John E. Smialek Patternsof .Injury
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State laws and standard medical practices obligate physician/health care providers in the emergency departments (EDs) to serve as an interface between patients and the state within the context of the legal and justice systems. To comply with these additional responsibilities, physicians must be aware of legal obligations and must be able to recognize patterns of injury. Observations must be appropriately documented and evidence must be processed in a manner consistent with legal standards.
Each ED should provide its physicians with a standard protocol for responding to state-imposed legal responsibilities such as reporting requirements. As an example, all states impose an obligation to report certain types of injuries to state social services or law enforcement agencies. Generally, these reporting requirements are centered around the vulnerable patients such as children, the elderly, and other victims of domestic violence. Reporting laws for other types of injuries vary from state to state. There may be obligations to report gunshot wounds, knife wounds, assaults and burns.
The physician must also take a proper history from the patient and other reporting witnesses, which must include a statement regarding the origin of the injury. These statements must be documented verbatim for several reasons. Firstly, they may be self-serving and the explanation may change upon subsequent reflection. Secondly, such statements are of legal significance and are admissible in subsequent legal proceedings where they will be analyzed in minute detail.
In addition to obtaining this initial history, the physician must also provide a physical examination of the injury and documentation of that examination before the injury is altered by healing or medical treatment. The physical examination should be supplemented by other diagnostic and documentary tools, such as x-ray. The legal significance of injury assessment also warrants documentation of the injury by photograph. Therefore, an autofocus, Polaroid, or digital camera should be standard equipment in every ED. The newer digital cameras may also suffice but may be more prone to accusations of computer alteration.
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