From examining an investigator's report to conducting a full autopsy, the state medical examiner's office is involved in about 5,000 sudden or unexpected deaths in Utah each year. And when a calamity strikes — whether a multiple-fatality car crash or a mass shooting — they're sometimes hard-pressed to keep up.

Each year, the four doctors in the medical examiner's office do 2,000 examinations to determine cause of death, with support from a handful of autopsy assistants, a few investigators and other staffers. All medical examiner autopsies are conducted in the state facility on the University of Utah campus.

Sometimes, it's a miracle they keep up, says chief medical examiner Dr. Todd Grey. They couldn't without part-time and subcontracted help. They operate on a shoestring, that lace often thin and frayed, worn by sheer numbers and the cost of transporting bodies to and from other parts of the state for examination.

That was never more clear, he says, than after the recent shootings at Trolley Square. Besides the typical five or six sudden and unexpected deaths they were already handling, they needed to examine the six who died at the mall, a process that can take from a half-day to a full day for each autopsy.

"The staff did a phenomenal job and we were all done within 36 hours, but we had to call in and basically beg part-time people with other responsibilities and jobs to come help."

The ME caseload seems to keep growing. Since 1999, deaths related to prescription narcotics have increased more than 1,400 percent. "These are not drug addicts, they're moms and pops and working folk who got addicted because of chronic pain and they get in trouble. And family after family is standing out there all alone."

A suicide isn't a suicide unless Grey says it is. A homicide is not a homicide. Without an autopsy, many families would never know the cause of a "natural" death that may have genetic implications for children and siblings.

While most think of the "CSI" TV series when they think of a medical examiner, the majority of the cases they handle are natural deaths that nevertheless need to be explained. The ME's office is also a sentinel for public health. It is at autopsy, perhaps, that a deadly, easily spread strain of meningococcal disease is noted in someone who appeared to have a cold or flu.

"Those folks are public servants of the first order," says Dr. David Sundwall, Utah Department of Health executive director. "They do a grisly public service day in and day out. I'm proud of what they do. They complement the public health focus of the health department."

For soldiers, "surge" means more troops. For hospitals, it's patients lined up for beds due to an epidemic or mass-casualty accident. Grey doesn't want to contemplate the word. "We simply deal with everything that comes down the pike at us." For several years, they've had shortfalls, although they've cut out staff training or trips to conferences to learn about advances in forensic medicine and they rarely buy new textbooks or other nonessentials. This year, they've asked the Utah Legislature for $270,000 in building block funds, half of it to cover an existing shortfall. The rest is keep-up money. If they can't cover the shortfall, the cost of transporting bodies may be passed on to families or, in criminal matters, police forces or prosecutors' offices.