Sexual Assault Management in the Rural ED
In rural areas there are no dedicated services for the initial management and forensic examination of victims of sexual assault. As such rural GPs and emergency doctors are required to perform this difficult and important task. There are a heap of good training courses and resources out there for clinicians who want to learn how to perform forensic examination and provide the initial care for these patients.
In WA we have a wonderful service based at King Edwards Memorial Hospital for Women – it is SARC [Sexual Assault Referral Service ]. When I was a trainee in the metro area we were lucky to be able to refer victims to this service 24/7. However, in the rural areas this is not usually possible.
So I thought I would put together the basic approach and a few tips I have learned over the years for a podcast. I am definitely not an expert, so I am really hoping there are some pearls from the listeners to help us out on this one.
Have a listen and let me know if you have any resources, experience or pearls you can share. DIRECT DOWNLOAD here
Great post, Casey. A couple of things have been drilled into my head by my mum (proper oz usage?), who is an adult and peds Sexual Assault Nurse Examiner with over 100 cases and some court time: 1) Make sure your patient isn’t intoxicated when you get consent, or, if you’re in a big city, don’t call and wake the SANE nurse up at 2 am if the patient won’t be sober till morning. Don’t know how the laws work down there, but here not having that level of informed consent will get a case thrown out. 2) talk through your exam with the patient and tell them before anything happens. They have just lost all control over their bodies and you want to give them back as much as you can. 3) There always seems to be good evidence found by swabbing the neck. For whatever reason, salvia tends to live here. And finally 4) they generally use a colposcope with film capability for gential exam close ups. Don’t know if its available in ED’s anywhere or everywhere.
As a former cop before becoming a PA, I think you we’re spot on with chain of custody. It’s also one of the more likely notes you’ll have to end up in court, so make it your best work. Finally, just publicly recognizing how big of a problem this is, and not being uncomfortable to talk about it does a great service to survivors and our colleagues.
There’s an excellent resource guide from RANZCOG which I will try to find a link to
Paperbags,, not plastic
Swab everything – good point on the neck
And if you get the chance, practice Court appearance – inevitably will be called to present evidence and practice helps. I did an excellent two day session with the sexual assault team in Tasmania a few years ago (actually, I think they flew down from Melbourne) – inc practical tips on forensic medical exam plus mock court appearance