Twenty Minutes in the Trauma Bay: Evidence Collection and Chain of Custody for Emergency Nurses
Student Name
Master of Science in Nursing Program, Aspen University
N560: Forensic Nursing
Instructor Name
Month Day, Year
Twenty Minutes in the Trauma Bay: Evidence Collection and Chain of Custody for Emergency Nurses
At 11:40 on a Saturday night, a composite 22-year-old man arrives at a community emergency department with a gunshot wound to the left flank. The trauma team's priorities are airway, breathing, circulation and getting him to the operating room. In the same twenty minutes, the team will cut off his clothing, find a bullet fragment in his waistband, clean his wounds and hand his belongings to a security officer. Every one of those actions affects whether anyone can later determine what happened to him.
Emergency nurses encounter forensic evidence far more often than forensic specialists do, yet many have little training in handling it. A review of the literature on emergency nurses' role noted growing numbers of patients presenting after interpersonal violence, a lack of department policy and a clear need for education in recognizing, collecting and preserving evidence, while stressing that the nurse's primary focus remains the patient's care (McGillivray, 2005). This paper explains what counts as evidence in the emergency department, how it should be collected and preserved without delaying care, and how chain of custody is maintained, then proposes steps for a department without a forensic nursing program.
Care First, Evidence Always
The first principle of forensic practice in emergency care is that treatment is never delayed for evidence. The forensic nursing standards describe evidence collection as part of care, not a competing task (American Nurses Association & International Association of Forensic Nurses, 2017). In practice this means integrating a few habits into resuscitation rather than adding steps. Clothing is cut along seams and away from holes, tears and stains, not through them. Items removed from the patient are placed on a clean sheet rather than the floor. Anything found on or in the patient, such as a projectile or a weapon, is handled as little as possible and set aside for packaging. None of these habits takes more than a few seconds.
What to Collect and How to Preserve It
Lynch and Duval (2011) group the evidence found in health care settings into physical items, trace evidence and documentation. The table summarizes the types most often encountered after a shooting or assault and how an emergency nurse should handle each.
| Evidence | Why it matters | Handling |
|---|---|---|
| Clothing | Shows entry points, gunpowder residue, blood patterns and trace material | Cut along seams avoiding holes; let wet items air dry if possible; package each item separately in a paper bag, never plastic |
| Projectiles and fragments | Can be matched to a weapon | Handle with gloved fingers or rubber-tipped instruments to avoid marks; place in a padded container, not loose in a specimen cup; label |
| Hands of a patient involved in a shooting | May carry gunshot residue | If law enforcement requests and care allows, cover with paper bags before washing |
| Swabs of bite marks or saliva | May yield DNA | Collect with a moistened then dry sterile swab, air dry, package in paper envelopes |
| Wounds | Pattern, size and location support reconstruction | Photograph with a scale before cleaning when the patient's condition allows; describe without labeling entrance or exit |
Two points in the table deserve emphasis. First, paper rather than plastic matters because moisture trapped in plastic encourages mold and bacterial growth that can degrade biological evidence. Second, nurses should describe wounds rather than interpret them. Deciding which wound is an entrance and which an exit requires expertise and is frequently wrong when attempted in the emergency department; a description of size, shape, margins and any surrounding soot or stippling is accurate and useful, while a wrong label can mislead an investigation.
Chain of Custody
Evidence is only useful if the court can be confident that it is the same item taken from the patient and that no one tampered with it. Chain of custody is the documented record of every person who handled an item, from the moment it was collected until it reached the laboratory or court. Each package should be sealed with tamper-evident tape, labeled with the patient's name and medical record number, a description of the contents, the date and time of collection and the collector's name, and signed across the seal. A chain of custody form records each transfer, with the date, time, reason and signatures of both the person releasing and the person receiving the item.
Breaks in the chain are common in emergency departments. Belongings bags left unattended at the bedside, items handed to a security officer without a signature, and evidence left overnight in an unlocked cabinet all give a defense attorney grounds to challenge the evidence. Federal protocols for sexual assault examinations set out the same principles for sealing, labeling, secure storage and documented transfer (U.S. Department of Justice, Office on Violence Against Women, 2013), and they apply equally to evidence from other kinds of violence.
Documentation
Documentation completes the evidence. The nurse should record what was collected, by whom, when, how it was packaged and to whom it was released, and should quote, verbatim, how the patient described the event. Photographs should be referenced in the chart and stored according to hospital policy. If law enforcement requests evidence, the nurse should follow hospital policy and applicable law on consent and release, which for an unconscious patient or a patient in custody may involve specific procedures.
Recommendations for a Department Without a Forensic Program
A community emergency department can improve evidence handling without hiring forensic specialists. It should stock evidence kits with paper bags, envelopes, tamper-evident tape, labels, chain of custody forms and a photographic scale in each trauma room. It should adopt a one-page policy covering clothing removal, packaging, storage in a locked location and transfer to law enforcement, reviewed by hospital counsel and the local police department. It should provide brief annual training, with a short simulation during trauma drills, and designate forensic champions on each shift. Finally, it should audit a sample of cases involving violence each quarter to check whether clothing was preserved, packages were labeled and chains of custody were complete.
Conclusion
In the first minutes of emergency care, nurses make decisions that determine whether evidence of violence survives. Treatment always comes first, but a few habits, cutting around holes, bagging items in paper, handling projectiles gently, photographing before cleaning and describing rather than interpreting wounds, preserve evidence without delaying care. An unbroken, documented chain of custody makes that evidence usable. For the patient in trauma bay two, these practices may be the difference between an unsolved case and justice, which is why forensic nursing's principles belong in every emergency department.
References
American Nurses Association & International Association of Forensic Nurses. (2017). Forensic nursing: Scope and standards of practice (2nd ed.). American Nurses Association.
Lynch, V. A., & Duval, J. B. (2011). Forensic nursing science (2nd ed.). Elsevier Mosby.
McGillivray, B. (2005). The role of Victorian emergency nurses in the collection and preservation of forensic evidence: A review of the literature. Accident and Emergency Nursing, 13(2), 95-100. https://doi.org/10.1016/j.aaen.2004.09.001
U.S. Department of Justice, Office on Violence Against Women. (2013). A national protocol for sexual assault medical forensic examinations: Adults/adolescents (2nd ed.). https://www.justice.gov/ovw/media/1367191/dl
How this N 560 Module 3 example is structured
Aspen does not publish N560 module prompts, so check your classroom for the exact instructions. This example opens with a trauma case, establishes that care comes first, sets out evidence types and handling in a table, explains packaging and wound description, defines chain of custody and where it breaks, covers documentation and closes with recommendations for a department without forensic specialists.
N560 Module 3 questions, answered
What does N560 Module 3 usually ask for?
The forensic nurse's bridging role is central to Aspen's N560 description, and a paper on recognizing, collecting and preserving evidence with a documented chain of custody is a typical early module. Check your classroom for the exact setting and focus.
Why should evidence go in paper bags rather than plastic?
Plastic traps moisture, which can cause mold and bacterial growth that degrade biological evidence such as blood and saliva. Paper allows items to breathe and dry.
Should a nurse identify entrance and exit wounds?
No. Nurses should describe each wound's size, shape, margins and surrounding marks. Labeling entrance and exit requires forensic expertise and is often wrong in the emergency setting.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.