Curriculum Update: Crime Scenes Behavioral Emergencies Toxic Exposure Abuse and Assault

1
Curriculum UpdateCrime ScenesBehavioral
EmergenciesToxic ExposureAbuse and Assault

• Condell Medical Center EMS System
• September 2006
• Site code 10-7200-E-1206
• Revisions by S Hopkins, RN, BSN

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Objectives

• Upon completion of the module, the EMS provider
  should be able to
• describe approach to a crime scene and steps
  taken to preserve evidence
• describe what a behavioral emergency is and
  medical legal considerations
• list drugs that are abused and field
  interventions that may be necessary

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Objectives contd

• list types of abuse and assault and the legal
  considerations
• actively participate in case scenario discussion
• review activation of cardizem syringe
• successfully complete the quiz with a score of
  80 or greater

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Crime Scenes
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Crime Scenes

• Crime Scene Definition
• A location where any part of a criminal act
  occurred
• A location where evidence relating to a crime may
  be found

6
Crime Scenes

• EMS personnel may be mistaken for police
• Uniform colors
• Badges
• Exiting a vehicle with lights and sirens
• Can initiate aggression toward
  an authority figure

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Approach to the Scene

• Approach is part of scene size-up
• Identification of possible hazards is part of
  scene size-up
• Key point identify and respond to dangers
  before they threaten
• Safety concerns begin with
  dispatch information
• Use available resources
  before arrival
• Do not enter the scene until it
  is safe and secured

8
Approach to the Scene

• A secured scene can become unsafe again - be on
  guard
• Retreat from the scene if the scene cannot be
  made safe there is no such thing as a dead hero!
• Know local protocols
• Begin observation several blocks before the scene

9
Use of Red Lights Sirens

• Urban areas - excess use may draw crowds
• Highway scene - lights required for safety
• lights can also be hypnotizing and cause drivers
  to drive into the lights

10
Known Violent Scenes

• Stage safe distance from the
  scene until police advise
  scene secure
• Out of sight of the scene
• If you can be seen, people will come to you
• Entering an unsafe scene adds another potential
  victim
• You may be injured, killed, or taken as hostage
• You may become another patient

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Violent Scenes

• Coordinate your approach with police
• You do not want to be misidentified
• Approach potentially unsafe environments single
  file
• If holding a flashlight, hold from the side
• Armed assailants often aim at the light
• Stand to the side of doorways when knocking
• Standing directly in front of a door makes you a
  target

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Approach to the Scene

• Remember non-violent dangers such as hazardous
  materials, power lines, dangerous pets, etc
• Scene safety considerations must continue
  throughout the call
• Others could expect you to intervene in violent
  situations
• Remember to include escape and strategic escape
  plans in your protocols

13
Crime Scene Preservation

• Evidence
• Prints
• Fingerprints - ridge characteristics are left
  behind on a surface with oils moisture from the
  skin unique in that no 2 people have identical
  fingerprints
• Footprints
• Blood and body fluids
• DNA and ABO blood typing possible
• Blood splatter pattern is evidence
• Particulate evidence
• Hairs, carpet clothing fibers - leave sheets
  under the patient in the ED (may hold evidence)

14
Crime Scene Observations

• Patient (victim) position
• Patient injuries versus marks you added (ie IV
  attempts)
• Conditions at the scene
• lights, curtains, signs of forced entry,
  anything moved or touched by EMS
• Statements of persons at the scene
• Statements of the patient/ victim
• Dying declarations
• place in quotation marks

He done it!
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Evidence Preservation at Crime Scenes

• Patient care is the ultimate priority
• You may be restricted to only 1 team member for
  initial scene entrance
• Evidence protection is performed while caring for
  the patient
• Carry in only necessary equipment
• Evidence preservation techniques
• Be observant
• Touch only what is necessary for patient care

16
Use of Gloves At Crime Scenes

• Wear latex gloves
• Used for infection control
• Prevents you from leaving your fingerprints
• Prevents smudging of other fingerprints

17
Crime Scene Documentation

• Note observations objectively, not subjectively
  (ie note color of bruising and not new bruise)
  
• Put patients or bystanders words in quotes
• Patient care records are legal documents
• Avoid opinions not
  relevant to patient care
• Patient care records
  will be used in court -
  will your charting stand up?

