"Don't Destroy the Evidence!"

AORN Journal, Nov, 2000 by Jane M. Wick

Although this article is written from the perspective of a perioperative trauma nurse, the information is valuable for nurses in all types of nursing practice. The information applies whether you see criminal cases on a regular basis; see them as random, infrequent events; or stumble upon one accidentally. The setting could be a hospital, somewhere in your community, or even in your own home or neighborhood.

We live in a violent society. The news is filled with stories of murder, assault, domestic violence, rape, drank driving, hit-and-run accidents, and other senseless violence. Tragically, deaths from firearm injuries now outnumber those from traffic injuries in several US states.(1) During the 1997 to 1998 biennium, intentional injuries accounted for 12.7% (n = 1,463) of patients admitted to hospitals in Oregon for trauma system care. More than 79% of intentional injuries resulted from assault, including fights, rape, and family violence. Almost 19% of intentional injuries were self-inflicted. Trauma, including intentional and unintentional injuries, accounted for the deaths of 4,089 Oregonians. A total of 1,075 injuries were related to transportation accidents, suicide accounted for 1,091 deaths, and violence accounted for 276 of total deaths.(2)

In Oregon, 10.8% of the patients who received trauma system care sustained penetrating injuries and 89.2% suffered blunt trauma. The frequency of penetrating trauma was higher in the Portland metropolitan area, where the blunt to penetrating trauma ratio was 82% to 18%. Firearms accounted for 50.5% of penetrating injuries, while cutting or piercing objects caused 46.4%. The incidence of death in patients with firearm injuries was 19.8% versus a fatality rate of 4.6% for victims of motor vehicle accidents.(3)

By law, hospitals are required to report all stab and gunshot wounds to local authorities; thus, OR cases involving gunshot wounds or stabbings all are potential police cases. At Legacy Emanuel Hospital and Health Center, Portland, Ore, a level one trauma center, a retrospective study of trauma surgeries from Nov 1, 1998 to Nov 1, 1999 was performed to identify reportable cases. Thirty-eight stab wounds and 38 gunshot wounds were identified from operative records. This number does not reflect the trauma center total because superficial wounds not requiring surgery could not be identified. Thirty-seven homicides were committed in Portland in 1999. This is well below a peak of 63 homicides in 1993. At least seven of the homicide victims died at local hospitals. Of the 37 homicides, 24 cases were solved, and 13 were unsolved at the time this article was written.(4)

Crime scene investigators are trained to look for physical evidence likely to yield significant results in ascertaining the circumstances and nature of a crime. Medical personnel can unintentionally wreak havoc on a criminal investigation. Ambulance personnel "scoop and run" with the wounded victim, perpetrator, or both. Some crime scenes involve multiple victims who are taken to multiple hospitals by various methods of transport. Evidence of the crime scene is scattered. Everyone who handles the person or property involved in a crime leaves trace evidence of himself or herself. Imagine the complexity involved in figuring out what is important and what is incidental to the events of a crime. As nurses, we are not expected to be crime scene investigators, but we can make the investigator's job easier with just a little effort. Table 1 is a glossary of common forensic terms.

Table 1 GLOSSARY OF FORENSIC TERMS(1)

Forensic medicine: The relation and application of medical facts
to legal matters, or the law, in its bearing on the practice of
medicine. Synonym: medical jurisprudence.

Coroner: An official whose duty is to investigate sudden,
suspicious, or violent death to determine the cause. In
some communities, the office has been replaced by a medical
examiner.

Deoxyribonucleic acid (DNA) fingerprinting: A pattern obtained from
a technique used to compare individuals by molecular genotyping.
The DNA is isolated from a specific individual, digested, and
fractionated according to size.

Trace: An extremely small amount or barely discernible indication
of a substance.

Criminology: The branch of science concerned with the physical
and mental characteristics and behavior of criminals.

Rigor mortis: Stiffening of the body, which occurs one to seven
hours drier death and disappears after one to six days, or when
decomposition begins. Rigor mortis reflects the hardening of the
muscular tissues due to the coagulation of the myosinogen and
paramysosinogen in the muscles.

Livid: Having a black and blue or a leaden or ash-like gray color,
similar to the discoloration from a contusion, congestion, or
cyanosis.

Postmortem livedo: A purple coloration of dependent parts of the
body after death, except in areas of contact pressure. Livedo
appears within two hours of death as a result of gravitational
movement of blood within the vessels.

Wound: Trauma to any of the tissues of the body, with interruption
of its continuity, especially that caused by physical means.

Nonpenetrating wound: Injury, especially within the thorax or
abdomen, produced without disruption of the surface of the body.

Penetrating wound: A disruption of the body surface that extends
into underlying tissue or into a body cavity.

Perforating wound: A wound with an entrance and exit opening.

Puncture wound: A wound in which the opening is relatively small as
compared to the depth. Usually produced by a narrow, pointed object.

Stab wound: A puncture wound produced by the stabbing motion
of a knife or similar object.

Gunshot wound: A wound made with a bullet or other missile
projected by a firearm.