Evaluation and Management of the Sexually Assaulted Or Sexually Abused Patient Second Edition

Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient Second edition eBOOK Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient Evaluation and Management Preface to the Second Edition of the Sexually Assaulted This handbook was first produced by the American College of or Sexually Abused Patient Emergency Physicians in 1999. This project was an enormous undertaking at the time and was produced under its contract 98- 2nd Edition 0347(P) with the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Several key stakeholder organizations were The American College of Emergency Physicians (ACEP) makes every effort to ensure that contributors assembled to produce and review this handbook (see next page). to its publications are knowledgeable authorities in their fields. Readers are nevertheless advised that the statements and opinions expressed in this book are provided as recommendations and should not be Since the first production of this handbook, “A National Protocol for construed as College policy. The College disclaims any liability or responsibility for the consequences of Sexual Assault Medical Forensic Examinations” was developed by the any actions taken in reliance on those statements or opinions. This handbook has been written to provide a US Department of Justice/Office for Violence Against Women. This consensus-based set of recommendations. The materials contained herein are not intended to establish policy, was revised in 2013. In addition, ACEP created the Forensic Medicine procedure, or a standard of care. Section in 2009. One of the goals of the section was to revise and update this handbook. In 2011, the Forensic Medicine Section was June 1999, updated, January 2013, American College of Emergency Physicians, Dallas, Texas. This publication awarded an ACEP Section Grant to accomplish this goal. may be reproduced, stored or transmitted in any form or by any means, electronic or mechanical, including storage and retrieval systems. Printed in the USA. This handbook represents the work of several members of the section to revise and update the information provided. We are grateful to Download additional copies at them for their work on this project. We also would like to thank www.acep.org/handbook ACEP for their continued dedication to the Section, its members, and to the victims we serve. Finally, we would thank the organizations listed below who graciously reviewed and commented on this 2nd edition of the handbook. We hope this becomes a valuable resource for ACEP Members. Ralph J. Riviello, MD, MS, FACEP Heather V. Rozzi, MD, FACEP Project Co-Directors 2 Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient | ACEP 3 Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient American College of Emergency Physicians Contributors to the Second Edition Shellie Asher, MD, MS, FACEP Ralph Riviello, MD, MS, FACEP Evaluation and Management of the Associate Professor and Residency Program Director Director, Division of Forensic Emergency Medicine, Department of Emergency Medicine Drexel University College of Medicine Sexually Assaulted or Sexually Abused Patient Albany Medical College Medical Director, Philadelphia Sexual Assault Response Team Albany, NY Philadelphia, PA Sally Henin Awad, MD, FACEP Heather Rozzi, MD, FACEP Special Thanks Medical Director, Forensic Nursing Program Medical Director, Forensic Examiner Team Memorial Hermann Hospital System This document was first created under the leadership of the American College of Emergency Physicians (ACEP). Wellspan Health Houston, TX York Hospital The intent was to prepare a set of useful and practical recommendations that will standardize the evaluation and York, PA management of sexual assault patients. The following individuals represent the original participants in this process. Chame Blackburn, MD, FACEP The organizations they represented at the time are identified. ACEP extends its greatest appreciation to each of these Director, Sexual Assault Forensic Examiner Program Derek J. Schaller, MD Albany Medical Center VMS/Detroit Medical Center/Sinai-Grace individuals as well as the organizations they represented for participating in this extremely important project. Albany, NY Emergency Medicine Residency Program Detroit, MI Stephen J. Groth, MD, FACEP Carolyn Levitt, MD, FAAP Tiffany Bombard, MD, MS, NREMT-P Chair, Emergency Medicine Practice Committee American Academy of Pediatrics Albany Medical College Nicole K. Schaller, RN, BS, SANE-A, SANE-P National Network Childrens Advocacy Centers Albany, NY Wayne County SAFE Peggy L. Goldman, MD, FACEP Detroit, MI Subcommittee Chair Patricia Loftus, RN, MSN, MFS, CCRN Mary Carr, MD SANE