Consequences of the lack of clinical forensic medicine in emergency departments

Abstract

Most victims of physical violence sooner or later will access a hospital or medical cabinet because of that violence, and in particular emergency departments (EDs). This paper aims to analyze the performance of emergency ward clinicians in the forensic management of such victims by examining the activities carried out and the data reported. A total of 991 medical records were extrapolated from the database of the ED of the Policlinico of Milan in an average pre-pandemic 1-year activity. For each medical record, 16 parameters were analyzed in-depth including epidemiological data, information on the type of violent actions, injuries, and time between the infliction of the lesion and access to the ED. In the vast majority of cases, all the actions with medicolegal implications had been neglected by health professionals causing loss of data not only for the justice system but especially for correctly interpreting what happened and taking appropriate measures to protect the patient/victim. Hence, given that clinicians in EDs are busy with non-forensic clinical tasks (and rightly so), it should be ensured that there be specific forensic clinical personnel. However, it is crucial that when unfortunately there can be no forensic staff, at least the clinicians who work in the ED are properly trained to correctly apply essential medicolegal measures. Overall, timely and informed medical and forensic intervention is possible and necessary for the improvement and maintenance of the mental and physical health of victims of violence.

Are autopsies on minors a taboo?: The experience of Milan in a 19-year retrospective study

“…These issues have not been fully explored, nor have the strategies to overcome them, so it would be beneficial to conduct further studies in this field. However, this type of awareness should also be directed to health and justice professionals so that they know that autopsy is the last bastion to protect the rights of all victims, but especially the most vulnerable age groups (included minors) when prevention and clinic fail [ 1 ]. Of course, it is also an extremely important tool for health surveillance and for protecting public health in its broadest sense [ 14 ].…”

“…Children and adolescents are among the most vulnerable population groups and for this reason are at higher risk of both direct and indirect violence [ 1 ]. In the domestic sphere alone, approximately 275 million children experience some form of violence each year [ 2 ], and the number of children who are victims of neglect and/or non-accidental trauma is also often underestimated [ 3 – 6 ].…”

“…In particular, injury-related causes remain the leading cause of death in children and adolescents [ 9 , 10 ]. Overall, there were nearly 1 million deaths in children and adolescents due to non-natural causes worldwide in 2019 alone [ 1 , 9 , 11 ]. These numbers are proportionally higher in developed countries, where deaths in children and adolescents from natural causes (infectious diseases and cancer) have become less common [ 9 , 10 ].…”