Forensic Science in Healthcare: Caring for Patients, Preserving the Evidence

353 Pages·2011·6.958 MB·English

by  Connie Darnell

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C M Y CM MY CY CMY K
FORENSICS & CRIMINAL JUSTICE
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Forensic Science e
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in Healthcare
Caring for Patients, Preserving the Evidence
“The author has distilled the essentials for those who do not have the time to wade through a lot of
peripheral ‘nice to know’ information to find immediate answers … . If you can have only one quick
reference manual, it should be this one!”
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—Janet Barber Duval, Forensic Nurse
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“. . . an excellent resource for all healthcare providers and right on target for our EMS colleagues.” n
— Philip J. Froman, MD, FACEP, EMS Medical Director s
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First responders confronted by forensic cases are forced to consider the competing concerns of administering S
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proper medical treatment while at the same time safeguarding vital evidence. Forensic Science in Healthcare:
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Caring for Patients, Preserving the Evidence presents precise on-scene protocol designed to ensure that e
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the actions of the response team provide the necessary care and yet maintain the integrity of the evidence
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for legal purposes. e

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Following an introduction to forensics, the book explains how to recognize and identify patients with

forensic issues, offers guidelines on proper documentation, and provides tips on forensic photography and H
capturing critical images. It reviews basic principles of evidence collection before moving into specific case e
scenarios, including domestic violence, sexual assault, child and elder abuse, youth violence, and death a
l
investigation. The book also examines occupational concerns for forensic personnel as well as legal issues t
h
such as testifying in depositions and in court.
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Enhanced with photographs, illustrations, templates for documentation, and case-specific recommendations, r
e
this one-stop reference provides first responders with practical understanding of the steps that should be
followed to ensure not only patient protection but evidence preservation.
K11993
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Composite
Forensic Science
in Healthcare
Caring for Patients, Preserving the Evidence
Forensic Science
in Healthcare
Caring for Patients, Preserving the Evidence
Connie Darnell
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
CRC Press
Taylor & Francis Group
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Library of Congress Cataloging‑in‑Publication Data
Darnell, Connie, author.
Forensic science in healthcare : caring for patients, preserving the evidence / Connie
Darnell.
p. ; cm.
Includes bibliographical references and index.
ISBN 978143984490-8 (pbk. : alkaline paper)
1. Medical jurisprudence. 2. Victims of crimes--Medical examinations. I. Title.
[DNLM: 1. Forensic Medicine--methods. 2. Forensic Nursing--methods. W 700]
RA1051.D37 2011
614’.1--dc22 2010044852
Visit the Taylor & Francis Web site at
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and the CRC Press Web site at
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Contents
Preface xvii
Acknowledgments xix
Author xxi
1 Introduction to Forensics 1
Red Flags 2
The Evolution of Crime, Violence, and Crime Detection 3
Living Forensics 3
The Scope of Crime and Violence in Modern Society 4
The Financial Cost of Violence 5
The Emotional Cost of Violence 6
The Role of Healthcare 6
Standards of Care 9
The Nursing Process 9
Assessment: Data Collection 10
Nursing Diagnosis 10
Planning 11
Implementation 11
Evaluation 11
Summary 11
Appendix 1.1: Signs of Abuse, Neglect, and Exploitation 13
References 14
2 Documentation 17
Medical Documentation 17
General Physical Examination 19
Wound Documentation 20
Blunt Force Injuries 22
Abrasions 23
Contusions 25
Lacerations 35
Sharp Force Injuries 37
Cuts or Incisions 38
Stab Wounds 38
v
vi Contents
Mixed Blunt and Sharp Injuries 4 3
Fast Force Injuries (Gunshot Wounds) 43
Range of Fire 4 5
Angle of Entry 5 1
Types of Projectiles and Intervening Objects 5 2
