Alternate Light Assessment of Skin Trauma (AtLAST): Guidelines for Clinical Practice

Abstract

The following document provides practice guidelines for using an alternate light source (ALS) to detect and document possible physical trauma during a clinical skin assessment. These guidelines offer recommended standards for forensic clinicians to apply the ALS technology during patient encounters and appropriately interpret observations based on available scientific evidence. Development of these guidelines included a contextual assessment of patient care practices, organizational resources, and stakeholder input (i.e., forensic clinicians, law enforcement professionals, and prosecuting attorneys) at two forensic nursing departments.1 Data collection included historical data from a forensic nursing department with ten years of clinical experience integrating ALS in medical forensic examinations of soft tissue skin injuries and a forensic nursing department at a separate organization integrating ALS as a new clinical practice. A focused grey literature search for existing standards and practice guidelines on ALS application in the clinical setting assisted in understanding current practices further. Finally, a systematic review and appraisal of peer-reviewed literature provided the scientific evidence base to support the practice recommendations in these guidelines (see Appendix A). These guidelines address considerations related to the physical clinical environment, equipment, and patient conditions for using ALS in clinical practice to assess for possible soft-tissue skin trauma. The included step-by-step protocol for ALS application in the clinical setting is trauma-informed, patient-centered, and considerate of patient and user safety. These guidelines also include sections introducing the reader to documentation considerations (written and image documentation) of ALS technology use, informed testimony preparation, and education and training requirements.