HonorHealth Forensic Nurses

Happy
Forensic
Nurses Week
November 9-15

November 2015
Upcoming Events:
MDT GFAC - Nov 19th 1pm
SFAC - Nov
cancelled
MFAC - next 12/15
FAC ChildHelp
11/24 @ 8:30
SWFAC - next 12/15

Nov Zoo Lights!

19 20 HonorHealth
Employees

Nov
21

Open Enrollment
Benefits last day to
enroll for Full and
Part time staff.

Jan
9th

After the Holidays

Holiday Party:
location to be
determinedopen
for suggestions.

SANE-A 40-hour
course:
Feb 17, 19, 24th, 26,
and Mar 4th

Graduation Celebrations!!!
Help me to congratulate Jaime Ambrose and Michelle
.

Friesen as they both graduate with a BSN this month.

Working full time hours, posting to discussion questions,
writing papers, and balancing life hopefully become
easier. It is time to really focus that new found free time
on the important things like casino trips, bootie class
and watching live feed of dogs sleeping.

HonorHealth Forensic Nursing Newsletter

November , 2015

**Exciting News**
Amber OMalley is now
SANE-A Certified
Great Job Amber!
Top Golf Outing was a
success! A total of 12
of us had a blast. We
will plan another fun
event soon!

Monthly Tip:
Do you know what
indicates the use of the
ALS?
The use of an Alternate Light
Source (ALS) is suggested when
performing medical forensic
exams. The ALS is an additional

J Forensic Sci, 2015

doi: 10.1111/1556-4029.12698
Available online at: onlinelibrary.wiley.com

TECHNICAL NOTE
GENERAL ; PATHOL OGY /BIOL OGY

Maria Lombardi,1 ,2 * D.O.; J ennifer Canter,1 ,2 * M.D., M.P.H.; Patricia A. Patrick,3 Dr.P.H.;
and Robin Altman,1 ,2 M.D.

Is Fluorescence Under an Alternate Light

Source Sufficient to Accurately Diagnose
Subclinical Bruising?

assessment tool. Research

supports utilizing the ALS source if
indicated.

ABSTRACT: This single-blinded, randomized validation study was conducted to evaluate whether fluorescence under alternate light sources

(ALS) is sufficient to diagnose subclinical bruising (bruising not visible under white light). Standardized trauma was induced on randomly
selected ventral forearms. On days 1, 7, and 14 investigators independently examined case forearms under white light for perceived bruising
and under ALS for fluorescence and compared body maps. 56 case and 62 control forearms (n = 118) were examined. Sensitivity of ALS on
days 1, 7, and 14 was 76.8%, 69.6%, and 60.7%, respectively, compared to 69.6%, 60.0%, and 32.1% for white light. The specificity of ALS
on days 1, 7, and 14 was 51.6%, 59.7%, and 53.2%, respectively, compared to 71.0%, 81.4%, and 86.9% for white light. ALS has increased
sensitivity yet low specificity compared to white light in accurately detecting bruises. Fluorescence under ALS is not sufficient to accurately or
responsibly diagnose subclinical bruising.

K EYWORDS: forensic science, alternate light sources, ultraviolet light, blunt force trauma, sexual assault, forensic science, sexual assault
examination, child abuse, tunable light, ecchymosis, bruising

Indications for the use of an ALS

The use of the ALS is included on
the medical forensic exam reports
for both Sexual Assault and
Domestic Violence examination.
Articles to Support Practice:

