TABLE 127.3 GUIDELINES FOR FORENSIC EVIDENCE COLLECTION General Obtain consent to collect forensic evidence in adolescent sexual assault cases Refer to your state and institutional consent requirements for forensic evidence collection Instruct patient not to wash, brush teeth, change clothes, urinate, defecate, smoke, drink, or eat until evaluated by examiners, unless medically necessary Wash your hands and wear gloves Use a photo documentation system to document physical findings a The first photograph should be that of the child’s ID label with full name, date of birth, and medical record number b Take as many photographs as needed to document examination and findings/injuries c Document each injury separately with ruler/color guide in photographs Complete anatomical diagrams from evidence collection kit to document findings including location, size, and appearance Initial debris and clothing collection Debris collection: Carefully inspect patient’s head, hands, and other all exposed skin surfaces, as well as outer surface of clothing, for any loose debris including hairs, grass, leaves, fibers, threads, etc Using one piece of clean white copy paper carefully remove the loose material and place it inside the unfolded paper Refold paper to retain material; indicate location on patient’s body or clothing from which material was collected Repeat as necessary Place folded paper into envelope marked “Miscellaneous,” seal, and label envelope as indicated Clothing collection: Spread clean sheet on floor, place large paper sheet from “Foreign Material” envelope in the middle of the cloth sheet Have patient stand in the middle of the sheet and remove clothing one piece at a time, careful not to shake the clothing If caregiver or nurse is helping the patient, advise them not to stand on the sheet with the patient Ask the patient to remove one article of clothing at a time If the article of clothing has wet stains of potential biologic material (blood, saliva, semen, etc.), lay flat to dry Place each article of clothing in a separate paper bag, labeled with patient identification sticker, biohazard label, date, time, and forensic examiner’s initials a Underpants and/or diapers should be collected even if they are not the pair worn during or immediately after the incident Vaginal secretions may accumulate, even if the patient has bathed or showered b Collect all clothing if worn during assault or immediately after assault If patient is not wearing the same underwear from the assault, the examiner should inquire about the location of the garment and instruct patient or family to save the garment for law enforcement (ideally unlaundered in a paper bag) Physical examination evidence collection Skin surface assessment: Carefully perform a visual inspection of the patient’s external skin surfaces Locate, describe, and photograph any evidence of trauma or adherent foreign matter Use a ruler if available a If areas of dried secretions are noted on external skin surfaces, document findings on anatomical diagrams Secretions collection: Prior to any swabs or evidence collection, an alternative light source should be utilized in a dark room over the patient’s entire body If there is a positive finding (fluorescent specimen), a sterile swab moistened with sterile water should be used to swab area Allow to air dry Place in “Debris or Miscellaneous” envelope—noting where specimens were collected a Use extra swabs to collect specimens if needed Be sure to label the “Debris or Miscellaneous” envelopes carefully to what evidence is inside and where it was obtained Bite mark evidence: Document location of bite mark(s) on anatomical diagram form and, where possible, photograph the bite mark with and without scale With two premoistened swabs, simultaneously rub swabs over area of potential/actual bite mark in order to collect any dried saliva left by the offender Examination of hands: Carefully inspect dorsal and palmar surface of hands for any signs of trauma Document all findings on anatomical diagram Swab only fingernails if there are dried secretions, if so, follow directions for dried secretions Oral swabs: Open the swab packet from the envelope marked “Oral Swabs,” grasp both swabs together by the shaft, and swab the area between the patient’s cheek and gum, and behind the back molars on both the maxilla and mandible a Mucosal membranes swabs not need to be moistened 6 Genital inspection: Carefully inspect entire external genital area for signs of trauma Use colposcope or other photo documentation system to examine for injuries Document findings, including size, shape, color, and location, on anatomical diagrams of genitalia Pubic hair combings: Remove paper fold from envelope marked “Pubic Hair Combings.” Ask patient to sit on unfolded paper so that the paper protrudes between the thighs; comb downward on pubic hair to dislodge any debris or loose hairs onto the paper Place comb on paper and fold paper to retain debris; place paper in the envelope marked “Pubic Hair Combings,” seal, and label as indicated Perianal swabs: Carefully evaluate the anus and buttocks for signs of injury Document positive findings on gender-appropriate anatomical diagrams Using two moistened swabs simultaneously, gently rub swabs on anal folds and anal opening Dry completely and place in the envelope marked “Perianal Swabs.” Rectal swabs: After external anal swabs have collected, the anal area should be cleansed by wiping carefully with a moistened gauze pad Simultaneously insert two sterile cotton swabs approximately cm into the rectum and swab rectal walls Remove swabs, avoiding contact with the external anal tissue Dry completely and place in the envelope marked “Rectal Swabs.” 10 External genital swabs: Use swabs in external genital envelope For male patients, wipe the surface of the glans and shaft; for female patients, wipe the inner surfaces of the labia minora with a downward motion After drying, place in a marked envelope 11 Vaginal swabs: Using two swabs simultaneously, collect secretions from the vagina near the vaginal fornix (area below the cervix) 12 Cervix swabs: If indicated, obtain using two swabs simultaneously to collect secretions from cervical os This step should be performed only with the use of a speculum to ensure visualization of the cervix and thus is not performed in prepubertal children unless under anesthesia Dry completely and place in envelope marked “Cervix Swabs.” a If using a speculum for cervical examination, after evidence is collected, use the NAAT swab to obtain specimen for STIs 13 All tampons, pads, pantyliners should be collected and dried Once dry, place in the “Miscellaneous” envelope