Forensic Evidence Collection
Definitions
Evidence: The means from which inferences may be drawn as a basis of proof in daily constituted judicial or fact-finding tribunals, and includes testimony in one form of opinion, and hearsay. The health care provider doesn't need to be able to determine what constitutes "relevant evidence", but does need to be able to identify any potential evidence. Evidence may include clothing, bullets, blood stains, hairs, fibers, weapons, gunshot residue, and small pieces of material such as fragments of metal, glass paint and wood.
Chain of Custody: To protect the integrity of the evidence, each individual who has possession of the collected specimens must sign for the evidence. The evidence must remain in their possession or in a locked area with limited access shown through proper documentation.
Anonymous Report: Any person age 18 or older, not injured by a gun, may opt to have evidence collected within 120 hours of a sexual assault without making a police report.
Trace evidence: May include but is not limited to: items related to firearms (bullets, cartridge casings, any fragments), or other potentially lethal weapons, hair, soil, glass fragments, fiber or biological sexual assault evidence.
Policy Statement: Nurses may collect evidence for release to the appropriate law enforcement agency when there is a reasonable suspicion a crime may have been committed resulting in the patient’s injury.
Procedure:
A. Identification of potential evidence:
1. Common types of injuries specific to abuse, assault, or other criminal behavior, may include but are not limited to contusions, abrasions, laceration, fractures, sprains, stab wounds, burns, multiple sites of injury, injuries in various stages of healing, repeated or chronic injures, or injuries that don't match the history provided.
2. Typical areas of injury may include but are not limited to face, head, neck, extremities, abdomen, chest, genitals, or breasts.
3. Patterned injuries are injuries that may show an imprint of a force or object used to strike or cause trauma to a patient. Injury may include, but is not limited to, belt marks, hand print marks, grab marks, stick/rods, bite marks, black eyes, cigarette burns, or strangulation marks.
4. History or suspected history of sexual assault. The SANE on call is to be notified if a sexual assault evaluation is requested.
B. Collection of evidence:
1. All personnel are to wear disposable gloves while handling all potential evidence.
2. Attempt to retain any object that arrives with the patient that may have been used to inflict the patient’s injuries.
3. Body fluid samples may include, but are not limited to: earliest blood/urine sample, gastric contents, possible surface body DNA from saliva, semen, or blood (i.e. bite marks, areas of licking, kissing).
4. All personal property in any potential case of "evidence" should be "cleared" by Law Enforcement or the Medical Examiner prior to returning to patient or family.
5. Evidence is not to be packaged in plastic or an airtight container. Bacterial growth in a wet environment destroys potential biological evidence.
6. Air dry all wet specimens whenever possible. Notify MUSC Public Safety if evidence is wet upon transfer.
7. Document any observations or features that may have been altered by medical treatment.
C. Clothing:
1. Items collected from different individuals are never permitted to come into contact with each other or placed together on the same surface.
2. Do not cut through bullet holes or stains. Cut along seams and away from the injured area to protect the integrity of potential evidence.
3. Do not shake clothing. Do not place clothing on the floor or allow it to come into contact with another individual’s clothing. A sheet may be placed on the floor or other surface to provide a clean location for clothing.
4. If possible, air dry wet or damp clothing in a secure area prior to packaging. Circle the area of wetness on any piece of clothing that may be a result from ejaculation due to sexual assault with a non-erasable marker.
5. The collector’s initials are to be written on the tag or a seam of each article of clothing.
6. Document the items collected and their condition (i.e. wet, torn, stained). Document the location of any debris or items found on or in the clothing. Collect all items as evidence.
7. Wet clothing or linens that must be packaged should be labeled on the outside of large paper bag as “WET”. Place a piece of paper in between the layers to prevent degradation of evidence.
8. Package each item of clothing separately in a paper bag.
9. Seal the entire top of the clothing bag with evidence tape and initial across the tape. Label the outside of each bag with a patient sticker, the police case number, and a brief description of the item.
