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sexual violence is prevalent throughout all of our communities
a victim can be of any age, gender, ethnicity, or economic class
each victim's experience in assault is extremely individualized
but what is universal is their need to be treated with dignity and respect
all while voluntarily participating in a forensic sexual assault medical
the medical profession has made great strides when it comes to providing
victims of sexual assault
with the best possible care with the development and training of sexual
assault nurse examiners also known as "s.a.n.e.s" the use of these highly skilled and
specialized group of nurses has become the gold standard when it comes to
performing these types of exams.
unfortunately, many communities are without access to sexual assault nurse
examiners until then adult victims of rape will receive their forensic
at local emergency departments
having a basic understanding of how to perform a proper forensic sexual assault
medical examinations is crucial
for any medical professional working in an emergency department
acute victims of sexual violence
individuals assaulted within the previous seventy two hours
may present at the emergency department in several different ways
they may come by themselves with friends or family members they may be escorted
by a sexual assault advocate from a local rape crisis center. A victim may
also present accompanied by local law enforcement officer
no matter what path leads the victim to your emergency department
treating them with compassion understanding and professionalism is a
crucial component for each forensic medical examination
when a victim of sexual violence presents to an emergency department for
an exam
it is best practice to move them to a private waiting room or exam room as soon
as possible
most victims feel extremely exposed and vulnerable after an assault
having the victim avoid waiting for an examination in a community space
will help to cultivate a sense of report with the medical staff
and the feeling of safety and security for the victim
especially if they're being escorted by a law enforcement officer
this is very important since the victim will be asked to share details regarding
their assault with the medical staff
and they will undergo a physical examination that has the potential to
mirror the trauma that they just experienced. Sexual assault forensic
examination kids are provided at no cost to to emergency departments by the
Arkansas state crime lab out of Little Rock.
these basic kits provide the medical professional with essential steps to
collecting forensic evidence after a sexual assault
the manner in which this exam is performed will create a lasting impact
on the victim.
At any point during the examination the victim has the right to refuse any parts
of the exam
and or evidence collection as well as the right to stop the examination
This exam is completely voluntary and under no circumstances should the victim
be made to feel otherwise.
It is recommended to advise the victim before and throughout the examination of
their right to stop at any time.
It is important to communicate the sense of control to the victim
since so many circumstances leading them up to this point
have been out of their control.
Let the victim know that you will explain every step of the examination before you
complete it so they will not be startled.
It is also best practice to offer to contact a local sexual assault advocate
for the victim if that resource is available in the community
and if they are not already involved
an advocate will play an essential role in the long term care of a victim of
sexual violence
as well as providing emotional care and support during the immediate medical
It is highly recommended that a sexual assault advocate be present during
the exam
but this decision is ultimately left to the victim.
The advocate's role is to provide emotional support,
professional advocacy, and follow-up resources to the victim as desired.
The advocate does not participate in any part of the investigation or the
collection of forensic evidence.
It is the medical professionals role to carefully collect evidence and provide
medical care for the victims in a supportive, compassionate environment.
Included in the forensic examination kits as a guide for obtaining
an appropriate history from the sexual assault victim prior to the examination
this will allow the medical professional to assess where on the victim's body
evidence may be collected.
The victim's body is a crime scene.
Preserving the evidence is an important part of solving the investigation
follow the instructions on the sheet
while maintaining a judgment free demeanor in providing a safe and
compassionate environment for them.
It is very important that the only information documented comes directly
from the victim.
When gathering evidence for the forensic examination,
keep in mind the idea of least invasive
to most invasive
the next step is not specifically included in the forensic examination kit
this step involves collecting the victim's clothing
if the clothing worn by the victim was what he or she was wearing during the
time of the assault
place a disposable drop off on the floor of the exam room
have the victim step onto the drop cloth to disrobe
if you have an advocate present or another nurse
please use another cloth to provide a sense of privacy for the victim during
this part of the exam
have the victim hand each article of clothing to you individually with gloved
place each item in a separate paper bag.
Once the victim's clothing has been collected,
have them put on a gown and sit on the exam bed.
Carefully perform a head to toe assessment
providing them with as much privacy as possible by sectioning off exposed areas
any injuries noted should be photo documented
with each injury a set of three pictures should be taken one for
anatomical identification
one with a ruler
and another closeup of the injury.
During this assessment, like all others,
talk the victim through what is being done and remember to ask their permission
throughout the process.
Once the head to toe assessment is completed
the victim should then be placed in the lithotomy position.
You will then perform a pubic hair coming by first placing the provided paper
underneath the victims buttocks.
Remember that explaining this process beforehand will reduce the anxiety of
the victim. It is never acceptable or needed to pluck a victims pubic hair.
