Exam and Evidence Collection Procedures (continued page 3)


Collect evidence to submit to the crime lab for analysis, according to jurisdictional policy.1

The following evidence from patients, along with completed documentation forms, typically is submitted to the crime lab designated by the jurisdiction.2 Jurisdictions may require collection of additional or different

specimens. Trained examiners should use the medical forensic history and the physical assessment of the patient to guide the evidence collection process. Instructions supplied in the kit may be helpful as a guide for those who are not experienced in the process of evidence collection. However, it should be recognized that the kit instructions should not be read in front of the patient, which could be cause further emotional trauma in the aftermath of the assault. If any requested evidence is not collected, examiners should note reasons on documentation forms.

Collect clothing evidence. Clothing frequently contains important evidence in sexual assault cases. It provides a surface upon which traces of foreign materials, such as semen, saliva, blood, hairs, fibers, and debris from the crime scene, may be found. While foreign matter can be washed off or worn off the body, the same substances often can be found intact on clothing for a considerable length of time following an assault. Damaged or torn clothing may be significant, as damage may be evidence of force (do not cut through any existing holes, rips, or stains on clothing). If the examiner detects damage to the clothing, ask the patient if that damage was related to the assault or present prior to the events in question. Evidence on patients’ clothing can be compared with evidence collected from suspects and crime scenes. Common items collected from patients include underwear, hosiery, blouses, shirts, and pants. Coats and shoes are collected less frequently because they are less likely to have evidentiary value and their loss may represent a significant financial burden for victims.3 Transgender individuals may be unwilling to part with prostheses and similar items for reasons of safety and/or cost.

Procedures for collecting clothing, underwear, and foreign material dislodged while undressing include the following:

  • Place a clean hospital sheet on the floor as a barrier. Then place the collection paper on the barrier sheet. Be careful to prevent evidence transfer. Document all findings. Ask patients to disrobe (assisting them as requested and then draping them appropriately).4 When disrobing, have patients remove shoes and then undress over the collection paper to catch any foreign material that is dislodged.5 If someone assists, she/he should wear gloves.

  • Collect clothing pertinent to the assault. First determine if patients are wearing the same clothes worn either during or immediately following the assault. If so, the clothing should be examined for any apparent foreign material, stains, or damage. When the determination has been made that items may contain possible evidence, those items should be collected. If it is determined that patients are not wearing the same clothing that they did either during or immediately after the assault, examiners should inquire as to the location of that clothing. If that clothing has not been brought to the exam site, information on clothing location should be provided to law enforcement (if involved) so that clothing can be retrieved and examined before any potential evidence is destroyed.6 In addition to collecting underwear worn at the time of or immediately after the assault, it may also be important to collect underwear patients are wearing at the time of the exam (if relevant to the case).

  • Be sensitive about how much clothing to take as evidence. For example, take patients’ coats or shoes only if it is determined that there may be evidence on them. The exam site can coordinate with advocacy programs to ensure that replacement clothing is available for patients in a range of sizes. This clothing is critical in some instances (e.g., a patient may own only the clothing that is being collected).

  • If female or transgender male patients are menstruating, collect tampons and sanitary napkins. Air- dry them as much as possible and then place them in a separate paper collection bag.

  • Follow jurisdictional policy for handling and transporting wet evidence that cannot be dried thoroughly at the exam site (e.g., wet clothing, tampons, and sanitary napkins). Ensure that it is packaged in leak-proof containers and separated from other evidence when being transported. It is critical to alert involved law enforcement representatives and crime lab personnel about the presence of wet evidence and the need for its immediate analysis or further drying.7

  • After drying items according to jurisdictional policy, place each piece of clothing and collection paper in a separate paper bag, label, seal, and initial the seal. If additional bags are needed, use new grocery-style paper bags only. The barrier sheet is not submitted as evidence.

    Tape/seal bags closed; label, seal,8 and initial the seal.

