1 . The first step in preserving evidence is
| A) | | contacting law enforcement. |
| B) | | thoroughly cleaning the victim's skin. |
| C) | | identifying the nature and origin of the injuries. |
| D) | | drying and placing the victim's clothing in an individual evidence bag. |
The emergency department can become a chaotic environment at
times, especially when managing multiple trauma patients. But even when working at a hurried
pace or when short-staffed, it is important to be mindful of evidence preservation. The first
step in preserving evidence is identifying the nature (e.g., physical, sexual, emotional) and
origin (e.g., accident, neglect, violence, torture, drug-related) of the injuries to determine
the type of forensic evidence that may be obtained from a variety of search locations. The
time from the assault should be ascertained, as evidence can deteriorate with time to the
point of uselessness. For example, DNA in saliva deteriorates especially rapidly, often in
less than 48 hours. It is recommended that a sexual assault forensic exam be administered
within 120 hours of an attack for the collection of trace evidence; however, bruises, bite
marks, and other injuries should still be documented after this time frame [8,9]. Forensic patients (especially sexual assault patients) must be encouraged
at every contact to rush to an evidence collection facility [9].
2 . When determining the level and nature of collaboration during interview of the forensic patient, it is important to consider the implications of
| A) | | how busy law enforcement officers are. |
| B) | | how many other patients are waiting for triage. |
| C) | | law on hearsay exceptions. |
| D) | | the nature of the crime and necessity for evidence preservation. |
PHYSICAL EXAMINATION AND INTERVIEW OF THE FORENSIC PATIENT
Information gathered from transport personnel or during an
interview regarding the type of attack can help to identify areas requiring particular detail,
but this should not distract from conducting a thorough exam. An important component of the
physical examination/interview is the patient's general appearance and demeanor upon
presentation [8,9]. This should be recorded as objectively and
with as much description as possible in a few sentences. The ability of the patient to
remember details of the incident and to cooperate with the exam should be noted [8,9]. Those seeking information about the assault should work collaboratively
to create an information-gathering process that is as respectful to patients as possible and
minimizes repetition of questions. However, one should consider the implications of the
evolving law on hearsay exceptions when determining the level and nature of coordination. In
the interest of providing culturally responsive care, the patient should receive information
about the procedures used during the exam before the examination begins and in a language the
patient understands [8,9]. Nurses should be aware of cultural issues
pertaining to specific populations and strive to respect and accommodate the needs of the
patient. These include having a friend or relative present during the exam, gender preferences
of medical/forensic personnel, and addressing the patient's physical comfort and
safety.
3 . Which of the following types of fluids are useful for DNA collection?
| A) | | Blood |
| B) | | Saliva |
| C) | | Semen |
| D) | | All of the above |
PHYSICAL EXAMINATION AND INTERVIEW OF THE FORENSIC PATIENT
Questions pertaining to the medical-forensic exam include the
last six on this list, as these can help to focus the search. If ejaculation took place,
this location should be identified; however, other fluids, such as blood and saliva, are
also useful for DNA collection. If more than one individual was involved in the attack, the
patient should identify which perpetrator committed which act(s). The account should include
all violence performed and/or threatened and should conclude by asking if there were any
other acts performed that were not already covered.
4 . Which of the following is NOT one of the components of forensic documentation?
| A) | | Photography |
| B) | | Written documentation |
| C) | | Diagrammatic documentation |
| D) | | Scanning with a Wood's lamp |
COLLECTION AND DOCUMENTATION OF EVIDENCE
Forensic documentation includes a written component, a
diagrammatic component, and a photographic component. Each should accurately inform the other.
The written component must be detailed, accurate, and objective; the diagrammatic component
must be thorough and legible; and the photographic component must include a measurement scale,
be representative of the evidence, and remain objective.
5 . All of the following are benefits of digital photographic documentation, EXCEPT:
| A) | | Inability to be altered |
| B) | | Ability to review images and reshoot |
| C) | | Ease of distribution during legal proceedings |
| D) | | Better control of the evidence chain of custody |
COLLECTION AND DOCUMENTATION OF EVIDENCE
In many cases of abuse and assault, the body is the only
"crime scene." It is the duty of the medical-forensic examiner to accurately and diligently
record the details of the injuries and the evidence present on the victim and/or
perpetrator. The somewhat special skills once required by a forensic photographer shooting
with a roll-film camera have been superseded by the widespread use of digital photography.
Digital documentation simplifies many aspects of forensics, including ease of use, the
number of images that can be recorded at very low cost, ability to review images and reshoot
if needed, better control of the evidence chain of custody, and later ease of distribution
during legal proceedings. Although useful as evidence, photography is not required to
provide care, and patient consent should be obtained [9].
