Emergency department doctors and nurses are experts at acting quickly to save crime victims' lives, but they generally don't know how to analyze a gunshot wound to determine whether the gun was fired at close range. And if a hit-and-run victim comes in covered in paint chips or glass, most ED teams aren't trained to save the debris as crime-scene evidence.
But that sort of training can make a difference between the perpetrator getting caught or going free, says Jayne Batts, M.D., an emergency department doctor at Carolinas Medical Center in Charlotte, N.C. When police are busy at the primary crime scene, hours can go by before they make it to the hospital to collect evidence. In the meantime, the surgical team might be cutting off and discarding clothes and removing shrapnel with metal forceps that leave marks instead of plastic forceps that do not.
"Medical students, residents and nursing students do not get training in forensic issues," laments Batts, who in 2001 launched a forensics training program at her hospital that has since expanded to hospitals throughout the county. "But we're on the front lines. When victims of gunshot wounds, stabbings or any type of forensic case come in, we're the first ones who see them."
Batts became interested in crime-scene investigation in 1999 when she attended an American College of Emergency Physicians lecture by University of Louisville ED doctor William Smock on clinical forensics and crime scene investigation. It made her more aware of how ill-trained hospital staff are in evidence collection. "A few months later, we had a case of a woman stabbed in the chest while she was being robbed," she recalls. "I knew it was going to be a high-profile case, and I basically told the trauma nurse we needed to keep the clothing with the victim. That didn't happen."
She approached the Charlotte police department to set up a training program in evidence collection for the health care workforce. Over the next year, she and criminologist Patricia Levins crafted a set of protocols covering all types of forensic cases, "everything from gunshot wounds and stab wounds to hit-and-run accidents," says Batts.
In 2002, they began offering a one- to two-day course on forensics to nurses at Carolinas Medical Center, the county's Level I trauma center. In 2003, they expanded it to a 40-hour course offered to nurses throughout the county. Since then, they have trained more than 200 nurses from as far away as Florida. Batts started the program with government grant funding, but it's now self-sustained through tuition.
In 2011 alone, according to the Mecklenburg County district attorney's office, Carolinas Medical Center staff collected more than 1,600 pieces of evidence from victims of stabbings, shootings, rape, arson, domestic violence, elder abuse and child abuse. In one case, a nurse who trained in the course helped nab a serial rapist. "She swabbed the patient's breast, and they were able to collect DNA, and they matched it to several other rape victims," Batts says.
Angie Alexander, the medical center's forensic program coordinator, says Batts has changed the way ED nurses view their jobs. "Their goal, of course, is to take care of the patient immediately and have a good outcome. But now they also see that it's important that our patients who are victims of crime are not re-victimized by the court system because evidence was lost or injuries weren't documented. They really feel that they're helping victims cope better with the traumatic events that happened."
Batts hopes evidence collection protocols and injury documentation will one day be nationalized. She's been pushing for that as a board member of the clinical forensic medicine section of the the American College of Emergency Physicians, a subgroup she helped found.
Batts and Alexander are setting up forensic training and minicrime investigation centers at the six other hospitals in the Carolinas HealthCare System. They've developed a "forensics cart" with plastic forceps, paper envelopes for trace evidence, little cardboard boxes to put bullets in and empty paint cans for storing clothes. "Just something as simple as having that cart and having supplies in it is very helpful," says Batts. "And it's easy to do."