Training EMS to Go Beyond the Basics in Crime Scene Etiquette

The observations of EMS responders are unique among crime scene personnel and can determine the course of an investigation, attendees heard at EMS Expo/Enforcement Expo Southeast in Atlanta, Ga. last week.

Presenter Beonicia Loveless, Medical Examiner Investigator and Child Abuse Investigator for the State of Georgia Bureau of Investigation, went beyond the routine advice in her presentation, "Crime Scene Etiquette for EMS."

Most responders already know the basics -- to try not to disturb blood spatter or cut through bullet holes, etc. "We're talking more subtle stuff," Loveless said. The session drew a mixed audience of EMS and law enforcement personnel and gave each side insight into how the other operates and how to bring their knowledge together.

The following advice is aimed at EMS responders, as well as officers to bring home to their local EMS response agencies.

The EMS Responder's Experience

Loveless qualified her recommendations by stating that the patient's concerns always come before those of the investigation. "By all means do what you have to do to bring them back," she said. "But if you can take notice of certain details and include them in your report, it could impact the cause of death determination," she said.

Loveless detailed how EMS personnel see a side of the incident that no one else will.

For one thing, "You may be the only person to see the inside of that house," she said. Even if investigators come back later, they may not see the scene as it existed before cleanup, etc.

Also, EMS is often the first to talk to anyone on the scene. This is an invaluable experience because those on scene are in the heat of the moment, are full of adrenaline, and have not had a chance to think through their story.

"The information you're getting from the family is generally very frantic, and very typically may be much more truthful than the information I get when they've had a chance to compose themselves," Loveless said.

It's invaluable if responders can document who said what, and perhaps prompt for further details. Loveless suggested non-alarming questions such as when the illness or injury occurred and who else has been around the home. If it's practical to talk to more than one person this is helpful

When stories change as told to later investigators they call it, "The shifting sands of the guilty mind," Loveless said. "...You are the first person we can actually trust that gets the story."

Infant Death

This is an area where responders can provide particularly invaluable insight, Loveless said.

When a baby dies, "If it's not something that's obvious you should immediately be thinking this is homicide," she said. This is statistically most likely, at least in Georgia, she said.

Loveless explained the difference between true SIDS cases and sleep-related infant deaths where the parents are at fault. SIDS actually accounts for a small number of these deaths; in Georgia it's about one third. "Everybody thinks in this country we have a huge SIDS problem, but we have a huge bed-sharing problem," Loveless said.

If responders see and document the baby's sleeping environment, investigators may base the cause of death on that report. To be a SIDS case, the infant must have been alone, on its back, in a crib, without any toys or bedding that could interfere with breathing. "That's not the sleeping environment we routinely see," Loveless said. "The floor is better than an adult bed."

Responders should always be suspicious if a baby shows signs of injury, Loveless said, because they can't injure themselves they way older children can.

Documenting Injury

EMS personnel should be aware that injuries from abuse are sometimes blamed on CPR, intubation and other medical procedures, Loveless said. Doctors and investigators generally know not to believe this, but responders can help by documenting any injuries they find already on their patients.

"If I can ask for anything else than you're already doing, it would be documenting previous injury and maybe documenting absence of injury, but only if you're sure," Loveless said. It can damage a case if a responder says there was no injury but a coroner then does find injury.

Loveless advised responders to describe injuries but not to try to date them, such as guessing at the age of a bruise based on color. Do note if there appears to be pattern of injuries, she said. She specifically suggests a quick examination of the mouth tissue before intubation, because a torn frenulum is indicative of child abuse from grabbing or shaking.

Sharing Observations

Loveless urged attendees to arrange for their agencies to reach out to their coroner (within protocol) to share any potentially relevant reports, 911 calls, or other case materials.