SOP ON FM CASES

 See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/283713130

Standard Operating Procedures for use in Clinical Forensic Medicine

Examination- S Janani, OPMurty

Article in Journal of Forensic Medicine and Toxicology · June 2012

CITATIONS

0

READS

1,757

2 authors:

Some of the authors of this publication are also working on these related projects:

Modular Teaching in Forensic Medicine and Toxicology - Series View project

Third Edition of Parikh's Colour Atlas -illusrated Atlas covering wide range of topics View project

Shanmugam Janani

9 PUBLICATIONS 18 CITATIONS

SEE PROFILE

Om P Murty

All India Institute of Medical Sciences, New Delhi 110029,India

213 PUBLICATIONS 939 CITATIONS

SEE PROFILE

All content following this page was uploaded by Om P Murty on 12 November 2015.

The user has requested enhancement of the downloaded file.

1

Journal of Forensic Medicine & Toxicology Vol. 29 No. 2, July - December 2012

ABSTRACT

Clinical forensic medicine includes a wide range of

procedures from examination of victims of injuries, sexual

assault victim/ accused examination, custodial torture

victims to much more. A wide range of clinical forensic

works are done by clinical specialists including the

medical, obstetric, surgical and orthopaedic experts.

Standardisation of reports, improving consistency and

quality of opinions prepared by experts will facilitate

better delivery of justice. Formulating standard operating

procedures for use in clinical forensic medicine is therefore

the need of the hour.

Keywords: Standard operating procedure; Clinical

forensic medicine; Protocol in forensic.

INTRODUCTION

Clinical forensic medicine refers to that branch of

medicine that involves an interaction among law, judiciary,

and police officials, generally involving living persons.1 It

includes a wide range of procedures from examination of

victims of injuries, sexual assault victim/ accused

examination, custodial torture victims and much more. With

developing awareness of Judiciary and the growing

complexity of crimes, expert opinions have become

mandatory for conviction of suspect. With growing

demands, it is also important that the procedures be

scientific, specific and accurate. Consistency and

repeatability increase the validity of any expert’s report

and opinion. The need for consistency emphasises the need

for Standard operating procedures. In clinical research, the

International Conference on Harmonisation (ICH) defines

SOPs as “detailed, written instructions to achieve uniformity

of the performance of a specific function”. SOPs get usually

applied in pharmaceutical processing and for related clinical

studies.2 SOP is a written document or instruction detailing

all relevant steps and activities of a process or procedure.3

To be effective, SOPs need to describe not only what needs

to be done, but who is qualified to carry it out, and under

what conditions the procedure can be performed

reliably.4This paper explores the possibility of having SOPs

in the field of Clinical Forensic Medicine and presents a

few examples for discussion and debate.

STANDARD OPERATING PROCEDURES FOR USE IN CLINICAL

FORENSIC MEDICINE EXAMINATION

S. Janani, O. P. Murty

1. Senior Demonstrator

2. Additional Professor

Department of Forensic Medicine and Toxicology

All India Institute of Medical Sciences, New Delhi - 110029

1.0 OBJECTIVE

To lay down protocols for use in the field of clinical

forensic medicine and thereby to ensure and enhance

consistency of medico-legal reports.

2.0SCOPE

This SOP will attempt to cover all types of cases handled

in clinical forensic medicine and devise protocols for them.

3.0PROCEDURE

3.1. Examination of victims of mechanical injury

3.1.1 Examination of victims of Assault- blunt object trauma

History

• Preliminaries- name, age, gender, address.

• Whether police was informed and report (FIR) prepared

at police station?

• Whether the victim was assaulted by a single person

or more than one person?

• Whether any weapon(s) used or assaulted with bare

hands?

• What kind of weapon was used?

• Was there a loss of consciousness, bleeding from ear,

nose, throat, dizziness, vomiting, respiratory distress,

abdominal pain, haematuria, difficulty in walking or any

other complaints?

• Who has accompanied the victim- relatives/police

person/unknown person?

