Transcript FORENSICS AND WOUNDS PREPARED BY ABU GHARBIEH …

MEDICOLEGAL
ASPECT OF
ER PRACTICE
PREPARED BY
ABU GHARBIEH MAZEN, MD.
EMERGENCY DEPARTMENT
MAKASSED HOSPITAL
JERUSALEM
•Palestinian laws
•Standard medical
practices
Obligate
ER
•Physician
•health care providers
ACT
patients
Interface
within the context of the
legal and justice systems
the state
CASES WITH
LEGAL ASPECTS
ASSAULT &
INJURIES
POISONING
What should ER health
Care providers know ?
Their duties
Rights of the
patient
Duties of Physician & health care providers
in ER
 Awareness of legal obligations.
 Recognize patterns of injury.
 Documentation of Observations.
 Processing evidences.
 History and data collection: patient & witnesses.
 Documentation of physical examination.
 Using diagnostic and documentary tools.
 Documentation of the injury by photography.
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Case reporting: to state social services or law
enforcement agencies.
 Death declaration.
RIGHTS OF THE PATIENT’S
1.
Respectful care.
2.
To know, by name, the physician responsible for coordinating
his or her care.
3.
To obtain from his or her physician complete current
information about diagnosis, treatment, and prognosis in
easily understandable terms.
4.
To receive from his or her physician information necessary to
give informed consent prior to the start of any procedure or
treatment. Except in emergencies.
5.
To refuse treatment to the extent permitted by law.
6.
To be transferred to another facility, providing the transfer is
medically permissible, and the facility has agreed to accept
the patient.
7.
To expect that medical information, will be communicated to
the referring physician.
8.
To privacy concerning the medical care program. Case
discussion, consultation, examination, and treatment are
confidential and will be conducted discreetly.
9.
The patient has the right to know in advance what
appointment times and physicians are available and where to
go for continuity of care provided by the Clinic.
Cases to be reported
1.
2.
3.
4.
5.
6.
7.
8.
Child and elderly abuse.
Domestic violence.
Suicidal cases.
Gun shot injuries.
Rape.
Illegal pregnancy.
MVA.
Infectious diseases:
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AIDS.
TB.
Meningitis.
Cholera etc.
9. Drug and narcotic abuse.
10. Mammals bite mainly rabies prone.
11. Unexplained death for any age.
PATTERNS
OF INJURY
Mode of
production
blunt force
electricity
sharp force
chemicals
missile
heat
components
1.
2.
3.
4.
5.
6.
7.
8.
Abrasion
Bruise (ecchym)
Contusion
Laceration/tear
Stab/cut
Bite
Burn
Missile
penetration
9. Strangulation
Wound
Description
circumstances
Homicidal
Accidental
Suicidal
MISSILE PENETRATING WOUNDS
Entrance wounds
Exit wounds
1
Circular, oval, or
triangular
Longitudinal
2
Circumferential rim of
abrasion
Do not sustain friction
damage
3
Presence of gunpowder Absent
4
Minimal bleeding
Large amount of bleeding
5
Smaller in size
Larger in size
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Physicians without forensic training should avoid giving any
opinion regarding a wound being an entrance or exit.
Identification of the site of the entrance and exit of a gunshot
wound path is an important step in the reconstruction of the
shooting incident.
Clothing soiled with gunpowder residue must be protected
and retained for collection by law-enforcement agencies for
analysis in the crime lab.
HISTORY EVALUATION
POISONING
NON – TOXIC
INGESTION
TOXIC
INGESTION
SUBSTANCE/S
ROUT
QUANTITY
TIME
AVAILABILITY
REASON
S/S &
TOXODROMES
LOCATION
Home/work
MEDICAL RECORDS
1.
Confidential.
2.
3.
4.
Subject of a legal proceedings.
5.
Cross-examine by the defendant or the accused.
6.
Physicians must recognize the legal responsibility
that society places on them and be prepared to
provide competent, professional testimony when
required.
Central part of the court deliberations.
Testimony from the physician that created that record.
6.
Should contains proper documentation & information.
6.
make the record more representative > use tools and
photos etc.
What do my medical records contain?
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Patient medical history (mainly patient’s own words).
Family’s medical history.
Lab test results.
Prescribed medications.
Details of patient’s lifestyle (which can include
smoking, high risk sports and alcohol and drug use).
Who holds and gives access to records?
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GPs.
Hospitals.
Social Workers.
Courts.
Law enforcing agencies.
Who can see patient’s medical records?

Patient.

Anyone who has patient’s written permission.
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Patient’s parent or guardian if they are under 16.
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A representative appointed by a court.
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After patient’s death >> his personal representative.
PRESERVATION AND COLLECTION OF EVIDENCE
 extremely valuable.
 Protocol > consultation with the local law– enforcement agency.
 The use of a simple envelope that enables a physician to:
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Identify the patient.
The date the evidence was recovered.
Where it was recovered from.
And to whom it was given.
Signed and sealed by the physician for its protection.
Use of an appropriate receipt form documenting the transfer
of this evidence.
Evidences to be collected and preserved
1.
2.
3.
4.
Weapons ( bullets, knifes etc ).
Wounds particles ( gun shot powder ).
Clothing.
Blood and other body materials. (evidence of sexual
assault).
5.
6.
7.
8.
9.
Gastric content.
Poisons and medications.
Photographs.
X – rays.
Notes & consultations.
REPORT OF DEATH

An important responsibility of the emergency physicians.
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Notification: local law-enforcement agency & attorney general.
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Case identification: those require an investigation of the
circumstances of the death.
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Determination: whether an autopsy is necessary or not.
Such deaths are generally those:
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individuals who die suddenly while not under the
immediate care of a physician.
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any death associated with some type of injury.
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suspicious or unusual death.
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It should be emphasized that:
1. the length of time a patient has been in hospital
2. the age of an injury associated with the underlying cause of death
Are not a factor in determining whether the death should be reported
to the law authority.
Legal aspect of CPR
Rescuers are
Volunteers
Rescuers are
Professionals
(Good samaritan)
CPR is part of their job
Protected
Not protected
(Gross mistakes)
CPR: WHEN TO STOP IT ?
1. The victim's breathing & heart beats begin on their
own.
2. Until other rescuers take over your effort.
3. Until you are exhausted & unable to continue.
4. Obvious signs of death are apparent.
5. A medical professional tells you to stop.
When not to start CPR
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Obvious signs of death:
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Dependent livido: black, blue or reddish discoloration of
the skin.
Rigor mortis: rigidity.
Algo mortis: low temperature.
Injuries that are incompatible with life.
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Threats to rescuers safety.
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Valid order of DNR ???.