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

Contents......Page 6
Preface......Page 18
Acknowledgments......Page 20
Author......Page 22
1. Introduction to Forensics......Page 24
Red Flags......Page 25
Living Forensics......Page 26
The Scope of Crime and Violence in Modern Society......Page 27
The Financial Cost of Violence......Page 28
The Role of Healthcare......Page 29
The Nursing Process......Page 32
Nursing Diagnosis......Page 33
Summary......Page 34
Appendix 1.1: Signs of Abuse, Neglect, and Exploitation......Page 36
References......Page 37
Medical Documentation......Page 40
General Physical Examination......Page 42
Wound Documentation......Page 43
Blunt Force Injuries......Page 45
Abrasions......Page 46
Contusions......Page 48
Lacerations......Page 58
Sharp Force Injuries......Page 60
Stab Wounds......Page 61
Fast Force Injuries (Gunshot Wounds)......Page 66
Range of Fire......Page 68
Angle of Entry......Page 74
Types of Projectiles and Intervening Objects......Page 75
Bite Marks......Page 80
Thermal Burns......Page 81
Electrical Burns......Page 84
Weather-Related Hazards......Page 93
In Conclusion......Page 95
Purposes of Photographs......Page 96
Basics of Photography......Page 97
Informed Consent......Page 98
Qualities of Photographs for Evidentiary Purposes......Page 99
Scene Photography......Page 100
Photographing Human Abuse and Assault Injuries......Page 101
Tips for Photographing Anatomical Features......Page 104
What Is the Unique Forensic Value of Digital Evidence?......Page 105
Implications for Healthcare and Forensic Personnel......Page 107
Tampering and Spoliation of Records......Page 108
Safety and Security Concerns......Page 109
Reporting......Page 110
Appendix 2.1: Adult Male Body Diagram......Page 111
Appendix 2.2: Adult Male Body Diagram, Side View......Page 112
Appendix 2.3: Adult Female Body Diagram......Page 113
Appendix 2.4: Adult Female Body Diagram, Side View......Page 114
Appendix 2.5: Head and Neck......Page 115
Appendix 2.6: Hands......Page 116
Appendix 2.7: Feet — Toes and Bottom......Page 117
Appendix 2.8: Feet — Side View......Page 118
Appendix 2.9: Hands, Feet, Head, Eyes, Ears......Page 119
Appendix 2.10: Female Genitalia......Page 120
Appendix 2.11: Male Genitalia......Page 121
Appendix 2.12: Child Body Diagram......Page 122
Appendix 2.13: Infant Body Diagram......Page 123
Appendix 2.14: Consent to Photograph Forms......Page 124
Appendix 2.15: Some Commonly Used ICD-9 and CPT Codes......Page 126
References......Page 127
3. Evidence......Page 128
Healthcare Providers......Page 129
Categories of Evidence......Page 130
Trace Evidence......Page 131
Verbal Evidence......Page 132
Digital or Electronic Evidence......Page 133
Basic Principles of Evidence Collection......Page 134
Collection Basics......Page 135
Chain of Custody......Page 139
Clothing......Page 141
Bullets and Other Projectiles......Page 142
Trace or Small Evidence......Page 143
Small or Loose Materials......Page 144
Fibers and Threads......Page 145
Metal or Sharp Items......Page 146
Pollen......Page 147
Control Swabs......Page 148
Urine Samples......Page 149
Bite Marks......Page 150
Blood Alcohol and Other Toxicological Specimens......Page 151
Testing for Drugs of Abuse......Page 153
Poisoning......Page 154
Things Not to Do......Page 155
DNA—CODIS......Page 156
After the Evidence Collection......Page 157
Summary......Page 158
Appendix 3.1: Evidence Tag and Chain of Custody......Page 159
Appendix 3.2: Classic Bindle Fold Diagram and Instructions......Page 160
Appendix 3.3a: Blood Collection Instructions......Page 162
Appendix 3.3b: Nail Collection Instructions......Page 163
Appendix 3.3c: Cord Tissue Collection Instructions......Page 164
Additional Resources......Page 165
Physical Abuse......Page 166
Economic Abuse......Page 167
Joint Commission......Page 169
Intervention for Domestic Violence......Page 170
Screening......Page 172
Be Prepared and Comfortable Dealing with a \"Yes\" Answer!......Page 173
Assessment......Page 174
Patient History......Page 175
Psychological History......Page 177
Physical Examination......Page 178
Intervention......Page 179
Care Plan......Page 180
Mental Health Plan......Page 181
Safety Plan......Page 182
Community Resources......Page 184
Documentation......Page 185
