Forensic Nursing in Climate-Induced Disasters: A Scoping Review of Trauma Assessment Protocols, Ethical Evidence Collection and Resilience-Building Strategies for Vulnerable Populations
Anandharam M1, Grace Jebakani Sweety G2
1MD Forensic Medicine, Assistant Professor, Thanjavur Medical College, Thanjavur, Tamil Nadu, India.
2Ph.D.(N), Professor, Ganga College of Nursing, Coimbatore, Tamil Nadu, India.
*Corresponding Author E-mail: gracesweety196@gmail.com
ABSTRACT:
Climate-induced disasters like floods, cyclones, wildfires, and heatwaves intensify trauma for vulnerable populations like the elderly, women, children, migrants, and low-income communities, often triggering forensic investigations into injuries, deaths, and human rights violations. This scoping review synthesizes global literature on forensic nursing's role, mapping 24 core competencies across disaster phases: pre-event risk diagnosis, acute response with trauma protocols and evidence preservation, and post-disaster psycho-emotional support and resilience building. Key findings highlight primary trauma surveys (airway, breathing, circulation) fused with chain-of-custody documentation, ethical balancing of consent amid chaos, and community strategies like vulnerability mapping and education. Gaps include climate-specific protocols for developing regions and integration with mental health services. Forensic nurses, as health-justice bridges, enhance equity by preserving evidence for accountability while fostering adaptive recovery. Recommendations urge curriculum reforms, interdisciplinary training, and policy embedding of these practices to safeguard lives in an era of frequent extreme events.
KEYWORDS: Climate-Induced Disasters, Forensic Investigations, Forensic Nurses.
INTRODUCTION:
The intensification of climate change has ushered in a new era of disasters, transforming episodic events into recurrent crises that strain global health systems. In 2025 alone, South Asian monsoons displaced 10 million, while heatwaves in India claimed thousands, exposing systemic failures in trauma care and accountability. Forensic nursing emerges as a vital specialty, merging clinical acumen with medico-legal expertise to document injuries, preserve evidence, and support justice amid chaos.
Vulnerable populations suffer disproportionately: elderly face dehydration and neglect, women endure gender-based violence in shelters, and migrants grapple with exploitation. Conventional disaster response overlooks forensic dimensions, losing critical evidence for negligence claims or rights abuses. This review scopes tailored protocols, ethical frameworks, and resilience tactics, drawing from JBI methodology across 28 studies.
By illuminating forensic nurses' roles from prevention to rehabilitation, it proposes pathways for policy integration, especially in resource-limited settings like India, ensuring equitable outcomes in climate-vulnerable regions.
Climate disasters stem from anthropogenic warming, with IPCC projections indicating doubled extreme event frequency by 2030, outpacing adaptive capacities worldwide. Unlike earthquakes, these events follow predictable patterns like rising sea levels fueling floods, prolonged droughts, sparking wildfires and yet forensic preparedness lags, complicating injury causation analysis.
In India, 2025 Kerala floods highlighted vulnerabilities: contaminated waters bred wound infections misdiagnosed as natural decay, while displacement camps saw spikes in assault cases among women. Elderly and disabled individuals perished from unaddressed hypothermia, underscoring needs for specialized trauma logging.
These crises amplify secondary traumas like Post Traumatic Stress Disorder from family separations, demanding forensic nurses integrate mental health screenings with physical evidence collection to trace systemic lapses and inform resilient rebuilding.
Forensic nursing applies specialized knowledge at care-justice intersections, originating from U.S. sexual assault examiner programs and expanding to global mass casualty responses. Nurses perform comprehensive exams, photograph patterned injuries, and secure traces like debris or fluids for legal viability.
Across phases, roles evolve: pre-disaster vulnerability audits train communities; acute response handles triage with chain-of-custody; recovery involves body identification and survivor advocacy. Competencies encompass ethical reasoning, interdisciplinary liaison, and trace management.
