Protocol

No standard or agreed protocol has been devised for the postmortem examination of these deaths, and, as a result, variation in the reported details of these examinations is expected. These differences in the procedures and the number and type of the specialist tests performed result in considerable variation in the pathological detail available as a basis for establishing the cause of death and, hence, available for presentation at any subsequent inquest. The absence of a defined protocol hinders the analysis of the results of these examinations and makes even the simplest comparisons unreliable. There is an urgent need for a properly established academic study of all of these deaths, such as that performed in Australia under the auspices of the Australian Institute of Criminology (6), to be instituted in the United Kingdom and the United States.

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