domingo, 16 de novembro de 2014

Medicolegal Incident Accidents Investigation

Incident Accidents that happen with the staff / Patient has a profound impact on their health, hospital, families and friends and places significant responsibility on the Quality & Safety Department, Agencies tasked with determining the cause of Incident Accidents.
Increasingly, science and technology play a key role in Incident Accidents. One of the hallmarks of science is adherence to clear and well-grounded protocols. This Policy & Procedures was created based on the forensic sciences developed by the CDC and the Bureau of Justice Assistance.
And it is a method of promoting uniformity in the approach to Incident Accidents and improving or assuring their quality at the same time.


  • When any Incident Accident occurs, the following procedure is taken in order to perform systemic analysis.
  • The employee / employer has the right to call Quality & Safety Department to start an investigation procedure
  • The procedures taken in order to improve the practice elevate the standards and advance the cause of the forensic sciences . . . .”


  • The quality & safety Department / Supervisor / Duty Manager called for an investigation post an Incident Accidents.
  • Prepare the Investigative Tools and Equipment (Refer to Table A). They are excluded to discuss in procedures at this point because tools and equipment are “things,” not procedural steps.
  • The Investigator follow these sections in order to perform an organized Investigation

Section A: Arriving at the scene

Identification Criteria:
1.Introduce and Identify Self and Role (esp to family)
2.Have the Incident/Accident Form and start Filling appropriate info.
3.Establish formal contact (as situ) with official administration / agency representatives (e.g. Committee Members, MA/NA, Fire officer, Head of Department, Public Relation, Supervisor, Duty Manager…); check if they are in hospital as to be part of investigation
4.Identify the first responder to ascertain if any artifacts or contamination may have been introduced to the Incident Accident scene.
5.Document all persons (esp. witnesses) presented at the scene (Full Name, Phone Number, availability during the investigation period).
6.Document the scene locations (floor, room number…) with the time of arrival to the scene.

Exercise Scene Safety (Responsibility: Head of Department - 1st Choice / Team Leader – 2nd Choice)
1.Secure all locations that leads to the Incident Accident
2.Establish scene safety prior to entering the scene to prevent injury or loss of life. Risks can include:

  • Hostile crowds (Staff, Trainees ….)
  • Collapsing structures
  • Traffic
  • and environmental (Slippery or wet …) and chemical threats

3.Assess and/or establish physical boundaries (esp. to open spaces where Incident/Accident took place)
4.Secure movable items (Bed, Stretcher, Comode…) and park as safely as possible
5.Use Personal Protective Safety Devices (physical, biochemical safety) as Table A Shows.
6.Obtain clearance/authorization to enter scene from the individual responsible for scene safety
7.While exercising scene safety, protect the integrity of the scene and evidence to the extent possible from contamination or loss by people, visitors, and elements.
8.Due to potential scene hazards (e.g., Crowd control, Collapsing structures, poisonous gases, traffic), the Patient / Staff whether alive / Injured / Death may have to be removed before scene investigation can be continued.

Confirm or Pronounce Death (If Death occur):
1.Locate and view the body
2.Check for pulse, respiration, and reflexes, as appropriate
3.Identify and document the individual who made the official determination of death, including the date and time of determination. Appropriate personnel (Dr in Hospital) must make a determination of death prior to the initiation of the scene investigation.
4.Ensure death is pronounced, as required

Participate in Scene Briefing with official administration / Agency representatives
1.Identify specific responsibilities, share appropriate preliminary information, and establish investigative goals of each administration / agency present at the scene. Take into account to:

  • Locate the staging area (entry point to scene, command post, etc.)
  • Conduct Scene “Walk Through” (it will provides you with an overview of the entire scene)

1.Reassess scene boundaries and adjust as appropriate
2.Establish a path of entry and exit
3.Identify visible physical and fragile evidence (Skin tissue, broken parts …)
4.Document and photograph fragile evidence immediately and collect if appropriate (See Collection criteria below).
5.Locate and view the injured / dead individuals.

Maintain the Chain of Custody (Establishment may be needed if necessary)
1.Determine custodian(s) of evidence that are responsible for collection of specific types of evidence (that is based on who get involved in investigation as he will be the custodian …)
2.Determine evidence collection priority for fragile/fleeting evidence
3.Identify, secure, and preserve evidence with proper containers, labels, and preservatives
4.Document the collection of evidence by recording its location at the scene, time of collection, and time and location of disposition.
5.Develop personnel lists, witness lists, and documentation of times of arrival and departure of each personnel.

Follow Laws (Related to the Collection of Evidence) to ensure its admissibility.

Section B: Documenting and Evaluating the Scene

Photograph Scene (A permanent historical record of the scene also important Learning Tool)
1.Use high-quality images (Need Special Camera)
2.Remove all nonessential personnel from the scene
3.Obtain an overall (wide-angle) view of the scene to spatially locate the specific scene to the surrounding area.
4.Photograph specific areas of the scene to provide more detailed views of specific areas within the larger scene
5.Photograph the scene from different angles to provide various perspectives that may uncover additional evidence
6.Obtain some photographs with scales to document specific evidence
7.Obtain photographs even if evidence has been moved (mention it as a note in the report)
8.Evidence should not be reintroduced into the scene in order to take photographs