• Whether the victim was taken to any other hospital

before being examined and intervention done/ report

prepared anywhere else?

• Is there a time lag between incident and examination

which could not be accounted for?

• In case of old injuries, was there any other trauma

between the assault and examination?

• Consumption of alcohol/ drugs?

Examination

• Site, size, shape, orientation, distance from anatomical

landmark, pattern, type of injury, signs of healing for

assessment of duration.

• Scalp: look for abrasions, contusions (swelling),

lacerations, petechial haemorrhages, etc (in instances

2

Journal of Forensic Medicine & Toxicology Vol. 29 No. 2, July - December 2012

of alleged hair plucking and pulling common among

females).

• Oral cavity for fracture/ dislocation of tooth.

• Examination for vision disturbances and hearing

defects.

• Chest and abdomen: signs of internal injuries with or

without external injuries, complaints of pain, tenderness

on examination, diffuse swelling, bruise, dyspnoea,

abdominal distension, rigidity and guarding of

abdomen.

• Peripheries: injuries on bony prominences, irregular or

pattern bruises, defence injuries, open or closed

fractures of long bones, deformities and dislocations

of joints.

• In pregnant females: signs of intra uterine/intraabdominal

bleed in the form of rigidity, guarding, loss

of foetal movements, drainage/bleeding per vaginum.

• Examination for loss of potency- injury to private parts/

lumbosacral injuries.

Investigation

• Radiography to rule out underlying fracture/

dislocation, haemo/pneumothorax/ air under the

diaphragm.

• Computed tomography of brain for intracranial bleed/

contusions.

• Ultrasonography of abdomen and pelvis for evidence

of collection of blood/fluid.

• Expert opinion for vision/ hearing defects.

• Blood, urine samples for alcohol/drugs.

Audit sheet

• Whether police was informed and report prepared at

police station?

• Whether the victim was assaulted by a single person

or a group of persons?

• Was it anticipated and defensive or unanticipated?

• What kind of weapon was used?

• Who has accompanied the victim- relatives/police

person/unknown person?

• Whether the victim was taken to any other hospital

before being examined and intervention done/ report

prepared anywhere else?

• Handedness of victim and suspect

• Consumption of alcohol/ drugs?

Examination

• Examination of clothes for cuts corresponding to

injuries over the body.

• Site, dimensions and depth (plane) of injuries, margins,

edges, surrounding tissues, active bleeding present/

absent, underlying neurovascular bundle damaged or

not, underlying tissues protruding or not, undermining/

bevelling if present.

• Whether single wound of entry (penetrating) or both

entry and exit (perforating) are present?

• In case of stab injuries- shape of injury, orientation

with the axis of the body, distance from anatomical

landmarks, distance from other injuries (in case of

multiple injuries), distance from heel of injured.

• Defence injuries in periphery: incised wounds/stabs

over forearm, arm, wrists, and hands.

• Diagrammatic representation.

Investigation

• Radiography to rule out underlying fracture/

dislocation, haemo/pneumothorax/ air under the

diaphragm.

• Computed tomography of brain to look for intracranial

bleed/contusions.

• Ultrasonography of abdomen and pelvis to look for

collection of blood/fluid.

• Doppler/ vascular studies to look for damage to vessels.

• Expert opinion for vision/ hearing defects.

• Blood, urine samples for alcohol/drugs.

Procedure Yes No

History elicited

Complete external examination

Appropriate investigation

Final opinion after investigation

Other expert opinion when needed

Referred to higher centre when needed

Nature of injury

Kind of weapon

Duration of injury

Blood sample for alcohol and drugs

3.1.2. Examination of victims of Assault- Sharp object

trauma

History

• Preliminaries- name, age, gender, address.

3

Journal of Forensic Medicine & Toxicology Vol. 29 No. 2, July - December 2012

Audit sheet • Sonography/ CT for damage of vital organs as needed.

• Saline swab around the entry wound for presence of

trace elements.

• Residue from hand/palm in suspected suicidal firearm

injuries.

• Retrieved foreign body for ballistic expert examination

and opinion.

