The Processing of Surgical Specimens With Forensic Evidence: Lessons Learned From the Boston Marathon Bombings

Abstract

pathology departments at hospitals across Boston, Massachusetts received numerous amputated limbs, as well as other surgical specimens from trauma surgeries. In the absence of clear guidelines, each department faced uncertainties in performing gross examination of these specimens.Objective.-To develop a protocol for processing surgical specimens with forensic evidence.Design.-We collaborated with representatives who knew the practices at 3 major Boston hospitals, the Office of the Chief Medical Examiner of Massachusetts, and a senior team leader for the evidence response team for the Boston, Massachusetts division of the US Federal Bureau of Investigation to construct a protocol for processing specimens with forensic evidence.Results.-A simple and robust protocol approved by experts in forensic evidence collection was developed. Important points in this protocol include (1) assigning the task of processing the specimens to one individual or one team of individuals, (2) photographing all specimens before and after washing, (3) obtaining a radiograph of each specimen, and (4) identifying a secure area to store forensic evidence.Conclusions.-When acts of terror occur, protocols provide order and clarification to the processing of surgical specimens. We propose a protocol that provides guidance for pathology departments across the country to handle trauma-related surgical specimens with forensic evidence in an efficient manner to allow optimal patient care and a secure way of gathering forensic evidence.

Gunshot-Related Injuries to the Foot & Ankle: Review Article

“…Similarly, it is important for pathologists to have their own strict procedure to follow, as suggested by Byrne-Dugan et al, 10 who recognized the need for a checklist-based protocol after the Boston Marathon bombings in 2013, when city pathology departments were inundated with pathologic specimens containing significant medicolegal evidence with unclear guidelines for the review and handling of specimens at the time. Unfortunately, the current national trend of more frequent mass-casualty events makes clearly defined hospital-based surgical and pathology protocols for the handling of forensic evidence even more important.…”

Surgical Specimen Management in the Preanalytic Phase: Perioperative Nursing Implications

“…The organized management of surgical specimens identified as forensic evidence is especially important during the chaos and confusion that often characterizes a criminal act and its subsequent investigation . Checklists and protocols are beneficial in these situations because they streamline procedures into a well‐defined sequence of actions, thereby decreasing the potential for human error .…”

“…A chain of custody is the documentation of a chronological sequence of events that can be used to illustrate the possession, control, transfer, analysis, and disposition of any potential forensic evidence. Perioperative personnel should ensure that forensic specimens are always in the secure possession of a responsible party and that investigators can verify that secure location via the specimen documentation …”