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Mandatory Reporting

• EMS providers are required to report certain
  types of crimes
• Child abuse - DCFS must be notified
• Suspected elder abuse (age 60 or older) and/or
  neglect
• Domestic violence
• If a refusal, EMS is mandated by the State to
  report all cases of domestic violence to the
  local police
• Offer an informational brochure to the patient
• Document your actions
• Certain violent crimes (i.e. sexual assault,
  gunshot, etc.)
• Confidentiality needs to be maintained

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Crime Scene Questions?
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BEHAVIORAL EMERGENCIES
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BEHAVIORAL EMERGENCEIS

• Normal Behavior
• No clear definition or ideal model
• Ideas vary by culture or ethnic group
• What society accepts at the moment

• Abnormal Behavior
• Deviates from societys expectations
• Interferes with well being and ability to
  function
• Harmful to individual or group

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What Is A BEHAVIORAL EMERGENCY?

• General term to describe a broad range of
  conditions of varying severity including
  unanticipated or maladaptive behavioral episode
• Use of the word abnormal is very subjective
• Recognized as behavior requiring immediate
  intervention
• Not always a clear cut EMS call

23
Behavioral Calls

• Indications of a behavioral or psychological
  condition include
• interference with core life functions (eating,
  sleeping, ability to maintain housing,
  interpersonal or sexual relations
• posing a threat to the life or well-being of
  themselves or others
• significant deviation from the expectations or
  norms of society

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Responses to Behavioral Emergencies

• Most of your assessment skills will depend on
  your interpersonal people skills more than use
  of diagnostic tools
• Remember, on all calls your safety is 1 and your
  partners is 2
• Will need to exercise observational skills
• patient
• family
• bystanders

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BEHAVIORAL EMERGENCIES

• Incidence
• Estimates vary with as much as 20 of the
  population experiencing some type of mental
  problem
• Incapacitates more people than all other health
  problems combined
• 1 person out of 7 will require treatment for an
  emotional disturbance

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BEHAVIORAL EMERGENCIES

• Common misconceptions
• Abnormal behavior is always bizarre
• All mental patients are unstable and dangerous
• Mental disorders are incurable
• Having a mental disorder is cause for
  embarrassment and shame

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Specific Psychiatric Disorders

• Cognitive disorders
• Organic causes such as brain injury or disease
• Includes delirium (rapid onset disorganized
  thought) and dementia (gradual development memory
  cognitive impairment)
• Schizophrenia
• loss of contact with reality
• hallucinations, delusions, depression
• Anxiety related Disorders
• panic attacks
• phobias
• post-traumatic stress syndrome

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• Mood disorders
• depression
• bipolar disorder (manic-depressive episodes)
• Substance use/abuse
• Physical symptoms with no apparent physiological
  cause
• Factitious disorders
• intentional production of signs/symptoms
• motivation to assume the sick role
• external incentives are absent (ie avoid police)

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• Dissociate disorders
• failure to recall (psychogenic amnesia)
• physically moving miles away (fugue state)
• multiple personality disorder (2 or more compete
  personalities)
• depersonalization (loss of ones self)
• Eating disorders
• anorexia - loss of appetite excessive fasting
• bulimia - uncontrollable bingeing vomiting or
  diarrhea
• these patients are at risk for electrolyte
  imbalance and dysrhythmia

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• Personality disorders
• acting odd or eccentric
• dramatic, emotional, fearful, anxious patients
• Impulse control disorders
• failure to control certain impulses that may be
  harmful to the patient or others
• Suicide/suicidal attempts

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BEHAVIORAL EMERGENCIES

• Management considerations
• Treat existing medical problems
• Maintain safety
• Do not confront or argue with patient
• Control violent situations
• Remain with patient at all times
• Avoid challenging the patients
  personal space
• Avoid judgements

