Forensic Science in Healthcare

Caring for Patients, Preserving the Evidence

By Connie Darnell

© 2011 – CRC Press

373 pages | 96 B/W Illus.

Purchasing Options:
Paperback: 9781439844908
pub: 2011-02-04
US Dollars$99.95

e–Inspection Copy

About the Book

First responders confronted by forensic cases are forced to consider the competing concerns of administering proper medical treatment while at the same time safeguarding vital evidence. Forensic Science in Healthcare: Caring for Patients, Preserving the Evidence presents precise on-scene protocol designed to ensure that the actions of the response team provide the necessary care and yet maintain the integrity of the evidence for legal purposes.

Following an introduction to forensics, the book explains how to recognize and identify patients with forensic issues, offers guidelines on proper documentation, and provides tips on forensic photography and capturing critical images. It reviews basic principles of evidence collection before moving into specific case scenarios, including domestic violence, sexual assault, child and elder abuse, youth violence, and death investigation. The book also examines occupational concerns for forensic personnel as well as legal issues such as testifying in depositions and in court.

Enhanced with photographs, illustrations, templates for documentation, and case-specific recommendations, this one-stop reference provides first responders with practical understanding of the steps that should be followed to ensure not only patient protection but evidence preservation.


". . . an excellent resource for all healthcare providers and right on target for our EMS colleagues."

—Philip J. Froman, MD, FACEP, EMS Medical Director, Albuquerque, New Mexico

"This quick reference guide is a resource of fundamentals for first responders confronted with forensic cases. Law enforcement officers, fire personnel, EMTs, nurses and physicians will find precise instructions for on-scene actions to ensure that valuable forensic evidence is properly safeguarded. The author has distilled the essentials for those who do not have the time to wade through a lot of peripheral nice to know information to find immediate answers for the forensic scenario at hand. Occupational health and safety issues are also addressed. Color illustrations, charts, tables, references and online resources amplify the text and provide useful guidance for field personnel. If you can have only one quick reference manual, it should be this one!"

—Janet Barber Duval, Forensic Nurse

"Well-organized chapters with plenty of key points, photographs, illustrations, references, tools, and information help empower health care professionals to protect patients entrusted to their care. … This book is an excellent resource for all first responders, but it is also a must-read for nurses at all levels in all settings. The author does an excellent job of incorporating forensic information with nursing observation and documentation. Managers will find valuable information for developing policies and procedures and the tools necessary to help staff members protect the forensic patient’s legal rights in the health care setting."

—Phyllis J. Fawcett, Regional Clinical Informaticist, Community Health Systems, Franklin, Tennessee, inJournal of Operating Room Nurses

Table of Contents

Introduction to Forensics

Red Flags

The Evolution of Crime, Violence, and Crime Detection

Living Forensics

The Scope of Crime and Violence in Modern Society

The Financial Cost of Violence

The Emotional Cost of Violence

The Role of Healthcare

Standards of Care

The Nursing Process




Medical Documentation

General Physical Examination

Wound Documentation

Blunt Force Injuries

Sharp Force Injuries

Mixed Blunt and Sharp Injuries

Fast Force Injuries (Gunshot Wounds)

Thermal, Electrical, and Chemical Injuries


Digital Evidence

Tampering and Spoliation of Records



Healthcare Role in Evidence Collection

Healthcare Providers

Categories of Evidence

Types of Evidence

Basic Principles of Evidence Collection

General Procedures

Chain of Custody

Common Types of Physical Evidence in Medical Settings

Biological Evidence

Body Fluid Collection

Bite Marks

Blood Alcohol and Other Toxicological Specimens


Fetal Drug Exposure


Sexual Assault


Domestic Violence and Abuse

Physical Abuse

Sexual Abuse

Psychological Abuse

Economic Abuse

Joint Commission

Intervention for Domestic Violence



Patient History

Psychological History

Physical Examination


The Care Plan

Mental Health Plan

Safety Plan

Resource List

Community Resources



Sexual Assault


Goals of Care


Role of the First Responder and Healthcare Provider

Sexual Assault Nurse Examiners (SANE)

A National Protocol


Child Abuse and Neglect

Definition of Child Abuse

Forensic Resources

Basic Assumptions

Healthcare’s Role

Child Neglect

Sexual Assault of Children

Pediatric Specimens

Munchausen by Proxy Syndrome

Sudden Infant Death Syndrome (SIDS)

Failure to Thrive


Sexual Assault of Children

Reporting Laws


Child Sexuality

Perpetrators and Victims

Short- and Long-term Psychological and Physical Harm

Signs of Sexual Abuse in Children

Prehospital Care

Physical Injury

Initial Disclosure


Nursing Diagnoses






Youth Behaviors and Violence

Risky Behavior

Drug Use

Dating Violence


Guns and Gangs



Stranger Danger

Child Pornography

Elder Abuse

Categories of Elder Abuse

Joint Commission Standards


Risk Factors for Abuse

Signs and Symptoms of Physical Abuse

Signs and Symptoms of Sexual Abuse

Signs and Symptoms of Emotional or Psychological Abuse

Signs and Symptoms of Neglect

Signs and Symptoms of Self-Neglect

Signs and Symptoms of Abandonment

Signs and Symptoms of Financial or Material Exploitation

Reasons Elder Abuse Isn’t Reported

Reasons for Abuse or Neglect in Institutionalized Settings




Safety Planning



Death Investigation

Some Thoughts to Consider


Cause, Manner, and Mechanism of Death


Role of the Death Investigator

Implications for Healthcare Providers

Assisting Survivors

Traumatic Grief

The Consultation Autopsy

Organ and Tissue Donation

Summary of HCFA CFR

In Conclusion


Occupational Issues for Forensic Personnel

Safety in the Workplace

Workplace Violence

Hostage-Taking Scenarios

Sexual Harassment

Electrical Hazards


Altitude-Related Illness

Bomb Threats

Forensic Response

Regulations and Reporting


Legal Issues

Testifying in Court



About the Author

Connie Darnell is an operating room nurse at Los Alamos Medical Center in New Mexico.

Subject Categories

BISAC Subject Codes/Headings:
LAW / Forensic Science
LAW / Medical Law & Legislation
MEDICAL / Emergency Medicine