CSI: Fairview - Assaults

The fourth crime scene I'd like to address is the assault (it should really be called battery, but that's a whole different blog post). Assault calls can actually be shootings or stabbings, but typically they come in much more innocently. While shootings and stabbings are definitely assaults, you'll typically be looking at a hand-to-hand combat situation or a blunt trauma injury. Like shootings and stabbings, your patient's (and bystanders') emotions will probably be running high and there are a lot of issues to consider.

Once again, stage until the scene is as secure as it can be. Enter carefully and preserve as much evidence as possible. Search for weapons and all that fun stuff.

So as you scan for evidence and evaluate the scene, approach the patient and conduct the initial assessment. Assaults frequently involve the use of alcohol, so you may need to brush up on your Drunkenese to conduct a thorough assessment.  Also keep in mind that the story you get may not necessarily be the truth, as the assailant and victim know each other much of the time. Especially in the case of domestic violence or family fights, the victim may downplay their injuries in an attempt to lessen the consequences for the perpetrator.

Shootings and stabbings are felonies and the detectives will conduct a very thorough investigation. Most assaults are misdemeanors, though, and the investigation will likely be conducted by a uniformed officer. The officer also has a great deal of discretion when dealing with misdemeanors, so the attitude test will have a huge impact on how things go down arrest-wise. There are three big exceptions here: the first is domestic violence, as many jurisdictions have a mandatory arrest provision; the second is aggravated assaults, which can often be charged as felonies; and the third is sexual assaults.

Many patients know that their version of the story can make the perpetrator's consequences greater or lesser, and they may change their story to some degree when giving a statement to the police. They often will then give a slightly more honest account to fire/EMS if the cops are out of earshot.

The type of weapon is an important piece of your puzzle. In my Nailed It! post, I quickly learned that a 2x4 can easily be modified to inflict grievous injuries, so it always pays off to take a second and take a look at the weapon if you can. Again, pictures can paint a great picture for the docs and nurses at the emergency department, but don't get yourself in trouble if your employer prohibits them. Also, don't take the weapon from the scene.

Speaking of pictures, the law enforcement officers on scene will likely want to take a picture of the patient's injuries prior to treatment and transport, and as long as that doesn't negatively impact the patient it's best to accommodate that.

The patient's injuries may be very superficial, and the pictures that the cops want to take could very well be the only physical evidence that the prosecution will have available if the case makes it to trial.

In a 'simple' assault, the mechanism of injury is typically a hand inflicting a punch or a foot inflicting a kick. Sometimes there will be bites. There could also be a shove, resulting in contact with a wall, furniture, the floor or the ground. Even a single blow can cause devastating injury, so be sure to be thorough in your assessments.

In these cases, you'll want to determine the size and physical capabilities of the assailant. A 5'9" 170lb MMA fighter possesses a much greater potential for inflicting serious injury than a 5'4" 170lb housewife, so try to get a well informed idea of the aggressor's potential to cause injury.

In the aggravated assaults/assault with a deadly weapon/assault with intent to cause great bodily harm calls, the greater injury/potential for injury allows for felony charges to be filed, and weapons are typically involved.

The weapons in more serious cases can range from brass knuckles and beer bottles to baseball bats and lamps. Furniture and even vehicles can be weapons, too. People can be very creative when it comes to hurting each other.

Just because there aren't bullet holes in the patient's clothing doesn't mean there's no evidence potential. Ripped or torn clothing can still be important evidence, and in the event that you need to remove clothing to treat the patient, do so very careful and avoid cutting through the rips. Don't dispose of the removed clothing.

Clothing will be extremely important evidence in the case of sexual assaults, so do your best to minimize any disturbance of the clothes. If the patient is wearing the same clothes that he or she was assaulted in, there is a very high probability that valuable forensic evidence is on the clothing. While the patient will probably want nothing more than to shower and put on fresh clothes, such actions will destroy a huge amount of that evidence. Do your best to attend to the patients physical and emotional needs, and try to convince them to remain in the clothing.

Especially in the case of head injuries, the patient may be altered or otherwise combative. Remember too that the patient might not be an innocent victim - they could be the perpetrator. Watch their hands, and be cautious of weapons.

Again, the patient may be suffering from multiple wounds, so the importance of a thorough physical exam cannot be stressed enough.

My earlier points about patient statements being important evidence still apply, so be sure to accurately document the patient's account of the circumstances, perpetrator and weapon, if applicable. Document everything else thoroughly as well.

The common theme throughout the CSI: Fairview series has been, and will continue to be, this: treat your patient appropriately and professionally while maintaining vigilant situational awareness, preserving the evidence and thoroughly documenting the circumstances.

Put it into practice on each and every run, and it'll soon become second nature.

If you have anything to add, I welcome your input.

Be safe!