Collect debris.9

  • Collect obvious debris on patients’ bodies (e.g., dirt, leaves, fibers, and hair) on a collection sheet— package, label, seal, and initial the seal.

  • Fingernail evidence: ask patients whether they scratched the suspects’ face, body, or clothing. If so, or if fibers of other materials are observed under patients’ fingernails, collect fingernail clippings, scrapings, and/or swabbings, according to jurisdictional policy.10 If fingernail scrapings are collected, package fingernail scrapings and tools used to obtain the sample, label, seal, and initial the seal. Cut broken fingernails at the remaining jagged edge for later comparison. If artificial fingernails or nail extensions are being worn by the patient, another nail should be enclosed as a known sample if one is missing. Package, label, seal, and initial the seals.

  • If requested, assist patients in putting on exam gowns after clothing and debris are collected.

Collect foreign materials and swabs from the surface of the body. Carefully inspect the body, including head, hair, and scalp, for dried or moist secretions and stains (e.g., blood, seminal fluid, sweat, and saliva) and other foreign material. Use an alternate light source to assist in identifying evidence. Obtain swabs from any suspicious area that may be a dry secretion or stain, any moist secretion, any area that fluoresces with longwave ultraviolet light, and any area for which patients relate a history or suspicion of bodily fluid transfer (e.g., licking, kissing, biting, splashed semen, or suction injury). Also collect swabs from potentially high-yield areas (e.g., neck, breasts, or external genitalia) if the history is absent or incomplete.

  • Use a moist swab to collect dry secretions, followed by a dry swab. Swab moist secretions with a dry swab. Separate swabs should be used for every sample area collected. Follow jurisdictional policies regarding the number of swabs required to collect each specimen.

  • Swab bite marks. In some jurisdictions, an initial moist swabbing followed by a dry swabbing has been shown to result in full DNA profiles.

  • Optional—smear swabs onto microscope slides, according to jurisdictional policy.

  • Cut matted head, facial, or pubic hairs bearing crusted material (or flake off material if possible) and place in an envelope.

  • According to jurisdictional policy, air-dry all specimens, package swabs and slides separately, label, seal, and initial the seals. Note that coding of evidence must allow the crime lab to know which swab was used to prepare which slide.

  • If teeth are flossed prior to oral swab collection, package used floss (if available), label, seal, and initial the seal.

Collect hair combings. Follow jurisdictional policy for collecting hair combings. The purpose of this procedure is to collect hair shed by suspects that may have been transferred to patients’ hair. Hair combings may also reveal other foreign materials. It is important to examine head, facial, and pubic hair for secretions, foreign materials, and debris and collect as appropriate (see above for collection of debris and foreign materials). Pubic hair combings may be necessary if the assault involved the genital area of patients, according to jurisdictional policy. To collect pubic hair combings:

  • Use the comb and collection paper provided for this procedure.

  • Place the unfolded paper under patients’ buttocks and comb hair toward paper (patients may comb).

  • Fold comb with debris/hair into paper. Package paper, label, seal, and initial the seal.

Collect hair reference samples as needed.11 Follow jurisdictional policy for collection of hair reference samples.12 Many jurisdictions do not routinely collect plucked head and pubic hair reference samples. Some will only collect these samples if the lab requests it at a later time. In other jurisdictions, both samples are collected routinely unless otherwise indicated or declined by patients.13 Whatever the jurisdictional policy, patients should always be informed about the purpose of collection, procedures used to collect samples, discomfort that may be involved, and how these samples may be used during the investigation and prosecution. If hair reference samples are not collected at the initial exam, it is important to inform patients that there might be a need to collect these samples for crime lab analysis at a later date. They should be aware that hair evidence collected at a later date may not be as conclusive as if it is collected at the time of the initial exam (e.g., due to the fact that hair characteristics can change over time).

