For the past eight years, the viewing public has been exposed to such prime-time crime shows as "CSI" and "NCIS." Supposedly filled with behind-the-scenes looks into the forbidden zone of city morgues, these TV dramas stretch the truth. And because very few people ever witness an actual autopsy, viewers are left none the wiser.

But when real-life crime victims—and perpetrators—come into hospitals, they may sometimes be covered in evidence. Do you know the proper method to process items so they are not compromised, even in the midst of attending to the person's health concerns? What if the patient expires? Are you well versed in the medical examiner's (ME) requirements for your state? Do you know how best to assist the office in its investigation?

To Debbie Rice, RN, NREMT, an emergency nurse at Memorial Regional Hospital in Hollywood, FL, the answer to these questions was a definitive, "I'm not sure." It was not until she connected with Stephen J. Cina, MD, the deputy chief medical examiner for Broward County, FL, that she discovered there was so much more to learn about the forensic side of nursing.

"Most people think that once a patient dies, that's the end," said Rice. "They do not realize that nurses can continue to care for their patients by attending to the little things that could possibly help solve a criminal case. Some of these details have not been thoroughly considered before now."

Educational partners

Rice is constantly on the lookout for new educational opportunities, both to satisfy her personal curiosity and to advance her career. "I have been a nurse since 1999, and I just absolutely love this profession. I am always seeking out growth opportunities, like recently enrolling in a master's degree program," she commented. In addition to furthering her education and practicing as an ED staff nurse, she passes on her knowledge by teaching Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS), as well as instructing paramedics. Rice also works part time at a plastic surgeon's office and as an agency nurse, and she serves as a first lieutenant in the U.S. Army Reserves. "I feel like there is always something more I want to accomplish."

It was with this intent that Rice wondered if there was "something more" nurses could be doing to prepare expired patients before transferring them to the medical examiner's office. "To my knowledge, there has never been a class instructing nurses on what to do," she stated. "I recognized this as an area where there was a lot to be gained."

Enter Dr. Cina. The two met last year when Rice called on the ME's office in her role as a paramedic instructor. During a conversation, she mentioned that a few of her nursing peers expressed an interest in observing an autopsy, and from there, the pair began discussing the existing relationship between medical examiners and hospital staff. "Dr. Cina asked why nurses didn't send all the necessary items with expired patients," she recalled. "My response was that we needed a better understanding of what was and wasn't required."

Last December, Rice and Cina joined forces to create a voluntary Forensics in Nursing course. "I am committed to education and have had emergency medical services (EMS) personnel, nurses, law enforcement, and other medical professionals attend my autopsies for years," said Cina. "There is a widely held perception that medicolegal investigations involve only pathologists and crime scene investigators. The fact is that correct certification of the cause and manner of death is a team approach involving every person who has come in contact with the body, including hospital staff.

"Although there is some state-to-state variabil-ity in coroner and medical examiner law, deaths due to trauma or in suspicious circumstances need to be investigated. Florida law mandates the ME's office investigate certain kinds of deaths, including suicides, homicides, child deaths, and other fatalities under suspicious circumstances or involving trauma or toxins. Our curriculum was developed to best meet the needs of our office and to add a new dimension to the practice of nursing."

"We routinely encourage our staff to pursue educational opportunities, and this idea was no different," added Melinda Stibal, RN, MBA, the administrative director of emergency trauma services at Memorial Regional Hospital. "Forensic cases do not happen often here, but when they do, we want to ensure that the ME's office obtains all of the necessary information and evidence."