Injury resulting from targeted violence: An emergency department perspective

Consequences of the lack of clinical forensic medicine in emergency departments

Most victims of physical violence sooner or later will access a hospital or medical cabinet because of that violence, and in particular emergency departments (EDs). This paper aims to analyze the performance of emergency ward clinicians in the forensic management of such victims by examining the activities carried out and the data reported. A total of 991 medical records were extrapolated from the database of the ED of the Policlinico of Milan in an average pre-pandemic 1-year activity. For each medical record, 16 parameters were analyzed in-depth including epidemiological data, information on the type of violent actions, injuries, and time between the infliction of the lesion and access to the ED. In the vast majority of cases, all the actions with medicolegal implications had been neglected by health professionals causing loss of data not only for the justice system but especially for correctly interpreting what happened and taking appropriate measures to protect the patient/victim. Hence, given that clinicians in EDs are busy with non-forensic clinical tasks (and rightly so), it should be ensured that there be specific forensic clinical personnel. However, it is crucial that when unfortunately there can be no forensic staff, at least the clinicians who work in the ED are properly trained to correctly apply essential medicolegal measures. Overall, timely and informed medical and forensic intervention is possible and necessary for the improvement and maintenance of the mental and physical health of victims of violence.

Prevalence of Physical Violence in the Medical-Forensic Approach in the Years 2015-2020 in City and Neighboring Municipalities: Perspectives from Poland-Poznań Study

Forensic medical opinions serve the appropriate classification of a crime against health. Violence, a multifaceted phenomenon, requires forensic medical examination in the case of causing damage to health. Due to the effects caused by the perpetrator, the damage to health is divided into severe, medium, and light. This study analyzed 7689 incidents of violence from 2015-2020, taking place in the area subordinate to the Provincial Police Headquarters in Poznań, based on anonymized documentation of forensic medical examinations performed at the Department of Forensic Medicine in Poznań at the request of the Police and privately. The analysis took into account: units ordering the test, type of exposure, medical help, sex and age of the victim, places of the incident, classification and localization of injury, manner of impact, attitude of the perpetrator to the victim, profession of the victim, gender of the perpetrator, and remarks. In Poland, statistics on violence victims are underestimated, resulting from the low reporting of crimes committed to law enforcement authorities. There is a need for programs to educate the perpetrator of violence on methods of conflict resolution and programs to prevent violence, covering events taking place in public spaces.

[Hate violence in the emergency rooms of third level hospitals. First data in Spain]

OBJECTIVE

To describe the cases of hate violence attended in emergency services.

METHOD

A cross-sectional study of a series of cases of aggression treated in the emergency rooms of two hospitals in Madrid, between April 2015 and March 2018. The cases of hate violence are described in terms of their sociodemographic, clinical-epidemiological and incident data and compared with other types of violence within the study.

RESULTS

A total of 147 patients were included and 49% reported having been victims of hate violence. Among the victims, 61% were men, the average age was 36 years and 48% had a medium-high level of education. The most frequent motivations were physical appearance, nationality and ethnic origin. The place of aggression was the street in 50%, and in 61% of the cases it was perpetrated by more than one person (83% by men). The most common injury was contusion (71%) and the most frequent location the head and neck (71%). Only 8% required admission.

CONCLUSIONS

The surveillance of hate violence would foster more accurate knowledge of the real magnitude and characteristics of this health problem and improve the quality of care for victims.