Audit sheet

Procedure Yes No

History elicited

Complete external examination

Appropriate investigation

Final opinion after investigation

Other expert opinion when needed

Referred to higher centre when needed

Nature of injury

Kind of weapon

Duration of injury

Tract of the injury assessed

Injury compatibility with weapon

Blood sample for alcohol and drugs

Clothes examined

Clothes preserved and sent to FSL

3.1.3. Examination of victims of Assault- Firearm injury

History

• Date and time of incidence

• Whether firing was witnessed?

• Distance of firing, kind of weapon, number of times

fired if known?

• Position of victim at the time of firing

• Whether victim was stationary or mobile at the time of

incident?

• Whether there was associated blunt object/ sharp

object trauma associated?

• Scene of crime visited?

Examination

• Preliminaries

• Clothing examined for number of injuries, signs of

burning, blackening and tattooing, blood stains and

pattern of stain over clothes.

• General status, vitals of the injured.

• Description of injuries site, size, number, shape, depth,

distance from bony landmarks, distance from heel,

presence of active bleeding, differentiate between entry

and exit wounds, evidence of blackening, seinging of

hairs, scorching, tattooing, direction of blood spatter.

• In case of shotgun injuries, area of dispersion of injuries

noted or not?

Investigation

• Radiography to detect underlying fracture and radio

opaque foreign bodies.

Procedure Yes No

History elicited

Complete external examination

Appropriate investigation

Final opinion after investigation

Other expert opinion when needed

Referred to higher centre when needed?

Nature of injury

Kind of weapon

Range of firing

Probable mode of firing

Recovery of foreign body?

Samples preserved?

Duration of injury

Track of the injury assessed

Documentation

Blood sample for alcohol and drugs

Clothes examined

3.1.4. Examination of victims of Road traffic accident

History

• Date, time, place of accident.

• Was the injured pedestrian? If yes what kind of vehicle

hit? From which direction did the vehicle hit? Was the

pedestrian lifted from the ground? Was there a run

over followed by hit?

• Was the injured a two wheeler driver/ pillion rider?

Was he wearing a helmet? Was he thrown off the

vehicle?

• Was he driver/ front seat occupant/ rear seat occupant

of a four wheeler? Was seat belt worn? Were there air

bags in the vehicle? Was there ejection of occupant

out of vehicle?

• Any other vehicle involved- three wheeler/ heavy

vehicles?

• Who had brought the injured to the hospital?

• Any other medical conditions in the injured- vision/

cardiac disturbances?

4

Journal of Forensic Medicine & Toxicology Vol. 29 No. 2, July - December 2012

• Consumption of alcohol or drugs?

• Was crime scene visited?

Examination

• Preliminaries- name, age, gender, address.

• General condition, vitals.

• Injuries- type, location, dimensions, pattern of

distribution, nature of injuries, colour changes/

duration of injuries.

• Pattern injuries of tyres

• Other systems for medical conditions – vision.

Investigations

• Radiography/ sonography as needed to assess

severity of injury

• Blood/ urine sample for alcohol/ drugs.

• Photographs of pattern injuries.

Audit sheet

Procedure Yes No

History elicited

Complete external examination

Appropriate investigation

Final opinion after investigation

Referred to higher centre when needed?

Nature of injury

Duration of injury

Documentation

Blood sample for alcohol and drugs

Scene visited

3.1.5. Examination of victims injured by fall from height.

History

• Date, time, place of incident

• Alleged manner: suicidal jump/ accidental/ homicidal.

• Who had brought the injured to the hospital?

• Height of fall/ distance between the place where victim

hit the ground/ hit by intervening object while fall/

part which struck ground first.

• Any other medical conditions in the injured- vision/

cardiac disturbances?

• Consumption of alcohol or drugs?

Examination

• Preliminaries- name, age, gender, address.

• General condition, vitals.

• Injuries- type, location, dimensions, pattern of

distribution, nature of injuries, colour changes/

duration of injuries.