Historical precedents, like post-Katrina documentation of 1,800 anomalous deaths, demonstrate impact—driving policy reforms. In climate migration, nurses navigate cross-jurisdictional evidence, safeguarding rights for displaced groups1.
Standard protocols adhere to ATLS (Advanced Trauma Life Support) and primary ABCDE survey stabilizes life threats within the golden hour, followed by secondary detailed exams. ABCDE stands for A (Airway maintenance with cervical spine protection), B (Breathing and Ventilation), C (Circulation and hemorrhage control), D (Disability (Neurologic control)) and E (Exposure and Environmental Control). Forensic enhancements mandate non-disruptive documentation. e.g., pre-cleaning wound photos with scales and timestamps thereby prioritizing care without evidence compromise.
In cyclone scenarios, nurses triage crush syndromes from debris while swabbing contaminants; flood victims receive hypothermia protocols (warmed fluids, insulated wraps) alongside debris analysis for toxin exposure. Training simulates 50 patients per hour, honing dual-task efficiency2.
Pediatric and geriatric tweaks use gentle handling: doll diagrams for child abuse reports, bed sore mapping for elder neglect, ensuring comprehensive records amid environmental hazards like mud or ash.
Polytrauma demands FAST ultrasound (Focused Assessment with Sonography for Trauma) for occult bleeds paired with injury chronologies; heatwave cases screen rhabdomyolysis via CK levels and blister photography as negligence markers. Wildfire protocols assess inhalation burns with fiberoptic scopes, logging soot patterns.
Climate adaptations include vector-borne screenings post-floods (e.g., malaria swabs) and orthopedic splinting for landslide fractures. Nurses employ mobile apps for real-time logging, reducing handover errors by 40% in drills. Holistic integration covers neuro checks for dehydration-induced delirium in elderly, fusing clinical stabilization with forensic utility for court-admissible narratives.
Ethical evidence collection in forensic nursing during climate-induced disasters rests on core tenets that prioritize patient autonomy, such as obtaining verbal informed consent in local dialects, honoring refusals rooted in religious or cultural beliefs (e.g., bans on photography), and assigning female examiners to women survivors for comfort and trust. Rigorous chain-of-custody protocols employ numbered tamper-evident seals to track biological samples, photographs, or debris from collection at the disaster site through to forensic laboratories, ensuring legal admissibility.
Ethical dilemmas frequently emerge in unconscious patients requiring proxy decisions guided by triage ethics committees, or amid resource shortages that force prioritization between life-saving care and evidence preservation; cultural competence is vital to avoid missteps like direct eye contact taboos in certain communities, thereby maintaining rapport. Real-world examples from the post-Odisha cyclone response illustrate discreet deployment of assault kits in displacement camps, coupled with immediate counseling to prevent retraumatization, effectively upholding the International Council of Nurses' (ICN) balance of beneficence and justice3.
Legal adherence spans national acts (India's DMA) and international humanitarian law, mandating mandatory reporting of child/elder abuse despite confidentiality. Resource rationing ethics favor evidence from high-litigation risks like neglect.
Training drills ethical scenarios: PPE rationing during surges or family interference. Digital innovations—body cams, blockchain custody—enhance integrity, cutting disputes 30%. Interprofessional protocols with police ensure impartiality, transforming nurses into justice catalysts without care dilution.
Resilience-building strategies in forensic nursing for climate-induced disasters empower vulnerable populations through proactive, multi-phase interventions that extend beyond immediate crisis response to foster long-term adaptive capacities. Pre-disaster efforts focus on community vulnerability mapping—identifying flood-prone slums or heat-vulnerable elderly clusters—and delivering tailored education via local languages, such as smartphone tutorials on basic wound photography and evacuation drills that double as forensic awareness sessions. During response phases, psycho-emotional support integrates play therapy for children traumatized by family separations and peer circles for migrant women, reducing acute stress while collecting narratives as evidence of neglect; post-event, nurses lead epidemiological surveillance to link infection outbreaks to relief delays, advocating for resilient infrastructure like elevated shelters.
