FORENSIC PHOTOGRAPHY GENERAL TIPS 1. DO NOT USE CHEAP POLAROID CAMERAS. Polaroids are generally user-friendly
and can be good for investigations
but must get Polaroid Spectra law enforcement camera (approx. $250) or top-of-line Polaroid ($800). 2. RULE OF THIRDS V/hen taking pictures of injuries: First picture should be of subject,
ie take head— to —toe picture of individualV at4—Sfeet. • Second picture should be closer, focus

a little more on area of body whereV injury
is present. • Third picture should be close up of injury; use ruler or other scale for measurement purposes.

If ruler or scale covers area of body, also take picture • without the ruler.V 3.FILMVVV Need to use
a film with

a fast speed. Often difficult
to get elderly or DD population

to stay still long enough for
a good picture. Fast film speed will reduce distortion from movement. ISO 400 15 good all-purpose film speed. Use 12 exposure film for photographing most injuries. One filmlpatient. Don’t use leftover pictures for personal use; could compromise professionalism. Better to take leftover pictures of facility or site or just rewind film without using all of the film. If you knoW that you will be photographing
site and subject, may want to get 24 exposure.- 4. MEASUREMENTSV Always have

a ruler and tape measure. Get ruler that is plain, no advertisement. Tape measure can help to measure items in a resident’s room (ie determine

if bruise on leg is at the same height
as a table in the room and therefore could explain the injury). Use right angle scales/rulers
for bite wounds. Forensic dentists can re-create biteV pattern. ME offices know of forensic dentists.If ruler is not available, canuse: pencil (every pencil has Y2” metal piece onthe end of it by the eraser); coins, paper money. 5. 35mm CAMERAS DO NOT USE DISPOSABLES. Disposables only focus at 4 feet away. Can’t get close enough
to get
a good picture of injury. They are of no forensic usefulness. 35mm with fixed focus areof noforensic usefulness. Need to have one that has interchangeable lenses that can focus for close-ups. 5. LIGHTiNG If pictures are taken under

a flourescent light, they will have

a more greenish tint than actual color. Try to take pictures
in area without flourescent light. 6. DIGITAL CAMERAS Biggest problem with digital cameras

is that photos canbe altered, manipulated, enhanced. If using one,it should be at least 3.something megapixels. The CD ROM becomes the master negative. Always immediately make

a copy of the master negative. Leave themasternegativeuntouched. Use the copy of enhancements, printing, etc. In report, explain the software used to make changes, enhancements
and explain exactly what types of changes were made. You are representing that the picture

is atrue and accurate representation

of what • yousaw. Not necessarily wrong
to enhance photo
to represent more accurately what yousawbut always record exactly what enhancements were made and haveVmaster negative available
in original form. 6. CHAIN OF CUSTODYV Chain of custody of film orcamera

is important, especially with digital since the images can be altered.. Ask local police where they take film to be developed.

If you goto Wal-Mart type store for developing, make surethat developers know this is evidence for law enforcement purposes. Chain of confidentiality: must be maintained
by medical professionals
for medicalpictures,

ie Xrays, MPJ images, labs, etc. Also, photos maybe taken as part of diagnosis and treatment. Medical professionals don’t need to maintain chain of custody but do need to maintain

achainof confidentiality.

# 7. CONSENT TO PHOTOGRAPH For individual who is competent, say “Unless you object, I’m going to take your picture”, then dD it. If individual

is not competent, say same to family or guardian.
If refuse to consent, use body maps. 8. LABELING PHOTOS Use Avery laser gum labels (2” x 4”). Each label should contain the following information: Client name Client number Client DOB Date and time of photo Name of photographer Physical location and body part location Label should be placed on the back of the photograph.
Do not write on white bottom border of Polaroid picture, especially when picture

is still developing. The white part contains the chemicals needed for developing the picture. Writing on it can distort the picture. 9. LOOKING FOR AND PHOTOGRAPHING 

# INJURIES To try to determine where injuries are, sometimes have to rephrase questions

in order 

# to get response:
To find out if someone

is abusing resident, should ask in a number of ways: “is someone abusing you?” “is someone hitting you?” “is someone hurting you?” Individual may respond “no” to one or more of those questions but “yes” to one. What
is happening

to the individual and the response

to the questions

is dependent
on that in divi dual’s perspective/understanding. Strangulation injuries: often not visible or can be easily hidden under clothing/hair. Defensive posture injuries: bruises/lacerations/cuts,

etc

. 

# to the forearm Hair pulling: very effective way to control people. Can cause neck/spinal injuries, alopecia.
To demonstrate albpecia, comb through hair, take picture of comb with hair next to resident’s face. Injury with central clearing: individual

is hit so hard and with such force that the blood explodes sideways; point of impact

is blanched
or whitened while dark, bruised areas appear around the point of impact.Beinghitonthesideoftheheadmayproduceinjuries

tothebackoforbehindtheear.Difficult

toseeunlesslookspecifically.FORENSICS Injury Terms Abrasion:

