EMS and Forensics

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EMS and Forensics

• Julia Lowery, CCEMTP, NREMT-P, Lic-P
• Weatherford College EMS Professions Dept. Chair

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Objectives

• 1. Identify ways EMS can impact a crime scene
  related to pre-arrival instructions.
• 2. Discuss the reasons for a staged response by
  EMS to a scene and safety concerns when making
  entrance to a scene.
• 3. List three types of activities that EMS can do
  to preserve a potential crime scene.

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Objectives

• 4. Describe the types of treatment a critical
  trauma patient would typically receive from EMS.
• 5. Identify the essential components for
  effective EMS documentation and how lack of
  documentation can impact the forensic
  investigation.

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What are some situations in which the medical
examiner or coroner become involved?

• Homicides
• Suicides
• Violent deaths
• Crash related deaths
• Unusual scene characteristics associated with
  death
• Sudden Infant Death Syndrome (SIDS)
• Dead upon arrival (depending on local protocol)

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EMS as Part of the Forensic Scene

• Forensics is usually law enforcement and the
  medical examiner.
• So what does EMS do that could possibly impact
  forensics?

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Pre-Arrival Instructions

• Purpose
• To give the patient / victim the best chance for
  survival
• Begins to benefit the patient before EMS arrives

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Pre-Arrival Instructions

• Detrimental Aspects
• Patient or family members may not understand
  directions
• May cause scene to be altered to accomplish
  instructions
• May cause patient to move from original position
• May enlist the assistance of bystanders thus
  increasing scene contamination

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Crime Scene Awareness

• Potential crime scenes are those in which police
  investigation may be warranted.
• Potential or actual suicide
• Homicide
• Drug overdose
• Domestic dispute
• Rape or abuse
• Robbery or riots
• Gunfire, or potentially dangerous weapons

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Scene characteristics crime scenes

• The simple presence of the PD on scene upon your
  arrival is not always good sign!Wait until PD
  has cleared the scene.If you arrive prior to
  PD, await their arrival if you have any
  concerns.

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Staging

• Why does EMS stage away from the scene?
• Necessary to ensure rescuer safety
• If the rescuer is not part of the solution then
  they may become part of the problem
• EMS doesnt carry weapons or have vests

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Staging

• Potential benefits aside from the obvious
  personal safety benefits
• The alert EMS professional will be observant and
  may be able to hear verbal information prior to
  PD arrival (depends on proximity to scene and
  type of scene)
• EMS scene observations may enhance documentation
  and assist PD gain a well-rounded picture of the
  overall incident

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Recommendations For Approaching A Crime Scene

• If a known threat exists from dispatch, consider
  shutting down lights and sirens when you draw
  near.
• Park at a safe distance.
• Study the crowd (size, hostility, etc.).
• Approach the scene cautiously.

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Determine Scene Safety

• When using a flashlight,
• carry it beside your person.
• Try to walk on grass to
• decrease noise.

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Determine Scene Safety

• Walk single file when
• entering a potentially
• hostile scene.
• The person in front
• should carry light the
• second can carry
• equipment.

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Determine Scene Safety

• Stand to side of the
• door when knocking.
• Never position your
• body in front of a
• door or window.

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Achieve A Smooth Transition Of Care

• Identify your arrival to those already on scene.
• Talk and listen to on-scene First Responders,
  Police, and Fire personnel.
• Expediently get to the patients side to begin
  your assessment.
• Be sure to properly greet the patient and
  identify yourself to them.

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When at the patients side

• Do not allow bystanders to disturb scene or
  patient.
• Establish rapport and initiate care.
• Do not disturb anything not related to immediate
  patient care.
• Keep in communication with the PD on scene so
  each is aware of the others actions.

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Maintain Control!

• Performing your duties is almost impossible in a
  scene that is chaotic.
• If the scene turns unstable, either retreat or
  return stability to it (just dont do nothing).
• Remember always, if you dont control the scene,
  it will control you!

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Reduce The Patients Anxiety

• Ease the fears of the patient.
• It may not seem like an emergency to you but may
  be a devastating event to them.
• Kindness goes a long way!
• This may make the whole experience much smoother
  for everyone concerned.

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Maintain Awareness of Your Situation

• Scene size-up is a dynamic process.
• Scenes can easily become dangerous after you
  believed they were initially safe.
• Situational awareness is the ability to shift
  your attention between patient assessment and
  management to the dynamics of the scene.

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Crime Scene Preservation

• Observe the scene before you enter
• Notice the location of your patient
• Any blood present and if so how much?
• What position was the patients body found in?
• What items other than clothing are on or by the
  patient/victim?
• Enter with caution!!!

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Crime Scene Preservation

• Once the scene is secure by police, EMS should
• Focus on emergency care.
• Touch only what you need.
• Move only that which must be moved.
• Observe and document anything unusual.

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Crime Scene Preservation

• Do not cut, remove, wash off, or cover anything
  that may be used as evidence later (unless
  emergency treatment requires this).
• Dont cut through holes!
• Keep clothing and personal articles in paper bags
• Keep a log of who the clothing and personal
  articles were released to
• Note the description of the personal articles
  released

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Treatment

• Golden Hour and Platinum 10 Minutes!!
• On scene care limited
• Airway
• Rapid Assessment
• Transport Decision
• MOVE!!!!!!!!

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Treatment

• In trauma, most therapies are done enroute
• IVs, splinting, bandaging, chest decompression,
  etc
• Time is essential in the survival of a trauma
  patient

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Documentation

• Oh, no!!!
• She didnt just say the D word

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Yes, Documentation!

• Just like in the rest of life..
• No job is done until the paperwork is done!

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Documentation

• So whats important?
• Scene observations
• Patient/victim statements
• These may be their last words
• Bystander/witness statements

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Documentation

• So what else is important?
• Medical information
• What was done to help the patient before EMS
  arrived?
• The location and a detailed description of the
  patient/victims wounds

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Documentation

• So what else is important?
• Amount of blood loss noted on scene
• Note the location and position in which the
  patient/victim was found
• Any clothing or personal articles removed from
  patient and to whom they were released
• Make sure the person signs for them

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Okay so lets talk about a stabbing case!!

• Ouch!!!
• No this is not the patient we will be discussing.

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The Case

• EMS is called to respond to the scene of a young
  adult male
• Bystanders report that the patients wife
  stabbed him with a large butcher knife.
• The patient is in clinical shock upon EMS arrival

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Patient/Victim Condition

• The patient has a sucking stab wound
  approximately 2 cm in length to his left chest a
  few inches below the armpit
• Vital signs BP 80/40, P 140, RR 32
• Breath sounds decreased to left
• Skin is cool and sweaty
• Neck veins are distended

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Patient/Victim Condition

• However, despite all this trauma the patient is
  alert and responds to verbal and painful stimuli
  by moaning
• Where do we go from here?

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EMS Response

• Once the scene is safe EMS will enter the scene
• General survey of scene and situation will take
  place
• Approach patient and determine the following
• Does the patient have a patent airway?
• Are there immediate life threats to the patient
  or to EMS?
• Do we stay or do we load and go?

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WE GO!!!

• All treatment interventions other than securing
  the airway are done enroute to the hospital.
• What this patient needs is surgery!!!

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On Our Way!!!

• We arrive at the Emergency Department and give
  our report
• We release the care of the patient to the ER
  doctors and nurses