Investigations

• Radiography/ sonography as needed to assess

severity of injury

• Blood/ urine sample for alcohol/ drugs.

• Photographs of pattern injuries.

Audit sheet

3.1.6. Examination of victims of Child abuse

History

• History of present incident, from parent/ guardian and child.

• Past history of previous incidents.

• Discrepancies in history of parent/guardian and child.

• Developmental history of child, family history of similar

complaints.

• Family history: substance abuse in parents, psychiatric

illness in parents, broken families, single parents,

illegitimate and unwanted children, children born out

of previous marriages, etc.

• Previous history of hospitalization/ institutionalization.

Examination

• Age, gender, built, appearance, nourishment, hygiene,

clothes.

• Hair loss/ malnutrition.

• Eyes: subconjunctival hemorrhage, ear bleeding, ear

ache, rupture of tympanic membrane, bleeding from

nose, rupture of frenulum, tears in lips, loss of tooth.

• Injuries all over the body in different stages of healing

and deformities due to mal union/ non-union of old fracture.

• Private parts for injuries.

Investigation

• Whole body radiographs to look for older injuries,

healing and age of injuries.

Procedure Yes No

History elicited

Complete external examination

Appropriate investigation

Final opinion after investigation

Referred to higher centre when needed?

Nature of injury

Duration of injury

Documentation

Blood sample for alcohol and drugs

Scene visited

5

Journal of Forensic Medicine & Toxicology Vol. 29 No. 2, July - December 2012

• NCCT brain for intracranial hemorrhages

• Fundus examination for intra ocular bleeding.

• Photography of injuries.

Audit sheet

3.1.7. Examination of injured in Bomb blasts

History

• Date, time, place of incident.

• Number of persons involved

• Any projection of victim/ fall from height/ fall of heavy

object over victim/ entrapment.

Examination

• Preliminaries

• General condition, vitals.

• Triad of injuries: abrasion, contusion and laceration,

area of distribution, pattern of distribution, active

bleeding.

• Tattooing, seinging of hair, blackening, peeling of skin.

• Clothes examined for blood stains, tattooing, etc.

• Hearing analysis, tympanic membrane examination.

• Vision assessment, eye examination.

Investigation

• Whole body radiography for fractures, foreign body/

missiles.

• Sonography for hollow viscus perforation.

• Foreign body/ missile for forensic analysis.

• Crime scene visit.

• Photography.

Audit sheet

Procedure Yes No

History

Injuries

Pattern of injuries

Severity of injuries

Whole body radiography

Associated burns

Crime scene visit

Photography

Missiles for forensic analysis

Procedure Yes No

History

Past history

Family history

Injuries over body

Private parts injuries

Whole body radiography

3.2. Examination of victims of thermal injuries

3.2.1. Examination of victims of Flame burns

History

• Day, time, place of incident.

• Duration for which person remained in the fire, history

of falling masonry.

• History of causative agent of fire, any combustible

substance used, manner of fire.

• Type of cloth worn by victim at the time of incident.

Examination

• Mental status of the patient, vital signs.

• Clothing, area of distribution, depth of burns,

percentage of burns, sketch of area involved,

examination of scalp, face and body hair, signs of

inflammation in old burns and signs of secondary

infection.

• Associated injuries due to trapping in masonry.

• Respiratory disturbances due to CO inhalation.

Investigation

• Clothes, Burnt hair and cuticle for detection of

combustible substance.

• Photography of burns

• Scene of crime visit.

Audit sheet

Procedure Yes No

History

Surface area involved/ sketch

Depth of burns

Injuries over body

Clothes/ hair/ skin preserved

3.2.2. Examination of victims of Scald burns

History

• Day, time, place of incident.

• Substance causing burns: water/oil/other chemicals.

• Duration of contact with skin.

• Type of cloth worn by victim at the time of incident.

Examination

• Mental status of the patient, vital signs.

• Clothing, area of distribution, depth of burns,

percentage of burns, sketch of area involved, signs of

dribbling.

