Local Fiscal Recovery Funds (ARPA/SLFRF)	¡	¡	¡	¡
Consultant fees/referral fees (e.g., autopsies, neuropathology)	¡	¡	¡	¡
Cremation waiver/authorization or permit fees	¡	¡	¡	¡
Opioid Settlement Funds	¡	¡	¡	¡
Report/record fees	¡	¡	¡	¡

1. Can you think of anything missing from this list?

B5. In 2023, did staff in your office use their own personal resources, or spend personal, out-of-pocket money for which there was no reimbursement, on any of the following? Select one for each row.

Expense	Yes	No
Personal protective equipment (PPE)	¡	¡
Specimen storage	¡	¡
Certifications/continuing education	¡	¡
Transportation (not including commute to work)	¡	¡
Other official work supplies	¡	¡

1. What do you think this question is asking?

2. What if this question asked “were staff in your office required to use their own personal resources”?

WORKLOAD

C1. In 2023, were there any deaths that your office investigated or otherwise documented?

¡ Yes

¡ No à Skip to Question C13

1. What do you think this question is asking? (If needed) What does “that your office investigated or otherwise documented” mean to you?

C2. In 2023, what was the total number of deaths the your office that your office investigated or otherwise documented?

Number of deaths reported:

¡ If estimate, check here

¡ Don’t know—This specific data was not tracked

1. What do you think this question is asking?

2. How easy or difficult would it be to provide this number? What would you have to do to come up with this number?

3. (If difficult for respondent to answer) Did you notice the estimate check box? Would you use it? Why or why not?

C3. In 2023, did any of the deaths reported in C2 meet your office’s criteria to perform additional death investigation functions?

¡ Yes

¡ No àSkip to Question C5

1. What do you think this question is asking? (If needed) What does “meet your office’s criteria to perform additional death investigation functions” mean to you?

2. (If needed) Is there a difference between C1 and C3? Why or why not?

C4. In 2023, for how many deaths did your office perform death investigative functions, beyond documenting the report of the death?

Number of deaths investigated:

¡ If estimate, check here

¡ Don’t know—This specific data was not tracked

1. What do you think this question is asking?

2. How easy or difficult would it be to provide this number? What would you have to do to come up with this number?

3. (If difficult for respondent to answer) Did you notice the estimate check box? Would you use it? Why or why not?

C5. In 2023, did any of the deaths reported in C2 meet your office’s criteria to determine cause and/or manner of death?

¡ Yes

¡ No àSkip to Question C7

1. What do you think this question is asking? (If needed) What does “meet your office’s criteria to determine cause and/or manner of death” mean to you?

C6. In 2023, for how many deaths did your office determine the cause and/or manner of death?

Number of deaths where cause and manner were determined:

¡ If estimate, check here

¡ Don’t know—This specific data was not tracked

1. What do you think this question is asking?

2. How easy or difficult would it be to provide this number? What would you have to do to come up with this number?

3. (If difficult for respondent to answer) Did you notice the estimate check box? Would you use it? Why or why not?

C7. In 2023, did your office receive any deaths from tribal lands? The term ‘tribal lands’ includes areas labeled Indian Country, federal or state recognized reservations, trust lands, Alaska Native villages, and tribal communities.

¡ Yes

Skip to Question C13

¡ No - Our office does not have tribal lands in our geographic jurisdiction

¡ No - Our office receives deaths from tribal lands, but none were reported in 2023

1. Is there anything confusing or unclear about this question?

C8. In 2023, what was the total number of deaths from tribal lands that your office investigated or otherwise documented?

Reported deaths from tribal lands:

¡ If estimate, check here

¡ Don’t know—This specific data was not tracked

1. What do you think this question is asking?

2. How easy or difficult would it be to provide this number? What would you have to do to come up with this number?

3. (If difficult for respondent to answer) Did you notice the estimate check box? Would you use it? Why or why not?

