Sexual Assault Medical Forensic Examinations in Indian Country

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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

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Created at http//www.wordle.net
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The Purpose of the examination

• To address the patients healthcare needs,
  collect evidence when appropriate, for potential
  use in the criminal justice system

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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

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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

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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

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The forensic exam is an interactive process that
is adapted to the needs of each individual patient
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The forensic exam is an interactive process that
is adapted to the needs of each individual patient
Age Gender issues/sexual orientation Health history/status Disabilities Language/ Communication
Beliefs and traditional practices Economic status Past experiences Life/police etc Drugs alcohol Involvement Relationship to offender
Family issues Community attitudes toward sexual assault What activities were occurring around assault Injuries sustained during assault Life style issues
Self blame Support systems Who else is effected by the assault? Safety needs of the patient and family Timing considerations related to the assault
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Adaptations may need to be made for the patient
based on any one or combination of these factors.
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The forensic examination
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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 patients consent

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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

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History

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

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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

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Collection of Evidence
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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

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Colposcope may be used during the examination
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Collecting swabs
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The ultraviolet light
Used to identify semen and other body fluids
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Evidence Bags
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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.

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

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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

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Questions?