WHAT DO FORENSIC NURSE CONSULTANTS MEAN BY "MECHANISM OF INJURY"?

Mechanism of injury (MOI) refers to the method by which damage or trauma occurs to the body (skin, muscles, organs, and bones).  Now, this is where forensic nurses get to use those high school and freshman college physics lessons!  Understanding MOIs and the resulting bodily insults requires combining a bit of physics with anatomy and physiology to determine the effect of the manner (type), direction, amount, and location of force applied to the body and the resulting injury/injuries.

Isaac Newton’s First Law of Motion states that a moving object will continue to move at the same speed until an opposing or outside force acts upon it.  When this happens, the object’s kinetic energy is transferred to the outside object. For our purposes, the object is a weapon of some type, and the outside object is the body and this transfer of energy causes trauma or injury (typically, blunt/non-penetrating or penetrating). However, the transfer of energy can also be through a thermal agent such as heat, chemical, or cold agents and can also cause trauma to the body. This concept of the transfer of energy helps healthcare providers assess the likelihood and severity of injuries based on the nature of the incident and the Forensic Nurse Consultant to link (or not) the injuries to the indicted charges.

In forensics, determining the mechanism of injury (MOI) is crucial for understanding how an injury occurred, which can help in criminal investigations and legal proceedings. Forensic experts analyze the physical forces and mechanical processes that caused the injury to determine the nature of the incident (i.e. accidental, self-inflicted, self-defense, or an intentional violent act).  For example, in cases of blunt force trauma, the MOI can help differentiate between injuries caused by falls, car accidents, or assaults. Similarly, in cases involving sharp force injuries, understanding the MOI can reveal whether the wounds were caused by knives, glass, or other sharp objects and the directionality and/or angle of entry.

More specifically, when evaluating a case, Forensic Nurse Consultants consider the following:

1. The nature of force applied to the body

2. The estimated amount of force applied to the body

3. The events leading up to the transfer of energy/trauma

4. Positioning, location, and movement of the assailant and victim

5. Physical capabilities of the assailant

6. General medical condition of the victim

7. Post-injury medical care (when and what) provided to the victim

MOI can be crucial in determining court cases for several reasons:

1. Establishing Liability

2. Supporting Evidence

3. Refuting or Confirming Defenses

4. Accurate Diagnosis and Treatment

MOIs are broadly sorted into several categories, based on the type and amount of energy transferred. Each has distinct characteristics and associated injuries.

1. Blunt

2. Penetrating

3. Ballistic

4. Acceleration/Deceleration

5. Thermal

6. Chemical

7. Electrical

8. Blast

9. Crush

10. Asphyxial

HOW FORENSIC NURSE CONSULTANTS EVALUATE VIDEO FOOTAGE IN CRIMINAL CASES!

Forensic nurses play a crucial role in assisting law enforcement with evidence collection and attorneys with analysis of this evidence. Part of this in-depth review includes reviewing video footage.  They will often be provided with video footage such as:
🎥 Body-Worn Camera Footage
🎥 Surveillance Cameras
🎥 Dash Camera
🎥 Security Systems
🎥 Interview Room Cameras
🎥 Personal video from victim, witness, or perpetrator

When forensic nurses review video footage, they focus on several key aspects:
👀 Injuries and Trauma:
They look for signs of physical injuries, such as cuts, bruises, or gunshot wounds. They also watch for the individual's movement, range of motion and for any signs of pain. Assessing the severity and location of injuries helps determine the force used and the potential impact on the victim’s current and future health.

👀 Behavioral Observations:
Forensic nurses pay attention to the behavior of both victims and suspects.
They note any signs of distress, fear, or aggression, which can provide valuable context. If a victim/suspect is known or suspected to be under the influence of drug or alcoholic substances, the forensic nurse can observe their behavior to corroborate or refute these assertions.

👀 Evidence of Assault or Abuse:
They examine the footage for any actions that indicate non-consensual behavior. Detecting signs of sexual assault, domestic violence, or other forms of abuse is crucial.

👀 Timelines and Sequences:
Forensic nurses verify the sequence of events. They correlate actions captured on camera with victim statements and other evidence.
They are also able to determine the injury progression through the videos if multiple videos were taken over a period of time.

👀 Medical Interventions:
If medical interventions occur during the footage (e.g., CPR, wound care), forensic nurses assess their appropriateness and effectiveness.

👀 Crime Scene:
Look at the crime scene to determine if there are elements that may have impacted the injuries sustained or explain the lack or absence of injury.
Reviewing police camera footage enables the forensic nurse consultant to obtain a “real-time” view of the incident aftermath and to obtain information with context that is lost with written/document evidence and photographs.  Helps them provide expert insight.

How can Forensic Nurse Consultants impact criminal charges?

