Examination of Injured Persons

Who examines the injured person? 

A medical officer or a casualty medical officer known as Registered Medical Practitioner (RMP). [Explanation (b) to Section 53 Crpc (now S.51 BNSS)-"registered medical practitioner" means a medical practitioner who possesses any medical qualification as defined in clause (h) of Section 2 of the Indian Medical Council Act, 1956 (102 of 1956) and whose name has been entered in a State Medical Register.]

What is an Accident register MLR? 

The details of examination is entered in an accident register for the purpose of preparing a medicolegal injury report (MLR). It is a confidential record. It has to be produced in court if required by court of law. It is maintained by all the government hospitals. Patient may be an outpatient or admitted in ward. 

Prior to a medicolegal examination, informed consent must be obtained from the injured party or from a legal guardian if the injured is unable to give consent. According to the provisions of Section 53(1)6 of the CrPC, an injured person may be examined without their consent and, if necessary, reasonable force may be applied. 

(a) serial number; 

(b) place, date and the time of examination; 

(c) name, age, sex, occupation and address of the injured person; 

(d) identification marks;

(e) name and address of the accompanying person; 

(f) name and number of the police constable; 

(g) brief summary of how the injury was caused as told by the injured person; 

(h) detailed description of the injuries; 

(i) opinion and medical officer’s signature.

Note: 

• No erasures should be made and if any alterations are made, they must be initialled. 
• The examining Doctor is then required to make an Injury Certificate where he is not allowed any overwriting or personal opinions but only medical opinion. 

Thorough examination of injuries is done and complete description of the injuries is provided in the medicolegal report (MLR). The types of injury, location, direction, dimensions, shape, presence of foreign bodies, age of injuries, probable weapon that caused the injury, nature of injuries must be recorded in the report.

 Numbering 

While describing the injuries observed during examination, it is extremely important to number all the injuries.

Types of Injuries 

like abrasion, bruise, lacerated wound, incised wound etc. are to be mentioned. Wounds are typed on the basis of their appearance and the method of causation. 

• Abrasion-  It  is  the  damage  occurring  in  the epidermis;  some  dermal  papillae  may  also  be damaged. It is caused by rough hard blunt objects or  surfaces  or  by  drawing  the  tip  of the pointed objects against the skin or mucous membrane. Most abrasions are caused by rubbing effect and others are caused by vertical pressure. Pattern of the impacting object may be retained at the abraded area. 

• Bruise- It is the extravascular collection of blood in the tissue, viz, dermis of the skin, subcutaneous tissue and other deeper tissues due to rupture of blood vessels caused by application of blunt force with overlying tissue remaining intact so that blood cannot escape outside. When the lesion is visible from outside it is called bruise and if not visible from outside it is called contusion. Bruises may be of different  sizes,  viz,  petechial  haemorrhage  of  pin  head  size,  purpura  of  size  2  to  5  mm, echymosis of more than 5 mm, haematoma causing local swelling. 

• Laceration- It is the tearing or splitting of the skin, mucous membrane and surfaces of any internal organs caused by application of blunt force. Blood escapes from the wound to the exterior or any body cavity.

• Fracture- It is the breach of continuity of bone or tooth caused by application of blunt force. Clinical features and X-ray findings are considered to diagnose this type of lesion. In dislocation of joint the bone ends get displaced completely from their normal anatomical positions with damage to the adjacent tissues. 

• Incised wound- It is caused by the sharp edge of the weapon applied to the skin perpendicularly or obliquely making regular clean edges of the wound. It is called a slash wound when the length of the wound is greater than its depth.

• Puncture wound- A  puncture  wound  is  produced  when  a  pointed  thin bodied weapon is pushed into the body. Its depth is also greater than its diameter. A penetrating wound is produced when a bigger type of pointed weapon like teta is pushed into the body making a greater depth.

• Firearm wounds- These wounds are produced by bullet or pellets fired from guns. Bullet usually causes perforation and pellets cause penetrating wounds. Firearm entry wounds are associated with burning, blackening, tattooing of the surrounding skin

• Burns- are caused by flame, heated objects and scalds by hot liquids and vapours or gases. 

• Blast wounds- are produced by explosion of bombs and are due to blast pressure  wave  (shock  wave),  blast  winds,  heat,  splinters,  shrapnels, surrounding small fragments propelled by blast winds. 

Dimensions 

Size of the injury is recorded with the help of measuring tape. Depending upon the type of injury, the dimensions are recorded. e.g. length and breadth of an abrasion and bruise; length, breadth and depth of laceration or incised wound. In case of a stab wound depth cannot be ascertained by naked eye examination. It is to be recorded by the surgeon in operation theatre while treating the wound of the injured.

Position 

Position of the injury is to described in relation to at least 2 bony points or other fixed points (like midline etc.), so that from the description of the position of the injury its exact location on the body can be known.

 Shape -circular, oval, elongated, irregular etc.

 Direction - like vertical, horizontal or oblique.

 Age of injury

It is not easy to give the exact time of infliction of any injury, but an approximate time can be given from charged with criminal wounding or with robbery, burglary. 

(a) The age of a bruise may be ascertained from the colour changes which its ecchymosis undergoes. These changes commence from 18 to 24 hours after its infliction, and pass through various stages. 

(b) The age of a wound may be ascertained from observing the stages of healing process. 

(c) In the fracture of a bone, the reparative process will enable one to fix its approximate time. The signs of inflammation  and exudation of  blood  (haematoma) in  the  soft  parts and around the fractured ends are noticed from the first to the third day. Inflammation slowly subsides, and granulation tissue, known as the soft provisional callus, is formed from the third to the fourteenth day. This callus binds the fractured ends of the bone. The formation of the amount of callus depends on the mobility or immobility of the fractured ends. It is less if the ends are immobile and impacted. It begins to ossify from the 14th day to the fifth  week,  and  6-8  weeks  is  the  average  period  taken  by  the  callus  to  be  absorbed completely, so that the fractured ends may be entirely united with the formation of the bone. 

(d) In the dislocation of a joint, the time can be judged from the colour changes of a bruise, which usually accompanies it, when caused by violence. 

(e) When a tooth has been knocked out, bleeding from its socket stops in about 24 hours, but sometimes, on probing it, the blood may come out even after two or three days. The cavity of the socket usually fills up in seven to ten days, and the alveolar process becomes quite smooth after 14 days. 

Also see:Medico-Legal aspect of Wounds