C9. In 2023, did any of the deaths from tribal lands reported in C8 meet the criteria for your office to perform additional death investigation functions?

¡ Yes

¡ No à Skip to Question C11

C10. In 2023, for how many deaths from tribal lands did your office perform investigative functions, beyond documenting the report of the death?

Investigated deaths from tribal lands:

¡ If estimate, check here

¡ Don’t know—This specific data was not tracked

1. What do you think this question is asking?

2. How easy or difficult would it be to provide this number? What would you have to do to come up with this number?

3. In your opinion, what is the difference between the two “Don’t know” options?

4. (If difficult for respondent to answer)Did you notice the estimate check box? Would you use it? Why or why not?

C11. In 2023, did any of the deaths from tribal lands reported in C8 meet your office’s criteria to determine cause and/or manner of death?

¡ Yes

¡ No àSkip to Question C13

C12. In 2023, for how many from tribal lands deaths did your office determine the cause and/or manner of death?

Number of deaths where cause and manner were determined:

¡ If estimate, check here

¡ Don’t know—This specific data was not tracked

1. What do you think this question is asking?

2. How easy or difficult would it be to provide this number? What would you have to do to come up with this number?

3. (If difficult for respondent to answer)Did you notice the estimate check box? Would you use it? Why or why not?

These next questions ask about autopsies your office ordered or performed in 2023.

C13. Did your office conduct medicolegal autopsies internally in 2023?

¡ Yes

¡ No àSkip to Question C15

1. What do you think we mean by “conduct internally”?

C14. In 2023, how many medicolegal autopsies did your office conduct internally? Include referrals from other medicolegal death investigation authorities but exclude any private or hospital autopsies. Include both partial and complete autopsies

Number of medicolegal autopsies conducted internally:

1. How easy or difficult would it be to provide this number? What would you have to do to come up with this number?

C15. Did your office order any medicolegal autopsies to be conducted externally in 2023?

¡ Yes

¡ No àSkip to Question C19

1. What do you think we mean by “conduct externally”?

2. (If needed) Would adding (e.g. at another location than your office) make this item more clear?

C16. In 2023, where were autopsies ordered by your office performed externally? Please select all that apply.

If your office does not use private facilities or hospitals to perform autopsies à Skip to Question C18

¨ State Medical Examiner’s office

¨ Other MEC office

• Private facility or hospital

C17. How many autopsies were performed for your office by private facilities/hospitals in 2023?

Number of autopsies performed at private facilitates/hospitals __________

1. How easy or difficult would it be to provide this number? What would you have to do to come up with this number?

2. What do you think we mean by the term “ordered” as it is used here? Would another term be more appropriate? What about “requested”?

C18. How far from your office is the autopsy facility or contractor your office uses most frequently?

¡ less than 50 miles

¡ 50-100 miles

¡ Greater than 100 miles

C19. In 2023, as part of practice or policy, did your office routinely perform or order autopsies for the following types of deaths when determining cause and manner of death and signing the death certificate?

Type of death	Yes	No
a. Drug related	¡	¡
b. Elderly	¡	¡
c. Homicides	¡	¡
d. Motor vehicle deaths	¡	¡
e. Suicide by firearm	¡	¡
f. Suicide by hanging	¡	¡

1. What do you think this question is asking?

2. What does “routine practice or policy” mean to you in this question?

3. (If no to any) Can you tell me why your office doesn’t perform/order autopsies for these types of deaths?

These next questions ask about your medicolegal death investigations (MDI).

C20. In 2023, did medicolegal death investigators in your office perform scene investigations?

¡ Yes

¡ No à Skip to Question C22

C21. In 2023, how many scene investigations did medicolegal death investigators conduct?

Number of scene investigations:

1. How easy or difficult would it be to provide this number? What would you have to do to come up with this number?

C22. For those functions that are conducted internally by your office, who is primarily responsible for performing the following duties? Select one for each row.