6 . When photographically documenting forensic evidence, it is considered good practice to capture
| A) | | one image of each finding. |
| B) | | two images of each finding. |
| C) | | four images of each finding. |
| D) | | at least 10 images of each finding. |
COLLECTION AND DOCUMENTATION OF EVIDENCE
Photo documentation will typically proceed along with the
physical examination and the collection of evidence. When an injury or other evidence (e.g.,
fluids, fibers) is found, it should be photographed. It is considered good practice to
capture four images of each finding [9]. One
should be an overall shot of the body and should include a clear anatomical reference (e.g.,
arm, hand, leg, foot), another should be a medium shot, and there should be two detailed
shots of the finding. The wide and medium shots can be used to document multiple findings.
Detailed shots of each finding should be taken before evidence collection, during
manipulation, and after the evidence is swabbed or removed. If a lifesaving measure may
disturb evidence, it is ideal to photograph the site/finding beforehand, if possible.
7 . When documenting gunshot wounds, nurses should
| A) | | identify the caliber of bullet. |
| B) | | attempt to identify entrance or exit wounds. |
| C) | | remove gunshot powder residue with a clean, damp cotton swab. |
| D) | | remove bullets or fragments with plastic-shielded forceps and handle as little as possible. |
COLLECTION AND DOCUMENTATION OF EVIDENCE
Bullets (or bullet fragments) are a vital piece of evidence
in cases of gun violence. It is recommended that when these are removed from victims, they
should be extracted with plastic-shielded forceps and handled as little as possible [1]. After they are removed, they should be
immediately wrapped in gauze, placed in an evidence envelope, and the envelope marked with
contents, name of person who extracted bullet, date and time of extraction, and name of
the patient. Additionally, when documenting gunshot wounds, healthcare professionals
should not attempt to identify entrance or exit wounds unless recording the patient's
statement [1]. The caliber of the bullet
should also not be guessed, as this can create a disagreement between the medical-forensic
report and the law enforcement report.
8 . When indicated by forcible oral copulation (or its attempt) or uncertain patient history, the nurse examiner should obtain two swabs of
| A) | | the tongue. |
| B) | | the tonsillar fossae. |
| C) | | behind the buccal sulci. |
| D) | | All of the above |
COLLECTION AND DOCUMENTATION OF EVIDENCE
The nurse examiner should then move to the oral cavity and
carefully observe every surface for injury from forced entry, a hand or gag over the mouth,
or other insult. Two swabs each are usually taken from the tongue, the tonsillar fossae,
behind the buccal sulci, and behind the upper incisors when indicated by forcible oral
copulation (or its attempt) or uncertain patient history (e.g., if the patient was drugged
or unconscious) [7,8,9].
9 . Which of the following areas sustains the most injury during a sexual assault involving penile penetration only?
| A) | | Cervix |
| B) | | Perineum |
| C) | | Vaginal walls |
| D) | | Posterior fourchette |
COLLECTION AND DOCUMENTATION OF EVIDENCE
During the exam, crusted secretions or other attached
material should be clipped out of the pubic hair and placed into evidence. Approximately 20
to 30 samples of the patient's own pubic hair should be plucked and kept separate as a
control. A Wood's lamp should be used in the collection of semen samples from the external
genital area, and again, enough swabs should be used to completely remove all visible
traces. Following collection, a magnification device should be employed to further examine
the area for microtrauma. A gynecologic colposcope is recommended for its sufficient
lighting, magnification, and photographic capability [7,8,9]. The labia minora, posterior fourchette, and
fossa navicularis typically sustain the most injury during an assault involving penile
penetration only, while assaults involving digital penetration cause damage to the
aforementioned sites and the vaginal walls, the cervix, and perineum (due to
fingernails).
10 . Collection of evidence from bite marks is particularly useful in
| A) | | identifying motive. |
| B) | | creating a solid legal case. |
| C) | | determining the assault timeframe. |
| D) | | perpetrator identification through DNA-tested saliva. |
COLLECTION AND DOCUMENTATION OF EVIDENCE
Bite marks are a feature in many types of crimes, including
assaults, homicides, and child abuse. They are typically found on the arms, breasts, and
neck in cases of sexual assault; on the arms, legs, and breasts in cases of homicide; and
over many body surfaces in child abuse cases [8,9]. Although the science
behind bite mark analysis (for perpetrator identification) is dubious, the presence of bite
marks is particularly useful for guiding saliva collection, which can be used to both tie
the victim to the suspect (self-defense biting) and the suspect to the victim (attack
biting) [6]. Therefore, bite injuries should
be given special attention and, whenever possible, should be examined by a forensic
odontologist.