Visible light is composed of wavelengths between 400 nm

(blue) and 720 nm(red), whileultraviolet light, which is invisible,
is composed of wavelengths between 190 nm and 400 nm. An
alternate light source (ALS) refers to an illumination system that
breaks down visible and invisible light into discrete wavelengths.
When used with filtering color goggles, this may causeasubstance
or object to changecolor or to fluoresce. Fluorescence refers to the
property of emitting alonger wavelength of light when radiated by
a shorter wavelength. Therefore, ALSs have the potential to
uncover evidencethat would otherwiseremain invisible.
ALSs are widely utilized for examinations of individuals who
present with concerns for sexual assault/sexual abuse in forensic
medical and law enforcement settings. ALSs will identify areas
of fluorescence (e.g., on skin, clothing, linens, etc.), which
may be potential body fluid substances (i.e., blood, semen, saliva) (15) and allow for swabbing of those areas to acquire specimens. To determine whether the fluorescing substance (or area)
is in fact body fluid with evidentiary significance, chemical, or
serologic analysis of the specimen is a routine component of this
process (6, 7). Therefore, fluorescence is used as a screening
*ML and JC contributed equally to this article.
1
Department of Pediatrics, New Y ork Medical College, Valhalla, NY .
2
Maria Fareri Childrens Hospital at Westchester Medical Center, Valhalla,
NY .
3
School of Health Sciences and Practice, New Y ork Medical College,
Valhalla, NY .
Funded by a grant from the New Y ork State Empire Clinical Research
Investigators Program (ECRIP).
Received 1 Oct. 2013; and in revised form 27 Feb. 2014; accepted 7 Mar.
2014.
2015 American Academy of Forensic Sciences

tool to collect specimens that may have evidentiary value, not to

render a conclusion that the fluorescing substance is indeed a
bodily fluid with evidentiary value. Because skin will fluoresce
in areas that are not limited to bodily fluids (i.e., skin conditions
and infections, detergents, lint, deodorant, minerals) fluoresced
areas swabbed for analysis often fail to reveal evidence of bodily
fluid. The sensitivity and specificity of utilizing florescence as a
means to detect evidence varies widely (8,9).
Ultraviolet light penetrates superficially into the epidermis and
is reflected or absorbed by hemoglobin, carotenoids, and bilirubin found in bruises (10,11). Hence, ALS fluorescence may signify bruising that is not visible to the naked eye (subclinical
bruising). A tool that could accurately identify subclinical bruising may have utility in the evaluation of children and adults with
concerns for inflicted injury including child physical abuse, sexual assault, and domestic violence (12). Skin bruising is often
one of the earliest and most common signs of child physical
abuse (13,14). However, studies have demonstrated that there is
a typical and predictable pattern of location, size, and frequency
of normal bruises in children that correlates with age and normal
development, highlighting the importance of accurate and
responsible interpretation of skin findings in the context of
forensic medicine (1520).
Accumulating case reports suggest that subclinical bruises
may be revealed using alternate wavelengths of light. Further,
bruising or other skin marks such as gunshot residue visible
under white light may be enhanced with the use of ALS (10, 11,
21, 22). These techniques have developed greater potential with
the advent of ALS digital imaging (2325). Of great forensic
significance is the aforementioned fact that skin will fluoresce
1

HonorHealth Forensic Nursing Newsletter

Recognition of
Commitment

Sandra Solomon
is also
recognized this
month by
HonorHealth and
our department
for her
dedication for

November , 2015

Char Sbrega
previously
worked with us
as a Forensic
Nurse and
returned 5 years
ago. Thanks for
your continued

We miss
you
Kathy!
+News

Hello Amazing Nurses,

Letter
Please
send me updates to add.
Requests

I feel in the last year we have been through a ton of change and you all have kept the Forensic Nursing
department functioning and providing care to hundreds of patients every month. Thank you for working
together to making a difference.
Here is my first attempt at a Newsletter. I have goals of improving communication; team building and
establishing practical, professional protocols and processes in our department. I have to say my mental
timeline for accomplishing all of this was a little off base. But my new way of thinking is work in progress
never give up and a dash of better late than never.
I would love to hear from you about with ideas for improved communication and connection of the staff. I am
open to ideas and suggestions for continued fun ways to keep everyone informed. If you have a great case,
lesson learned, awesome or not so awesome experiences please send it to me. We all can grow, learn, laugh
and debrief when sharing our work with each other.
I hope to continue to provide a Newsletter to come monthly to share articles, practice tips, trainings,
meetings, news etc. A group effort would be fantastic. Please know if I fail to remember or recognize you, it is
not intentional and I may need a gentle reminder. Pictures would be great too.

Thanks for your help ~ Jill