Considering that death is first a medical
issue and secondly a legal issue, intuitive intellect indicates a need for
individuals with a stronger background in the biomedical sciences, such as
pharmacology, anatomy and physiology, medical terminology, and psychology among
other related issues to pronounce death and recover medical/forensic evidence. The
criminal investigator’s responsibility is to determine if a crime was
committed, if so, who committed the crime. Medical investigators are charged
with the determination of death, if so, what caused the death based on medical
evidence.
The
role of a forensically skilled nurse serving as a medical/forensic death scene
investigator provides one solution to problems faced by the forensic
pathologist, police and community at large. Medical death investigation must include
preparation in medical science to help determine the precise precipitating
factors and causes of death. This forensic clinician not only benefits the
crime scene investigators, but also serves the public’s general welfare by
ensuring that natural, accidental and crime-related trauma is systematically
identified and investigated regarding cause, manner and mechanism of injury or death.
The FNE is not a criminal investigator, but rather a clinical investigator with
separate but integrated responsibilities to assist in the recovery of medical
evidence and documentation of injury in circumstances not generally addressed
in law enforcement education and training. Such is this partnership in Health and Justice.
Regardless
of the circumstances of death, the family and/or significant others typically
experience an acute emotional reaction of shock and grief. Events that surround
the process of death cannot be viewed apart from the consideration of civil and
criminal laws and collective justice principles that govern human existence
from a social, moral and religious perspective. Intervention in grief benefits
the family’s ability not only to recover from unresolved emotional trauma, but
increases cooperation between the bereaved and the investigative agencies.
Further, it increases confidence and respect in the medicolegal systems. The
ability to review health histories and medical records, understand medical
terminology, interpret medical abbreviations, communicate with physicians and
paramedical personnel is essential. Evaluation of the surgical or chemical
interventions prescribed and performed prior to death relating to the social,
financial and interpersonal relationship factors of the psychological autopsy
must also be included in the armamentarium of the investigator of medical/forensic
deaths. These skills are unique to nursing.
Essential knowledge regarding sudden and
unexpected deaths or the clarification of suspicious and/or natural deaths
across the life span must begin with an incisive understanding of the phenomenon
of death. An elucidation of these issues may become a point of contention in a
court of law. Recent advances in the medical and legal sciences require an
understanding of the disease mechanisms and biomechanical factors associated
with death for the benefit of public health and the administration of justice.
Thus, a new generation of medical death investigators, blending bio-psycho-social
and medical training with the scientific investigation of death indicates a new
trend in the 21st century forensic sciences.
Role of CSI in crime prevention
measures
This
century has brought positive change to global endeavors in the reduction and
prevention of violence. Enlightened
countries have recognized the need to support the development of a new forensic
specialist that serves to assist the forensic medical community, law
enforcement and public health. This new
specialist is known as the Forensic Nurse Examiner (FNE) who provides forensic
services under the direction of the forensic pathologist or clinical forensic
physician. It is well known that the
practice of forensic medicine is the second smallest specialty in medicine and
has long deserved a clinical associate to evaluate trauma and questioned death.
The FNE does not assume any criminal investigative responsibilities, but rather
serves to augment forensic services that may require an immediate response to
victims, families, police, and emergency services where the physician is absent
or not readily available. Preventive factors evolve in the immediate provision
of forensic services in the emergency room, or at the crime scene that may avoid
the transfer of a survivor to another medical facility or distant location.
Reduction and prevention of violence is a
major responsibility of the FNE. U.S. research
indicates that victims of interpersonal violence (battered and vulnerable
persons) are admitted 7-9 times before being identified as crime victims by
hospital personnel due to the lack of forensic training for nurses and clinical
physicians. These categories of victims are often afraid or ashamed to admit
that they were assaulted by a spouse or parent. Such cases are required to be
reported to police who are not trained in the recognition of trauma or
psychological intervention. If these victims are not identified upon admission
by nurses or physicians, they are subsequently readmitted time and again. The
perpetrator often goes unpunished and the cycle of violence continues until the
same victim becomes a homicide case. Thus, prevention results when crime is
detected and reported with the cooperation of law enforcement and the courts.
The FNE, as a forensic educator provides individual, family and community
education in public health and safety. The FNE educator also provides
medical/forensic education to police and the judicial system on the clinical aspects
of crime scene investigation when the body becomes the scene of crime. This
approach helps to alleviate the wrongful interpretation of medical evidence,
injury or death that may convict an innocent person. Further prevention is
achieved with the skilled recovery of trace and biological and medical evidence
on the body/scene unique to those with biomedical training that may not be recognized
by non-medical/forensicinvestigators.