When these samples are collected, the indications, timing, and techniques vary. Jurisdictional policies should be in place and followed. Give patients the option of collecting samples themselves.

Collect oral and anogenital swabs and smears. Patients’ consent, the medical forensic history, and exam findings should guide collection of oral and anogenital specimens. In general, specimens should be collected only from orifices and areas surrounding the orifices that patients report to be involved in the assault.14 Keep in mind that some patients may be vague about the type(s) of sexual contact that occurred. Examiners can help clarify which orifices were involved by asking appropriate questions. If there is uncertainty about involved orifices (e.g., because patients have little memory of the assault, were unconscious or incoherent, or do not understand what occurred), collection from oral, vaginal, and anal orifices (with patients’ permission) may be appropriate. In some jurisdictions, policy calls for collection from all three orifices. Again, patients’ consent is needed to collect these samples. Things to note when collecting these swabs and smears:

  • Caution patients who use a bathroom prior to the exam that evidence may be present in pubic, genital, and anal areas and urge them not to wash or wipe away secretions until after evidence collection.

  • When taking a swab, examiners should take care not to contaminate the collection with secretions or materials from other areas, such as vaginal to rectal or penile to rectal.

  • Follow jurisdictional policy for collecting swabs (and the number of swabs used to collect a sample), smearing swabs on slides, and drying and packaging swabs and slides. Also, follow jurisdictional policy for timeframes in which samples should be collected unless otherwise indicated.

  • Do not stain or chemically fix swabs or smears.

  • When preparing slides, note that coding of evidence material must allow the crime lab to know which swab was used to prepare which slide.

  • Document any foreign substance or material introduced by health care providers (e.g., lubricating jelly on a speculum or betadine prior to introduction of a catheter).

Oral sample15

  • Place swabs together to collect specimen from oral cavity between gums and cheeks and under tongue. Remove dentures and swab with same swabs.

  • Optional—smear swabs onto two microscopic slides.

  • Air-dry swabs and slides.

  • Package slides and swabs, place in envelope, label, seal, and initial the seal.

External genital sample16

  • Swab external genital dry-skin areas with swabs (blind swabbing by protocol or history), at least one dry and one moistened with a drop of sterile, distilled, or deionized water, according to jurisdictional policy.

  • Optional—smear swabs on two microscope slides.

  • Air-dry swabs and slides.

  • Package slides and swabs, place in envelope, label, seal, and initial the seal.

Vaginal/cervical sample

  • Use swabs together to collect a sample from vaginal pool. It is prudent to collect swabs from both the vagina and cervix, regardless of time between assault and exam.

  • Optional—smear swabs onto microscope slides.

  • Air dry swabs and slides.

  • Package slides and swabs, place in envelope, label (specifically indicating sampling site), seal, and initial the seal.

 Table of Contents Exam and Evidence Collection Procedures- continued page 4





1 Much of this section was drawn from the American College of Emergency Physicians’ Evaluation and Management of the Sexually Assaulted or Abused Patient, 1999, pp. 103–107.