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BEHAVIORAL EMERGENCIES

• Medical Legal Considerations
• Standard of care must always be followed
• Obtaining consent may help avoid charges of
  assault or battery
• assault - a verbal or physical threat
• battery - patient force without consent
• Limitations of legal authority
• if in doubt regarding action, contact
  medical control
• Objective documentation will be
  your best defense

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Use of Restraints

• Methods of restraint
• Verbal de-escalation
• speaking in a calm manner
• avoid patients personal space
• Physical restraint
• includes soft (ie sheets) and hard restraints
  (ie handcuffs, leathers)
• Have enough man-power available prior to
  beginning restraint procedure, if possible
• Restraint in a prone (face-down) position can
  make the patient susceptible to positional
  asphyxia - watch for airway compromise!!!

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Restraints

• Once a patient is restrained, never leave them
  unattended
• Once restrained, frequently monitor and document
  neurovascular assessments of restrained
  extremities
• need to maintain adequate circulation
• EMS personnel need to contact medical control as
  soon as possible when restraints are being
  considered or have been used

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Restraints

• Never compromise the patients airway
• Do not further aggravate injuries or illness
• EMS to clearly document the behavior that led to
  use of restraints
• Handcuffs are to be applied by police only
• If handcuffed, a police officer must accompany
  the patient in the ambulance while being
  transported (CMC policy)

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Taser Use By Law Enforcement

• Use of propelled wires to conduct energy that
  affects the sensory and motor functions of the
  central nervous system
• Overrides the central nervous system to achieve
  incapacitation
• previous weapons worked on pain compliance which
  can be overcome by drugs, alcohol, or focused
  combative patients

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Taser Use

• Static discharge on a doorknob - 35,000 -100,000
  volts
• Taser system - 50,000 volts
• Does not cause electrocution in a wet environment
• Electricity will not pass to others in contact
  with the subject unless contact is made directly
  between or on the probes
• Patient can be touched while Taser is active
• do not touch probes or step on wires

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Taser Use

• Do not place yourself in the pathway of the unit
  being discharged

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Taser Probes

• Probes are embedded in the skin they do not
  continue to give off charges

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Taser Probes

• Law enforcement may remove/break wires near
  probes
• CMC EMS have not been authorized to remove laser
  probes
• Removal of probes most commonly performed in the
  ED
• probed grabbed firmly and pulled straight out
• skin wiped with alcohol pad
• Treat removed probes with precautions similar to
  contaminated sharps

41
Transportation Against The Patients Will

• Patient presents as a threat to themselves or
  others
• When ordered by medical control
• Implemented by law
  enforcement authorities
• An incompetent patient will not be allowed to
  make health care decisions
• When in doubt, contact medical control and
  document the contact

42
Transportation of Patients with Psychiatric Issues

• All patients must be evaluated in an ED before
  psych admission can occur
• Admission destination often based on many factors
  including but not limited to diagnosis,
  available beds, insurance requests
• Just because one facility has a psych unit is no
  guarantee a patient stays at that facility if in
  the ED there

43
Petition for Involuntary Admission

• Completed by person(s) witnessing the behavior
  (ie police, EMS, family, hospital)
• If petition not completed in ED and ED staff have
  not witnessed behavior, patient may be discharged
• Petition may be completed by family only if they
  witness behavior or conversation
• Transporting authority acting in good faith and
  without negligence shall incur no liability,
  civil or criminal, due to transport

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Most of form often completed as group effort with
EMS and hospital staff for accuracy legal
boundaries
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This is the section EMS or other witness would be
expected to objectively describe behavior
observed
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Signatures important Phone numbers may be work
numbers
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Questions Behavioral Emergencies?
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Toxic Exposure
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Multiple Forms of Toxic Exposure Substances

• Biological
• Nuclear
• Irritants
• Chemical
• Nerve agents
• Blister agents
• Blood agents