Medical Director Federal Bureau of Investigation Monique I. Sellas, MD, FACEP Department of Emergency Medicine Gail Burns-Smith, RN Attending Emergency Physician Regions Hospital Massachusetts General Hospital National Alliance of Sexual Assault Coalitions John C. Nelson, MD, MPH, FACOG St. Paul, MN Instructor of Emergency Medicine American Medical Association Harvard Medical School Randolph J. Cordle, MD, FAAP Maura Dickinson, DO Certified Forensic Physician American College of Emergency Physicians Carla M. Noziglia, MS, FAAFS Boston University School of Medicine American College of Forensic Examiners International American Society of Crime Lab Directors Boston Medical Center Emergency Medicine Residency Bonnie Dattel, MD, FACOG Boston, MA Cynthia A. Singh, MS American College of Obstetricians and Gynecologists Frances E. Page, RN, MPH ACEP Forensic Medicine Staff Liaison Public Health Service Office on Women’s Health William M. Green, MD, FACEP Deborah D’Avolio, RN, CS, MS Medical Director Sheila Steer, MD California Clinical Forensic Medicine Training Center Emergency Nurses Association Diana M. Riveira, Senior Attorney Associate Professor NEOMED Sacramento, CA American Prosecutors Research Institute SUMMA Health Systems Akron, OH Jamie Ferrell, RN, BSN, CEN Rebecca S. Hierholzer, MD, MBA, FACEP International Association of Forensic Nurses Alexandra Walker Medical Director Lindsay Stokes, MD STOP Technical Assistance Project Collection of Victim Evidence Regarding Sexual Assault Albany Medical Center Marianne Gausche, MD, FACEP, FAAP (COVERSA) Albany, NY American College of Emergency Physicians Michael L. Weaver, MD, FACEP Kansas City, MO American College of Emergency Physicians Michael L. Weaver, MD, FACEP Deborah L. Horan Judith A. Linden, MD, FACEP, SANE St. Luke’s Health System American College of Obstetricians and Gynecologists Chief N. Frank Winters Associate Professor or Emergency Medicine Kansas City, MO International Association of Chiefs of Police Boston University School of Medicine and Boston Medical Center Peter J. Jacoby, MD, FACEP Wendy Woolley, DO Boston, MA American College of Emergency Physicians Douglas M. Hill, DO, FACEP Associate Program Director Department of Emergency Medicine Board Liaison, ACEP Phillip Peterson, MD Albany Medical College Denise Johnson, MS Senior Resident, Department of Emergency Medicine Albany, NY Centers for Disease Control and Prevention Marjorie Geist, PhD, RN Drexel University College of Medicine Staff Liaison, ACEP Philadelphia, PA Dale P. Woolridge, MD, PhD Linda Ledray, PhD, RN, FAAN Associate Professor of Emergency Medicine and Pediatrics American Psychological Association Julie Dill Valerie Prulhiere, RN Department of Emergency Medicine Administrative Assistant, ACEP SUMMA Health Systems University of Arizona Akron, OH Chair, ACEP Pediatric Section 2012-2013 External Reviewers We would like to extend a personal thank you for the following external reviewers of this handbook. Your comments and insights were invaluable in completing this project. Kim Day, RN, FNE, SANE-A, SANE-P Ecoee Rooney, MSN, RN-BC, SANE-A International Association of Forensic Nurses International Association of Forensic Nurses SAFE Technical Assistance Coordinator SAFE Technical Assistance Consultant 4 Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient | ACEP 5 Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient At a minimum, professionals caring for sexual assault patients should be proficient in the core content of the Overview evaluation and management of cases of sexual assault (Module—Minimum Core Content). The responsibilities To minimize unnecessary variations in care, the American College of Emergency Physicians (ACEP), in concert with and activities of each participant in the community plan should be clearly identified (Modules—Victim-Centered a broad range of clinical, legal, forensic, judicial, advocate, and other organizations, has developed the following Responsibilities Matrix). consensus approach to assist in the care of the patient presenting to the Emergency Department following sexual assault or sexual abuse. Clinical Considerations Identification of sexual assault or sexual abuse Introduction Identification of sexual assault is often difficult for many reasons. The sexually assaulted or abused patient often The evaluation of the sexually assaulted or abused patient, particularly those with cognitive impairment or young age, delays seeking medical evaluation due to feelings of shame, fear, or lack of understanding that they are victims of is a challenge for health care professionals. Appropriate management of the patient requires a standardized clinical a crime. Delayed reporting

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