Trafik kazası nedeniyle 2011-2020 yılları arasında acil tıp ve adli tıp anabilim dalları tarafından düzenlenen form ve raporların karşılaştırılması
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Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Her türlü kaza, cinayet, intihar girişimleri sonucu meydana gelen yaralanmalar adli nitelik taşır. Kendilerinin ya da bir başkasının kusurlu veya kasıtlı eylemi sonucu yaralanarak adli nitelik taşıyan bu kişilere ilk müdahaleleri sıklıkla sağlık kuruluşlarının acil servislerinde yapılmaktadır. Adli olgular böylece acil servislere başvuran olguların önemli bir kısmını oluşturmaktadır. Bu sebeple; acil serviste çalışan hekimler hastaları ile ilgili kayıt tutma yükümlülüğünün bir uzantısı olarak adli rapor düzenleme yükümlülüğü ile de sık karşılaşmaktadırlar. Acil servislerde çalışan hekimler hastalara gösterdikleri özenin yanı sıra adli vakalarda düzenleyecekleri belgelere de ayrıca özen göstermelidir. Çünkü düzenlenen bu belgeler, soruşturma safhasında tek başına kullanılabileceği gibi, savcılıklar tarafından veya ilerleyen süreçte mahkemeler tarafından istenmesi halinde bir adli tıp uzmanı tarafından düzenlenecek olan adli rapora dayanak da oluşturabilir. Bu nedenle, travma sonrası ilk müracaat edilen sağlık kuruluşundaki hekimlerin kişide meydana gelen tıbbi hasarları eksiksiz ve doğru şekilde rapora aktarmaları çok önemlidir. Bu çalışmada hipotezimiz; yaralanan kişi adli rapor düzenlenmesi için cumhuriyet savcılıkları, mahkemeler ya da kolluk kuvvetleri tarafından gönderildiğinde kişide meydana gelen tıbbi hasarların acil serviste düzenlenen belgelere yeterince aktarılmadığı yönündeydi. Bu hipotezimizi sınamak için trafik kazası sonucu yaralanan olgulara Acil Tıp Anabilim Dalı'nda düzenlenen belgeler ile aynı olgulara Adli Tıp Anabilim Dalı tarafından düzenlenen adli tıp raporları karşılaştırılmıştır. Acil servis muayene formunda yazılı olan abrazyonların %28,1'inin, laserasyonların %12,4'ünün, ekimozların %58,8'inin, hematomların %28,9'unun, iç organ hasarlarının %54,5'inin, kırıkların %40,4'ünün genel adli muayene raporuna aktarılmadığı, laserasyonların %16,5'inde, ekimozların %21,8'inde, hematomların %28,9'unda, abrazyonların %41,6'sında boyutları hakkında herhangi bir bilgi belirtilmediği saptanmıştır. Genel adli muayene raporunda yazılı olan abrazyonların %49,1'inde, hematomların %40'ında, ekimozların %45,2'sinde, laserasyonların %16'sında herhangi bir boyut bilgisi bulunmadığı saptanmıştır. Adli tıp raporunda belirtilen kırıkların %48,4'ünün acil servis muayene formunda, %45,4'ünün genel adli muayene raporunda belirtilmediği saptanmıştır. Acil Tıp Anabilim Dalı'nda düzenlenen belgeler ile Adli Tıp Anabilim Dalı'nda düzenlenen adli tıp raporları arasında istatistiksel olarak anlamlı farklılıklar saptanmıştır. Acil servislerde çalışan hekimler acil bir olgunun klinik sorunları ile baş etmelerinin yanı sıra çoğu zaman hastalardan ya da hasta yakınlarından kaynaklanan gerilimleri de yönetmek durumunda kalırlar. Ayrıca acil servise başvuran adli olgular da mevcut gerilimleri artırırlar. Böylelikle adli olguya müdahale eden hekim bütün bu gerilimlerle baş etmenin yanı sıra ilerde kendilerinin yasal sorunlarla karşılaşmasına neden olabilecek bir adli rapor düzenlemek zorunda da kalırlar. Oysa acil serviste hekimin adli olguya yapmış olduğu müdahale tıbbi bakımdan herhangi bir hastaya uygulanan müdahaleden farklı değildir. Bu nedenle düzenlenen rapor hekimi strese sokan ve düzenlemek istemediği bir adli rapor olarak değil "Adli Olgu Durum Bildirir Raporu" şeklinde düzenlenmelidir. Bu belgede travmaya bağlı kişide meydana gelen tıbbi hasarlar özenli ve usulüne uygun şekilde belirtilmeli ve hastanın klinik durumunun yaşamını tehlikeye sokup sokmadığı bilgisi belgeye eklenmelidir. Bunların dışındaki değerlendirmeler adli tıp uzmanınca yapılmalıdır. Bu durum acil servis hekimini yukarıda tanımlanan gerilimlerden kurtaracaktır. Esasen uygulamada düzenlenen genel adli muayene raporu yasal süreçte bir adli tıp uzmanına gönderilerek yeniden rapor düzenlenmektedir. Yani adli rapor olarak düzenlenen belgenin bir adli tıp uzmanınca düzenlenmesi gerektiği aşikar bir durumdur. Anahtar Kelimeler: Adli olgu, acil servis, genel adli muayene raporu, adli rapor
