By Kathleen Struck, Senior Editor, MedPage Today BOSTON -- In the aftermath of Monday's marathon bombing, emergency physicians here are tasked not only with saving lives but also saving evidence.
The challenges posed by that dual charge are daunting, but not impossible said Louis Alarcon, MD, of University of Pittsburgh Medical Center.
"We collaborate closely with forensic pathologists and law enforcement," said Alarcon, medical director of trauma surgery. "Our first priority is to save the patient's life -- life and limb over everything. Once we achieve those goals, we also have a strong duty to the evidence."
Oscar Guillamondegui, MD, of Vanderbilt Multidisciplinary Traumatic Brain Injury Clinic in Nashville, said that after treating the victim, "the next step would be to identify if there are foreign bodies, and in the case of a blast event, such as in Boston, that would be the shrapnel that remains within the tissue."
That ‘evidence’ should then be handled as any pathology specimen from a patient: It would be collected in the appropriate container, sealed, documented in the chain-of-command paperwork and sent to a pathologist who turns it over to the appropriate authorities, he said.
At Tufts Medical Center in Boston after Monday's marathon bombing, doctors worked with law enforcement to collect and save fragments of shrapnel that became projectiles with the force of the bombing, Robert Osgood, MD, told Boston's WBUR-FM.
Emergency physicians painstakingly search for bullets, metal, wood, plastic, or other substances that become projectiles in bombings or other events, Alarcon said. His hospital formalized that search with a standard process for evidence collection and preservation, a process so granular that it stipulates when plastic versus metal instruments should be used for collection
"You don't want to deform the object," Alarcon said explaining that plastic or rubber instruments are used when extracting metal fragments.
Once collected the evidence is wrapped in gauze, placed in sterile containers, and given an identifying lab number. The chain of custody is identified by carefully notating every person who comes in contact with the samples, he said.
The transfer of evidence from doctors to police is handled by the hospital's security staff, Alarcon said.
At Brookdale Hospital Medical Center in Brooklyn, N.Y., where roughly 300 patients are treated in the emergency department daily, the police typically oversee evidence collection, said Lewis Marshall Jr., MD, disaster medicine specialist.
But here, too, the bullets are carefully catalogued, photographed, bagged, and then re-bagged before being catalogued by the hospital's pathology department -- all before transfer to authorities.
"It should not be that the emergency room doctor takes the bullet and hands it to the police officer," he said.
"A bombing is a crime scene. We need to train people to understand that so if we prosecute the person who perpetrated the crime -- if we find that person -- the case will stand up in a court of law," Marshall said.
Kathleen Struck
Senior Editor
Kathleen Struck joined MedPage Today after serving as Managing Editor for EverydayHealth.com, Stars and Stripes and MediaNews Group. She lived and traveled internationally for more than 15 years and has written and edited for publications including, Washington Post, Baltimore Sun, Newsday and Regulatory Affairs Professional Society. At MedPage Today, she reports and edits on general news and information.
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