CSI in sex related crimes and domestic
violence
The FNE is highly skilled in performing
evaluation of sexual trauma, recovery of biological and physical evidence, and
documentation of genital and non-genital injury. Magnification of microscopic
body surface injuries such as abrasions, lacerations, contusions, or human bite
marks with colposcopic enhancement and the application of a chemical marker (for
observation only) are simultaneously photo-documented with an attached digital
camera for evidentiary purposes. In numerous countries the FNE is recognized as
a specialist and gives both expert and fact testimony. Board Certification in
sexual assault examination is provided by the International Association of
Forensic Nurses. The field of forensic nursing science was first recognized by
the American Academy of Forensic Sciences in 1991. Police and homicide
detectives in the U.S. frequently request the FNE sexual assault expert to
respond to the scene of a suspected rape homicide. Forensic pathologists often
request the FNE to provide the rape examination prior to autopsy. Police who
bring rape victims to the hospital find this service is preferred as compared
to the frequently long wait (7-8 hours) for a physician to arrive or to take
emergency physicians away from patients that require life-saving interventions.
Nurses are also known for their ability to appropriately intervene with
emotionally traumatized patients, which may enable the victim to provide better
information and become a better witness. Because victims of domestic violence
are also commonly victims of rape/sexual abuse, it is important for the
forensic examiner to have an acute awareness and understanding of the
association between physical, psychological, and sexual trauma. The ability of
the FNE to identify patterned injuries, photodocument evidence of violence and
skillfully interview victims of interpersonal crime is essential for the
patient to respond truthfully regarding how the injuries occurred. Privacy,
patience and resource support also entail the need for a dedicated professional
who sincerely cares about their patience. The reduction and prevention of
cyclical violence must include the support of laws and law enforcement agents
and the courts to act in the best interest of these victims. Forensic Nurse
Examiners cannot change a society’s state of mind alone.
The FNE is well educated and highly trained to
perform a thorough medical investigation
of natural and unnatural deaths, recovery of medical evidence pertaining to the
cause of death, communicate delicate information to the grieving family and
provide the forensic pathologists with a detailed medical report along with
photographs of the body at the scene. This new role, as an associate to the
forensic pathologist is authorized by the physician who has jurisdiction of the
body and medical evidence. The FNE works in partnership with the police who maintain
jurisdiction of the criminal investigation,
criminal evidence and the crime scene. This objective incorporates all skills
and knowledge identified in previous objectives.
CSI in mass disasters
Forensic Nurse Examiners trained in mass disaster
evidence and body recovery respond to the scene along with the forensic
pathologists, fire fighters, paramedical personnel, and law enforcement
officers. Such specialist are assigned
responsibilities in a variety of areas including overseeing the proper recovery
and removal of bodies without loss of evidence essential to personal identification,
determination of cause and manner of death and notification of death among
other tasks requiring medical/forensic supervision or skills. Much has been
learned from major disaster scenes where insufficient medical/forensic personnel
resulted in serious misinformation, loss of evidence, incorrect notification of
kin, and lack of coordination/cooperation among the various teams of forensic
investigators.
Interactions among different components of CSI teams
As an associate to the medical examiner, the
FNE works within a team of forensic and legal experts. This forensic specialist
is one member of the CSI team that assists law enforcement officers and serves
as a liaison to the medical/forensic community. Some FNEs are employed by
police departments (as a civilian), prosecution, defense, insurance agencies,
government agencies, military services, and
Office of the Attorney General as consultants, educators, direct service
providers, and risk assessment research. One unique role as a hostage
negotiator involved a forensic psychiatric nurse who worked with the police department
after completing an FBI training program.
Advanced techniques and modern
technology in CSI
Considering that the body is the crime scene,
one important aspect of advanced techniques applied by the FNE in pediatric
sexual assault examination requiring expert skills is the ability to minimize
emotional trauma while maximizing collection and documentation of forensic
evidence. Such methods and techniques include a 3 step approach known as inspection, separation and traction. This
method refers to inspection of external female genitalia, separation of the
labia majora and minora, and traction of the labia majora to provide a gentle
tunneling of the labial tissue for visualization and evaluation of the hymenal
rim. This technique must be used by a skilled clinician with intricate
knowledge to prevent further injury
With advanced education in the forensic
nursing sciences, these specialists are experts in the use of alternate light
sources, the binocular magnifying colposcope, digital and other categories of
forensic photography. Some FNEs are forensic laboratory scientists trained in
‘touch’ DNA and other types of biological evidence who are employed in crime
laboratories. With the current method of digital documentation in healthcare, informatics
has become an essential tool for nurses and physicians. Medical errors,
malpractice, neglect or intentional actions causing injury or death and has
become an area of investigation requiring attention by the forensic nurse known
as a Legal Nurse Consultant. This forensic nurse may be employed by the
prosecution or defense. Numerous other technological skills and methods are
also provided by the FNE.
