Clinical forensic medicine in Eastern Denmark: Organisation and assessments

Abstract

Internationally, clinical forensic medicine (CFM) is diverse in content and conduct, and forensic medical methods are not always evidence based. The first step towards evidence-based practice is to achieve a thorough knowledge of international diversity, which necessitates that CFM practitioners provide information about their national practice. This paper’s aim is to describe the organisation of CFM in Denmark, exemplified by the set-up in Eastern Denmark, and the types of assessments performed. In Denmark, forensic medicine is a board-certified specialty under the health authorities, with mandatory qualifications. The Danish Accreditation Fund accredits the Departments of Forensic Medicine as inspection bodies, according to an international European standard that is approved by Danish Standards. Mainly at police request, forensic doctors perform examinations of both victims and suspected perpetrators of perilous crimes. The examinations’ purposes are documentation and assessment of the findings and collection of biological evidence. The clinical forensic examinations do not include any treatment or medical follow-up. Thus, the forensic doctors must be neutral, objective and impartial. The clinical forensic examinations provide documentation of findings and conclusions not otherwise available for the police investigation and legal aftermath. Moreover, the accredited, standardised protocols ensure that the Departments of Forensic Medicine meet their obligations as inspection bodies, thus ensuring public confidence in the departments’ services.

The usefulness of a trauma probability of survival model for forensic life-threatening danger assessments

“…One limitation of the present study is its use of highly selected data, which introduces selection bias. The included CFM cases with a PS score may not be representative of all CFM examinations, which are performed in many places [1]. The inclusion criteria may also explain the second limitation of this study: the relatively small number of included cases.…”

“…The inclusion of prior-protocol CFM cases necessitated a reassessment of the life-threatening danger because the criteria and conclusions changed after the protocol implementation in September 2016 [1]. Instead of comparing the previous assessment practice with the PS score, the study examined the up-to-date practice.…”

“…Clinical forensic medical (CFM) examinations may include an assessment of the life-threatening danger of the documented injuries. This also applies to the Danish CFM examination [1], and the forensic assessments may have an impact on the police investigation and the legal aftermath of a case. The application of any protocols should ensure that boardcertified forensic medical specialists follow standardized approaches; therefore, a protocol regarding the assessment of life-threatening danger was implemented in 2016 at our institution, the Department of Forensic Medicine, University of Copenhagen.…”

“…The application of any protocols should ensure that boardcertified forensic medical specialists follow standardized approaches; therefore, a protocol regarding the assessment of life-threatening danger was implemented in 2016 at our institution, the Department of Forensic Medicine, University of Copenhagen. Following this protocol, our forensic specialists may come to one of the following conclusions: the examined individual (1) was not in life-threatening danger (NLD) due to stable vital parameters, sparse haemorrhage, no blood transfusion, no treatment except suturing etc. ; (2) could have been in life-threatening danger (CLD) because of the necessity for treatment of the injuries; or (3) was in life-threatening danger (LD) as the injuries required emergency treatment, surgery, blood transfusion etc.…”

Life-threatening danger assessments of penetrating injuries in Eastern Danish clinical forensic medicine

“…Studies discussing these types of assessments [2,3] may not present their practice guidelines in detail or provide the underlying evidence-based validation, and this complicates any assessment of the scientific background or comparison of national practices. Life-threatening danger assessments are also part of the Danish standardized victim CFM examination [4], which is requested by the police authorities in cases of serious violence, as defined in the Danish Penal Code [5]. The CFM examination may contribute to the police investigation by clarifying some of the case circumstances, including the extent and dangerousness of the injuries.…”