• Examination of scalp, face and body hair, signs of

6

Journal of Forensic Medicine & Toxicology Vol. 29 No. 2, July - December 2012

inflammation in old burns and signs of secondary

infection.

Investigation

• Clothes and cuticle for detection of chemicals.

• Saline swab for detection of chemical substances.

• Photography of burns lesions.

• Scene of crime visit.

Audit sheet

Procedure Yes No

History

Surface area involved/ sketch

Depth of burns

Clothes/ hair/ skin preserved

3.2.3. Examination of victims of Electrocution

History

• Day, time, place of incident.

• Source of current: domestic/ occupational/ others

• Type, strength, tension, resistance of current.

• Was there a contact? If yes Duration of contact?

• Was the scene wet or dry?

• Type of cloth worn by victim at the time of incident

Examination

• Mental status of the patient, vital signs.

• Entry wound, exit wound of electrocution (if any).

Number, site, size, location, surrounding area.

• Associated flash/ flame burns.

Investigation

• Photography of burns

• Scene of crime visit.

Audit sheet

Procedure Yes No

History

Surface area involved/ sketch

Depth of burns

3.3.1 Examination of Age estimation cases

History

• History of the case pertaining to which the person is

being brought for examination- kidnapping/ abduction/

theft/ assault/ sexual offence victim, accused/ disputed

age in job retirement, etc.

• Brought by whom? If female accompanied by whom?

• Approximate age as alleged? Any supporting

documents?

• Brought by parent/ guardian in case of children?

• Any accompanying medical conditions for which

under treatment- hypothyroidism/ acromegaly/

hypopituitarism/ osteogenesis imperfect/

achondroplasia/osteoporosis in old age.

• Family history of height abnormalities/ metabolic

conditions?

• Past history- History of trauma?

• Personal history- use of tobacco (teeth changes), past

surgeries

Examination

• Informed written Consent from person/ guardian.

• General examination- anthropometry (height, weight,

circumferences in children)

• Built (average, thin, heavily built), external appearances,

any abnormal facies, disproportion in the body parts,

associated congenital malformations.

• Skin changes, Appearance of creases, colour changes

in hair in older individuals.

• Changes in eye- cataract, arcus senilis, vision

disturbances in older persons.

• Secondary sexual characters- breast, pubic and axillary

hair development in female, body hair, voice change,

penis size and testicular volume in male.

• Oral cavity and tooth examination- eruption of tooth,

after eruption of all 32 teeth secondary changes in the

form of periodontosis, root resorption, cementum

apposition.

Investigation

• Radiography/Computed tomography of joints

appropriate to the suspected age.

• Expert dentist opinion in cases where needed.

Audit sheet

Procedure Yes No

History elicited

Available Documents examined

Consent taken

Complete external examination

Dental chart prepared

X ray taken

Final opinion of age after investigation

Documentation

7

Journal of Forensic Medicine & Toxicology Vol. 29 No. 2, July - December 2012

3.3.2. Examination of Female victim of sexual assault

History

• Detailed History of the incident pertaining to the date,

time, place, number of person involved exact nature of

the act.

• Whether associated Physical violence was there?

• Has the victim urinated/ defaecated/ douched/ changed

clothes after the incident?

• Menstrual history- age of menarche, details of

menstrual cycle.

• Marital history, history pertaining to pregnancy,

vaginal delivery and lactation.

• History of alcohol intoxication/ drug abuse in victim

as well as accused.

Examination

• Scene visit and photography as needed.

• Preliminaries- name, age, address, brought by whom?

• Consent by victim/ guardian as per case.

• General examination- built, height, weight, demeanor

and appearance (violent/ depressed), mental status

• Injuries over the body, abrasions and bruises over arms

indicating struggle, bruises over thighs, back, around

the oral cavity suggesting smothering, bruises and bite

marks over the body.

• Per vaginal examination: inspection for matting of pubic

hair, bleeding per vaginum, bruises over labia, tears in

fourchette, labia, vaginal wall, hymenal rupture, signs

of healed tear, signs of vaginal delivery- carunculae

myrtiformis, cervical/perineal lacerations.