🔎 Mitigating Factors:
Forensic nurse consultants identify mitigating factors related to the injuries. They examine all available documentation to understand the case background and context of the injuries. They also review all medical records of the alleged victim and/or perpetrator for medical conditions or medications that may have contributed to the injuries.

🔎 Severity Assessment:
The severity of the injury needs to meet the definition of the charges.  By accurately determining injury severity, forensic nurses can provide expert input as to whether charges could be upgraded or downgraded.
❓ Are the injuries consistent with the explanation?
❓ Are there alternative explanations?
❓ Do the injuries look chronic or recent?
❓ Are there injury patterns that may indicate the type of object used?
❓ Do the medical records provide clear timeline of the medical history?
❓ Were there treatments, previous injuries, or follow-up appointments?
❓ Are there inconsistencies that could indicate underlying issues?
❗ They consider factors like healing time, pain level, and long-term consequences such as disfigurement, scarring, physical limitations, loss of function, and/or risk of death.
📸 They interpret photographs of injuries taken at different stages (immediately after the incident and during healing) and document the extent and progression of injuries visually. The absence of photographic evidence of injuries significantly hinders injury evaluation and analysis

🔎 Expert Testimony:
Forensic nurses can testify in court as expert witnesses. The objective of their testimony is to educate the judge and jury on the medical evidence and issues in order for an informed decision to be made. Their objective analysis can support a defense argument for reduced charges or the prosecution argument for greater charges.

🔎 Collaboration with Legal Teams:
Forensic nurses work closely with attorneys, providing insights into the medical aspects of the case. They collaborate with legal teams to build a stronger defense or prosecution litigation strategy and/or negotiate plea deals.

⭐ Forensic nurses DO NOT directly change the charges but contribute valuable information to the legal process.

Distinguishing the TYPE of wound present and its specific characteristics

Forensic Nurse Consultants see many types of injuries when they are evaluating cases. It is important to know the specific type of injury when reviewing cases.

Some of the more common types of wounds are:

🔴 Incision: Clean, straight cuts typically caused by sharp objects where length is usually greater than depth

🔴 Laceration: Irregular tear-like wounds caused by blunt force or trauma

🔴 Abrasion: Superficial wounds resulting from friction or rubbing of the skin’s surface

🔴 Puncture: Small but deep wounds typically caused by sharp, pointed objects where depth is usually greater than length

🔴 Contusion (AKA bruise): When small blood vessels are torn and leak blood under the skin

🔴 Thermal, chemical, or electrical burns: Skin tissue damage caused by heat, chemicals, electricity, etc.

🔴 Penetrating wounds: Injuries that extend into internal organs or body cavities

🔴 Skin ulcers: A type of chronic sore where the skin layers “break down”

🔴 Avulsion: When a body part is torn off by trauma

🔴 Hematoma: A collection of blood that forms outside of the blood vessels

🔴 Fracture: A break or crack in the bone

It is ESSENTIAL to document the specific identifying characteristics of each wound including:

🔷 Location: The wound’s position on the body can provide insights into the assault or criminal acts

🔷 Pattern and Shape: The wound’s shape, edges, and any visible patterns can help identify potential weapons or objects involved

🔷 Depth: The wound's depth can help assess the weapon, the assailant/size of the suspect, etc.

🔷 Contamination: Detecting foreign materials (e.g., dirt, debris, or clothing fibers) within the wound can provide clues about the circumstances, location, etc. of the crime

🔷 Bruising: Forensic nurses look for bruising to understand the force applied during the injury

🔷 Healing Stage: Evaluating the "freshness" of the wound can help determine when the wound occurred

❗ Photographic Documentation is ESSENTIAL to accurately record the wound and can be used in legal proceedings

Forensic nurses collaborate with law enforcement, attorneys, and other professionals to build a comprehensive picture of the injury. 🕵️‍♀️🔍

FORENSIC NURSE CONSULTANT AND CASE EVALUATION

Another crucial role of FNEs in case evaluation is analyzing medical records and other pertinent documentation. Discrepancies, inconsistencies, injuries, timeline gaps, documentation, or explanations of events, can hinder the FNE’s analysis and expert opinion and warrant further investigation.

Initial Case Assessment:

FNE LNC's review medical records, forensic reports, police reports, statements, interviews, indictments, Grand Jury testimony, etc. to get case details as to what the prosecution aims to prove, and the defense may try to dispute or mitigate.

Medical Records Examination:

They review medical records looking for discrepancies between the patient’s account and the documented injuries. This also allows for the identification of issues such as pre-existing conditions, medications, or deviations from the standards of care that may have impacted or contributed to the injuries sustained, and incomplete or vague documentation that does not provide a clear medical picture of the patient or injuries. They may also need to evaluate the suspect's medical records to identify mitigating factors to assist in explaining their behavior or to dispute their capabilities to perform certain criminal actions.

