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  • The nurse with forensic training is an asset to the patient, the hospital, and the criminal justice system.

  • The determination of entrance versus exit wounds is made by examination of the wound’s physical characteristics, not the wound size.

  • Incised wounds have sharp wound margins and result from a sharp-edged implement (knife, glass, razor blade, or scalpel) being drawn across the skin.

  • Superficial and/or parallel incisions should be assumed to be self-inflicted.

  • A laceration has irregular wound margins and results from blunt-force trauma.

  • The age of a contusion cannot be accurately determined from its color and appearance.

  • A victim of strangulation can be rendered unconscious in less than 7 seconds without evidence of external trauma. The deprivation of oxygenated blood to the brain results in an anoxic brain injury.

  • Physical injury, such as petechial hemorrhage, is not required to prove a patient was strangled. More than half of fatal strangulations have no visible external evidence of trauma.


Nurses providing patient care in acute care settings care for the young and the old, the sick and the injured. And they must do it without compromising valuable forensic evidence, jeopardizing the police investigation that may ensue, or reducing the patients’ chances of getting justice in the court system if they seek it later. With the incorporation of forensic nursing into the hospital, the scope of the practice of nursing has been broadened (American Nurses Association [ANA], 2009). A nurse trained in forensics is one who can recognize traumatic conditions and evidence, document their presence, collect and preserve short-lived findings, and understand how the patient’s illness or injury happened (Lynch & Duval, 2011).

When patients who are victims of assault, abuse, violent crimes, or even motor vehicle collisions present to the hospital, their wounds, clothing, and bodies may be ripe with forensic evidence (Darnell, 2011; Lynch & Duval, 2011). This forensic evidence can be used to connect perpetrators with their victims, to protect innocent parties, to help determine who was the driver versus the passenger in an automobile crash, and to ensure forensic questions regarding injury causation can be answered (Davis, Parks, Kaups, Bennink, & Bilello, 2003; Smock, 2007a). Unfortunately, forensic evidence is usually fragile (a dusting of soot, blood spatter patterns, biologic fluids, wound characteristics), and forensic evidence can be lost or contaminated while nurses and physicians provide care in the acute care setting (Eisert et al., 2010).

The purpose of this chapter is to provide a basic outline of the forensic examination of patients who present to the clinical setting with evidence on their person. It also explains how nurses can provide the highest standard of care without destroying or disposing of forensic evidence that presents on or in their patients.


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