Duty	Autopsy Pathologists	Coroners/Non-physician Medical examiner/non-autopsy physicians	Death Investigators	Other Internal Staff	Not applicable, this function is not performed by my office
Determination of which deaths are accepted for further investigation	¡	¡	¡	¡	¡
Death scene investigations with inspection/examination of body	¡	¡	¡	¡	¡
Determination of which deaths are autopsied	¡	¡	¡	¡	¡
Determination of which deaths receive forensic toxicology testing	¡	¡	¡	¡	¡

C23. At the death scene, external examination/inspection, or at autopsy, did your office routinely perform drug screening tests (e.g., urine screen or Randox^®) in 2023?

¡ Yes

¡ No à Skip to Question C25

C24. After performing drug screening tests, did your office routinely confirm positive results with toxicology testing in a laboratory in 2023?

¡ Yes

¡ No

C25. For your office, who of the following is primarily responsible for notifying next of kin about the individual’s death.

¡ Law enforcement personnel

¡ Medical examiner/coroner personnel

¡ Someone else (please specify): ______

1. (If Sherriff Coroner/Deputy serving as MEC) Which option would you choose given your dual roles?

C26. In 2023, did your office respond to a multiple fatality event with four or more decedents?

¡ Yes

¡ No à Skip to Question D1

2. What do you think we mean by the term “multiple fatality event”?

C27. In 2023, how many multiple fatality events (4 or more decedents) did your office respond to?

¡ 1-5

¡ 6-10

¡ More than 10

C28. Did your office need and/or use assistance from other jurisdictions to respond to multiple fatality events in 2023 for functions your office would normally complete independently?

¡ Yes

¡ No

SPECIALIZED INVESTIGATIONS

For the following questions, unidentified remains refer to remains that are unidentified for 60 days or more.

D1. As of December 31, 2023, did your office have any records of remains that were unidentified for 60 days or more? Please include cases regardless of disposition of the remains.

¡ Yes

¡ No à Skip to Question D7

1. What do you think this question is asking?

2. What does “regardless of disposition status” mean to you?

D2. In what year was the oldest case of unidentified remains currently on record reported to your office?

Year:

1. How easy or difficult would it be to provide this year?

D3. How many cases of human remains did your office have on record that were unidentified for 60 days or more as of Dec 31, 2023? Please include cases regardless of disposition of the remains.

Total number of unidentified humans remains on record:

¡ If estimate, check here

¡ Don’t know

1. What do you think we mean by “on record”?

2. How easy or difficult would it be to provide this number? What would you have to do to come up with this number?

3. (If difficult for respondent to answer) Did you notice the estimate check box? Would you use it? Why or why not?

D4. How long does your office generally hold unidentified human remains before disposition?

¡ Less than 1 month

¡ 1- 2 months

¡ 3-6 months

¡ More than 6 months to a year

¡ More than 1 year

¡ Our office holds unidentified remains indefinitely

D5. How does your office dispose of unidentified human remains? Please select all that apply.

¨ Bury

¨ Cremate

¨ Our office holds unidentified remains indefinitely

¨ Other (please specify)_______

D6. What biometrics and samples do you routinely collect before disposition of unidentified human remains? Please select all that apply.

¨ Dental records (charting)

¨ Dental Radiographs/X-rays

¨ Fingerprints

¨ Full body radiographs (X-ray, CT)

¨ Photos of identifying characteristics (e.g., tattoos, scars, etc.)

¨ Samples for DNA analysis (e.g., blood card/spot, bone)

1. Is there anything confusing or unclear about this question?

2. Is there anything missing from this list that should be included?

This next question asks about suspected drug overdose deaths in 2023.

D7. For suspected overdose deaths in 2023, did your office do the following for all deaths, some deaths, or not at all? Exclude delayed overdose deaths. Select one for each row.

