A 22-year-old male is brought to the emergency department (ED) with a gunshot wound to the thigh. His vital signs are stable. There is only one wound, and the bullet is palpable under the skin. The wound is surrounded with soot. How should you document the injury prior to removing the bullet and providing wound care?

When law enforcement is investigating a crime, forensic photography is an important part of the investigation. Forensic photographs enable all investigators and prosecutors involved to view the crime scene as it is in that moment of time, but what happens when your patient’s body is the crime scene? Victims of violence frequently present for emergency medical care prior to meeting with investigators. Interventions such as debridement and basic wound care may destroy evidence and alter the appearance of wounds; as injuries heal, their appearance changes. Photographs taken in the emergency department provide investigators with the opportunity to see injuries as they originally appeared. Photographs of injuries such as bruises, lacerations, bite wounds, and firearm injuries can be crucial to the successful prosecution of violent crimes. Photographs should be taken before medical intervention if the patient’s condition permits.

Equipment

There is a broad spectrum of photographic equipment available, ranging from smartphone cameras to professional-grade single-lens reflex cameras. Digital cameras used for forensic photography should have features including macro (close-up) mode and image stabilization. Ideally, emergency departments should have cameras specifically for medical and forensic photography, thus eliminating privacy concerns present if cell phone cameras are used. If using dedicated cameras, protocols should be in place for HIPAA-compliant storage of images.

The lighting in patient care areas is generally sufficient for basic forensic photography, but the camera’s flash and additional lighting should be utilized if lighting is poor. Fluorescent light may distort the appearance of color in photographs; if available, a color scale should appear in at least one photograph. Off-camera flashes or ring lights may improve detail, particularly when in macro mode.

The widespread adoption of electronic medical records (EMRs), many of which have available smartphone apps, means that most emergency physicians can place photographs directly into the medical record. Cameras on personal phones should not be utilized for forensic photography unless the EMR app places the photo into the medical record without storing it to the phone’s memory. While most smartphones do not have features desirable for forensic photography such as macro mode, they are still able to capture images adequate for investigation and prosecution if a few basic principles are followed.