Paramedics attend to patients in a variety of circumstances and environments, so it’s no surprise that we often attend to situations which are the result of a crime. Despite this common occurrence, paramedics report receiving little to no training about how to preserve a crime scene. Whilst there is no expectation for paramedics to fulfil the role of police, where possible we should try to support our law enforcement colleagues and give justice the best chance of occurring.
When should paramedics consider something a ‘crime scene’?
There’s no clear criteria to describe this, however we should be mindful of preserving evidence any time we suspect a crime may have been committed. Some of these instances include;
- Cases where the patient tells you they’ve been assaulted
- Traumatic deaths, particularly if a weapon was involved
- Serious vehicle collisions causing injury or death
- Unexpected deaths
- Cases involving serious illicit activity (ie. meth lab fire)
- Workplace accidents resulting in injury or death
- Major incident such as aircraft crash, train derailment etc
- Multi-casualty incidents which may be malicious
So – paramedics are not crime scene investigators. What are some simple tips that will help preserve evidence?
- Firstly – always consider ‘could this be a crime scene’? If the answer is ‘yes’, you want to be thoughtful about everything you do
- Our primary concern is always patient care, do not delay care in order to preserve evidence. However we can often be mindful in the way we provide care so as to not destroy evidence
- Restrict access to the scene until police arrive. This may involve asking fire fighters/other paramedics to remain outside, closing doors to maintain the scene or asking someone to keep watch
- If you don’t have to touch something – don’t touch it
- If you DO have to touch something, make a note of what was touched, by who, and how it was moved. Wear gloves too
- Minimise disturbance to the scene – this can be achieved by only using one entrance/exit and walking in a set path (rather than stomping everywhere)
- Do not throw anything away – including things you add to the scene such as dressings, cannulas, ECG dots etc
- Document everything – if there is detail not appropriate for the patient care record, make a diary entry as soon as possible after the incident
Let’s explore some of these in greater detail
Preserving the crime scene itself:
- Restrict access where possible
- Don’t move anything unless you have to. If you do, make a note of
- Who moved it
- When they moved it
- Where they moved it from and to
- Why they moved it
- Always wear gloves when handling potential evidence
- Avoid cleaning or decontaminating any part of the scene
- Particularly try to avoid stepping into pools of blood
- If you have to move a weapon to make the scene safe, do it carefully and take note of where it originally was
- Be conscious of your vehicle as well – avoid driving over obvious tyre tracks or skid marks
Preserving evidence at scene:
- Remember that everything is potentially evidence – even seemingly innocuous things like rubbish. If it’s not in your way, do no touch it. Leave it for the experts
- Patient clothing is often a valuable piece of evidence which is inadvertently destroyed by paramedics. Some tips to preserve clothing include;
- Avoid cutting where possible
- When something has to be cut – avoid cutting through blood stains and knife/bullet holes to the clothing
- As soon as clothing is removed, place it in a bag for storage. Sealed paper bags are preferable, but often paramedics will only have access to plastic “patient belonging” bags
- Document how the clothing was removed (ie. cut with shears along seams of shirt)
- Clear labelling and documentation of evidence is important. For anything that is bagged up
- Label the outside with a note or sharpie detailing the contents
- Make a note in your PCR or diary about what you bagged
- It’s important to maintain chain of custody for evidence. In most cases the evidence will be transported with the patient and can be handed over to police at hospital. Another option is to leave the evidence with someone at scene (usually an infield manager)
- If you hand the evidence over to someone else, note who it was and what time it occurred
- The patient themselves is also a source of evidence
- Where possible we should avoid decontaminating them, particularly areas such as hands
- If it’s necessary to provide treatment (such as gaining IV access), clean the area with sterile water and preserve the gauze used to clean them. This may retain important substances such as gunpowder or chemicals
- Avoid unnecessary cleaning of blood from the patient until police have photographed it, as blood spatter can be important evidence
- If foreign bodies are removed from the patient (such as shrapnel) these should be retained as evidence
- Consider retaining the sheet off the stretcher, especially if you removed patient’s clothing on it. Evidence may fall on to the sheet during that process.
Putting it ‘on the record’ – documentation tips
- As always, documentation should be objective and only detail what you observed
- Consider documenting the patient’s statements throughout the case – particularly if they suggest who an offender could be
- Always thoroughly document who attended the scene and how they can be contacted
- Make note of anything abnormal at the scene
- Unusual damage
- Odd positioning of the patient
- Presence of weapons
- If you have information that you feel isn’t appropriate for the patient care record, consider making a diary entry or writing a police statement. I often do this immediately after attending an odd case so the details are fresh in my mind
- Always document the patient’s injuries completely, including superficial injuries. However avoid commentary of issues such as the age of injury or cause of injury (okay to write the patient’s statement about how it occurred)
- As usual, include details of any vehicles involved
- Not all notes need to be written – you may find sketching the scene more useful
Bottom Line:
Paramedics are not police officers, and certainly not crime scene technicians. However we are often first of scene, often before we even realise a crime may have been committed. By being aware of our impact on the investigative process, we can take reasonable steps to minimise that impact and help justice prevail.
References:
https://www.ncbi.nlm.nih.gov/books/NBK499999/
https://www.jems.com/best-practices/emergency-medical-services-in-the-crime-scene/
https://www.nysvara.org/pulseCheck/2011/materials/Fried_CrimeScene_2011.pdf
