Forensic Nurses on Crime Scene:  The Southern Italian Experience

The goal of this presentation is to provide an overview of the development of forensic nursing in Southern Italy and to illustrate the unique contributions of the professional nurse in death investigation. This presentation will impact the forensic community by demonstrating how nurses are utilized within the Office of the Medical Examiner of the University of Bari.  The use of forensic nurses has positively impacted the forensic science community and demonstrates the unique contributions of the professional nurse in solving cases.

The University of Bari has chosen to give major emphasis to forensic nursing in the advanced educational degree (i.e., Magisterial Bachelor Degree). The educational program addresses forensic topics such as elder and child abuse, domestic violence, mass disasters, evidence collection and preservation, and death investigation. A Master’s program on postmortem findings and crime scene investigation provides additional information and advanced clinical training in the field. Four typical examples of forensic nursing activities in Bari will be presented.

Case #1 - Multiple Self-Inflicted Incised and Stab Wounds: In September 2007, a 48-year-old man was found dead in his summer residence by his wife and daughter. Police investigators, a medical examiner, and a forensic nurse investigated the crime scene. The man’s body was on the floor of bedroom; his shirt was unbuttoned and soiled with blood. There was also blood on the bedroom floor and on the bed. A kitchen knife was found near the body and there was a suicide note on the bedside. The cause of death was 36 incised and stab wounds. In this case, a forensic nurse recorded body and environmental temperatures, collected evidence while preserving the chain of custody, and took onscene photographs. Upon order of a prosecutor, a few days later, the nurse interviewed relatives and friends of the victim to reconstruct the last moments before death in order to understand the manner of death.

Case #2 – Starvation Due to Religious Delirium:  In July 2007, the bodies of two elderly sisters were found mummified on chairs within their country home. A third sister was found alive, but with mental confusion.  Mummified carcasses of cats and dogs were found close to the bodies.  There were small containers with white powder that was later identified to be sodium carbonate (Na2CO3).  Procedures to solve the case involved the contributions of different forensic specialists including a pathologist, nurse, entomologist, criminologist, toxicologist, and a veterinarian to define the time since death, the cause and manner of death, and to obtain a psychiatric profile of the surviving sister. The role of forensic nurse was important in noting and collecting any evidence at the crime scene: mapping the positions of the bodies,

documenting entomological findings, searching for unknown substances closest to the bodies, etc. The nurse discovered a secret diary of the surviving sister where she noted daily events during last three years.  In this diary there were many attached receipts, checks, and bills.  All of this evidence was useful in understanding what happened in the house and the reasons that the remaining live sister continued to reside among the mummified bodies.

Case #3 – Work-Related Death: In February 2008, four workers died suddenly from inhaling hydrogen sulfide (H2S) while washing a road-tanker at their workplace.  One died 24 hours later in a public hospital. The forensic nurse interviewed the other workers on the scene, documented evidence about substances that the tanker was transporting, and went to the hospital to review clinical documentation of the survivors a day later. 

Case #4 – Anthropological Excavation: In August 2007, human remains were discovered by a forester during a search of the country surrounding Miglionico (Southern Italy).  There were 286 bone fragments excavated that had been buried.  The forensic nurse with a special background on skeletal remains, assisted with verification of personal identity during all phases of the excavation procedures and examination of each fragment. His contributions were particularly effective in the collection and packing of all the evidence that had to be sent to the laboratory.

Conclusion: Forensic Nursing is a new career opportunity in the Office of Medical Examiner of Bari (Southern Italy). The Office oversees the majority of forensic cases associated with 48 towns located in the Region (Apulia) with a total population of about 1.5 million. Special investigations are submitted from other southern regions (Calabria, Basilicata, Campania) when a specialized forensic team is required in solving a case. The forensic nurse is an effective member of the forensic team.