• Farm chemicals
• Cleaning agents
• Petroleum products and by-products
• Medicine/drugs
• Inert gases
• Explosion hazards

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Alcohol

• A central nervous system depressant
• A common favorite mood-altering drug
• Affect on body influenced by
• age
• gender
• physical condition
• amount of food eaten
• other medicines/drugs taken
• Is a toxic drug producing pathological changes in
  liver tissue (cirrhosis) and can cause death

51
Alcohol

• Low dose effects
• relaxed feeling, reduces tension, lowers
  inhibition
• impairs concentration slows reflexes
• reduces coordination impairs reaction time
• Medium dose effects
• slurred speech, drowsiness, altered emotions
• Higher dose effects
• vomiting
• breathing difficulties
• unconsciousness
• coma

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Chronic Use of Alcohol

• Damage to frontal lobes of brain
• Brain shrinkage
• Vitamin deficiency (B-1 or thiamine)
• Wernickes encephalopathy - impaired memory,
  confusion, lack of coordination
• Korsakoffs syndrome - amnesia, apathy,
  disorientation
• Health deterioration of multiple systems
• Fetal alcohol syndrome in newborn
• alcohol passes thru placenta
• normal brain development disrupted

53
Alcohol Withdrawal

• Typically 6 - 48 hours after last drink
• Shaking (tremors)
• Sleep problems
• Decreased appetite, nausea
• Anxiety
• Increased heart rate, increased blood pressure
• Hallucinations
• Seizures

54
Delirium Tremens (DTs)

• Usually start 48 - 96 hours after last drink
• 20 fatality when untreated
• DT's can produce fatal seizures, MI, stroke
• Hallucinations - usually visual
• Profound confusion, disorientation, hyperactivity
• Cardiac dysrhythmias
• Seizures - true emergency

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Treatment of DTs

• Valium to stop seizure activity
• Fluid resuscitation
• Treat dysrhythmias per SOP
• Increased risk of vomiting
• protect airway from aspiration
• have suction available
• consider transport of patient side-lying

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Marijuana

• One of the worlds most commonly used illegal
  drugs
• Usually smoked can be cooked/baked into food
• Interferes with normal function of certain
  receptors in the brain (memory, concentration,
  perception, movement)
• Effects in 1-10 minutes lasts 3 - 4 hours
• High doses cause hallucination, delusions,
  impaired memory, disorientation
• Metabolites detected 45-60 days after use

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Inhalants

• Huffing or sniffing products which are easily
  found available everywhere
• Damage the nervous system other organs (ie
  lungs, liver, heart, kidneys)
• Vapors inhaled into lungs enter bloodstream then
  travel to brain other tissues
• Immediate effects relaxation, slurred speech,
  euphoria, hallucinations, drowsiness, dizziness,
  nausea, vomiting, DEATH from heart failure or
  suffocation from plastic bags or aspiration of
  vomit

58
Inhalants

• Long term use effects memory loss, concentration
  problems, visual disturbances, blindness, motor
  problems, peripheral nerve damage
• Products abused hair spray, nitrous oxide,
  cleaning fluids, typewriter correction fluid,
  nail polish remover, gasoline, glue, rubber
  cement, paint paint thinner, lighter fluid,
  room deodorizers, marker pens

59
Cocaine

• A local anesthetic and central nervous system
  stimulant
• Can be chewed (leaves), smoked, inhaled
  (snorted), or injected
• Acts by blocking reuptake of neurotransmitters
  dopamine, norepinephrine serotonin in brain
• Affects peripheral nervous system constricts
  blood vessels, causes irregular heart beat,
  pupils dilate
• Risk of MI or stroke within 3 days of OD

60
Cocaine

• Within a few seconds to a few minutes
• euphoria, excitement, reduced hunger, feeling of
  strength
• Various doses may also produce
• dizziness, headache, movement problems, anxiety,
  insomnia, depression, hallucinations
• After the initial high (approx 1 hour) users
  may crash into depression. Users then seek more
  cocaine (cycle causes addiction)
• Withdrawal depression, anxiety, paranoia