If the victim does not have pubic hair
simply visualize the area for any possible hairs from the offender or
other foreign d_n_a_ as well as any obvious signs of body fluids.
The final two parts of the examination are the vaginal or penile swaps
and the rectal swabs.
if you are not a s.a.n.e.
these two steps will need to be performed by a physician
There are four vaginal or penile swabs
on a female victim
use two swabs for the outside of the vagina
moving the labial folds to swab for evidence
always talk to your victim and prepare them before touching them.
Use the second set of slots for internal vaginal collection. A speculum may be
inserted at this point for more effective swab collection but it is not
if there is vaginal injury do not attempt the speculum insertion
this will only cause severe pain and possibly result in further injury to
the victim
lubrication may not be used on the speculum because it has the potential to
contaminate the evidence.
Visually look for any abrasions,
tearing, or bruising externally
and internally
when doing the penile swabs on a male victim
use the swabs one-by-one and cover the shaft and head of the penis making
sure the entire area has been swamped.
Do not insert the swamp inside of the penis.
This portion of the exam has the potential to be extremely emotional for
the victim.
It is imperative that the medical professional walks the victim through
the process and is aware of their emotional state.
Allowing them to stop,
or take a break
may be needed.
The final step of the collection process is the rectal swabs.
This is a a very important part of the examination even if the victim does not
disclose that any rectal penetration had occurred.
Have the victim continue to lie on their back
and if physically able,
have them gently pull their own leads up to their chest with their knees bent.
Take the rectal swabs and roll them on the inside of the anus and then
slightly insert the tip of the swap on the inside of the rectum.
Once the exam is completed,
allow the swabs to dry completely.
you may use a swab dryer if available or simply flip a disposable cup over to act
as a drying station for your swabs.
Remember to label everything and do not mix up the swabs or allow the swabs to
The victim may now get dressed in new clothing
that they have brought themselves
or ones that have been provided to them by the advocate or the hospital.
At this point
prophylactic antibiotics to prevent sexually transmitted infections and
emergency contraceptives
should be discussed with the victim.
The victim has the right to choose to refuse or accept the medication.
Once all the evidence is dry, place in the corresponding envelope.
Once the envelopes are correctly filled out in sealed, place them back in the
forensic evidence collection kit.
fill out the front of the kit and sign,
date, and time record only when you are handing it to the investigating officer
who is now taking the evidence into custody.
Many times, the sexual assault examination is the only potential piece
of evidence from an assault.
The need for professional,
and compassionate personnel to perform these examinations is an unavoidable
for many emergency departments.
Providing these examinations are not only about collecting the evidence
they are also about preserving the last amount of dignity
a sexual assault survivor may have after an assault.
Please invest in organizational and or individual education
on providing proper and effective
forensic sexual assault examinations.
Well the forensic examination itself is important because you're looking for any
evidence that you can find
at all
to determine if there is anything out there that can coaberate with what the
victim said.
It can be just as important when you have a trained
nurse who has training, experience, education
if they're isn't anything that shows up
because as long as that person, that nurse is doing her job
correctly, she can explain to the jury
the procedure that she follows, why it's the correct procedure and in the absence of
any physical evidence or forensic evidence that
can be found
why that doesn't necessarily mean that nothing happened
and that
victims story can still be accurate.
if the collection and the procedure that the nurse is following is
done incorrectly or done poorly
uh... certainly that will be exploited at trial
the defense attorney can cross-examine the nurse and
bring out all the reasons that it was a
good procedure was not followed
uh... and that can always hurt the credibility
which is why
any education any training
is very valuable when you want a nurse that's on the stand and it goes
to credibility
if a nurse can
when shes being introduced to the jury and she can explain to the jury
all of the training that she's had all the education she's had
she's basically testifying as an expert anyway because this is a specialized
Very few people know about it certainly very few people do it rape
So it's vital that the jury gets to hear that nurse that witness has a
that gives her credibility to show the jury that she knows what she's
talking about and that she's doing it correctly because there are other people
out there that will be able to inform the defense of this is really the proper
procedure and here's the procedure they followed
um which can exploit the weakness, damage the credibility and hurt the case even
if something was found. I think it is really important for any nurses going to do
sexual assault examinations using rape kits and doing that type of work
it's important that they don't wait on the education and training to come to
they need to search it out and
the Arkansas coalition against sexual assault, their their website
has links to a lot of education material also training material
on that website as well as they're are a great place to go to to find where
training may be coming up.
You've got to be trained when you're doing a job as important as this you
have to have good training.
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Forensic Sexual Assault Examinations in Emergency Departments

2146 Folder Collection
Pedroli Li published on March 12, 2016
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