Forensic Nursing Chronicles

Forensic Photography Recently I had the opportunity to document a child abuse case and follow through with the incident from triage straight through resolution. I actually had the opportunity to put to practical use what I have been studying in the texts. Although obtaining photographs is not new to our facility, we do have a stricter policy and procedure in place, including a photo log that has to be documented along with the digital camera cassette. These are sent to medical records for development and labeling. Although the child had five injuries from a supposed fall off a couch against a coffee table, the injuries were circumferential about the skull. We measured and documented all the wounds and ended up taking twelve photographs to get good resolution of some of the sites. In retrospect, however, I realize that we should have had the tape measure in the picture itself. That is something I will address next time I take pictures. We obtained consent from the mother (which was documented), obtained the investigator’s name, CPS worker name, etc., and otherwise I think we did a fairly good job. In the end, the officer felt he had enough of a case to arrest the significant other of the child’s mother for abuse. Since all the injuries were either abrasions or ecchymotic areas, only “before” photos were taken, i.e. before the CT scan, since no intervention other than antibiotic ointment was needed. Supposedly, per the mother’s initial report, the child, who was 15 months old, had fallen off the couch and hit her head on the coffee table, sustaining and abrasion above her left eye. She also had a 3 cm ecchymotic area on her sphenoid wing. This is a believable story. However, on examination, I noticed, an ecchymotic area laterals to her right orbit, petechial abrasions on the inner auricle (not on the pinna at all) of her right ear, and a 4 cm petechial-like abrasion on her right occiput. When I questioned the mother about this, she calmly responded that “she falls a lot.” I asked her if she was delayed in her walking, and she said yes. To me, this was unusual. Most toddlers are up and running by this time. Even my youngest son, who had 2 older siblings who loved to carry him around, was running the halls by this time. I had been concerned because my oldest was walking at 8 months, while this one didn’t feel compelled to start until 13 months, but then there was no stopping him! Her story just did not make sense to me. The ear injury was also odd. How can a child only injure the inside of the ear without abrading the pinna? For this reason, I took about 3 shots of the ear alone. The digital cameras are nice because they have the close up feature to focus and we got some really good shots. Hopefully, we obtained some credible evidence for prosecution. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby.

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