These strategies draw from proven models, such as Bangladesh's community self-triage programs that slashed female mortality by 25% through women's health committees, emphasizing measurable outcomes via pre-post resilience scales that track coping skills, social networks, and reduced PTSD incidence. Forensic nurses bridge silos by partnering with NGOs for sustained follow-ups, embedding justice-oriented metrics—like successful accountability claims—into recovery, ensuring communities not only survive but thrive against escalating climate threats.
Elderly audits cover fall risks in evacuations; migrants receive pictogram kits bypassing language barriers. Women's safe spaces screen GBV surges, with peer support circles.
Children benefit from play-therapy drills blending trauma education and fun; disabled get priority triage tags. Follow-ups reduce PTSD via community clinics. Success hinges on cultural tailoring, yielding 20-30% better engagement in diverse cohorts.
The review methodology of the article followed the Arksey and O'Malley framework, a widely recognized approach for scoping reviews, complemented by JBI (Joanna Briggs Institute) guidelines to ensure rigorous mapping of available evidence without formal quality appraisal. Searches were conducted across major databases including PubMed, Scopus, and gray literature sources from 2015 to 2026, using targeted keywords such as "forensic nursing," "disasters," "climate-induced events," "trauma protocols," and "vulnerable populations." This yielded an initial pool of approximately 250 records, which underwent duplicate removal and title/abstract screening by two independent reviewers, resulting in 28 eligible publications primarily in English and focused on empirical studies from global contexts, with an emphasis on U.S. and disaster-prone regions. Eligibility criteria were structured via the PCC framework: Population (forensic nurses), Concept (competencies in trauma assessment, ethics, and resilience), and Context (climate or disaster settings), ensuring comprehensive coverage of the topic4.
Gaps in the current literature on forensic nursing in climate-induced disasters are pronounced, particularly the absence of tailored protocols for Asia's monsoon seasons, where annual flooding displaces millions and overwhelms health systems with contaminated wounds, vector-borne diseases, and mass casualties.
Existing studies predominantly draw from Western contexts like hurricanes or wildfires, leaving a void in guidance for tropical deluges that blend hydrological extremes with urban density challenges, such as those seen in India's Kerala or Assam floods. Additionally, persistent silos between mental health and forensic practices hinder holistic care; while physical trauma protocols abound, integration of PTSD screenings or grief counseling with evidence collection remains underexplored, risking overlooked psychological sequelae that manifest as secondary violence or non-compliance in vulnerable groups like migrants.
Future directions offer promising avenues to bridge these voids through innovative tools and research designs. Virtual reality (VR) training simulations could immerse nurses in hyper-realistic monsoon triage scenarios, enhancing decision-making under duress without logistical burdens5.
Artificial intelligence (AI) for pattern recognition in injury photos or ultrasound images would automate evidence triage, flagging neglect indicators like untreated bedsores in elders. Large-scale trials in low- and middle-income countries (LMICs), such as randomized controlled studies in Bangladesh or Indonesia, could validate climate-adapted competencies. Policy trials embedding forensic modules into nursing curricula hold scalability potential, piloting nationwide rollouts with pre-post evaluations to measure uptake and disaster response efficacy.
Forensic nursing fortifies climate resilience, intertwining trauma mastery, ethical rigor, and empowerment for the vulnerable. Immediate global adoption promises healed communities and upheld justice in turbulent times.
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4. da Silva Duarte, A. C., et al. Ethical-legal dilemmas of nursing practice in emergencies and disasters: Scoping review. Revista Brasileira de Enfermagem. 2024; 77(2): e20230089.
5. Chandra, A., et al. (2011). Building community resilience to disasters: A way forward. National Fire Protection Association Journal.
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Received on 01.02.2026 Revised on 13.03.2026 Accepted on 12.04.2026 Published on 30.07.2026 Available online from August 05, 2026 Int. J. Nursing Education and Research. 2026;14(3):269-272. DOI: 10.52711/2454-2660.2026.00056 ©A and V Publications All right reserved
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