Death Investigations and the Role of the Forensic Nurse

The International Association of Forensic Nurses website states, “Every state/ county has different needs and resources, and every state/county may run death investigations with a different approach. What matters is that every effort be made to ensure a thorough, accurate, and timely investigation. A faulty cause of death determination can significantly impact surviving family members, agencies responsible for planning public health policy, civil or criminal action, and even public safety. (Schindell, 2006) The possibility of forensic investigations may begin in first aid situations, or in the emergency department. The nurse’s first duty is to provide immediate care to the patient, but the nurse must also be prepared to preserve evidence for possible criminal investigations. (Dean ; Mulligan, 2009) This becomes andatory in the situation where the patient dies. It is very important that evidence and intormation surrounding the death is preserved The body should not be cleaned prior to transport to the morgue, and any tubes, IVs or other medical equipment should be left in place.
The nurse on duty can be instrumental in making sure that everything remains as it was in order to make it easier for the medical examiner. The nurse must also be sure to document all procedures performed, including attempts to establish an ‘V, as well as noting all injury sites. (Erricksen, 2008, p. 40) Other investigations begin when a suspicious death is reported to the ppropriate agency. The death investigator will go to the scene in order to collect evidence, photograph the area, and gather information regarding the environment and positioning of the body.
The investigator will also question witnesses, family members, and law enforcement officials to gather more information regarding the victim, including past medical history, condition prior to death, circumstances leading up to the death, if known, and if the body has been moved. This would be followed by detailed investigation of the body, any clothing, and clues to medical conditions such s medic alert bracelets or presence of insulin pumps, etc. (McDonough, 2013) The forensic nurse can perform or assist with all of these duties, and must be careful and meticulous in writing reports of their findings. The completion of good contemporaneous records may be vital to any statements of evidence that a nurse may be required to produce at a later date, to either the police or coroner. ” (Dean & Mulligan, 2009, p. 39) In many cases, if the primary investigator does not have medical training, the forensic nurse’s experience and knowledge can be invaluable. Schindell, 2006) Forensic nurses can also apply information and practices from other areas to death investigations.

Researchers in Alaska have determined that sex- related homicides can be difficult to properly identify, and may be under-reported for that reason. Calling upon the expertise of a Sexual Assault Nurse Examiner (SANE), the researchers were able to apply standard techniques from sexual assault cases with living victims to investigations of homicides. These techniques, especially examination with a colposcope to identify anogenital injuries, were able to identify exual assault related injuries, and to properly classify some homicides as being sex- related (Henry, 2009).
Inclusion of forensic nurses in further sex-related homicides would be beneficial to law enforcement officials. “Forensic nurses have taken a leadership role in improving healthcare’s response to living victims of sexual assault and forensic pathologists and law enforcement would benefit from including a forensic nurse, specialized in sexual assault examinations, in the multidisciplinary response to deceased victims. ” (Henry, 2009, p. 64) A qualified and trained forensic urse can even act as the coroner if there is no medical examiner available. In counties where non-medical Deputy Medical Examiners are being asked to conduct the majority of a death investigation, medical expertise should be readily accessible to them. A forensically trained nurse can be an ideal medical representative in these situations. ” (Schindell, 2006) The primary goal of a death investigation is to determine the cause and manner of death. This can sometimes require detailed and painstaking investigation, not only of the immediate cause of death, but of possible comorbidities that may have contributed to the death.

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