Purchasing 101:

By John Roark

In the burgeoning field of forensic science, technology is ever changing in its response to industry demands. Many forensic nurses are responsible for evaluating and purchasing the products and services they need to do their jobs daily. To help busy clinicians, forensic nurse has assembled a special section that explores how to buy forensic products that meet their needs in the examination room and out in the field. In this first part of a two-part series, we offer tips on purchasing evidence collection products, drying equipment, light sources, colposcopes and light-staining microscopes. In the second part of the series, to appear in the May/June issue, we will look at what's in the marketplace for photography and examination equipment and supplies, and much more.

Evidence Collection

When it comes to evidence collection kits, standardization frequently is not the status quo. Fifty percent of states use custom-designed sexual assault evidence kits designed to conform with state laws or crime laboratory requirements, according to Tri-Tech Inc. president Jay Walker. One of the largest designers and producers of forensic evidence kits in the U.S., Tri-Tech markets a generic victim sexual assault evidence collection kit called the RE-1MS for states that do not have statewide programs incorporating a custom-designed kit.

The process of evidence collection from victims of sexual assault has evolved in recent years. Tri-Tech was the first to develop the Drug-facilitated Sexual Assault Toxicology Kit, used in conjunction with a standard sexual assault kit.

"If the assailant has used a date-rape drug to incapacitate the victim, that's when our new kit comes into play," says Walker. "If the victim cannot remember details concerning the assault, that should trigger a forensic nurse to collect either a urine or blood and urine specimen from the victim to be tested for drugs such as "ruffies" or "GHB."

Walker also stresses the importance of having a close working rapport within the different departments in the crime lab. "It helps the forensic nurse understand the importance of collecting certain evidentiary specimens, and how that evidence is analyzed and used in court." He suggests forensic nurses make an appointment to go to their state, city or county crime laboratory to gain a better understanding of what the crime laboratory needs, and why the variety of specimens is needed.

Walker emphasizes that forensic nurses should check with their crime laboratory to see what kit to use. A large number of state crime labs will send the kits at no charge, or suggest which kit to purchase, he says.

"You only have a short period of time to properly collect evidentiary specimens. If specimens are not collected and preserved properly, they cannot be used in court, resulting in the possibility of the assailant being released and repeating the crime. Our job, working in conjunction with the forensic nursing community and crime laboratories, is to design sexual assault evidence collection kits to assure this worst case scenario does not happen," Walker adds.

Lightning Powder Company, Inc., creators of the first fluorescent fingerprint powder, Redwop, manufactures a full line of conventional, magnetic and fluorescent powders in-house, and employs an in-house chemist. Lightning Powder is constantly comparing its products with the competition in order to differentiate its product line and ensure the best possible quality. Allen Miller, forensic technical manager, advises forensic nurses to look for a powder that is easy to apply, doesn't paint a background or stick to the entire surface, but just to the fingerprints. "Not so light that it flies off the brush, and not so heavy that when it hits the table you can hear it thud. It has to be a good adhesive powder so that it will stick to the print, and not so coarse that it will rake it off of the surface."

Lightning Powder carries a full forensic library that offers all titles from CRC Press and Academic Press, leaders in forensic publishing. The company also offers all certification titles for crime-scene latent print and forensic photography certification through the International Association of Identification, is a governing board for laboratory personnel.

Swabs

There is a wide variety of swabs available for evidence collection. "(Forensic nurses) have choices," says June Fitz, CEO of Fitzco. When shopping the swab market, "look for products that are of good quality, sterile, no contaminants, swabs with a good tight head," recommends Elaine Logan, sales manager of diagnostic products at Hardwood Products, an FDA manufacturer-controlled company. With warehouses on both coasts, their products are easily obtainable. They also service 42 countries worldwide. Hardwood Products specializes in single-use items, sticks and swabs for DNA collection, sterile foam swabs which enable collection of very small samples.

"Most of our good ideas come from our customers," Fitz says. "We're not just going to sell you a product. We want to know why you use it, what it's used for, and how we might improve it. If we can make our customers comfortable with what they're doing, we can give them confidence."