Injuries resulting from all kinds of accidents, murders, and suicide attempts are of legal nature. First aids to these people who have been injured as a result of their own or someone else's faulty or intentional action and have a judicial quality are often made in the emergency services of health institutions. Forensic cases thus constitute an important part of the cases admitted to the emergency services. Therefore; Physicians working in the emergency department are also frequently faced with the obligation to issue a forensic report as an extension of their obligation to keep records regarding their patients. Physicians working in emergency departments should also pay attention to the documents they will issue in forensic cases, as well as the care they show to the patients. These prepared documents can be used alone during the investigation phase, or they can also form a basis for a forensic report to be prepared by a forensic medicine specialist, if requested by the prosecutor's office or by the courts in the future. For this reason, it is very important that the physicians in the first applied health institution after trauma report the medical damage to the person completely and accurately. Our hypothesis in this study can be explained that when the injured person was sent by the public prosecutor's office, courts or law enforcement officers to prepare a forensic report, the medical damage to the person was not adequately transferred to the documents prepared in the emergency room. In order to test this hypothesis, the documents prepared in the Emergency Medicine Department for the cases injured as a result of traffic accidents and the forensic medicine reports prepared by the Forensic Medicine Department for the same cases were compared. It was determineted that 58.8% of ecchymoses, 28.1% of abrasions, 12.4% of lacerations, 28.9% of hematomas, 54.5% of internal organ damages, 40.4% of fractures, mentioned in the emergency service examination form were not specified in the the general forensic examination report. No size information was found in 16.5% of lacerations, 21.8% of ecchymoses, 28.9% of hematomas and 41.6% of abrasions written in the emergency service examination form. No size information was found in 49.1% of abrasions, 40% of hematomas, 45.2% of ecchymoses and 16% of lacerations written in the general forensic examination report. It was determined that 48.4% of the fractures mentioned in the forensic medicine report were not specified in the emergency service examination form, and 45.4% in the general forensic examination report. Statistically significant differences were found between the documents prepared in the Emergency Medicine Department and the forensic medicine reports prepared in the Forensic Medicine Department. In addition to coping with the clinical problems of an emergency, physicians working in emergency departments often have to manage tensions arising from patients or their relatives. In addition, forensic cases applying to the emergency department also increase the current tensions. Thus, the physician who intervenes in the forensic case not only has to deal with all these tensions, but also has to prepare a forensic report that may cause them to face legal problems in the future. However, the intervention of the physician in the emergency room to the forensic case is not different from the intervention applied to any patient in medical terms. For this reason, the report should be prepared as a "Forensic Case Status Report", not as a forensic report that stresses the physician and does not want to issue it. In this document, medical damage to the person due to trauma should be carefully and duly stated, and the information whether the patient's clinical condition endangered his life should be included in the document. Evaluations other than these should be made by a forensic medicine specialist. This will relieve the emergency physician from the tensions described above. In fact, the general forensic examination report prepared in practice is sent to a forensic medicine specialist in the legal process and a report is prepared again. In other words, it is obvious that the document prepared as a forensic report should be prepared by a forensic medicine specialist. Keywords: Forensic case, emergency department, general forensic examination report, forensic report