Injury Descriptions - Correlation with Explanation:

Forensic nurses compare the documented medical findings and injuries with the patient’s explanation paying close attention to details such as location, size, shape, and characteristics of each injury. 3 key elements are:

1. Timing: Do the reported time and nature of the injury align with the medical evidence?

2. Mechanism of Injury: Do the injuries match the described cause (e.g., a fall, assault, self-defense or accident)?

3. Patterns of Injury: Are the injury patterns typical of the stated cause, or do they suggest a different mechanism (e.g., defensive wounds vs. accidental cuts)?

Timeline and Chronology:

They utilize available records, medical and others, to establish a timeline of events based on records and determine if the injuries correlate with the described sequence of events.

KEY WAYS THAT FORENSIC NURSE CONSULTANTS EVALUATE CRIMINAL CASES

An FNE’s comprehensive understanding of the mechanisms of injury and the resulting insult to the human body significantly enhances their ability to evaluate criminal cases and provide insights into the nature and potential causes of injuries.

The key ways FNEs do this are:

• Accurate Injury Assessment: assessing and documenting the nature, extent, and patterns of injuries and distinguishing between different types of trauma, such as blunt force, sharp force, or ballistic injuries.

• Determining Cause of Injuries: inferring the potential causes of injuries, determining whether injuries are accidental, self-inflicted, or inflicted by another, and establishing the mechanism of injury.

• Correlating Injuries with Evidence: reconstructing the events leading to the injury and correlating physical injuries with other evidence, such as bloodstain patterns, weapon characteristics, and environmental factors.

• Identifying Signs of Abuse or Neglect: signs can be subtle and may be easily missed by those without specialized training.

• Collaborative Investigations: working with other professionals to guide investigations, support the development of case theories, and assist in formulating questions for witnesses and suspects.

• Evaluation of Consistency: determining if the victim’s and/or suspect’s accounts of events correlate with the physical evidence and/or medical findings.

By leveraging their knowledge of trauma, forensic nurse consultants play a vital role in uncovering the truth in criminal cases and providing a thorough and scientifically sound evaluation of injuries.

HOW FORENSIC NURSE CONSULTANTS EVALUATE CRIMINAL CASES!

One of the most important aspects of any criminal case is the EVIDENCE! An FNE uses the myriad of knowledge, skills, and abilities they have developed to assist in criminal cases. One way they do this is to IDENTIFY GAPS IN COLLECTION AND MISHANDLING OF EVIDENCE.

This is CRUCIAL in criminal cases because evidentiary issues can:

• invalidate the evidence

• compromise the admissibility of evidence

• compromise integrity & credibility of evidence in court

• cause inconsistencies

• create confusion or ambiguity about the origin, context, or significance of evidence with the jury

• can WIN or LOSE a case!

Common gaps identiofied by Forensic Nurse Consultants include:

• Chain of Custody Issues

  • Ex. lack of proper documentation and/or tracking of evidence from crime scene to laboratory

• Incomplete Documentation

  • Ex. missing or inadequate documentation of injuries, observations, or collection procedures

• Contamination or Tampering

  • Ex. improper handling techniques or contamination during collection, storage, or transportation

• Failure to Use Standardized Protocols

  • Ex. deviations from established protocols for evidence collection, preservation, and documentation

• Insufficient Training

  • Ex. inadequate training of personnel involved in evidence collection and handling can result in errors or omissions

• Inadequate Preservation

  • Ex. improper storage conditions or delays in submitting evidence to the laboratory

• Documentation Errors

  • Ex. errors in labeling, dating, or describing evidence can create confusion or ambiguity

How can a Forensic Nurse Examiner (FNE) assist with Criminal cases?

Some FNEs choose the route of legal nurse consulting on criminal and/or civil cases. Because of their specialized skills and knowledge, they are equipped to understand and interpret medical evidence within the context of the law.
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Types of cases that benefit from the consultation services of an FNE include:
🔴 Death investigation/homicide
🔴 Physical assault
🔴 Sexual assault
🔴 Human trafficking
🔴 Domestic/interpersonal violence
🔴 Assault
🔴 Strangulation
🔴 Child abuse/neglect/sexual assault
🔴 Elder abuse/neglect
🔴 Malpractice
🔴 Wrongful Death
🔴 Insurance Fraud
🔴 DUI/MVAs

How do we do this??
FNEs who consult or provide expert services do so by
🔷 leveraging their knowledge and skills in forensics, evidence collection and handling, mechanism of trauma, human anatomy and physiology, nursing standards of care and the legal system
🔷 providing expert insights into medical evidence
🔷 helping attorneys, judges and juries understand the significance of injuries, trauma, and other relative health-related aspects
🔷 collaborating with legal teams to ensure proper evidence collection, maintain chain of custody, and adhere to legal protocols.

Their expertise bridges the gap between healthcare and the legal system,
contributing to a more comprehensive understanding of criminal cases.