Medical forensics in workplace incident investigations

When loved ones die or are seriously injured in workplace incidents, families often turn to their physicians. They look for answers surrounding such deaths and life-altering injuries, and it’s sometimes up to their doctors to help them put things in perspective. The better a workplace incident is understood, the better the opportunity to prevent a similar occurrence in the future. That’s where WorkSafeBC’s Fatal and Serious Injury (FSI) Investigations Section comes in.

This Section investigates workplace incidents for the purposes of education and prevention. Alongside a team of investigators, engineers, occupational safety officers, lawyers, and other professionals, FSI also incorporates a forensic medical role within its occupational injury and fatality investigations. The traditional approach to investigations often overlooks the evidentiary value of the body, thus excluding the key information provided by forensic medicine.

This role is filled by an investigations officer, who is also a forensic nurse specialist. This officer evaluates trauma, determines the mechanism of injury, assists in event reconstruction, interprets medical information, and helps to understand natural versus traumatic events.

WorkSafeBC is the only known North American agency of its type that applies this focused expertise to serious workplace injury and fatality investigations. WorkSafeBC’s forensic nurse specialist is a master’s-prepared forensic nurse, a former coroner with law enforcement and investigative experience, and a board-certified advanced forensic nurse and medicolegal death investigator with occupational health and safety training.

As is necessary with criminal investigations, occupational incident investigations require identifying, preserving, documenting, and collecting all possible evidence, even if the immediate relevance of this evidence is unknown. Both mechanism of injury and trauma characteristics are important in regulatory investigations for cause and have evidentiary value in legal proceedings.

The expertise of the forensic nurse specialist is particularly useful in unwitnessed fatalities. Forensic evaluation of trauma can help determine if the injury was caused by blunt or sharp force, the direction of impact, and the type of impacting object. It can also ascertain if it was a matchable patterned injury, or if trace evidence was transferred. The information may help determine the individual’s position and activity prior to the incident. The evaluation is valuable in discerning if the injuries were consistent with the event and how it was portrayed to the investigator, and will corroborate or disprove witness statements.

Applying forensic medical knowledge at the workplace scene establishes an investigative pathway by following the injury evidence rather than constructing a theory of the event and then looking for evidence to support that theory. The result is a more accurate understanding of the incident circumstances, which contributes to enforcement of occupational health and safety requirements and the direction of prevention initiatives.

Not all workplace fatalities have the benefit of a forensic pathologist’s evaluation. When the coroner determines that cause of death is obvious, such as from known, multiple blunt-force injuries, no autopsy is conducted. Part of the coroner’s mandate is to determine cause of death, and the constellation of injuries is not necessarily of prime importance. However, injury characteristics are crucial in determining how the worker died—the mandate of FSI Investigations—and when to draw on the expertise of forensic nurse specialists. Determining the how associated with worker injuries is key to preventing similar injuries in the future.

When a worker survives a serious workplace injury, a forensic pathologist is not involved. To determine the cause of the incident, WorkSafeBC’s forensic nurse specialist applies a living forensics methodology to analyze circumstantial, positional, and directional information about wounds and injuries. In order to establish whether a natural event precipitated a workplace incident, the forensic nurse specialist may also obtain paramedic and medical records to interpret a patient’s pathophysiology.

WorkSafeBC’s forensic nurse specialist works collaboratively with other FSI Investigations officers; attends workplace incident scenes to interpret injuries; attends forensic autopsies to photograph, document, and measure injuries; and helps to bridge the information gap between the FSI Investigations Section and the coroner or forensic pathologist. This enables autopsy and toxicology results to be interpreted in the context of other investigative material. The forensic nurse specialist ensures that final incident investigation reports contain accurate causal and medical content. As a result of having this expertise available, WorkSafeBC is establishing new best practices for occupational incident investigations.

For further information about the role of forensics in investigating serious and fatal injuries, contact Mr Colin Harris, an investigations officer who specializes in advanced forensic nursing for WorkSafeBC’s FSI Investigations Section, at Colin.Harris@worksafebc.com.
—Colin Harris, MSN, BSc (Crim), RN, AFN-BC, F-ABMDI
WorkSafeBC Investigations Officer

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This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.