EMS Crime Scene Responsibility

Issues of Concern

When Should an EMS Provider Treat a Location as a Crime Scene?

Identifying a location as a crime scene helps EMS providers decide how to respond. A crime scene is any location where a criminal act occurred or evidence of such an act may be found, including violent acts, drug manufacturing sites, fires, and less suspicious situations. EMS providers should be careful to consider as crime scenes the location of runs that appear to be obvious or reported suicides or accidents. Reported self-inflicted or accidental injuries must be investigated by law enforcement to confirm these reports. These scenes should be treated like any other potential crime scene regarding evidence preservation and documentation.[2][3]

What Are the Responsibilities of EMS?

Once personal and rescuer safety is established, EMS personnel must prioritize providing medical care to the sick and injured. When there is an associated crime scene, reaching this goal with minimal disruption to possible evidence is essential. EMS should use a single, designated entry and exit point into the scene, document the point, and record the details of the scene as best as possible. EMS should keep track of everything they touch or disturb and must avoid moving any items that are not necessary. If an item does not need to be touched or examined to provide appropriate care, it should be left undisturbed. In cases of death at the scene, EMS should only move the body to the extent necessary to confirm death. If the body must be moved or if clothing must be cut and removed, EMS should be sure to document this in the run report and inform the investigating officer on the scene. In some locales, documentation of asystole may be required to declare death. Suppose the circumstances of the death and the condition of the body allow for the declaration of death without cardiac monitoring or documenting the absence of a pulse. In that case, the body should not be touched at all.

Evidence Collection

Removing an item of potential evidence from a scene to provide optimal care is unusual for an EMS provider—medication bottles or a medication list may be some of the few such items. Weapons, shell casings, or personal clothing items are never valuable to the treating providers and should never be transported. If removing an item is necessary, it should be placed in a brown paper bag. If the item is saturated in liquid, the item is placed in a paper bag, and then the paper bag is put in a plastic bag. Articles of clothing containing evidence are frequently transported as full exposure of the patient does not occur until inside the ambulance or the emergency department. When removing the clothing from victims of violence, care should be taken not to cut through bullet holes or knife holes. Likewise, EMS should avoid cutting through bloody or contaminated areas of the clothing, cutting instead through clean areas. The method of clothing removal and the location of any cuts made should be clearly noted in the run report (medical record); for example, the sweatshirt and shirt were removed by cutting up each of the sides, including the sleeves. Removed clothing should be placed in a paper bag, in a clean plastic bag (not a biohazard bag that may contain biohazard from another run), or on a clean sheet and saved for law enforcement. When caring for a victim of an alleged sexual assault, EMS should minimize clothing removal and avoid contaminating the clothing. EMS should not clean any skin except as needed for direct patient care. Forensic sexual assault examiners may need to collect possible evidence from the patient's face, fingers, nails, or any site that may contain DNA evidence. 

Documentation

EMS professionals should document and observe the setting of the scene. If the nature of the run is dispatched as a potential crime scene, EMS should always wait for police officers to arrive and declare it safe for medical responders. If an EMS professional is the first person to arrive and unexpectedly discover a possible crime scene, they may have significant knowledge of how the crime scene looked. EMS professionals should take note of signs of forced entry, positions of bodies, lighting, and any open doors. Blood and bloody footprints can be significant evidence in an investigation, so EMS professionals should avoid stepping in blood or other fluids whenever possible.

Documentation should be free of any opinion and state the facts. If the patient is a victim of a crime, it can be beneficial for EMS providers to document victim statements accurately and precisely. Quotation marks should be used to document exactly what the patient or witness says happened. These quotes can assist law enforcement in their investigation and possible prosecution later. Statements that may not seem relevant or essential at the time may later prove to be very valuable. Victims of domestic violence may openly discuss how injuries occurred and who caused them, but they may later be hesitant to testify due to fear of retaliation.

Clinical Significance

The knowledge of optimal procedures and documentation of findings at crime scenes may not directly impact clinical outcomes. Such knowledge is, however, essential for ensuring that the patient's interest in the criminal justice system is protected. Successful prosecution of potential violent crimes may be significantly impacted by how medical personnel provide and document medical care. Ultimate outcomes in the criminal justice system can be an essential factor for victims' emotional recovery.[4]