• Speculum examination: with or without sedation/

anesthesia as per need. Tears in vaginal wall, cervix,

fornix.

• Per rectal examination: in cases of suspected anal

penetration for tears, bleeding. Anoscope/ proctoscope

as per need.

• Oral examination: in case of suspected oral penetration.

• Age estimation when needed.

Investigation

• Swabs for salivary stains from suspected bite sites.

• Swabs for semen from vaginal walls, introitus, cervical

os, anal opening, anal canal, buccal cavity according

to the case.

• Hanging drop preparation for motile sperms.

• Blood sample/ salivary sample for cross matching.

• Clothes for detection of blood/ semen.

• Loose hair for identification.

• Nail scrapping in case of struggle.

• Pregnancy tests to rule out conception.

• Vaginal/anal smears for sexually transmitted infections.

• Blood/urine for toxicology.

Audit sheet

3.3.3. Examination of Male victim of sexual assault

History

• Detailed History of the incident pertaining to the date,

time, place, number of person involved exact nature of

the act.

• Whether associated Physical violence was there?

• Has the victim urinated/ defaecated/ douched/ changed

clothes after the incident?

• History of alcohol intoxication/ drug abuse in victim

as well as accused.

Examination

• Scene visit and photography as needed.

• Preliminaries- name, age, address, brought by whom?

• Consent by victim/ guardian as per case.

• General examination- built, height, weight, demeanor

and appearance (violent/ depressed), mental status

• Injuries over the body, abrasions and bruises over arms

indicating struggle, bruises over thighs, back, around

the oral cavity suggesting smothering, bruises and bite

marks over the body.

• Per rectal examination: in cases of suspected anal

penetration for tears, bleeding. Anoscope/ proctoscope

as per need, signs of repeated anal penetrationsmoothening

of anal ridges, flattening of buttocks,

laxity of anal opening.

Procedure Yes No

History of incident

Menstrual history

Marital history

Consent

General examination

External examination for injuries

Examination of private parts

Swabs/ smears for semen

Hanging drop preparation

Blood/ urine for alcohol/drugs

Scene visit

Photography

8

Journal of Forensic Medicine & Toxicology Vol. 29 No. 2, July - December 2012

• Oral examination: in case of suspected oral penetration.

• Age estimation when needed.

Investigation

• Swabs for semen from anal opening, anal canal, buccal

cavity according to the case.

• Hanging drop preparation for motile sperms.

• Blood sample/ salivary sample for cross matching.

• Clothes for detection of blood/ semen.

• Loose hair for identification.

• Nail scrapping in case of struggle.

• Anal smears for sexually transmitted infections.

• Blood/urine for toxicology.

Audit sheet

Procedure Yes No

History of incident

Consent

General examination

External examination for injuries

Examination of private parts

Swabs/ smears for semen

Hanging drop preparation

Blood/ urine for alcohol/drugs

Scene visit

Photography

3.3.4. Examination of Accused of sexual crime

History

• Detailed History of the incident pertaining to the date,

time, place, number of person involved exact nature of

the act.

• Whether associated Physical violence was there?

• Has the person urinated/ douched/ changed clothes

after the incident?

• History of alcohol intoxication/ drug abuse in victim

as well as accused.

• Any associated psychiatric illness?

Examination

• Scene visit and photography as needed.

• Preliminaries- name, age, address, brought by whom?

• Consent by victim/ guardian as per case.

• General examination- built, height, weight, demeanor

and appearance (violent/ depressed), mental status

• Injuries over the body, abrasions and bruises

corresponding to incident narrated by victim.

• Loose hair/ fibers corresponding to the victim

• Private parts: development, matted/loose pubic hair,

smegma, urethral opening for inflammation, discharge,

bleeding, and injuries over shaft.

• Semen stains in undergarments/ clothes.

• Age examination when needed.

Investigation

• Urethral swab for vaginal cells, sexually transmitted

infections.

• Blood/ saliva for cross matching.