10. Document the chain of custody for each piece of clothing collected in the medical record.
11. In the case of a deceased patient in the Emergency Department, or one who is dying while in the Emergency Department, all clothing, shoes and linen in contact with the body is kept with the body for release to the medical examiner.
D. Trace Evidence:
1. Any person involved in a shooting should have their hands placed in a paper bag sealed with tape to the wrist to prevent loss of residue that can be collected later.
2. When applicable, save linens for collection of potential trace evidence and package in a paper bag.
3. Items maintained for evidence are documented in the medical record.
4. Areas of concern (i.e. fluorescent areas, location of reported bites, areas of injury that may have been bitten) should be swabbed first with a sterile water-moistened swab, then swabbed with a dry swab over same area.
5. Each swab is to be labeled with a patient sticker and the initials of the collector and the site of collection.
6. Wet and dry swabs can be packaged together.
E. Firearm evidence:
1. Bullets, cartridge casings, glass or metal fragments may be found near or a within a patient with a firearm injury.
2. Gloved hands or rubber tipped forceps are used to collect evidence.
3. All evidence collected is to be air dryed thoroughly prior to packaging.
4. Evidence is to be packaged in a paper envelope or a cardboard box, sealed and labeled according to chain of custody guidelines.
5. Document the chain of custody for each item collected in the medical record.
F. Blood and/or urine for toxicology:
1. Blood samples must be collected in tubes containing sodium fluoride and potassium oxalate.
2. Blood may be kept at room temperature no longer than 72 hours. Blood should be stored under refrigeration whenever possible. Blood is never frozen.
3. Blood and/or urine collected for evidence is to be documented in the medical record with the chain of custody maintained.
4. Blood and urine samples are to be labeled with container with the patient’s sticker and the initials of the collector, and the date and time of collection.
5. Blood and urine samples collected as part of a sexual assault evaluation are to be placed inside the State Law Enforcement Division (SLED) sexual assault collection kit. A biological sample sticker is to be placed on the outside of the SLED kit. SLED kits are to be released to MUSC Public Safety.
G. Photo-Documentation:
1. Informed consent must be obtained from an adult age 18 or older. In emergent cases when a signature cannot be obtained, consent will be implied.
2. Photo-documentation should take place prior to any alteration whenever possible (i.e.cleaning, sutures, surgery, interventions, etc), without compromising the patient’s medical care.
3. Photo sequence should begin and end with a photograph of the patient sticker marked with the photographer’s initials.
4. Photograph a sequence of the full body at a distance, using overlapping landmarks.
5. Mid range photographs to illustrate a closer perspective of the injury are to be taken.
6. Close up photographs of the injury are taken with and without an approved measurement scale.
7. Take at least two photos of every injury area.
8. If extensive bruising is expected to be visible at a later date, the patient may be advised to return for additional photo-documentation.
9. Each memory card will be used for only one patient at a time.
10. Chain of custody will be maintained for all photo-documentation.
H. Chain of Custody:
1. Documentation of the items collected as evidence must be in the patient’s medical record and include:
a. Victim’s full name
b. Date and time of collection
c. The signature of the individual collecting the evidence with the date and time
d. The identification of the evidence
e. The signature of the individual receiving the evidence, with date and time.
2. Evidence is to be sealed with evidence tape and given directly to MUSC Public Safety.
I. Search warrant
1. Law Enforcement may request evidence collection on any patient and/or alleged suspect via a search warrant that identifies the specimens to be collected when a(an):
a. patient is unable to give consent due to a medical condition.
b. alleged suspect does not voluntarily consent to evidence collection.
2. A search warrant is not required when:
a. legal guardian or guardian "ad litum" is available to give consent for evidence collection regardless of age.
b. military members have been directed by OSI (Office of Special Investigations) to submit specimens.
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