61
Cocaine Overdose

• Presentations that may be observed
• tachydysrhythmias
• stroke (from ? blood pressure)
• subarachnoid hemorrhage
• chronic accelerated atherogenic disease (coronary
  atherosclerosis in younger people)
• agitation, paranoia, change in behavior
• seizure activity
• respiratory depression
• hyperthermia
• MI from acute vasospasm, dysrhythmia or coronary
  atherosclerosis

62
Treatment Cocaine Overdose

• Evaluate and monitor ABCs
• O2 - IV - cardiac monitor - frequent VS
• Check glucose level
• Seizures treated with benzodiazepines (valium)
• Agitation treated with versed (medical control
  order)
• Hyperthermia - routine cooling measures
• Nitroglycerin okay for chest pain
• Narcan used cautiously for respiratory depression
  (consider smaller dose slow IVP)

63
Heroin

• Illegal opiate drug main ingredient - morphine
• Effect is depression of central nervous system
• Affects receptors in brain responsible for
  breathing, pain emotions
• Brain manufactures its own opiates - endorphins
  released during pain and stress
• Smoked or inhaled as a powder
• Can be mixed with water,heated, then injected
• Crosses blood brain barrier x100 faster than
  morphine

64
Heroin

• Effects produced
• IVP - 7 - 8 seconds
• IM or SQ - 5- 8 minutes
• Short term effects
• analgesia
• brief euphoria (rush)
• nausea
• sedation/drowsiness
• reduced anxiety
• hypothermia
• reduced respirations reduced coughing

65
Other Effects of Heroin

• Long term
• tolerance - need higher drug dosages
• addiction - psychological physiological need
• withdrawal - 8-12 hours after last dose are
  symptomatic
• risk of HIV/AIDS, hepatitis, infections
• poisoning - from added product to heroin
• increased risk of stroke
• collapsed veins
• lung infections

66
Speedballing

• Combining cocaine with heroin use
• Causes frequent sometimes fatal complications
  because of combining these 2 drugs
• Deaths of John Belushi, River Phoenix, Chris
  Farley
• Heroin injected or smoked followed immediately by
  smoking cocaine

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Treatment of Heroin Overdose

• Support ventilations
• Narcan
• May negate sedative effect of opioid (heroin) and
  leave stimulating effect of cocaine unopposed
  which worsens toxicity
• Use narcan to treat respiratory depression
• 2 mg slow IVP repeated every 5 minutes to total
  of 10 mg
• consult with medical control for possible smaller
  dose (to avoid increased agitation and
  uncontrollable behavior in the patient)

68
Amphetamines

• Stimulants of the central nervous system
• Many effects similar to cocaine
• Addiction, withdrawal, tolerance possible
• Taken orally, injected, smoked, snorted
• Common products
• dextroamphetamine - dexies
• benzedrine
• ritalin
• methamphetamine - speed, meth, crystal
• OTC cold allergy products no longer easily
  accessible to the public due to abuse factor

69
Amphetamines

• Originally developed to treat
• asthma
• sleep disorders (narcolepsy)
• hyperactivity
• Short term effects
• increased heart rate
• increased blood pressure
• reduced appetite
• dilation of pupils
• feelings of happiness and power
• reduced fatigue

70
Amphetamines

• Long term use effects
• insomnia, restlessness
• paranoid psychosis
• hallucinations
• violent aggressive behavior
• weight loss
• tremors
• Popular abused drugs in the club and rave scenes
• rave - all night underground party

71
Treatment of Amphetamine Use

• Scene safety very important
• patients often agitated, hostile, paranoid
• meth lab volatile environment with risk of
  explosion and fire
• Acute overdose produces
• seizures
• hypertension
• tachycardia
• hyperthermia
• psychosis, hallucinations
• stroke, death

72
Barbiturates

• Depresses central nervous system
• sleeping pills
• May lead to tolerance (need for increasing doses)
  and dependence (feeling you must use the drug
  withdrawal symptoms occur when you stop using the
  drug)
• Easily cross blood/brain barrier

