Recognition, Collection, and Preservation of Forensic Evidence by Perioperative Nurses in Trauma Patients: A Scoping Review
This scoping review highlights that while forensic evidence management is well-studied in emergency and sexual assault settings, perioperative nursing remains under-researched despite the critical risk of evidence loss during trauma surgery, underscoring the urgent need for specialized protocols, education, and further research to standardize evidence recognition and preservation in the operating room.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When a person arrives at a hospital with a severe injury from a fight, a shooting, or a stabbing, the medical team faces a dual mission. Their primary duty is to save a life, cutting away clothing, cleaning wounds, and removing dangerous objects to stop bleeding and repair damage. Yet, the very items they remove or the way they clean a wound can hold the key to solving a crime. A bullet fragment, a piece of fabric, or the pattern of blood on a shirt can tell a story about what happened before the patient ever reached the hospital. In the legal world, this physical information is called evidence. For that evidence to be useful in a courtroom, it must be handled with extreme care from the moment it is found until it is presented in court. This careful handling is known as the chain of custody, a continuous record that proves the item has not been tampered with, lost, or contaminated. If a nurse cuts a shirt with scissors that have touched a bullet, or if a wet garment is sealed in a plastic bag that causes mold to grow, the evidence can become useless, and a case might collapse.
Surprisingly, while the importance of protecting evidence in emergency rooms and for victims of sexual assault is well known, the operating room has remained a blind spot in research. This is the place where the most critical, life-saving interventions happen, and where the risk of accidentally destroying evidence is highest. A new review of existing literature, conducted by researchers Burcu Özkan and Esra Eren, sets out to map exactly what is known about how nurses in the operating room handle these delicate situations. The team did not conduct new experiments or interview patients; instead, they gathered and analyzed every available study, report, and expert guide from around the world that touched on this specific topic. They looked for any document that discussed how nurses recognize, collect, and preserve physical evidence during surgery for trauma patients.
The researchers searched through six major scientific databases and a Turkish national archive, casting a wide net to find any relevant information. They started with 375 records, which is a large collection of documents, but after removing duplicates and screening out articles that did not fit their specific criteria, they were left with just 16 sources to study in depth. These 16 sources included expert guides, practice recommendations, and a small number of actual studies that measured what nurses knew and did. The findings revealed a stark reality: the operating room is a high-stakes environment where evidence is frequently at risk, yet there is very little solid research to guide the nurses working there. Most of the available information consists of expert opinions and guidelines rather than data collected from real-world practice.
The review highlighted that the types of evidence most commonly discussed are bullets, bullet fragments, and gunshot residue, followed by clothing that may be stained with blood or other biological material. The literature agrees on several basic rules for handling these items. For instance, metal tools like forceps should never be used to pick up a bullet, as they can scratch the surface and ruin the ability to match the bullet to a specific gun. Instead, plastic or rubber-tipped tools are recommended. Similarly, wet clothing should be air-dried and placed in paper bags, never plastic, because plastic traps moisture and can destroy DNA. Despite these clear recommendations, the studies included in the review showed that many nurses and doctors lack the training to follow them. One study from Turkey found that more than half of the medical staff had never received any training on forensic evidence, while another study from South Korea showed that even when nurses knew the rules, they often failed to apply them in practice.
The researchers also found that when hospitals do create specific, written protocols for handling evidence, the results are significantly better. One study described a pediatric trauma center that implemented a new system for managing ballistic evidence. Before the new system, many pieces of evidence were lost or left unclaimed for years, with a median delay of nearly four years before they were handed over to police. After the new protocol was introduced, every piece of evidence was delivered to law enforcement within two weeks. This single example suggests that structured procedures can make a massive difference, but the review noted that such proof is rare. Most of the guidance currently in use comes from experts who have developed these rules based on experience rather than from large-scale studies that compare different methods.
The authors of the review conclude that while the operating room is a critical point for preserving evidence, it remains an under-researched area. The gap is not just in the United States or Canada, where forensic nursing is more established, but also in other countries, including Turkey, where the national literature on this specific topic was found to be almost non-existent. The review suggests that the solution lies in three areas: creating clear, standardized procedures for every hospital, integrating forensic training into the education of operating room nurses, and conducting more research to test which methods work best. Until these steps are taken, the risk remains that the very people dedicated to saving lives may inadvertently destroy the clues needed to bring justice to the victims they treat. The work of these researchers serves as a call to action, urging the medical community to recognize that saving a life and preserving the truth are not separate tasks, but two sides of the same coin that must be handled with equal care.
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