THE NEED FOR EMERGENCY MEDICINE RESIDENT TRAINING IN FORENSIC MEDICINE

Jennifer L. Wiler, MD. Heatherlee Bailey, MD Department of Emergency Medicine, Philadelphia Annals of Emergency Medicine Volume 50, No 6 December 2007 THE NEED FOR EMERGENCY MEDICINE RESIDENT TRAINING IN FORENSIC MEDICINE

Mathew Brigmon Catalina Castañeda Erika Paola Ibarra

CONTENTS Introduction Epidemiology Cases Reports Common Mistakes The Need for training Current Efforts Future Directions Conclusions Questions

INTRODUCTION Millions of victims are treated in hospital emergency departments (ED). Physicians don’t receive formal training in clinical forensic medicine. Need to include clinical forensic medical training.

EPIDEMIOLOGY Total : Assault, abuse/neglect domestic violence, and sexual assault ♂ 830,000 ♀1.5 million per year. Nonfatal firearm- crime to nearly Review 100 medical records: 70% negligence.

CASE REPORT No.1

CASE REPORT No. 2 us.123rf.com/400wm/400/400/photoconcepts1/photoconcepts10810/photoconcepts / jpg

CASE REPORT No. 3 impresos.com.co/shop/images/gif%20016.jpg

CASE REPORT No. 4 4.bp.blogspot.com/_7LS4WnHcgiw/RYwGmZt05MI/AAAAAAAAAP4/n-zu1lZIfYo/s320/machete.JPG farm1.static.flickr.com/109/ _4e683e7917.jpg?v=0

COMMON MISTAKES

EMERGENCY DEPARTMENT First contact. Lack of knowledge about forensics needs. ED/ML have close relationship. Important roles in criminal investigations and their solution.

FORENSIC EMERGENCY MEDICINE A proper evaluation: Detection, collection, and preservation of evidence. Also: Injury pattern recognition, interpretation of injuries, documentation of testimonial and injuries, reporting requirements, and regulations.

NEED FOR TRAINING First medical evaluation. Studies show that criminals respond to overwhelming evidence. Statements and medico legal reports. Good evidence = 85-95% conviction rate or plea bargin.

NEED FOR TRAINING Successful prosecutions in certain cases: child or elder abuse % require medical experts. Almost all physicians will be involved. Inconvenience.

NEED FOR TRAINING Conflict of being to involved. Lack of knowledge even amidst good intentions. In California: 70% poor documentation and 38% improper handling of evidence. Legal Consequences.

NEED FOR TRAINING Complaints: Reports of poor quality, contain highly technical language, structured incorrectly, or do not address the issues doe the “fact- finding” process. In Victoria, Australia found the need for reexamination.

GUIDE TO BAD TRAINING Traininig doesn’t exist Will be call to testify Well- intentioned forensically untrained Failure to document Uncertain of our role

CURRENT EFFORTS - USA Mandatory training does not exist. 1990: 1st postgraduate training program (2 days annually) 1991: Iniciated 1st clinical forensic medicine training program. –Firearms –Photography

CURRENT EFFORTS - USA 2004: Developed a curriculum for academic physicians. –Forensic evaluation. –Documentation requirements. –Web: education, technical assistance, interdisciplinary case consultations. American forensic nurses association: SAFE/SANE (sexual assault examiner training program)

CURRENT EFFORTS - WORLD Australia 1996: 6 months accredited forensic medical rotation. Goals: specific training in medico legal and forensic medial practice. –Police intervention –Collection of biological samples –Preparation of medicolegal report –Photography South Africa. –Attendance at crime scene –Autopsies –Forensic toxicology

FUTURE DIRECTIONS Safety Plan Awareness Evidence collection Presevation Documen- tation Case preparation Trial testimony Forensic photography Firearms analysis Examination

FUTURE DIRECTIONS Goal: create an emergency medicine resident training in forensic medicine. There exists a necessity in emergency medicine residency training. Will improve the quality care for ED patients: Social Justice Help Communities resolve

RESULTS OF GOOD TRAINING gente5.telecinco.es/blogs/cuandokarlaencontroaivan/files/2009/02/mujeres-maltratadas1.jpg

CONCLUSIONS Proper forensic evidence identification and collection is an important part of the medical evaluation: physicians should be prepared. It is best to describe injuries. Destruction of evidence and misinterpretation of injuries have deleterious effect in patients. Need for emergency medicine forensic training should have a similar priority than that of emergency medicine training.

Any Questions?

GRACIAS!!!