Hold Team Meetings . Monitor and Evaluate Your Efforts . Sustain Your SART . Know Your Team . Critical Issues
Health Care Providers
Emergency Medical Services
Emergency medical services (EMS) may be provided by fire departments; private ambulance services; city-, county-, or government-based services; hospitals; or a combination of these. Emergency medical technicians (EMTs), paramedics, and first responders may be paid or could be volunteers in the community. Although a small percentage of sexual assault victims enter the medical system through EMS (e.g., by ambulance), including EMTs and paramedics as core SART members can be a critical component of an ideal coordinated response that meets the needs of all victims.
If you include EMS personnel on your SART, they can
- Provide the team with medical information related to emergency procedures in response to sexual assaults.
- Give the team detailed explanations of EMS procedures and protocols.
- Address issues regarding crime scene preservation practices (e.g., recognition of drug-facilitated sexual assault and the importance of saving urine).
- Act as liaisons between the team and the EMS community.
- Provide testimony in court.
Whether or not you invite EMS to be a member of your SART, you can
- Train EMS providers on how to properly assess and treat victims of sexual assault and on the importance of transporting victims to a designated sexual assault medical forensic exam site.
- Contact schools offering initial first responder, EMT, and paramedic training to set up workshops.
- Inform EMS of designated exam facilities.
- Define procedures for transferring patients to designated exam facilities.
- Discuss reimbursement benefits available when victims are transported or transferred by ambulance (e.g., victim compensation).
- Inform EMS about evidence collection.
- Provide information about the aftermath of sexual assault on victims.
State EMS Agency Information Lists EMS offices by state and territory.
EMS providers are trained to follow a formal and carefully designed protocol or standard of care, which has been created and approved by physicians. It is important to note that a request for assistance following sexual assault does not automatically imply consent for treatment. If injuries do not appear serious, EMS providers should still emphasize the need for further medical evaluation to address related health concerns. The amount of information that victims want or need at this time varies and could be offset by other issues such as concerns about safety or family or language barriers. EMS personnel need to tailor their responses as appropriate.
- Ask victims if they would like family members or friends to be contacted.
- Explain victims' rights for advocacy, even if victims choose not to receive medical care or have the medical forensic exam.
- Explain reporting options to victims, keeping in mind that the amount of information desired will vary with each individual.
- Take measures to preserve crime scene evidence, including evidence on victims.
History and Documentation
- Document victims' demeanor and statements related to the assault (e.g., time, date, place of attacks).
- Obtain medical history, including the possibility of pregnancy.
- Document physical areas violated in the attack (if patients volunteer the information). Include all marks or evidence of trauma and other significant physical findings.
- Record information about whether victims bathed since the attack.
- Document all treatment given.
Physical Exam (unless a life-threatening condition occurs)
- Keep in mind that physical exams need to be limited in scope without causing further emotional distress to victims.
- Explain to victims the importance of preserving bodily evidence until it can be collected (e.g., do not wash, change clothes, urinate, defecate, smoke, drink, eat, brush hair or teeth, rinse mouth).
- If drug-facilitated sexual assault is suspected and victims can't wait to urinate until arriving at the exam site, collect urine samples.
- Obtain consent for all treatment.
- Obtain vital signs.
- Stabilize injuries that need immediate attention (e.g., fractures, bleeding).
- Advise victims of their right to have an advocate meet them at the exam facility.
- If victims are wearing clothing worn during their assaults, make sure that they bring replacement clothing to the hospital because victims' clothing is taken into evidence.
- If victims changed clothes after their attacks, make sure that they bring the clothing they were wearing while assaulted. Use paper rather than plastic bags as plastic bags trap moisture and promote mildew, which destroys vital evidence. Follow law enforcement procedures for retrieving clothing or other items from a crime scene so that evidence is not inadvertently destroyed or contaminated).
- Transport victims to designated facilities where rape evidence exams are performed, unless medical conditions or local protocol dictate otherwise.
- Victims with disabilities may have equipment (e.g., wheelchairs) or service animals that also need to be transported.
- Notify receiving facilities of estimated time of arrival according to jurisdictional policies.