Appendix 4.1: Danger Assessment — English......Page 186
Appendix 4.2: Danger Assessment — Spanish......Page 188
Appendix 4.3: Domestic Violence Assessment Tool......Page 190
Appendix 4.4: Domestic Violence CQI Tool......Page 193
Goals of Care......Page 196
Injuries......Page 197
Role of the First Responder and Healthcare Provider......Page 198
Sexual Assault Nurse Examiners (SANE)......Page 199
A National Protocol......Page 200
Appendix 5.1: Suggestions for Police Officers in Sexual Assault Cases......Page 218
Appendix 5.2: Suggestions for First Responders in Sexual Assault Cases......Page 221
References......Page 224
Physical Abuse......Page 226
Forensic Resources......Page 227
Child Abuse: Not an Isolated Event......Page 228
General Assessment......Page 229
Recognizing Child Physical Abuse......Page 230
Evaluating Childhood Injuries......Page 231
Physical Exam......Page 233
Review of Records......Page 236
Healthcare Provider Actions in Cases of Suspected Poisoning......Page 237
Sexual Assault of Children......Page 238
Prenatal Alcohol and Drug Abuse......Page 240
Laboratory, Radiological, and Ophthalmic Testing......Page 241
Munchausen by Proxy Syndrome......Page 242
Summary......Page 245
Appendix 6.1: Guidelines for Initial Healthcare Provider –Child Interaction......Page 247
References......Page 248
Additional Resources......Page 249
7. Sexual Assault of Children......Page 250
Definitions......Page 251
Perpetrators and Victims......Page 252
Signs of Sexual Abuse in Children......Page 253
Physical Injury......Page 254
Assessment......Page 255
Intervention......Page 257
Prevention......Page 258
Summary......Page 259
Three Years......Page 260
Thirteen Years and Older......Page 261
References......Page 263
Additional Resources......Page 264
Risky Behavior......Page 266
Dating Violence......Page 267
Bullying......Page 270
Guns and Gangs......Page 272
Effects of Gangs on Children......Page 273
Suicide......Page 274
Intervention......Page 275
Stranger Danger......Page 277
Child Pornography......Page 278
References......Page 279
9. Elder Abuse......Page 282
Joint Commission Standards......Page 285
Emotional or Psychological Abuse......Page 286
Fraud, Theft, and Financial or Material Exploitation......Page 287
Abandonment......Page 288
Signs and Symptoms of Sexual Abuse......Page 289
Signs and Symptoms of Self-Neglect......Page 290
Reasons Elder Abuse Isn\'t Reported......Page 291
Physical Assessment......Page 292
History......Page 293
Intervention......Page 294
Safety Planning......Page 295
Resources......Page 296
Freedom......Page 297
Privacy......Page 298
Appendix 9.2: Elder Abuse Assessment Tool......Page 299
References......Page 301
Some Thoughts to Consider......Page 304
Cause, Manner, and Mechanism of Death......Page 306
Manner of Death......Page 307
Autopsy......Page 308
Death Investigation Basics......Page 310
Handling the Deceased......Page 311
Traumatic Grief......Page 313
Organ and Tissue Donation......Page 314
Summary of HCFA 42 CFR 482......Page 315
In Conclusion......Page 316
Appendix 10.1: Deaths to Be Reported to the Office of the Medical Investigator (OMI)......Page 317
Appendix 10.2: Suspicious Circumstances of Death......Page 318
Appendix 10.3: Death Investigation Report......Page 319
References......Page 320
Safety in the Workplace......Page 322
The Clean Room......Page 323
Workplace Violence......Page 324
Precipitating Factors......Page 325
Prevention......Page 326
Awareness and Responses......Page 327
Responding to Violent Behavior......Page 328
OSHA Guidelines......Page 329
Hostage-Taking Scenarios......Page 330
Sexual Harassment Policy......Page 331
Two Important Rules......Page 332
Carbon Monoxide and Oxygen Deprivation......Page 333
Hydrogen Sulfide......Page 334
Bomb Threats......Page 335
Regulations and Reporting......Page 336
Appendix 11.1: Equipment and Supplies......Page 337
Appendix 11.2: Minimum Required Equipment for Nontransport Medical Rescue Vehicles: New Mexico Administrative Code 2009......Page 339
Appendix 11.3: Violent Incident Report Form......Page 342
Appendix 11.4: Bomb Threat Report......Page 343
References......Page 344
What Is the Law?......Page 346
Be Prepared......Page 347
Attire......Page 348
Do\'s and Don\'ts When Testifying......Page 349
Testimony......Page 350
Depositions......Page 351