CSI: Fairview - Stabbings

The third crime scene I'd like to address is stabbings.  The "stabbing" call could actually be a cut, puncture, stab, slash, chop, clice, thrust or scrape, all of the above or none of the above. Like shootings, they are often very dynamic and charged scenes. While bullets differ mainly in size and velocity, edged weapons come in all shapes in sizes, and there is a huge variety of wounds that can be inflicted by them.

Many of the points from the CSI: Fairview - Shootings post apply to stabbings, but there are a few additional considerations.  Take a look to refresh your memory - I'll wait - and then we can explore the differences.

Again, hopefully you'll stage until law enforcement has arrived on scene and cleared the scene to the best of their ability.  You'll still want to enter carefully, scanning for evidence and not stepping in puddles of blood whenever possible.

It's nice to think you won't have to look as carefully for shell casings, but don't fall into that trap. It amazes me how many people think it's a good idea to bring a knife to a gun fight. It's also very important to note that shootings and stabbings are often confused for each other, either by the calling party, the call taking dispatcher, the radio dispatcher, or even the patient.

I think a lot of the problem lies with the person reporting the emergency. They may not hear shots and assume it's a stabbing, or they may have heard some loud noise and just assumed that stab wound is actually a bullet hole. The fight or flight response has a way of skewing people's perceptions and recall, so that's a factor, too. Further complicating matters is that the Emergency Medical Dispatch (EMD) code is the same - 27 - for both shootings and stabbings, as they're both penetrating trauma.

Don't assume that you don't have to pay attention to your surroundings just because the call came in as a _________ and not a shooting or other obvious crime scene.

So, being mindful of evidence as you approach, you size up your scene, evaluate your surroundings, and assess your patient.  If the butcher knife/ice pick/ninja sword is still penetrating the patient's body, secure it as you would any other impaled object.

I've heard of a paramedic intern (or rookie paramedic, or a stupid paramedic) who responded to a stabbing and found a large steak knife lodged in the unconscious patient's chest. Without thinking, he quickly pulled the knife out. When he realized that he'd breached protocol by removing the impaled object, he immediately replaced it in the original wound in the patient's chest. That's right - the paramedic stabbed his own patient. Since the patient would have died no matter what, the paramedic only got a slap on the wrist.  Now, this is almost certainly an urban legend - very non-specific details coupled with very specific details never strike me as believable - but it illustrates the point well. Don't remove any impaled objects that you don't need to. The chances that you'll need to are very rare indeed.

Anyhow, that little digression aside, let's continue.

If the weapon is no longer embedded in the patient but it is on scene, try to obtain a description of it. Again, the weapon is evidence, and you should not disturb it without the knowledge and consent of the law enforcement officers on scene. While a description is great, a picture can be very helpful too. A picture of a knife may or may not indicate scale, but a picture of a knife with a ruler or other common object next to it for scale - quarter, dollar bill, trauma shears, etc - paints a much more accurate picture for the hospital staff. If your agency prohibits taking pictures, don't do anything that risks you getting fired though.

If the assailant fled with the weapon, you may be able to ask the patient what the weapon was.  The wound itself may give you an idea of how big the weapon was, but not necessarily. It will likely be impossible to tell how deep the wound is.

Remember that the patient may be altered or otherwise combative, and remember that the patient might not be an innocent victim. Watch the hands, and check for weapons.

It's important to again point out that the patient may be suffering from more than one wound, so do a complete and thorough physical exam. Remove the clothing carefully, and don't cut through any puncture holes if at all possible. Keep the clothes together, and don't dispose of them at the hospital.

My earlier points about patient statements being important evidence are still applicable, so be sure to accurately document the patient's description of the weapon, assailant and circumstances. You'll probably remember the guy attacked by a ninja sword for the rest of your life, but the guy that was stabbed by a pocket knife may not be as memorable. Both runs could land you in court, though, so be sure to document thoroughly.

So to recap: treat your patient appropriately and professionally while maintaining vigilant situational awareness, preserving the evidence and thoroughly documenting the circumstances.  It may be easier said than done, but it gets a lot easier with practice.

Again, this isn't all-inclusive, and I welcome input from other responders. Whether you're a stockbroker whose only public safety experience is getting stopped for speeding and watching Third Watch reruns or fire chief/SWAT medic/Navy SEAL/dog catcher/paperboy, the odds are that you've got good ideas and a different perspective than me, so let me hear it.

Stay safe out there...