When to Escalate
The First Decision: Medical Safety
Forensic evidence is valuable only when the patient is safe and the evidence remains traceable.
Forensic evidence is valuable only when the patient is safe and the evidence remains traceable. Biological material may support DNA analysis, while fibers, soil, glass, and other trace material may demonstrate contact or transfer. The sample itself is only part of the evidence; its identity, condition, and documented history also matter. Begin with immediate threats: airway compromise, respiratory distress, uncontrolled hemorrhage, shock, altered mental status, overdose, severe pain, and other traumatic injuries. Separate the patient from the alleged perpetrator, provide privacy, and summon emergency assistance when needed. Stabilization is not postponed so that a kit can be completed. Ask neutrally whether the patient has bathed, changed clothes, eaten, drunk, urinated, brushed the teeth, or discarded personal items. Record what occurred and when, without suggesting that the patient has ruined the examination. Do not tell a patient to delay urgent treatment, food, fluids, or normal bodily needs solely to preserve evidence. Evidence collection may still be appropriate after washing or changing clothes; the history and examination remain clinically meaningful. A patient may accept medical treatment while declining forensic collection. Those are...