Develop Descriptive Documentation of the Scene (used to correlate with and enhance photographic documentation)
1.Diagram/describe in writing items of evidence and their relationship to the Patient / staff affected with necessary measurements.
2.Describe and document, with necessary measurements, blood and body fluid evidence including volume, patterns, spatters, and other characteristics.
3.Describe scene environments including odors, lights, temperatures, and other fragile evidence

Establish Probable Location of Injury or Illness
1.The location where the injured is found may not be the actual location where the injury/illness that contributed to the incident accident occurred
2.Document location where injury was confirmed
3.Determine location from which injured one was transported and how body was transported to scene
4.Identify and record discrepancies of injured parts of the staff / Patient (ecchymosis, blood, bruises …)
5.Check body, clothing, and scene for consistency/inconsistency of trace evidence and indicate location where artifacts are found.
6.Check for drag marks (on body and ground, clothes that were on the Patient and replaced).
7.Establish post-injury activity (Medical Actions)
8.Obtain ward/unit record(s).
9.Interview family members and associates as needed.

Inventory, collect, and safeguard
1.Drugs, money, personal valuables at scene and at office or keep with official partner

Interview Witness(es) at the Scene (they are the primary source data)
1.Collect all available identifying data on witnesses (e.g., full name, address, DOB, work and home telephone numbers, etc.).
2.Establish witness’ relationship/association to the injured/deceased personnel
3.Establish the basis of witness’ knowledge (how does witness have knowledge of the injury/death?).
4.Obtain information from each witness.
5.Note discrepancies from the scene briefing (challenge, explain, verify statements).
6.Tape statements where such equipment is available and retain them

Section C: Documenting and Evaluating the Body (Staff/Patient/Visitor)

Photograph the Body/injured (preserves essential details of the body position, appearance, identity, and final movements)
1.Photograph the body and immediate scene (including where it is initially found).
2.Photograph the injured parts (plus the face if the individual is dead/severe morbidity)
3.Take additional photographs after removal of objects/items that interfere with photographic documentation of the staff/Patient (e.g., body removed from Toilet).
4.Photograph the staff/Patient with and without measurements (as appropriate).
5.Photograph the surface beneath the body of the staff/Patient (after the body has been removed, as appropriate).
6.Never clean injured parts, face, do not change condition. Take multiple shots if possible.

Conduct External Body Examination (Superficial) - objective data regarding the single most important piece of evidence at the scene, the body

  • Physical characteristics
  • The presence or absence of clothing and personal effects
  • The presence or absence of any items/objects that may be relevant
  • The presence or absence of marks, scars, and tattoos
  • The presence of treatment or resuscitative efforts

2.Based on the findings, determine the need for further evaluation/ assistance of forensic specialists (e.g., pathologists, odontologists)

Preserve Evidence (on Body); Once evidence on the body is recognized, the investigator should:
1.Photograph the evidence
2.Document blood/body fluid on the body (froth/purge, substances from orifices), location, and pattern before transporting.
3.Collect trace evidence before transporting the body (e.g., blood, hair, fibers, etc.).
4.Arrange for the collection and transport of evidence at the scene (when necessary).
5.Ensure the proper collection of blood and body fluids for subsequent analysis (if body will be released from scene to an outside agency without an autopsy).

Participate in Scene Debriefing
1.Determine post-scene responsibilities (identification, notification, press relations, and evidence transportation).
2.Determine/identify the need for a specialist.
3.Communicate with the pathologist about responding to the scene or to the autopsy schedule (as needed).
4.Share investigative data / Communicate special requests

Section D: Establishing and Recording Decedent Profile Information

Document the Discovery History and circumstances surrounding the discovery
1.Establish and record person(s) who discovered the body and when.
2.Document the circumstances surrounding the discovery (who, what, where, when, how).

Determine Terminal Episode History
1.Document any complaints/symptoms prior to the Incident/Accident.
2.Obtain relevant Medical / Nursing records (copies).

Document Staff/Patient/Visitor Medical History
1.Document medical history, including medications taken, alcohol and drug use, and family medical history from family members and witnesses.
2.Document information from treating physicians and/or hospitals to confirm history and treatment.
3.Document significant family health history

Document Staff/Patient/Visitor Mental Health History (provide insight into the behavior/state of mind of the individual).
1.Document mental health history, including hospitalizations and medications.
2.Document the history of suicidal ideations, gestures, and/or attempts.
3.Document mental health professionals (e.g., psychiatrists, psychologists, counselors, etc.) who treated the Staff/Patient/Visitor.
4.Document family mental health history.

Document Social History (will aid in establishing the cause, manner, and circumstances of death.)
1.Document employment history.
2.Document daily routines, habits, and activities.
3.Document relationships, friends, and associates.
4.Document educational background

Section E: Completing the Scene Investigation

Maintain Jurisdiction Over the Body
1.Protect the chain of custody as the body is transported from the scene
2.Arrange for, and document, secure transportation of the body to a medical / Surgical Intervention
3.Coordinate and document procedures to be performed when the body is received at the facility.

Perform Exit Procedures
1.Identify, inventory, and remove all evidence collected at the scene.
2.Remove all personal equipment and materials from the scene.
3.Report and document any dangerous materials or conditions.

Assist the Family
1.Inform the family if any intervention is required.
2.Inform the family of available support services (e.g., Complaint office...).
3.Ensure family is not left alone with body (if circumstances warrant).
4.Inform the family of approximate body release timetable.
5.Inform the family of information release timetable (Medical / Surgical Interventions as required).
6.Inform the family of available reports, including cost, if any.