73
Barbiturate Effects

• Low doses
• reduces anxiety
• reduces blood pressure, respirations heart rate
• reduces REM sleep
• Higher doses
• increase some types of behavior and actually act
  as a stimulant (depression of inhibitory brain
  circuits)
• Can cause excessive sedation, anesthesia, coma,
  death

74
Drugs Abused For Sexual Purposes

• Added to drinks and food
• Can be forced on the person by coercion
• Known versus unknown ingestion of substances
• Self gratification or fulfillment of another
  person
• If called for one person at a
  party, anticipate multiple patients
  affected
• 
  

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GHB (Gamma hydroxybutyrate)

• Central nervous system depressant
• Takes minutes for user to lose control, have
  amnesia, or lose consciousness
• Colorless, odorless, slightly salty taste
• High can last 1 1/2 - 3 hours with a rapid return
  to normal with no hangover
• Can be extremely addictive
• Used by body builders

76
GHB

• Low doses (similar to alcohol intoxication)
• drowsiness
• hypnosis
• dizziness
• euphoria
• High doses
• vomiting
• convulsions
• hypotension, bradycardia, bradypnea
• coma

77
Assessment GHB

• Often called to a party of many unconscious young
  adults
• Powerful CNS depressant (often GCS is 3)
• Skin will be hot and in some
  cases dry
• Pupils fixed and dilated
• Nausea and uncontrollable vomiting
• Gag reflex intact
• Loss of recall of current events leading to
  present condition
• Duration 1-2 hours full recovery 8 hours

78
Ketamine

• Powerful anesthetic (tranquilizer) used
  for animals (derivative of PCP)
• CNS depressant, sedative amnesic properties
• Can be injected, consumed in drinks, smoked,
  inhaled
• Renders victim physically helpless, unable to
  refuse sexual advances, unable to remember events

79
Ketamine Effects

• Low doses
• impaired concentration, learning memory
  functions
• feeling of floating outside body
• increased heart rate blood pressure
• High doses
• hallucinations
• sensation of rising above ones body
• potentially fatal
• Long term - flashbacks shortened attention span

80
Rohypnol (Roofies)

• Benzodiazepine but 10 times more powerful than
  equivalent of valium
• Outside USA used as sleep aid presurgical
  sedative (sedative-hypnotic effect)
• Illegal in USA
• Tasteless, odorless, dissolves easily in food or
  drink
• Manufactured now to release a blue dye when
  dissolved in a liquid
• Onset 15-30 minutes, peaks 2 hours, last 6-8
  hours

81
Rohypnol

• As date rape drug, causes blackouts, memory loss,
  removes inhibitions, long lasting
• Impairs judgement, confusion, amnesia
• Dilated pupils
• Respirations depressed (common)
• B/P decreased, pulse increased
• Impaired motor skills
• Slurred speech
• Seizures, coma

82
Assessment Drugs Abused for Sexual Purposes

• Watch for decreasing level of responsiveness
• Anticipate slow, shallow respiratory rate
• Watch for apnea (dose dependant)
• Frequent monitoring vital signs and
  EKG
• Monitor level of responsiveness

83
Management Drugs Abused for Sexual Purposes

• Scene safety very important
• Activate triage if multiple patients
• Most EMS care is supportive
• Control the airway
• BVM use
• Narcan may reverse respiratory depression
• Vomiting precautions
• Seizure precautions - valium as needed
• Be prepared for cardiac arrhythmias

84
Toxic Exposure Questions?
85
Abuse and Assault
86
EpidemiologyIncidence, Mortality/Morbidity

• Abuse of spouse, elderly relatives, and children
  is greater than most estimate
• Only 10 of women report battering incidents
• Over 1 million children suffer from abuse
  or neglect
• Victims may die of the abuse or assault
• Victims may suffer mental or physical injuries