DNA Collection

The Bode Technology Group, Inc. produces the Buccal DNA Collector, a system for collecting buccal cell samples and protecting the chain of custody. The Buccal Collector provides better results because it gathers the cells from the inside of the cheek instead of collecting saliva, according to Randy Nagy, vice president of sales and marketing. It also allows forensic nurses to collect samples directly so there is no transfer of the sample for shipping. The bar code or identification label is applied directly on the handle of the device, so there's no chance of sample mix-up. The sample processing is automated, so turnaround time is faster.

"We make it very simple," says Nagy. "If you're collecting samples from several different people and you have swabs drying some place, there's an opportunity for mix-up. Since the DNA Buccal Collector requires no drying step and they have a bar code right on the device, the sample goes right into the envelope."

Drying Equipment

The importance of collecting evidence both at the crime scene and during a sexual assault examination is a vital step in the forensic process. Evidence must be gathered from victims and possible suspects, and the samples must be preserved free of any possible contamination. Swab driers and drying chambers store this evidence in a safe environment that protects the integrity of the sample. There are a variety of drying chambers available, many fully customizable. For example, Kinderprint's compact Dry-Fast Swab Drier has an optional adaptor for use in crime scene vehicles, and features a numbered security lock to maintain evidence integrity.

Air Science Technologies also offers a line of drying cabinets and benchtop swab driers fully customizable to specific user requirements in terms of size and application. President Andy Chambre cites his company's response to the recent Anthrax scare; Air Science Technologies developed a mail inspection workstation used by the FBI and other leading law enforcement agencies.

Sirchie drying chambers feature automatic waste pumps that easily allow the user to wash away any waste after disinfecting the chamber, and an automatic controller that monitors all filter conditions and airflow to ensure optimum operator safety.

The importance of operator safety is a chief concern among manufacturers. "Be aware of the potential dangers in the handling of evidence such as the possible presence of HIV, Hepatitis A and B, and insist on reasonable precautions in terms of the equipment designed to protect against possible infection," Chambre advises. Be aware of proper protocol for garbing and handling contamination-sensitive materials, follow guidelines, and wear the proper personal protection equipment.

When deciding on which line of drying equipment is best for your needs, "Look for a company with a proven history," says Kinderprint president Mike Nagel. "Meeting the requirements to preserve the evidence in a manner that won't degrade over time and that will be usable by forensic scientists."

Forensic Light Sources

Forensic light sources project specific wavelengths, causing certain evidence to fluoresce. The operator wears filtered goggles that block out all of the initial light wavelength and the fluorescence pass through. The user can visualize anything from body fluids, bruises and wound marks, treated and untreated fingerprints and small amounts of trace evidence.

Evident Crime Scene Products distributes the SPEX line of forensic light sources, which utilizes wavelength-specific interference filters. These filters allow the use of low-cost, high power bulbs, instead of specific bulbs or extremely expensive lasers. Because these light sources generate high-intensity wavelengths, there is definitely a safety factor. "Wear safety goggles, protect both yourself and others at the crime scene," cautions George Setola of SPEX forensics.

Michael Grim, vice president of Evident Crime Scene Products, underscores the importance of understanding what type of evidence you are looking for, based on the type of crime. "With assault or rape you're looking for body fluids and bruising. Different bits of evidence that can be collected in a timely manner and preserved so that law enforcement can then work with the nursing staff to collect evidence in a secure manner that's not questionable by any attorney. That will help down the road when you get into the courtroom."

Grim advises those in the market for forensic light sources to balance the needs of the hospital with the cost of the light source. Setola concurs. "All other things being equal, look for a balance between the most wavelengths, the brightest source and the ease of use."

Kinderprint distributes an Ultra Violet lamp can be used to examine skin and clothing in a darkened room for semen stains.

Light-Staining Microscope

Optical Services Company produces the only microscope for forensic nurses that makes it easy to identify sperm during a post-rape examination. Employing an illumination system that produces a color contrast, sperm and STDs appear bright yellow against a blue background. There is no chemical staining involved; all of the color is produced by the microscope.

"Sperm often has been missed or misdiagnosed in the past. Most sexual assault nurses are not skilled microscoposists. Using a microscope isn't something they're comfortable with or have had enough experience to use optimally," says Karen Podvin, Optical Services owner. "The Light Staining Microscope is very simple to use. It makes the nurse's job so much easier."

