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Firearm evidence and the roles of the ER nurse and forensic nurse
Steven A. Koehler, MPH, PhD
Forensic Epidemiologist, Associate Professor, Forensic Science Program, Point Park University, Pittsburgh, Pennsylvania

Correspondence Steven A. Koehler, MPH, PhD, Forensic Epidemiologist, Associate Professor, Forensic Science Program, Point Park University, 201 Wood Street, Pittsburgh, PA 15222-1984. Tel: 412-487-2531; E-mail:

doi: 10.1111/j.1939-3938.2009.01030.x

Homicide is the 15th leading cause of death within the United States with a total of 18,124 deaths in 2005 (Kung et al., 2008). Homicides involving the use of a rearm comprised 12,352 or over 68% of the deaths. A number of these victims make it to the emergency room (ER). The ER nurses and forensic nurses who interact with these types of patients, aside from rendering medical care, also play an important part in the identication, collection, and persevering of forensic rearm evidence located on the body and clothing. Individuals who present with rearm-related wounds could have been self-inected (suicide), shot while hunting or from a discharge while playing or cleaning the rearm (accident), or due to the deliberate action of another (homicide or attempted homicide). This paper will provide some basic rearms information, features of varying types of rearm wounds, and the steps nurses can perform to preserve forensic rearm evidence.

shows some of the features of the four type of rearms (DiMaio, 1999).

Forensic rearm evidence on the body

The body of a rearm-related shooting victim contains forensic evidence that must rst be identied, documented, persevered, and then collected. The ER or forensic nurse should possess the basic understanding of how to recognize an entrance wound caused by a rearm and the methods to document and preserve rearm-related forensic evidence. When an individual is shot the bullet will pass through the skin and produce an entrance wound; it may exit the body (exit wound) or remain lodged within it. When a bullet passes through the skin it produces a cavity and shearing, compression, and stretching to the surrounding tissue. The size and shape of the cavity is a function of the kinetic energy of the bullet. The entrance wound is surrounded by a reddish or reddish-brown zone of abraded skin called the abrasion ring. The abrasion ring is caused when the bullet rubs the edges of the hole as it indents and then pieces the skin. Around the entrance wound may be soot, tattooing, or powder residue. Only the entrance wound will display these markers (DiMaio, 1999). Once an entrance wound has been identied photographs should be taken. Telltale physical markers at the entrance site are used to determine if the shooter was:

Basic rearm information

There are four basic types of rearms: revolver, pistol, shotgun, and rie. Revolver and pistol are typically referred to as handgun, while shotgun and ries as long ries. The basic differences between the four types of rearms are the number of rounds they carry, the rate of re, features of the barrel, and their function. Table 1


Journal of Forensic Nursing 5 (2009) 4648 c 2009 International Association of Forensic Nurses

S. A. Koehler

Firearm evidence and the roles of the ER nurse

Table 1 Basics features of the four type of rearms Type of rearm features Example Capacity (Rounds) Use Anatomy of the Bullet Revolver Smith & Wesson.45 6 Protection Primer Propellant Bullet Land and grooves Pistol (automatic) Lugar 9 mm 1020 Protection Primer Propellant Bullet Land and grooves Shotgun 12 Gauge 5 Hunting Primer Propellant Wad Pellets/slug Smooth Rie 3030 510 Hunting Primer Propellant Bullet Land and grooves Assault rie AK-47 >30 Military Primer Propellant Bullet Land and grooves

Barrel Composition

(1) in a direct contact, (2) in a close proximity, or (3) at a signicant distant from the victim (DiMaio, 1999). The physical characteristics of these three types of shots are described in Table 2. Soot is due to ne carbon particles around the entrance wound and can be wiped off the skin early. Therefore, care should be taken when working around an entrance wound; limit the amount of handling around the wound site and the area should not be washed. Tattooing is due to coarse particles of unburned and partly burned powder being driven into the skin which cannot be wiped off (Spitz, 1993). Nurses should document the location, measure the wound, and the diameter of spread of the soot and or tattooing in their nursing notes. A sketch of the wound and the surrounding tissue would be benecial. During the physical examination of the patient the bullet may, if close to the surface, fall out of the body. The bullet should be placed in a small paper envelope or a small box and sealed. At no time should the bullet come into contact with another metal surface such as metal forceps or cleaned. Follow the chain of custody protocol described below. When a handgun is red, exiting the barrel is the bullet, unburned and partially burned powder (propellant), and small amounts of the components of the primer (barium, antimony, and lead) called Gunshot Residue (GSR). GSR can deposit on the hands of an individual under three conditions: (1) he or she red the handgun, (2)

he or she handed a recently red handgun, or (3) he or she was in very close proximity when a rearm was red (James & Nordby, 2005). Nurses should carefully examine both hands and document the exact location (posterior, anterior surface) on the hands and on each nger, areas that display a black-or dark-pigmented deposit. In cases where the victim dies while in the ER the hands should be protected by placing paper bags over each hand and then securing them. This will prevent the loss of any trace evidence and prevent cross-contamination. Nurses should contact their local ME/C ofce to receive specic instruction as to how to perform this task.

Forensic rearm evidence on the clothing

The clothing worn by the victim is another key piece of forensic evidence. It provides landmarks for the point of entrance and exit, it may contain GSR evidence, and it may contain trace contact evidence transferred from the actor to the victim. Therefore, the following steps should be taken to preserve the forensic value of the clothing and thereby permit future forensic examination and admissibility of that evidence into court. First, if at all possible prevent the cutting through of the possible entrance and exit holes within the clothing. Second, if

Table 2 Characteristics of entrance wound by distance Distance of barrel from skin Muzzle impression on skin Yes No No

Wound type

Particles of the primer



Powder residue

Contact Against the skin Close 18 inches from the skin Distant 18 inches from the skin

Located inside the body Location inside the body Location inside the body Location inside the body Disposed around the Disposed around the Disposed around the Disposed around the entrance wound entrance wound entrance wound entrance wound No No No No


Firearm evidence and the roles of the ER nurse

S. A. Koehler

the clothing is not removed take photographs highlighting the holes and blood splatter patterns and remember to include a scale. If the clothing is removed carefully wrap the clothing in something close to sterile, then place it in a paper bag and seal it with tape and then write the time, date, and your signature. If you know the victims name add it to the bag; if not, then write, clothing from possible shooting victim; a black male age approximately 22. This item then must be placed in a secure location such as a cabinet or locker for which only a superior possesses the key. This evidence bag can also be transferred to either hospital police, local police ofcers, or in the case of death to the death investigators from the Medical Examiners or Coroners ofce. Remember to sign a Chain of Custody Form during the transfer. The same procedure must be followed for recovered bullets listed above. A failure to properly protect the

clothing and follow a chain of custody protocol may result in legal challenges to the admissibility of the forensic evidence due to claims of possible tampering, contamination, or substitution of the presented evidence.

DiMaio, V. J. (1999). Gunshot wounds. 2nd ed. Boca Raton, FL: CRC Press. James, S. H., & Nordby, J. J. (2005). Forensic science: An introduction to scientic and investigative techniques. 2nd ed. Boca Raton, FL: Taylor & Francis. Kung, H. C., Hoyert, D. L., Xu, J. Q., & Murphy, S. L. (2008). Deaths: Final data for 2005, National vital statistics reports; vol 56 no 10. Hyattsville, MD: National Center for Health Statistics. Spitz, W. U. (1993). Medicolegal investigation of death. 3rd ed. Springeld: Charles C. Thomas Publisher.