Injuries resulting from all kinds of accidents, murders, and suicide attempts are of legal nature. First aids to these people who have been injured as a result of their own or someone else's faulty or intentional action and have a judicial quality are often made in the emergency services of health institutions. Forensic cases thus constitute an important part of the cases admitted to the emergency services. Therefore; Physicians working in the emergency department are also frequently faced with the obligation to issue a forensic report as an extension of their obligation to keep records regarding their patients. Physicians working in emergency departments should also pay attention to the documents they will issue in forensic cases, as well as the care they show to the patients. These prepared documents can be used alone during the investigation phase, or they can also form a basis for a forensic report to be prepared by a forensic medicine specialist, if requested by the prosecutor's office or by the courts in the future. For this reason, it is very important that the physicians in the first applied health institution after trauma report the medical damage to the person completely and accurately. Our hypothesis in this study can be explained that when the injured person was sent by the public prosecutor's office, courts or law enforcement officers to prepare a forensic report, the medical damage to the person was not adequately transferred to the documents prepared in the emergency room. In order to test this hypothesis, the documents prepared in the Emergency Medicine Department for the cases injured as a result of traffic accidents and the forensic medicine reports prepared by the Forensic Medicine Department for the same cases were compared. It was determineted that 58.8% of ecchymoses, 28.1% of abrasions, 12.4% of lacerations, 28.9% of hematomas, 54.5% of internal organ damages, 40.4% of fractures, mentioned in the emergency service examination form were not specified in the the general forensic examination report. No size information was found in 16.5% of lacerations, 21.8% of ecchymoses, 28.9% of hematomas and 41.6% of abrasions written in the emergency service examination form. No size information was found in 49.1% of abrasions, 40% of hematomas, 45.2% of ecchymoses and 16% of lacerations written in the general forensic examination report. It was determined that 48.4% of the fractures mentioned in the forensic medicine report were not specified in the emergency service examination form, and 45.4% in the general forensic examination report. Statistically significant differences were found between the documents prepared in the Emergency Medicine Department and the forensic medicine reports prepared in the Forensic Medicine Department. In addition to coping with the clinical problems of an emergency, physicians working in emergency departments often have to manage tensions arising from patients or their relatives. In addition, forensic cases applying to the emergency department also increase the current tensions. Thus, the physician who intervenes in the forensic case not only has to deal with all these tensions, but also has to prepare a forensic report that may cause them to face legal problems in the future. However, the intervention of the physician in the emergency room to the forensic case is not different from the intervention applied to any patient in medical terms. For this reason, the report should be prepared as a "Forensic Case Status Report", not as a forensic report that stresses the physician and does not want to issue it. In this document, medical damage to the person due to trauma should be carefully and duly stated, and the information whether the patient's clinical condition endangered his life should be included in the document. Evaluations other than these should be made by a forensic medicine specialist. This will relieve the emergency physician from the tensions described above. In fact, the general forensic examination report prepared in practice is sent to a forensic medicine specialist in the legal process and a report is prepared again. In other words, it is obvious that the document prepared as a forensic report should be prepared by a forensic medicine specialist. Keywords: Forensic case, emergency department, general forensic examination report, forensic report
Açıklama
Anahtar Kelimeler
Adli Tıp, Forensic Medicine
