When cutting clothes, avoid cutting through bullet holes or sharp force injuries. Clothing items should be individually placed in PAPER bags, labeled, sealed, and turned over to law enforcement. Plastic bags retain moisture and promote the growth of bacteria and potential degradation of DNA. If clothing items are wet, the clothes can be wrapped in craft paper and placed into the paper bag. The bag should be labeled as “WET” and law enforcement notified so that they can place the clothing in driers at the crime lab.

Firearms Injuries

Firearm violence is one of the important public health issues facing the U.S. today. It is estimated that for every firearm fatality there are 3-5 times as many survivors.¹² Firearm injury victims often present with forensic evidence. Clothing should be handled as previously mentioned.

Cases and cartridges can often be found intermixed with patient clothing and bandages, and on the stretcher. They should be handled as little as possible and with gloved hands. These items should be placed in a small box or coin envelope and sealed.

Bullets themselves contain important forensic evidence and ballistic markings. Bullets should not be handled with metal instruments. Plastic forceps or metal forceps with rubber tips or Surgical BootsTM should be used to remove bullets from the body. The bullets should not be dropped into metal bowls or emesis basins. This metal on metal contact can alter the ballistic marks on the bullets and make comparative analysis impossible. Bullets should be placed in a small envelope or small box and sealed.

In addition, firearm wounds should not be classified as exit or entrance wounds by the untrained practitioner. Entrance and exit wounds have unique characteristics that allow their identification; however, the majority of emergency physicians and trauma surgeons do not have adequate training to properly classify these wounds and often do it erroneously.¹³ Size is not an important determinant in classifying entrance and exit wounds. Wounds should be described by their size, shape, precise anatomic location, and surrounding characteristics, such as soot and tattooing.

Bullet caliber should not be estimated by merely looking at the size or shape of a wound, as many factors go into creating these wounds.¹⁴ Also, caliber should not be estimated by looking at a bullet on a radiograph. Radiographs may over or underestimate the size of a bullet and can lead to mistakes.¹⁵

Other Important Forensic Tips

Shrapnel and other objects associated with blasts should be handled in the same manner as bullets. Items should be carefully removed from the victim’s body and placed in a box or coin envelope. Sharp force weapons that are recovered should be wrapped in craft paper or cardboard to protect them from causing injury and sealed.

Chain of Custody

An important aspect of collecting forensic evidence is the chain of custody. The chain of custody is documentation of evidence handling. It recreates the trail of the evidence from victim to collector to police officer to crime lab. A specific Chain of Custody Form should be used. It should include the patient name and information, description of the evidence, time collected, location collected, and name and signature of the collector. It should also include what was done with the evidence, date and time it was turned over, and name and signature of the person it was turned over to.