A wound caused by rubbing
or scraping the skin or mucous membrane. ‘The location of the abrasion should give clues to mechanism

of injury (ie abrasions

to back indicate dragging along

a rough surface). An abrasion will have debris in the injury after incident that will give clues. This is called trace physical evidence. Nurses usually fail to document what’s found in the, abrasion and often clean the wound without looking
or documenting what’s
in the abrasion. Trace physical evidence will give clues as to how and where the person received abrasion,

ie carpet fibers, dirt, concrete. Fall down vs. found down: if fall is unwitnessed, nursing staff may document that resident fell down when in fact resident was “found” down. There
is a need to ‘clarify the nursing notes when
it states resident down to determine
if the ‘fall’ was witnessed

or if the resident was actually “found’ down. If the resident is found down, there is the need to try to determine how the resident got to the ground.- Avulsion: the tearing (chunking) away of a structure
or part. Often seen as a partial avulsion. Example of avulsion

is a skin tear. A skin tear results from blunt or shearing force trauma. Often,
it may be accidental but look at all circumstances (ie CNA fmds out she will have to work the weekend,

is an-y, goes to bathe resident while still angry, scrubs

a little too hard, causes skin tear). Bruise: blunt force trauma that results
in a superficial discoloration
due to hemorrhage into the tissue from ruptured blood vessels from beneath the skin surface without.. the skin itself being broken. Also called

a contusion. An individual may have an abrasion, avulsion and bruise in one injury but it is rarely documented that way. An investigator needs to ask whether any or all are present because each gives clues as to how the injury occurred. Contusion:

a bruise. Traumatic injury of tissue without breakage
of skin. Blood accumulates

in the surrounding tissue producing pain, swelling, tendemess, and discoloration., Discoloration process:

1. red 2. black andblue 3. blue-green 4. green-brown 5. brown-yellow 6. yellow
to fadeV/here

a bruise/contusion

is in the discoloration process gives clues as towhen the injury occurred. The elderly bruise faster and heal more slowly. Cut: see iucision. Distal trauma: Trauma
to the peripheries

of the body. Versus proximal trauma which is trauma
to the central or midline parts of the body. Proximal injuries are easier to conceal under clothing and therefore, such injuries are more likely to be present in abusive situations. Ecchymosis:

a hemorrhagic spot or blotch, larger than petechia,

in the skin or mucous membrane forming

a non-elevated
(no swelling), rounded
or irregular blue or purplish purpuric patch. This term is misused by medical and non-medical staff

9 times out of 10. It is often misused

asa synonym for
abruise or contusion. Ecchymosis

is usually not an injury from blunt force trauma.

It is often from spontaneous oozes that can occur in the elderly.
In the elderly,

it is found most often onarms and hands. However, ecchymosis and bruising can result from

aleak from another part of the body that has suffered trauma,
ie if an individual

is hit between the eyes, hemorrhaging
will not appear onthe areathat suffered the trauma but it will appear around the eyes. Certain medications
can put an individual

at greater risk for bruising and ecchymosis: aspirin (antiplatelet), warfarin (coumadin, anticoagulant), ibuprofen and ketorolac (NSAIDs), heparin (anticoagulant), vaiproic. acid and depakote (thrombocytopenia), prednisone (steroids). Routine handling of patients taking these meds can result in bruising.
If there is significant bruising, the individual should have blood labs drawn right away. Labs can provide clues onthe source of the bruising. Compare labs to baseline lab draws (pre-injury). The labs should include:. CBC with platelets; basic chemistries (CHEM-7, albumin, BUN/creatinine); liver function
(a bad liver will promote bleeding); coagulation panel (PT/PTT); urinalysis. Certain supplements can put an individual

at greater risk for bruising and ecchymosis: herbals (over 40 herbs can affect bleeding), bilberry (may prolong coagulation times), garlic (reduces coagulation), ginger (increases risk of bleeding when used concurrently with anticoagulants, bilberry,
or aspiin), gimko (increases risk of bleeding when used concurrently with anticoaulants

or bilberry). Incision:

a cut;
a wound made by a shar instrument

or object,
ie scalpel, knife, paper..

# Laceration:
The act of tearing
or splitting;

a wound produced
by the tearing andior splitting of body tissue often from blunt impact, usually over

a bony surface, that is distimguished from

a cut or incision. This term is often misused.

A laceration

is not
a 

# cutting injury.

11 usually has jagged edges. There
is often debris in.a laceration. Patterned injury:

an 

# injury where one is reasonably certain an object caused the injury, or certain which object caused the injury and/or by what mechanism

an injury was caused. Glove bums or sock bums are examples. Glove bums occur when hand is immersed

in hot water. Sock bums when foot is immersed

in hot water. Pattern of 

# injury: Injuries
in various stages of healing, including new and old scars, contusions, fractures, wounds. Petechia: minute, pinpoint, non-raised, perfectly round, purplish-red purpuric spot caused by intradermal

or sub-mucous hemorrhage, which later turn blue and yellow. (Plural
is petechiae; adjective

is petechial). Strangulation (not choking)

is most common cause of petechia. There are
3 types ofstrangulation:

1) Manual: hands or headlock used arOund neck; 2) Ligature: something

is tied around the neck, usually leaves

a mark;
3) Mechanical: example

is when head
is wedged into something. Other causes ofpetechia 1. Labor and delivery of baby; 2. Severe vomiting
or coughing; 3. Sneezing; 4. Constipation, straining duing BM Petechia occurs when there
is no blood to the brain (anoxia). The capillaries burst causing the spots (blood builds up because carotids are blocked). Puncture:
the act of piercing
or penetrating with

a 

# pointed object or instrument. Purpura:

a hemorrhagic rash with leakage of blOod into the tissue often associated with a bleeding
or clotting disorder. Diffuse purpura under the skin or mucous membrane

is eccbymoses while pinpoint purpura

is petechiae. Wound:

A bodily injury caused by physical means, with disruption
of the normal structures. Contused wound- 

# one which skin 5 

# unbroken Incised wound- 

# one caused by cutting instrument Lacerated wound- 

# one in which tissues are torn Open wound- 

# one having free outward opening Penetrating wound- 

# one caused by
a sharp, slender object that passes through the skin into tissueV