2 In some cases, it may be appropriate to submit evidence to the FBI Laboratory. It accepts cases from any duly authorized law enforcement agency. However, if the case is not a FBI case and the jurisdiction has capability to analyze DNA, then the DNA Unit of the FBI Lab will generally not accept the case. Cases that occur on Indian reservations may be submitted directly to the FBI Lab from local or tribal law enforcement agencies, the Bureau of Indian Affairs, or the FBI and will be worked on by the Indian Country Evidence Task Force. Should a jurisdictional lab not have a hair examiner but have the capability to analyze DNA, items requiring only DNA analysis should not be submitted. Items such as clothing that will be examined for both DNA and trace evidence should be submitted to the FBI Lab first. These items will be returned after processing for trace evidence and can then be sent along with DNA-only evidence to the jurisdictional lab. Do not submit items to the FBI Lab for trace evidence analysis after they have been previously examined by another lab. For more information or help submitting a case to the FBI Lab, contact your local FBI office or see the Handbook of Forensic Services at https://www.fbi.gov/file-repository/handbook-of-forensic-services-pdf.pdf/view.
Paragraph drawn from the West Virginia Protocol for Responding to Victims of Sexual Assault, 2008, p. 32. http://www.fris.org/Resources/PDFs/Books/WVProtocol.pdf.
4  If patients are concerned about disrobing in front of advocates and/or personal support persons, they can turn around, hold up a sheet to shield patients, or leave the room while patients disrobe.
5  For patients with mobility impairments, put the foreign material collection sheet on the exam table and leave in place until the exam is completed. If patients prefer to disrobe in their wheelchairs, sheets can be tucked in around the wheelchair to catch debris. Avoid putting chairs on paper, as debris from wheels may contaminate evidence. (Commonwealth of Massachusetts SANE Protocol, 2002, p. 33.)
6 Paragraph drawn from the West Virginia Protocol for Responding to Victims of Sexual Assault, 2008, p. 33. http://www.fris.org/Resources/PDFs/Books/WVProtocol.pdf. In the course of the exam process, additional crime scene items that could be potential evidence may be identified and should be collected and preserved.

7 Drawn from Connecticut’s Video Training Program, Part 1, The Examination: Sexual Assault Evidence Collection, 1998.

8 Do not use saliva to seal envelopes; rather, try using moistened gauze pads or paper towels. (Drawn from Connecticut’s Video Training Program, Part 1, The Examination: Sexual Assault Evidence Collection, 1998.)

9 Debris-containing evidence may be found on equipment, such as wheelchairs, scooters, canes, wheelchair pads, assistive communication devices, catheters, and service animals, used by some patients with physical impairments. Swab equipment and/or animals for evidence, if appropriate, according to jurisdictional policy. Always ask patients for permission to do so.

10 Some jurisdictions routinely collect fingernail samples and photograph fingernail damage that may have been related to the assault.

11 See footnote under hair combing regarding patients with limited mobility.

12 Crime labs use reference samples to determine whether or not evidence specimens collected are foreign to patients. There is a lack of consensus across jurisdictions about whether to collect these samples routinely during the initial exam. Head and pubic hair reference samples from patients can provide a source of comparative information for forensic scientists, but these samples are not needed in many cases and can be retrieved from patients at a later date if necessary. If the samples are not taken at the time of the exam, however, patients may be reluctant to return later for collection. Also, hair characteristics may change over time. For patients, gathering these samples can be a painful and embarrassing procedure that follows the trauma of the assault. But, given the choice of having samples taken at the initial exam or at a later date, many opt to get it over with during the exam. Hair pulled or cut from patients is rarely used to prosecute a case. With the advent of DNA technology, the court’s use of these reference samples declined. Yet, particularly in cases where DNA evidence is not available, hair reference samples could be useful evidence. SARTs (or involved responders) should ensure that their decisions about collecting hair reference samples reflect current best forensic practices, advances in technology, and the need for sensitivity to patients.

13 Note that a patient may believe hair is sacred and thus may be reluctant or decline to have hair evidence collected.

14 It is important to note, however, that there is a lack of consistency across jurisdictions as to whether specimen collection from all orifices is routine or conducted on a case-by-case basis, based on the assault history and exam findings.
15 One jurisdiction also collects a lip/lip area swab and smear and an oral rinse if there was oral contact.

16 Note that cleansing the area for catheterization and/or applying Lidocaine may dilute or contaminate the evidence. Therefore, when Lidocaine is applied to the perineal and anal areas to minimize the risk of autonomic dysreflexia, it should be done only after swabbing the external genitalia for evidence. If catheterization is required either for evidence collection or to empty the bladder for speculum examination, it should be done only after swabbing the external genitalia. (Commonwealth of Massachusetts SANE Protocol, 2002, p. 38.)