Photographing Gunshot Wounds 57
Important Terms to Remember about Gunshot Wounds 5 7
Bite Marks 5 7
Fractures of Bone 58
Thermal, Electrical, and Chemical Injuries 58
Thermal Burns 58
Classifications 5 8
Scalding Burns 5 9
Inhalation Injuries 6 0
Electrical Burns 6 1
Definitions 6 1
Basics of Electricity 6 1
Types of Electrical Burns 6 5
Lightning Injuries and Death 6 8
Weather-Related Hazards 7 0
Overheating-Related Tissue Injury 7 0
Cold-Related Tissue Injury 7 1
Chemical Burns 7 2
In Conclusion 7 2
Photography 7 3
Photographic Evidence 7 3
Purposes of Photographs 7 3
Basics of Photography 74
Consent to Photograph 7 5
Informed Consent 7 5
Implied Consent 7 6
Admissibility of Photographs 7 6
Qualities of Photographs for Evidentiary Purposes 7 6
Equipment for Forensic Photographs 77
Scene Photography 7 7
Sequence of Photographs 7 8
Photographing Human Abuse and Assault Injuries 78
Tips for Photographing Anatomical Features 8 1
Digital Evidence 8 2
What Is Digital Evidence and Cyberforensics? 8 2
What Is the Unique Forensic Value of Digital Evidence? 8 2
Implications for Healthcare and Forensic Personnel 84
Contents vii
Tampering and Spoliation of Records 85
Safety and Security Concerns 86
Reporting 87
Appendix 2.1: Adult Male Body Diagram 8 8
Appendix 2.2: Adult Male Body Diagram, Side View 8 9
Appendix 2.3: Adult Female Body Diagram 90
Appendix 2.4: Adult Female Body Diagram, Side View 9 1
Appendix 2.5: Head and Neck 9 2
Appendix 2.6: Hands 9 3
Appendix 2.7: Feet—Toes and Bottom 9 4
Appendix 2.8: Feet—Side View 9 5
Appendix 2.9: Hands, Feet, Head, Eyes, Ears 9 6
Appendix 2.10: Female Genitalia 97
Appendix 2.11: Male Genitalia 9 8
Appendix 2.12: Child Body Diagram 9 9
Appendix 2.13: Infant Body Diagram 100
Appendix 2.14: Consent to Photograph Forms 101
Appendix 2.15: Some Commonly Used ICD-9 and CPT Codes 103
References 104
3 Evidence 105
Healthcare Role in Evidence Collection 106
Healthcare Providers 106
Categories of Evidence 107
Types of Evidence 108
Physical Evidence 108
Trace Evidence 108
Verbal Evidence 109
Questions to Ask 109
Demonstrative Evidence 110
Testimonial Evidence 110
Digital or Electronic Evidence 110
Behavioral Evidence 111
Basic Principles of Evidence Collection 111
General Procedures 112
Personal Protective Equipment 112
Collection Basics 112
Drying 113
Labeling 114
Sealing 114
Processing 115
Storage and Security 115
viii Contents
Chain of Custody 116
Common Types of Physical Evidence in Medical Settings 118
Clothing 118
Bullets and Other Projectiles 119
Foreign Objects 120
Trace or Small Evidence 120
Gunshot Residue 121
Small or Loose Materials 121
Large Loose Foreign Materials 122
Fibers and Threads 122
Hair 123
Paint 123
Metal or Sharp Items 123
Glass 124
Pollen 124
Guidelines for Collecting Pollen Samples 125
Biological Evidence 125
Body Fluid Collection 125
Control Swabs 125
Dried Blood 126
Moist Secretions (e.g., nondried blood or other moist
substances; semen or unknown liquid) 126
Dried Secretions 126
Urine Samples 126
Gastric Contents 127
Bite Marks 127
Blood Alcohol and Other Toxicological Specimens 128
Testing for Drugs of Abuse 130
Poisoning 131
Things Not to Do 132
Fetal Drug Exposure 133
DNA—CODIS 133
Sexual Assault 134
After the Evidence Collection 134
Summary 135
Appendix 3.1: Evidence Tag and Chain of Custody 136
Appendix 3.2: Classic Bindle Fold Diagram and Instructions 137
Appendix 3.3a: Blood Collection Instructions 139
Appendix 3.3b: Nail Collection Instructions 140
Appendix 3.3c: Cord Tissue Collection Instructions 141
References 142
Additional Resources 142
Contents ix
4 Domestic Violence and Abuse 143
Physical Abuse 143
Sexual Abuse 144
Psychological Abuse 144
Economic Abuse 144
Joint Commission 146
Intervention for Domestic Violence 147
Screening 149
Be Prepared and Comfortable Dealing with a “Yes” Answer! 150
Assessment 151
Safety First 152
Patient History 152
Psychological History 154
Physical Examination 155
Intervention 156
Care Plan 157
Mental Health Plan 158
Safety Plan 159
Resource List 161
Community Resources 161
Documentation 162
Appendix 4.1: Danger Assessment—English 163
Appendix 4.2: Danger Assessment—Spanish 165
Appendix 4.3: Domestic Violence Assessment Tool 167
Appendix 4.4: Domestic Violence CQI Tool 170
References 172
5 Sexual Assault 173
Definitions 173
Goals of Care 173
Injuries 174
Role of the First Responder and Healthcare Provider 175
Sexual Assault Nurse Examiners (SANE) 176
A National Protocol 177
Appendix 5.1: Suggestions for Police Officers in Sexual Assault
Cases 195
Appendix 5.2: Suggestions for First Responders in Sexual
Assault Cases 198
References 201