Forensic Evidence and The Emergency Department

1. Forensic Evidence and The Emergency Department Taken from: The Manual for Forensic Medicine: A guide for clinicians authored by Ralph J. Riviello

2. …pertaining to a legal process • Forensic Nursing…applying nursing principles and practice to matters that are legal in nature Forensic

3. Improper actions made inadvertently by undertrained staff include: • Destroying evidence • Throwing away evidence • Losing pertinent evidence • Writing illegible records • Creating partial documentation • Incomplete medical records • Delaying forensic examination • Missing subtle injuries • Making “educated guesses” about projectiles Things NOT to do

4. Medical trauma nursing care is the FIRST priority • Forensic work can be done simultaneously or after the patient has been stabilized Victims of Violent Crimes

5. Clothing worn by the victim should be saved and placed into PAPER bags • Plastic bags encourage mold that can influence analysis of DNA • Place each piece of clothing in a separate bag to prevent cross contamination • Label each bag with patient information and give it to the law enforcement officer • If clothing is soaked with blood or body fluids place it in a red biohazard bag • If the clothing must be cut avoid cutting through bullet holes or penetration sites • Document, in detail, this process 1. Collect the victim’s clothing

6. If time and safety permit, photograph the injuries • This provide visual documentation and will help with legal recall at later dates • Document, in detail, this process 2. Photograph the Injuries

7. Clearly and objectively document any injuries found during your examination of the patient • i.e. circular, red area noted to the patient’s right forearm, no bleeding or open wounds found • NOT bite marks seen on patient’s right forearm • This would be an assumption and could discredit other documentation 3. Document the Injuries

8. Sexual assaults • Domestic violence • Substance abuse • Assaults • Automobile or pedestrian accidents • Worker’s compensation cases • Elder abuse or neglect • Institutional abuse or neglect • Death in the Emergency Department • Sudden infant death Who is a victim?

9. Can cause a severe and lasting psychological effect in healthcare personnel • Can lead to alterations in self and professional identity • ED staff observe many different forms of trauma suffered by their patients Vicarious Trauma in the ED

10. ED staff are valuable to forensic evidence collection and preservation • Proper treatment and documentation help avoid unintentional destruction of evidence • Anyone can be a victim that requires forensic interventions • Violence affects all those involved, including the healthcare worker Recap