Action	All deaths	Most deaths	Some deaths	None/My office does not do this
Go to scene of death if outside of hospital	¡	¡		¡
Order an autopsy	¡	¡		¡
Draw toxicology specimens	¡	¡		¡
Run toxicology tests	¡	¡		¡
Consult with a toxicologist before determining cause and manner of death	¡	¡		¡

1. Is there anything confusing or unclear about this question?

2. What do you think we mean by the term “delayed overdose deaths”?

3. Is there anything missing from this list that should be included?

RECORDS AND EVIDENCE RETENTION

E1. Did your office have a computerized system used to manage, compile, or track cases or evidence as of December 31, 2023? Such a system is also known as a computerized information management system or CMS. This does not include the use of Excel or other spreadsheet software to manage case information.

¡ Yes à Skip to Question E3

¡ No

E2. What is the primary reason your office does not have a CMS? Select one

¡ Do not want CMS

¡ Funding

¡ Privacy or security concerns

¡ Technology constraints

¡ Too few cases/records

¡Other (please specify) ______

E3. For deaths reported to your office in 2023, how often was a narrative report of investigations produced, distinct from any logs, death certificates, law enforcement or autopsy reports?

¡ All deaths

¡ Some deaths

¡ No deaths

¡Did not have any deaths

1. What do you think this question is asking?

2. (If needed) What does “narrative report of investigations” means?

E4. Did your office have a written retention schedule for the following items in 2023? Select one for each row.

	Yes	No	Not applicable, our office does not produce or use this
Case records	¡	¡	¡
Forensic toxicology specimens	¡	¡	¡
Biological specimens other than toxicology specimens	¡	¡	¡
Non-biological evidence	¡	¡	¡

E5. Did your office maintain records for storage as hard copies, electronically, or both in 2023?

¡ Hard copies

¡ Electronically

¡ Both

¡ Don’t produce written records

E6. Upon last administration change (e.g., appointment of a new medical examiner or election of a new coroner), did the current office administration receive comprehensive death records from the prior administration?

¡ Yes

¡ No

¡ Don’t know

¡Not applicable - Not appointed or elected

1. Is there anything confusing or unclear about this question?

E7. Does your office archive hard copies of your official investigative records and reports?

¡ Yes

¡ No à Skip to Question F1

E8. Does your office archive hard copies of your official investigative records and reports in the any of the following places? Check ‘Yes’ or ‘No’ for each row.

Location	Yes	No
Government-owned office	¡	¡
Government- run or government-controlled storage facility	¡	¡
A regulated third-party storage facility (e.g., Iron Mountain)	¡	¡
Personal storage (including both home and rental storage)	¡	¡
Other business or office (e.g., funeral home, hospital, law office)	¡	¡

2. Is there anything confusing or unclear about this question?

3. Is there anything missing from this list that should be included?

RESOURCES

F1. As of December 31, 2023, did your office have access to the Internet, separate from a personal device, to use for official job functions?

¡ Yes

¡ No

F2. As of December 31, 2023, did your office have a work vehicle dedicated to death investigation functions, separate from personal vehicles?

¡ Yes

¡ No

1. In your own words, what is this question asking? (If needed) What does a “work vehicle dedicated to death investigation functions” mean?

F3. As of December 31, 2023, did your office, or the agency with administrative oversight of your office, own a body storage cooler that you used for death investigation functions?

¡ Yes

¡ No à Skip to Question F5

F4. What is the official maximum capacity of the body storage cooler(s)?

Maximum Capacity:

1. Is there anything confusing or unclear about this question?

F5. Did your office have access to the following resources, either directly or through another agency, as of December 31, 2023? Select one for each row.

Resource	Yes, directly	Yes, through a partner agency	No access
Criminal history databases	¡	¡	¡
EMS records	¡	¡	¡
Fingerprint databases	¡	¡	¡
Law enforcement or other criminal records databases	¡	¡	¡
Medical records databases	¡	¡	¡
Prescription drug monitoring programs	¡	¡	¡

F6. In 2023, did staff at your office participate in any of the following trainings? Select one for each row.