• Clothes for semen detection

• Blood/ urine for alcohol/drug abuse

Audit sheet

Procedure Yes No

History of incident

Consent

General examination

External examination for injuries

Examination of private parts

Swabs/ smears for semen

Blood/ urine for alcohol/drugs

Scene visit

Photography

3.3.5. Examination of Alcohol intoxication

History

• Detailed personal and social history- duration of

addiction, amount consumed on an average per day,

any associated addiction, medical illness, withdrawal

symptoms

• Medications to withdraw alcohol, history of

institutionalization/ de addiction.

• Occupation, travel, drug abuse, allergies.

• Associated mental illness/ treatment.

Examination

• Preliminaries: age, gender, marital status, address,

brought by whom?

• External appearance, clothing, personal hygiene, hair,

beard, tattoos, scars, wasting, malnutrition.

• External injuries

• Higher mental functions: consciousness, orientation

to time, place, person, talkative, slurring of speech,

depressed, violent

• Gait- normal, waddling, ataxic

9

Journal of Forensic Medicine & Toxicology Vol. 29 No. 2, July - December 2012

• Vision disturbances- blurring, diplopia, watering of

eyes.

• Eyes: conjunctiva congestion, pupillary dilatation,

response to light, direct and indirect pupillary reflex,

accommodation, nystagmus, cilio spinal reflex.

• Co-ordination- walk in a straight line, romberg sign,

finger nose test, finger nose finger test,

dysdiadochokinesia, speech disturbances, picking a

pen from the ground.

• Smell of alcohol from breathe and mouth.

• Any other condition which resemble alcohol

intoxication, head injury, metabolic disturbances.

Investigation

• Blood/ urine sample for alcohol estimation.

• Radiography/ sonography of associated injuries (if

any).

Audit sheet

3.3.6. Medical examination before sending to a person

Police custody/ Judicial custody

History

• Date, time of arrest, case for which arrested

• Any struggle at the time of arrest?

• Injuries sustained before arrest?

• Associated medical conditions/ illness?

• Person is under medications/ any addiction?

• Previous arrest/ medical examination done elsewhere?

Examination

• Preliminaries: age, gender, address.

• Identification marks.

• General status, vitals and gait.

• Marks of physical violence: abrasions, bruises in

various stages of healing, deformities, swelling, recent

scars.

• Marks of thermal and chemical violence: burns,

electrocution marks.

• Examination of private parts for injuries.

• Co-relation with previous examination findings.

Investigation

• Radiography/ sonography to assess severity of injury

as per need.

• Blood for alcohol/ drug abuse.

Audit sheet

CONCLUSION

Clinical Forensic Medicine is a growing branch of

Forensic Pathology. With increasing demands from the

Judiciary and legal authorities it has developed to become

a speciality in itself. Majority of the work are done by

Casualty Medical Officers without proper training in the

speciality. The decision of conviction of accused or

acquittal of hundreds of innocents is dependent on their

expert opinions. Focus and development of the speciality

is the need of the hour and devising protocols is the first

step towards improving performance and consistency of

experts. Consistency, specificity and scientific nature of

reports would aid in better aid of justice, which is the primary

goal of the speciality.

REFERENCES

1. Jason Payne James. History and development of

Clinical Forensic Medicine. In:Margaret.M.Stark,

Clinical Forensic Medicine, A physician’s guide. 2nd

Edition.New Jersey:Humana Press; 2005.p1-37.

2. McMurdo Station Medical Standard Operating

Procedures as of 2006/06.

3. Anderson, Chris. How To Write Standard Operating

Procedures, Bizmanualz, June 4, 2012.

4. Standard operating protocols (SOPs), http://

www.webguru.neu.edu/book/export/html/103

accessed on 12/8/12.

Procedure Yes No

History

Medical illness/ addiction

Identification marks

General examination

External examination for injuries

Blood/ urine for alcohol/drugs

Procedure Yes No

Personal history

Medical illness/ addiction

General examination

External examination for injuries

Higher mental functions

Smell of alcohol

Blood/ urine for alcohol/drugs

View publication stats