Gunshot Wound Evidence Collection in the Emergency Department
Written by Dr. Jennifer Johnson   


Courtesy of the Academy of Forensic Nursing

This article appears in the September-October 2021 issue of Evidence Technology Magazine.
You can view that full issue here.

EVIDENCE COLLECTION in the emergency department can be a challenge for the forensic nurse examiner (FNE), especially in situations where a gunshot wound was sustained. Life-saving measures must be implemented while trying to preserve evidence, if possible.

In this article, the types of evidence that may be collected from the individual while they are receiving medical care will be discussed. Implementing and maintaining the chain of custody throughout the medical forensic examination will be imperative for the FNE. It is very important to understand that all evidence collected must be identified and properly labeled, the date and time that it was collected must be noted, and the item must be sealed in an appropriate evidence collection bag, envelope, or container. Subsequently, all information must be documented in the medical forensic report to accompany the forensic photography—an aspect that will not be discussed in this article.


When the individual arrives, there may be gunshot residue on their hands. If collection is impeded by medical intervention, the FNE, while wearing clean gloves, will place paper bags over the hands and secure the bags with paper tape. Collection of gunshot residue will be discussed later in the article.

Clothing should be removed while attempting to preserve any trace evidence that may be present. Preserve the fiber defect of the entrance and exit of the projectile. If cutting of the clothing is required, the cutting should not be through the fiber defect.

Once removed, flat-wrapping of the clothing will decrease cross-contamination of blood and other forms of evidence. Using non-waxed butcher paper, place the clothing in the center of the paper. Then, place a piece of paper or evidence bag over any damaged or stained areas and between any layers of the clothing to reduce cross-contamination. Next, fold into a bindle. This initial bindle should then be placed in another bindle for the final outer packaging and secured with evidence tape on all seams.

In the case study published in the August edition of Evidence Technology Magazine, the jeans were collected, small evidence bags were inserted through the legs of the pants, and a large evidence bag was placed in the top of the jeans at the waist area. Additional evidence bags were placed on top of the jeans to allow for folding the bottom half of the legs of the jeans on top to make the package smaller. Then, the bindle process mentioned above was completed.

When the flat wrapping is completed, you may have something that is as large as a picture, which the author refers to as the “making of a Rembrandt.” Soaked clothing will require drying and should be reported to law enforcement upon evidence transfer.


Gunshot residue evaluation should be completed once the clothing has been removed. The FNE can employ the use of alternate light sources and filters to aid in identifying the presence or absence of gunshot residue. If visualized, the FNE can perform adhesive tape lifting, swabbing of the area, or both. Using the adhesive tape lift, the FNE will dab the surface area that is to be sampled until the tackiness is lost, to aid in maximum collection. If swabbing is to be completed, two cotton-tipped swabs will be either moistened with sterile water or left dry. Assuming that both lifting and swabbing are to be completed, the FNE will perform the adhesive tape lift first and then swab the sample using either swab technique. When collecting residue from the hands, focus on the area between the thumb and index finger. For other anatomical locations, collect from the entire area visualized with the alternate light source, using the adhesive tape lift, swab, or both.

While moving and positioning the individual, there may be loose casings or projectiles found in their clothing or on the stretcher. The individual may have retained projectiles that will require surgical removal. The removal of projectiles or shotgun pellets can be completed by using a gloved hand or a plastic instrument. Should removal of the projectile be required, and plastic instruments are not available, plastic tips may be applied to the metal pickups to reduce placement of additional instrumentation marks. The theory behind using a protective method of removal is due to rifling. When a gun is fired, the bullet travels down the barrel of the gun in a spinning fashion because of grooves and ridges in the barrel formed during the process of rifling during manufacturing. Rifling assists in the stabilization and accuracy of the fired projectile. These markings on the projectile are called striations, which become specific identifiers in matching projectiles to a specific firearm. (Note: Shotguns have smooth barrels.) The projectile is a soft metal. If the surgeon is to apply metal pickups to surround the projectile retained in the body, it will likely cause additional tool marks that may ultimately change the physical characteristics of the projectile and potentially interfere with the forensic ballistics examination.

If the projectile has blood or debris attached, this should not be removed. Items collected should be packaged separately in a wet-dry package with a desiccant pouch, paper envelope, or an evidence bag, then sealed with evidence tape under chain-of-custody practices previously mentioned.

Another crucial piece of evidence collection is toxicology with urine and blood collection. One way to ensure that both the hospital and the criminalistics laboratory has a sample for analysis is to have the FNE perform the collection in a split fashion. Medical providers need to be aware of alcohol or drugs that may be present in the individual to identify potential complications. However, the hospital lab typically runs a urine drug screen (UDS) that covers classes of drugs and not specific drugs or the quantity that is present at the time of arrival. Dividing the urine into two samples is optimal for immediate testing at the facility, while also preserving the other portion for the toxicology department at the criminalistics laboratory. Blood collection may also prove beneficial to obtain for the criminalistics laboratory as an additional sample source, if needed. Blood alcohol testing should be completed in the emergency department to accompany the UDS. A minimum of one 10 mL grey-top tube should be collected after cleaning the skin with iodine, then the tube should be sealed and refrigerated. During evidence transfer from the FNE to law enforcement, communication about replacing the item into a refrigerator will be necessary.

Not all gunshot wound cases will necessitate collecting all the items discussed but should be based on the circumstances of the event, collaboration with law enforcement, and criminalistics laboratory preferences in your geographic location.

About the Author

Dr. Jennifer Johnson is a board-certified women’s health nurse practitioner, board-certified advanced forensic nurse, and sexual assault nurse examiner with more than 20 years’ experience in practice. She previously developed and managed a comprehensive forensics program in the Midwest and is the president and owner of Johnson Legal Nurse Consulting, LLC. Johnson is an appointed member of several professional and governmental organizations related to forensic nursing, including the National Institute of Standards and Technology / National Institute of Justice Evidence Management Project, and is the president elect and a co-founder of the Academy of Forensic Nursing.

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