Training or resource	Yes	No
Mass fatality investigation	¡	¡
Disaster planning (e.g., National Incident Management System [NIMS])	¡	¡
Bloodborne pathogens	¡	¡
Proper lifting procedures	¡	¡

1. Is there anything confusing or unclear about this question?

2. Is there anything missing from this list that should be included?

F7. In 2023, did your office provide mental health/wellness support (e.g., counseling, therapy, peer support) for staff?

¡ Yes

¡ No

F8. In 2023, did your office participate in county/statewide emergency response drills?

¡ Yes

¡ No

¡ Our county/state does not conduct emergency response drills

F9. In, 2023, did your office participate in any multidisciplinary review teams? For example, for child fatalities, elderly/vulnerable adult fatalities, or overdose fatalities?

¡ Yes

¡ No à Skip to F11

1. What do you think we mean by “multidisciplinary review teams”?

F10. In 2023, did your office participate in the following multidisciplinary review teams? Select one for each row.

Specialty area	Yes	No	My office did not have cases of this type in 2023
Child fatality	¡	¡	¡
Elderly/vulnerable adult fatality	¡	¡	¡
Overdose fatality	¡	¡	¡
Maternal death investigative team	¡	¡	¡
Suicide investigative team	¡	¡	¡

F11. In 2023, did your office participate in any of these data collection efforts or programs? Select one for each row.

Data collection	Yes	No	Don’t know
National Missing and Unidentified Persons (NamUs) Sponsor: Department of Justice (DOJ)	¡	¡	¡
National Violent Death Reporting System (NVDRS) Sponsor: Centers for Disease Control and Prevention (CDC)	¡	¡	¡
State Unintentional Drug Overdose Reporting System (SUDORS) Sponsor: Centers for Disease Control and Prevention (CDC)	¡	¡	¡

F12. In 2023, did your office directly provide the following support services or provide referrals for these services? Select one for each row.

Support service	Service directly provided	Referral to another entity or organization	No
Advocates for families of victims	¡	¡	¡
Grief and bereavement services for survivors (e.g. counseling or therapy, homicide survivor groups)	¡	¡	¡
On-scene support or advocacy for bystanders or other family and friends of deceased	¡	¡	¡

1. Is there anything confusing or unclear about this question?

2. Is there anything missing from this list that should be included?

F13. As of December 31, 2023, did your office have a dedicated family support specialist or counselor for family and friends of the deceased?

¡ Yes

¡ No

ADDENDUM PROTOCOL

[INTERVIEWER: DIRECT PARTICIPANT TO THE ADDENDUM INSTRUMENT]

Next, we are going to review the 2023 CMEC addendum instrument. This is a brief and optional supplement to the CMEC that BJS is considering for 2023. This optional section will not require any additional data gathering/pulling and is mostly be yes/no questions. The addendum instrument collects data on a few additional topics, like sudden infant death, unclaimed remains, and the use of MRI and CT machines.

AD1. Are the following procedures standard parts of your office’s death investigations for sudden unexpected infant deaths?

Procedure	Yes	No	Don’t Know
Scene investigation
Scene or doll re-enactment
Comprehensive forensic toxicology (e.g., multiple toxin screens)
Complete autopsy
Child or infant death review
Genetic testing (e.g., sudden cardiac deaths)
Metabolic screening (e.g., pediatric inborn errors of metabolism)
Microbiologic testing
Pediatric skeletal survey (e.g., radiology)

AD2. Does your office use the Sudden Infant Death Syndrome, or SIDS, diagnosis?

	Yes
	No

1. How relevant or important do you feel AD1 and AD2 are to the MEC field? Why or why not?

2. How would you answer these questions? Would you answer “yes” to any of these items?

AD3. Do you record decedents’ sex?

