Sexual Assault
PATIENT’S IMMEDIATE EMOTIONAL NEEDS
Rape represents a profound, true emotional crisis for virtually all patients.
It should be made clear at the beginning of the patient encounter that he or she is no longer in danger of harm. Patients should first be placed in a quiet, comfortable, private room, where a member of the staff should remain with the patient at all times.
Although details of the incident should not be explored at this time, the patient should be comforted and allowed to express any feelings he or she feels are appropriate.
Before the physical examination, the patient should be discouraged from changing clothes, washing, urinating, or defecating; oral intake should be prohibited when oral penetration may have occurred.
Although serious physical injury may occur, in most patients, emotional or psychological damage is initially and ultimately more disabling and must be thoroughly addressed.
It is the responsibility of the emergency provider to consider these initial psychological needs and to make clearly available appropriate counseling services.
It is strongly recommended that the appropriate counseling service, whether it be a designated nurse responsible for rape counseling or a member of the psychiatry or social service department skilled in the initial care of such patients, comes to the emergency department and establish contact with the patient before discharge.
This contact will not only allow an initial assessment of the patient but also make clear the availability of psychological assistance if it becomes necessary over the next 24 to 48 hours.
Aside from acute care, a psychological referral at an appropriate interval as suggested by the consultant should be strongly advised.
CONSENT AND THE CHAIN OF EVIDENCE
Consent must be obtained from the patient for each part of the evaluation process.
Some patients will not wish to prosecute and, on this basis, will wish to forego the formal collection of evidence substantiating the allegation of rape; this is clearly the right of the individual and in no way alters other care.
Patients should, however, be encouraged to allow a complete formal evaluation for the collection of evidence, because they may change their minds and then wish to proceed with prosecution; this clearly will be made difficult or impossible without the initial substantiation of rape through the proper collection of evidence.
Again, the evaluation and treatment, medically and psychologically, of patients who elect to forego the forensic evidence gathering are unchanged in all other respects.
The “chain of evidence” refers to the orderly and recorded transferal of information and evidence from the person obtaining it to its ultimate destination in the crime laboratory or court.
The transmittal form is designed to make clear the person or agency responsible at any given time for the collected material.
Each time information or collected material is transferred to another person or institution, its custody must be formally recognized and signed for.
Separate transferal forms should be generated for each group of collected specimens.
Each collected specimen must be labeled with the date and time of collection, the patient’s name and hospital number, the origin of the particular specimen, and the name of the individual who collected the specimen.
Failure to document formally and in writing the transferal of information or evidence with each passage and to identify or label collected information correctly and completely may result in the rejection of such material by the court.
HISTORY
In some jurisdictions, a specially trained nurse conducts the history and physical examination, whereas in other jurisdictions, the physician is responsible for the pertinent medical evaluation; details related to the actual incident are more appropriately obtained by police officers with an appropriate member of the staff available at all times to provide emotional support to the patient.
Medically pertinent facts should be investigated sequentially.
These are as follows:
The date, time, and location of the incident
Whether force or the threat of force was used to coerce or intimidate, whether drugs or alcohol were used, or whether the patient was unconscious or intellectually abnormal in any way before or during the incident
What specific type of assault the patient believes to have occurred?
Was there oral, anal, and/or vaginal penetration?
Was such penetration attempted and with what specifically?
Did ejaculation occur and, if so, then where?
Was a condom used?
When was the patient’s last voluntary intercourse?
A negative history of previous intercourse should specifically be noted.
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