Don't be the one to destroy important forensic evidence
Your clinical assessment and interventions might save a gunshot victim's life, but there is another important concern: that of forensic evidence.
"Remember, your patient is the crime scene," says Ann Heywood, RN, BSN, CEN, SANE, trauma nurse coordinator for the Emergency Care Center at Champlain Valley Physicians Hospital Medical Center in Plattsburgh, NY.
According to Sheila R. Briggs, RN, BSN, BSW, SANE-A, MEI, clinical nurse III, domestic violence and sexual assault educator for the ED at St. Joseph Mercy Hospital in Ann Arbor, MI, when caring for a gunshot victim, "each person is responsible for evidence preservation and documentation."
Heywood adds that "when handling any item that may have evidentiary value, limit the opportunities for that item to be contaminated." She recommends the following:
- When removing your patient's clothing, handle each item with a new set of clean gloves. "Place each item in its own bag, to prevent cross-contamination of evidence. We do not want blood from a shirt contaminating the pants," says Heywood.
- Place each item of clothing in a separate paper bag and document this. "Place the clothing items in bags as they come off the patient. Don't pile the clothing up on the floor," says Heywood.
- Assign one staff member to label and seal each bag of evidence. "You want to minimize the number of staff involved in handling the evidence as much as possible," says Heywood.
Recently, Heywood rolled over a gunshot victim and a bullet fell into an ED nurse's hand. "If a bullet is found, we must promptly secure this vital piece of evidence," says Heywood. Take these steps, she advises:
- With a clean glove, place the bullet in a nonmetallic container such as a urine specimen cup.
- Seal it, label it, and secure it.
- Document the time it was recovered, the time it was secured, who found it, and who picked it up and secured it.
Use these collection tips
Often, a gunshot wound patient arrives with a sterile 4x4 dressing over the injury site. "This particular dressing may contain gunshot residue. It should be placed in a brown paper bag and labeled," says Briggs.
Document the name of the person who collected the items, a description of each article collected, the total number of sealed brown bags, and who released the articles collected to whom. "Also include the police agency involved and the case number, when available," says Briggs. Here are other tips to preserve forensic evidence with gunshot wounds:
• Prepare the room.
If you are notified that a gunshot victim is coming to your ED, Heywood says to have brown paper bags, clean gloves, sterile urine cups, a camera, and chain of evidence forms available. "Ask a SANE nurse to prep the staff on evidence preservation," she says.
Place brown paper bags over each hand, marked "right" and "left."
"Until it is determined by the medical examiner that this is not warranted, this procedure should occur," says Briggs. "Tape should be placed around the bag, not on the skin of the patient. If the bags become soiled or wet, new bags should be placed over the existing bags."
• Pay attention to "verbal forensics."
"Excited utterance by patients when they are in a hyper adrenaline rush can provide important information," says Terry O'Shea, RN, CCRN, an ED nurse at Providence Portland (OR) Medical Center. "Listen to the patient's or the family's babbling or blurting. Take note of what patients and families are saying to each other."
Instead of summarizing what the patient states happened, use direct quotes. These comments made by a patient are considered "excited utterances" and may be admissible in court, says Briggs.
• Roll the patient so that the exit wound is visible.
O'Shea says, "It can indicate the trajectory of the bullet, which can be helpful in evidence. If the bullet did not exit the body, a lot more damage can be present. If a 'blowout hole' is considerably larger than the entrance wound, the patient could bleed to death." [The evidence collection guidelines used by ED nurses at St. Joseph Mercy Hospital are included.]
Sources
For more information about forensic evidence of gunshot wounds, contact:
- Sheila R. Briggs, RN, BSN, BSW, SANE-A, MEI, Clinical Nurse III, Domestic Violence and Sexual Assault Educator, Emergency Department, St. Joseph Mercy Hospital, Ann Arbor, MI. E-mail: [email protected].
- Ann Heywood, RN, BSN, CEN, SANE, Trauma Nurse Coordinator, Champlain Valley Physicians Hospital Medical Center, Plattsburgh, NY. Phone: (518) 562-7378. Fax: (518) 562-7950. E-mail: [email protected].
- Terry O'Shea, RN, CCRN, Emergency Department, Providence Portland (OR) Medical Center. Phone: (503) 215-6000. E-mail: terry.o'[email protected].
Swab injury site with sterile swab Use a sterile swab, moistened with sterile water, to swab a gunshot injury site, says Sheila R. Briggs, RN, BSN, BSW, SANE-A, MEI, clinical nurse III, domestic violence and sexual assault educator for the ED at St. Joseph Mercy Hospital in Ann Arbor, MI. "Normal saline has salt in it, and this will break down potential DNA," she explains. "This swab contains important forensic evidence and should be sealed in an evidence kit envelope or brown paper bag." |
Follow these steps when cutting clothing Are you about to cut off a gunshot victim's clothing to visualize the extent of their injury? Consider these tips from Sheila R. Briggs, RN, BSN, BSW, SANE-A, MEI, clinical nurse III, domestic violence and sexual assault educator for the ED at St. Joseph Mercy Hospital in Ann Arbor, MI:
If you are the person collecting the clothing, document this information on the outside of each bag: The full name of the patient, the medical record number, the date of birth of the patient, the date of collection, a description of the item collected, and the full name of the person collecting the item. "Care should be taken to fold over the top of each bag and secure it with tamper-proof tape," says Briggs. "The seal of the tape should be dated and initialed by the person collecting and sealing each item." |
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