	Always
	Sometimes
	No

AD4. Do you record decedents’ gender?

	Always
	Sometimes
	No

1. Is it clear what we are asking for when we ask about “sex” and “gender”?

2. If your office does record gender, how does it do so?

AD5. Do you capture race and/or ethnicity for decedents?

	Yes
	No  SKIP to AD6 on Page 3

AD5. Which of the following race and ethnicity categories do you capture for decedents?

	White
	Black or African American
	Hispanic
	American Indian or Alaska Native
	Asian
	Native Hawaiian or Other Pacific Islander
	We do not capture race or ethnicity for decedents

1. How relevant or important do you feel AD3 – AD5 are to the MEC field? Why or why not?

2. How would you answer these questions? Would your office be able to provide this information?

AD6. How does your office dispose of unclaimed human remains? Please select all that apply.

	Bury
	Cremate
	Donate body to a body donation program
	Donate body to other program(s) (e.g., museum)
	Our office holds unclaimed remains indefinitely
	Other (please specify)

AD7. For unclaimed remains, does your office work with Veterans Administration or other groups to determine if the descendent is a veteran?

	Yes
	No

1. How relevant or important do you feel AD6 – AD7 are to the MEC field? Why or why not?

2. How would you answer these questions? Would your office be able to provide this information?

AD8. When your office receives a death of a foreign national do you notify the consulate of the decedent’s country of origin?

	Yes
	No

AD9. Are you aware of genetic screening as a test that medical examiner and coroner offices are starting to use?

	Yes
	No

AD10. In the last 5 years have you sent any cases for genetic testing?

	Yes
	No

1. How relevant or important do you feel AD8 – AD10 are to the MEC field? Why or why not?

2. In your own words, what do you think we mean by “genetic screening test”?

3. How would you answer these questions? Would your office be able to provide this information?

AD11. Are you aware of the new Centers for Disease Control and Prevention’s Collaborating Office for Medical Examiners and Coroners (COMEC) and the resources it offers MEC offices?

	Yes
	No

AD12. Does your office have access to a computerized axial tomography (CAT or CT) scan, either directly or through a partner agency?

	Yes, directly
	Yes, through a partner agency
	No

AD13. Does your office have access to magnetic resonance imaging (MRI), either directly or through a partner agency?

	Yes, directly
	Yes, through a partner agency
	No

1. How relevant or important do you feel AD12 – AD13 are to the MEC field? Why or why not?

2. How would you answer these questions?

ADDENDUM DEBRIEFING PROBES

1. If you received this optional addendum questionnaire with the CMEC, how likely is it that you would complete it?

2. Are there any questions (from the addendum questionnaire) that you don’t think would be of interest to the field or needed by the field? If so, which ones?

3. Do you feel any of these questions are critical to include in the main CMEC instrument and not in an optional addendum? If so, which ones?

4. Were there any questions that were unclear or confusing that we did not already talk about? If so, which ones?

GENERAL DEBRIEFING PROBES

Now I would like you to think about the instrument as a whole, not including the addendum items we just discussed.

1. Not including the addendum items, how long do you think it would take to complete the survey, including gathering all of the data necessary to answer these questions? (If needed) Would multiple people be involved in responding?

2. When completing this survey, would you be able to provide your exact numbers or would you estimate?

3. Overall, what did you think of this survey?

4. Were there any questions that were unclear or confusing that we did not already talk about? If so, which ones?

5. Are there any questions that you don’t think would be of interest to the field or needed by the field? If so, which ones?

6. Are there any questions that would be more effort than they’re worth? If so, which ones?

7. Are there any questions/topics that you feel are critical to include in the main CMEC instrument that are not currently included? If so, what?

8. If you were to receive this survey without having participated in this testing, would you complete it?

On behalf of BJS and RTI, thank you so much for your time. Those are all of the questions I have. If you think of anything else that would be helpful for us to know as we refine this survey, please don’t hesitate to send us an email.