Colposcopes

This instrument for the magnified documentation of many kinds of trauma is a vital means of effective assessment and documentation that may be used in medico-legal proceedings. Some studies have indicated that in 10 percent to 73 percent of cases, additional evidence is seen with the photocolposcope when compared with examinations conducted without magnification. There are many different models on the market to meet the needs and preferences of forensic clinicians.

Cooper Surgical manufactures the ImageQUEST system, a colposcopic digital documentation system with internal software capable of establishing a chain of custody. From the point of image capture to the moment of presentation, the system is designed to prevent tampering or alteration. ImageQUEST is available with additional integrated 35mm camera capabilities for jurisdictions still requiring that format of evidence presentation.

"A forensic nurse needs a system that will help further their credibility as an expert witness," says Cooper Surgical product manager for colposcopy, Kevin Gilmore. "Utilizing a system with extensive internal anti-tampering safeguards, and reporting and presentation capabilities will only improve the perception of their professionalism and credibility."

Confidence in both operation and image accuracy will empower the forensic nurse.

Wallach Surgical Devices' Total Recall system consists of six different optical/video colposcopes which can be combined with a number of image capture systems to help in the collection of images. The lead system consists of their top end Video ZoomScope with Power Zoom/Focus, combined with a full PC digital imaging package with the addition of a flat panel monitor and integrated display stand. The Total Recall System also makes use of current email technology to provide the easy and confidential distribution of information. For image security, it employs a proprietary file watermarking system to guarantee image accuracy.

"Total Recall is extremely straightforward in its use," says Craig Citron, Wallach vice president of sales. "With minimal training or a review of our quick-start manual, any forensic nurse can be taking and storing images."

The ZoomScope, also from Wallach, provides superior Nikon optics for direct visualization. The clarity and brightness of the Nikon-provided image help in the delicate work of determining the precise nature and extent of injuries. The zoom feature allows an infinite range of magnifications between the range of 4.5x and 21x. It also enables the examiner to precisely visualize the area of concern with the best field of view possible. Further, the Nikon optical head offers angled eyepieces for greater user comfort and use flexibility. Additionally, the optical head may be inverted for positioning over the patient should that be necessary based on the injuries. The exclusive Wallach overhead scope design allows a sizable range of motion and colposcope control.

The Olympus OCS-500 adjusts focus and zoom by moving knobs rather than the complete colposcope head. This feature allows the surgeon to adjust the working distance for space requirements, enables smooth and fast operation with either hand, minimizing stress and reducing exam time. The compact design features a flat screen monitor and video system, and has recording capability with digital camera, 35mm camera and video. The system also comes with a complete set of interactive e-tutorials to help train new nurse examiners and refresh the memories of nurses in need of review.

"We recommend forensic nurses begin the process of defining what type of end product they are looking for in a forensic system," says Citron. "We have a wide range of options and try to provide the forensic nurse the best system at the best price based on their needs. Some typical questions that help define the need are:

• Do you want a digital image? How and where do you want to share this image?
• Do you want to have your information on a 3 1/2 floppy, or a CD ROM?
• How many patients do you see?
• Do you need a video tape?
• Do you need a 35mm camera system?
• Will you have more than one point of observation?

Welch-Allyn has created a direct video colposcope designed to eliminate the need for binocular optics, couplers and beam splitters that can degrade image quality. A video printer can be easily connected to the system, providing immediate documentation of the examination. Welch-Allyn's Solarc lamp generates light 50 percent brighter and whiter than any halogen light (typically found in most optical colposcopes) for truer tissue color and for easier diagnosis and faster examinations. In addition, a video printer can be easily connected to the system providing immediate documentation of the examination.

The Medscope is a video colposcope--a small camera on the end of a wire. Simplicity of design and use is the salient feature, says Fred Fischer, vice president of Medscope. "An optical colposcope has to be learned and practiced. The Medscope is something that is quite literally point and shoot." He also touts the Medscope's compact format as less jarring and intrusive, great for examining children.

To Fischer, the advantage of the Medscope is its ease of use and versatility. "We can collect images of sexual and physical abuse. An optical colposcope cannot do this--we can pan out with video, show a bruise on an arm, then pan out and show that it was on the left arm."

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