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Sexual Assault Medical Forensic Examinations in Indian Country

Sexual Assault Medical Forensic Examinations in Indian Country . Based on the National Protocol for Sexual Assault Medical Forensic Examinations of Adults and Adolescents By: Kim Day, RN, FNE A/P, SANE-A IAFN SAFE Technical Assistance Coordinator. Created at http://www.wordle.net.

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Sexual Assault Medical Forensic Examinations in Indian Country

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  1. Sexual Assault Medical Forensic Examinations in Indian Country Based on the National Protocol for Sexual Assault Medical Forensic Examinations of Adults and Adolescents By: Kim Day, RN, FNE A/P, SANE-A IAFN SAFE Technical Assistance Coordinator

  2. Created at http://www.wordle.net

  3. The Purpose of the examination To address the patient’s healthcare needs, collect evidence when appropriate, for potential use in the criminal justice system

  4. The needs of the patient addressed in the medical forensic examination • Evaluating and treating injuries • Conducting prompt examinations • Providing support, crisis intervention, and advocacy • Prophylaxis against STI and pregnancy risk • Providing follow-up care for medical and emotional needs

  5. Justice system needs • Obtaining assault history • Documentation of exam findings • Proper collection, handling, and preservation of evidence • Interpretation and analyzing findings • Presenting findings and giving factual and expert opinions related to the exam and evidence collection

  6. A coordinated team approach is recommended as a response to sexual assault • Team members should reflect the community it serves • Composed of professionals involved in the immediate response to sexual assault disclosure

  7. The forensic exam is an interactive process that is adapted to the needs of each individual patient

  8. The forensic exam is an interactive process that is adapted to the needs of each individual patient

  9. Adaptations may need to be made for the patient based on any one or combination of these factors.

  10. The forensic examination

  11. General principals • Acute injury, trauma care and safety needs are addressed before collecting evidence • As soon as possible after the acute medical evaluation, management and stabilization of acute problems and before treating non acute injuries, the medical forensic examination can be conducted with the patient’s consent

  12. The Exam will include • Obtaining Consent for the examination and photographs • A detailed health history and assessment as well as history of the assault • Collection of evidence including clothing and specimens from the body • Treatment options for sexually transmitted infections and pregnancy prevention • Documentation of all of the above • A plan for follow-up care and resources

  13. History Includes: Pre-existing health status and issues Pre-assault sexual activity Use of drugs or alcohol Post-assault hygiene Details of the assault

  14. Assault History • Pain or injuries/bleeding • Alterations in memory or consciousness • Physical surroundings • Assailants • Sexual acts performed • Body fluid transfers • Methods employed by the assailants

  15. Collection of Evidence

  16. The Examination • Consists of a head to toe medical evaluation • The following evidence may be collected: *Oral swabs *Hair (head and pubic and/or foreign) *Swabs of any areas of debris, licking, biting *vaginal/penile/rectal swabs *blood/blood card

  17. Colposcope may be used during the examination

  18. Collecting swabs

  19. The ultraviolet light Used to identify semen and other body fluids

  20. Evidence Bags

  21. Bagging Evidence • Make sure items are packed up separately • Items should be dry (or as dry as possible) • Do not shake items, handle as little as possible, with gloves on. • Have the victim undress over a sheet to keep any debris dropped off of them contained on the sheet.

  22. All items need to be documented on a chain of custody form

  23. General principals • There does NOT need to be an officer in the room for the examination • The SANE nurse will perform the medical forensic examination and after treatment, the patient may be discharged if not further medical treatment is needed. • Safety planning for the patient is a part of the discharge process

  24. Property/Evidence that may be turned over to the officer • Sexual Assault Evidence Kit • Clothing bags (dependant upon the weather this may be quite a few items!) • Documentation of examination • Photographs of any injuries (jurisdictional) • Chain of custody form with all evidence documented

  25. Questions?

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