Forensic Nursing Chronicles

Since the development of Sexual Assault Response Teams, SANEs (Sexual Assault Nurse Examiners) have improved the quality of care for rape victims. Before the advent of SART programs, rape exams were performed by ER physicians. This meant that a victim had to wait (usually for hours) in the emergency department waiting room. The exam was then performed by a physician who most likely did not have specialized training in evidence collection.

Now a patient who has been sexually assaulted can be seen by a specially trained nurse in a more private setting. Some patients are seen in emergency departments by SANEs and some are seen in separate SART clinics.

The SANE nurse has received both classroom education and clinical education in sexual assault evidence collection. The nurse only has one patient and can take the time for a thorough interview, proper examination and evidence collection and support of the patient. The interview is done in conjunction with law enforcement so that she does not have to repeat the same
information over and over.

In 2002 the International Association of Forensic Nurses instituted a certification exam for sexual assault nurses. This certification can give additional credibility in court as well as setting national standards for sexual assault nurses. The certification is not required for performing
SART exams.

For a broader certification in Forensic Nursing itself, Canyon College is accepting applications for Online Forensic Nursing Certifications.

In recent posts we have talked about the procedure for using photography to document evidence in criminal investigations and how photographic evidence can be helpful in documenting injury cases

Here we revisit this topic on how the photography of injuries can tell a story for those trained in forensic nursing and science.

A photograph can be a powerful witness in court. A genital tear during a sexual assault, a bruised arm where a victim was grabbed, linear bruising from a lash with a belt, all tell a story. However, the impact of the story can be lost if the the photography is not done well.

A forensic nurse may not testify in a particular case for a year or more. Many other cases may
have come and gone by then. A close-up photo may be displayed in court and the nurse should be able to describe exactly what she sees. Sometimes a photo is so close-up that no one can tell where on the body the injury is located. There may be no way to identify the size of the injury.

Each injury should have at least three photographs. One should be from a distance to show the viewer where on the body an injury is located. For example, a photo of a bruise on the cheek should be taken from a distance to show the whole face. That way the jury can see that it is the left cheek and it is approximately the same size as the victim’s eye. The next photo should be somewhat closer and the final photo should be close-up to show detail such as shape and color. In at least one of these photographs a ruler should be held near the wound to show the exact measurement. Good photography can result in an accurate story being told.

If you are ready to pursue Certification in Forensic Nursing Online, Canyon College is now accepting applications.

Injury photographs are a representation of the actual assault or attack. They can provide evidence long after the crime scene is gone. These pictures help to tell the story of the injury, whether it is self-inflicted, accidental or intentional. Occasionally in domestic cases, it may be necessary for the victim to present for additional pictures approximately 48-72 hours post injury as bruising will show up more readily.

Injuries are photographed using color film. No filter is used. Color charts are used to determine the age of injuries. It is imperative to take at least two shots of each wound or injury. Three photographs are ideal: one for a overview of the injury, one for a close-up view and one for close-up with ABFO #2 scale. The overview photo should provide information about the location of the wound in relation to other body parts. It is important to focus on entrance and exit wounds from gunshots. Black and white film might help to show contrast between trace residue, tattooing or stippling.

There are several tips for better pictures. First, be sure hold camera on the same plane as the injury. Secondly, overexposure should be avoided by diffusing the flash. To diffuse a flash, one should use a handkerchief or other thin piece of material.

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Recovery of latent prints is dependant on multiple factors. The first factor is the surface where the print is suspected to be found. Depending on the surface texture, its condition, the composition of the surface and how clean the surface is will play an important role about whether or not a latent print is discovered.

Secondly, the handling of the item may distort the latent print. Additional ridge prints may be added to the print, smear the print or distort the print to a point that may make the print unreadable. The readability of the print is affected by the condition of the collector’s skin, how much the collector sweats and how much pressure that is applied.

Finally, the conditions present after the print transfer may alter the final product. Heat and rain will deteriorate a latent print. The proper handling of the latent print and the developing with the appropriate medium are important factors to consider for best use of the latent print.

Does this sort of topic interest you? Are you a nursing student? Check out the Online Forensic Nursing Certification Program at Canyon College

The understanding of the formation of friction ridge skin and the permanence of fingerprints is imperative to the criminal investigator. Fingerprints never change (apart from temporary abrasion and permanent scarring). The understanding of friction skin growth during the fetal development period is necessary for anyone doing fingerprint analysis.

Friction ridges develop on the fetus before birth. Friction ridge skin is the skin on the palms and fingers of the hand and soles and toes of the feet. Friction ridge skin has ridges and furrows between them. This surface helps individuals to grasp and hold onto items. The ridges are formed three to four months into fetal growth. Fingerprints are constant. They never change unless there is permanent scarring that occurs. The ridge patterns are unique and are never repeated.

The embryonic skin begins to form at 4-5 weeks of fetal growth. Volar pads (the pad of your fingers) are developed somewhere between 6.5 and 10.5 weeks in fetal growth. By the 9th week, the volar pads vary by position and shape. The development of the volar pads coincides with the epidermal ridges.

We know that by 8 weeks, the epidermis is strongly constructed. Scientific research has shown that the developments of epidermal ridges are preceded by the formation of volar pads. The five digits develop about one week after the development of the volar pads.

Referenced from http://www.clpex.com/Articles/TheDetail/1-99/TheDetail09.htm

From a Forensic Nursing Student’s Perspective this is the approach to using photography to document a crime scene.

The three-step approach is used to photograph crime scenes. The first step is taking overview photographs. The overall scene should be photographed in the state that the crime scene is in when the photographer first arrives. A complete set of photos should be taken before the scene is altered in anyway.

