The role of the registered nurse in collecting and documenting physical forensic evidence related to fatal gunshot wounds: Recommendations for policy and practice

The purpose of this study was two fold. The first was to determine the quality of the forensic physical evidence, specifically clothing, cartridges and gunshot residue preservation, collected and documented in the medical examiner record. Looking at data retrospectively gives a historical analysis that will provide a systematic review of evidence collection practices. In this case, the data examined were collected by RNs in Harris County from 2004 to 2006. The second purpose was to propose nursing practice guidelines and standard operating procedures to preserve forensic evidence without interfering with emergency life-saving care efforts. The research questions that guided this study were: (1) What percentage of fatal gunshot wound physical forensic evidence documented in the medical examiner record from 2004 to 2006 in Harris County was collected by registered nurses? (2) Of the investigations formally filed in a court of law, what percentage of fatal gunshot wound physical forensic evidence collected by RNs as documented in the medical examiner record from 2004 to 2006 in Harris County was admissible in legal proceedings? (3) What policy and practice implications can be derived from the evidence related to the RN role as found in research questions 1 and 2? (4) What are the similarities and differences of these roles when compared to the standardized Sexual Assault Nurse Examiner (SANE) protocol? (5) Does the hospital trauma level designation and accreditation reflect differences in the amount and type of gunshot wound physical forensic evidence collected by RNs?

The study was a retrospective chart review examining medical examiner records from 2004-2006 of fatal gunshot wound victims dying in a hospital. The medical examiner record consists of hospital records, police reports, and investigator and autopsy reports, including photographs and subpoenas. An instrument derived from national standards and protocols, was developed specifically for this study.

A total of 451 records was reviewed and analyzed focusing on physical forensic evidence from gunshot wound victims: clothing, cartridges and gunpowder residue. The findings revealed current nursing practice when collecting evidence from fatal gunshot wound victims. The review also provided guidance in development of evidence collection hospital policies and procedures and clear nursing roles when caring for these victims.