Drs. Wiler and Bailey highlighted the fact that emergency physicians are prepared to manage medical issues of acutely ill patients but do not receive formal training in clinical forensic medicine.⁶ Their paper highlights forensic emergency medicine efforts and calls for residency training in forensic emergency medicine. Far beyond what is currently provided. Dr. William Smock first proposed a potential forensic emergency curriculum in 1994, yet it has not been adopted by most programs.⁷

This article will highlight some important forensic principles to apply when caring for victims of violent crime and provide information about developing a Forensic Care Program in your department.

As with everything in emergency medicine, the ABCs and lifesaving procedures always take precedence. However, forensic needs should not take a backseat entirely. Some simple tips and techniques can make a difference in fulfilling the forensic needs of the patient and the criminal justice system.

Injury Documentation

One of the most important forensic techniques emergency medicine personnel have at their disposal is proper documentation. Proper documentation of injuries is crucial because many procedures performed during resuscitation, and even wound cleansing techniques, can alter the appearance of wounds, and the initial emergency department documentation may be the only accurate description of them. Wounds also change their appearance over time, which can lead to misinterpretation by the time they are evaluated.

Descriptions of wounds should include their shape, precise body location, and size (a measuring device should be used). Be as specific as possible. Specific characteristics should be noted, such as the presence of foreign materials, coloration, and patterned injuries. Patterned injuries (abrasions or contusions) retain some features of the impacting object, possibly allowing it to be identified.⁸

In addition to written documentation, body diagram maps, illustrations, and photodocumentation should accompany all written documentation of injuries. Proper forensic photographic protocols should be followed. A digital camera should suffice for most image capture. The department and/or hospital should have a policy regarding image security and storage.

The use of correct terminology is also important. Incised wound/cut is the correct term for violation of the epidermis by a sharp instrument. A laceration is caused by blunt force trauma and often includes crushed edges and tissue bridges. So, for example, a patient struck in the head with an intact beer bottle sustains a laceration, while a patient slashed with a broken bottle sustains an incised wound.

Wounds/bruises should not be dated.^9,10,11 The science of dating/timing an injury is very imprecise and several patient factors, tissue types, medications, and injuring items can influence a wound’s coloration. Wound colors should be described as they are seen, and no comment on age of the bruise or time of occurrence should be provided.⁹

Clothing Evidence

Clothing is another important piece of forensic evidence encountered in the emergency department. Clothing is almost always removed in the care of trauma patients.