Photographs should be taken of the outside of the scene, showing the exterior of the building or crime scene, showing parking lots, alleyways, and pertinent landmarks. If photographing a building, pictures of the entrances, exits and the each different room should be taken. Each corner of the room should also be photographed.

The use of a wide-angled lens will help to show relation on a large scale. The second step is to take mid-range photos. For mid-range photos you would use a wide-angle lens as well to show the relation of evidence to relevant items from the scene (i.e., the body, the weapon).

The location of the evidence should be focused on. Photographs should be taken to show from one corner of the crime scene to the other help to show the layout of the scene. These photographs also show positions of any potential items of evidence.

Lastly, close-ups are used to help identify weapons, injuries or other key items related to the crime. The evidence should be detailed using close-up photos. Notes should be taken in regards to the order of the pictures taken, what each photo represents or shows, and pertinent notes related to the photo.
To illustrate, the three-step approach would be used for photographing a traffic fatality. Overview photos should show areas where the vehicles ended up after the accident. Overview would include relationship between vehicles, vehicle with stationary object, or vehicle vs. pedestrian. Landmarks from the environment should be included. Overview photos would include skid marks, photos of view that each driver had approaching the accident, and views that the witnesses had.

Mid-range photos would include multiple views of the cars involved. Multiple views should be taken in relation to where the deceased was found upon rescue to the scene. Close-up views should include the interior of the vehicle. Multiple pictures should be taken to show any contact that the body had to the car components (i.e., steering wheel, windshield).

Interested in Online Forensic Nursing Certification Courses? The Canyon College Online Forensic Nursing Certification Program is currently accepting applications.

Ricin is a poison that can be made from the waste left over from processing castor beans. It can be in the form of a powder, a mist, or a pellet, or it can be dissolved in water or weak acid. It is a stable substance. Ricin is not contagious. Exposure happens through inhalation, ingestion, or skin or eye exposure.

Ricin is found as castor beans are processed throughout the world to make castor oil. Ricin is part of the waste “mash” produced when castor oil is made. Ricin works by getting inside the cells of a person’s body and prevents the cells from making the proteins they need. Eventually this is harmful to the whole body, and death may occur. It has some potential medical uses, such as bone marrow transplants and cancer treatment (to kill cancer cells).

Symptoms typically occur in less than 6 hours after ingestion of ricin. The effects of ricin poisoning depend on whether ricin is inhaled, ingested or injected. Ricin also depends on the dose received. Ricin is very toxic.

Death from ricin poisoning could take place within 36 to 72 hours of exposure. Inhalation causes initial symptoms to occur within 8 hours of exposure. Those symptoms are respiratory distress, fever, cough, nausea, tightness in the chest and heavy sweating. Ingestion causes vomiting, bloody diarrhea, severe dehydration, hallucinations, seizures, and blood in the urine. Within several days, multisystem organ failure may occur. Skin and eye exposure from ricin powder or mist form can cause redness and pain of the skin and the eyes.

Diagnosis is by clinical evaluation. In more complex cases where pulmonary edema is a concern, a chest x-ray may be obtained.

Currently, there is no antidote for ricin. Supportive care should be given. If exposure cannot be avoided, the most important factor is then getting the ricin off or out of the body as quickly as possible.

As a forensic nurse, it is important to realize that these poisonings are possible. Although there are not common, ricin poisoning needs to be considered in the differential diagnosis as the outcome could be fatal if misdiagnosed.

Jimson weed is a highly poisonous weed. It is characterized by large white or violet trumpet-shaped flowers. The weed has globular prickly fruits. The main ingredients from the weed are belladonna alkaloids, atropine and scopolamine. One can ingest jimson weed by smoking leaves or drinking tea that contain jimson.

Multiple symptoms are exhibited. The common saying “red as a beet, hot as a hare, dry as a bone, blind as a bat, mad as a hatter, the bowel and bladder lose their tone, and the heart runs alone” describes Jimson’s effects.

The atropine and scopolamine block the neurotransmitter acetylcholine which results in mydriasis, cycloplegia, dry mouth, high temperature, ileus, urinary retention, and tachycardia. Psychological effects can be seen as well: confusion, euphoria, delirium, and hallucinations. In extreme cases, users can experience seizures, intense visual or auditory hallucinations, or cardiac arrest.

The onset of symptoms is within 30-60 minutes after smoking leaves or drinking tea. The onset after ingestion of plant material or seed is 1-4 hours. The duration of symptoms is often 24-48 hours because of delayed gastrointestinal motility. Symptoms have been reported to last up to 1-2 weeks.

Diagnosis may be determined by detection of atropine and hycosyamine in urine. Elevated aspartate aminotransferase, LDH, bilirubin and prothrombin time levels may be detected secondary to muscle breakdown from seizures, increased tone and hyperthermia. An EEG may show changes from an increased slow wave activity to a bizarre high voltage pattern.

Treatment for jimson weed poisoning is based on the clinical evaluation. As with all poisonings, priority is given to the ABC’s of resuscitation. Providing a nonstimulating environment and assessing frequent vital signs are a must. If stupor or coma exists, the patient may be treated with dextrose, thiamine, or naloxone. A cooling blanket is used for hyperthermia. Administration of activated charcoal should be considered to decrease the amount of absorption.

As a forensic nurse, it is important to realize that these poisonings are possible. Jimson weed is not a common poisoning, but should be considered as a possible diagnosis. The symptoms of jimson weed have a tendency to mimic other disorders and may be overlooked if not part of the differential diagnosis.