87
Abuse Assault Estimates

• 4-6 million women are beaten
• 1/2 of all homeless women and children are
  homeless as a result of domestic violence
• 15 - 25 of pregnant women are battered
• 63 of young men between 11 20 years of age are
  serving time for killing their mothers abuser
• In 1996 elder abuse affected more than 1 million
  elderly

88
EpidemiologyRisk Factors

• Men and women who beat one another
  are most likely beating their children
• Children of abusive and unloving homes
  are more likely to become spouse or
  child batterers and later, abusers of
  their elderly parents

89
Types of Abuse

• Physical abuse - physical force
• Sexual abuse - nonconsensual sexual contact
• Emotional abuse - anguish, pain, or distress
• Financial/material exploitation - illegal or
  improper use of funds, property, assets
  
• Neglect
• failure to provide adequate medical or personal
  care or maintenance, which failure results in
  physical or mental injury to a person or in the
  deterioration of a persons physical or mental
  condition

90
Battered Women Reasons for Not Reporting

• Personal fear or fear for her children
• A belief that the offenders behavior will change
• A lack of financial and/or emotional
  support
• A womans belief that she is the
  cause of the violent behavior
• A belief that battering is part of
  the marriage and must be
  endured to keep the family
  together

91
Battered WomenCharacteristics of Wife-Battering

• Beatings do not stop
• Beatings become more severe frequent
• Beatings occur without provocation
• Violence can turn toward the children

92
Characteristics of Spousal Abusers

• Low self esteem
• Violence learned from their parents
• Believe they are demonstrating discipline
• They do not like being out
  of control
• Fail to see alternative
  behavior
• Unable to back down from
  conflict
• Feel powerless to change

93
Characteristics of Spousal Abusers

• Alcohol abuse is often a factor
• Mental illness occurs in less than 10 of abusers
• Occurs in all socio-economic
  groups but most abusers are
  in lower socio-economic
  groups

94
Characteristics of Spousal Abusers

• Abuser goes into sudden rages
• Abusers feel insecure and jealous
• May appear charming and loving after
  the incident
• History of financial problems,
  holding a job and possible
  legal problems

95
Risk Factors for Domestic Violence

• Male is unemployed
• Male uses illegal drugs at least once a year
• Partners have different religious backgrounds
• Family income below poverty line
• Partners are unmarried

• Violence toward children
• Male did not graduate from high school
• Blue collar job if employed
• Male age 18-30
• Male saw father hit mother

96
Battered MenOverview

• Men also rarely report incident
• Humiliation is multiplied for a man
• Men feel as trapped as women do
• Same psychological emotional effects
• Society is less empathetic
  toward men
• Fewer resources exist for men

97
Homosexual Relationships

• Spouse battering occurs in homosexual
  relationships as well
• Homosexuals are conditioned the same as
  heterosexuals
• gt150,000 men in the US each year are victims of
  physical violence by a spouse or partner (both
  opposite and same sex
  relationships)

98
Legal Considerations for Battered Spouses

• Spousal abuse is a crime
• Assault is a misdemeanor or a felony
• Attacker may be released within hours of arrest
• Patient must be aware of this for their
  protection
• Victim-witness assistance programs are available
• Know resources in your community

99
Legal Considerations for Sexual Assault

• Take steps to preserve any evidence
• use paper not plastic bags
• Patient should not urinate, defecate, douche,
  bathe
• Notify law enforcement as soon
  as possible
• Remember there will be a
  chain of evidence
• Follow local state protocols

100
Resources and Support

• Nationwide 24 hour hotline toll-free for domestic
  violence
• 1-800-799-SAFE (7233)
• TDD 1-800-787-3224
• Elder abuse hotline
• Elder defined as 60 or older
• 1-800-252-8966 (M-F 0830-1700)
• 1-800-279-0400 (all other times)
• DCFS - 1-800-25-abuse (800-252-2873)

101
EMS Responsibilities

• Document objectively
• EMS mandated by the State to report all cases of
  domestic violence to local police
• EMS mandated to offer a referral brochure to all
  patients that sign a release
• Document all efforts offered and all reports made
  to other non-EMS parties

102
Abuse Assault Questions?