Intake Medical Personnel

Triage: Patients who report acute sexual assaultSexual assault that occurred—or in instance of child or vulnerable patient, the last contact with suspect occurred—within seven days prior to medical examination (U.S. Army Medical Department Center and School, 2017). • All patients who were acutely sexually assaulted should be offered a medical forensic assessment.
• Facilities that are not on a military installation follow state statutes regarding evidence collection up to 120 hours post-assault (Texas Code of Criminal Procedure §56A.303). Some jurisdictions, including military installations, collect evidence up to seven days af... More, or those who are suspected of being acutely sexually assaulted, should have an Emergency Severity Index (ESI) Triage Level 2 (U.S. Department of Health and Human Services, 2012). The patient should be seen as soon as possible and triaged to assess for life- or limb-threatening injuries or psychiatric emergencies. Any life- or limb-threatening injuries or psychiatric emergencies take precedence over forensic evidence collection. Once the patient is stable, offer a medical forensic assessment, if appropriate. The medical assessment may take place before or concurrently with forensic sexual assault assessment, depending on facility policy. Be aware of time-sensitive medications that may be administered.

Escort the patient and family, caregiver or support person(s) to a private waiting area:

1. Provide clear information about wait times.
2. Elicit information as privately as possible, regarding:
   • Safety (Is the patient physically and psychologically safe? Is the suspected perpetrator present? Speaking with patient alone is important to obtain accurate information),
   • Pain, and
   • Bleeding.
3. Instruct patient to not use restroom, wash, change clothes, smoke, vape, eat, or drink until evaluated by the forensic health care professional. Educate patient about benefits and risks of actions listed above. If patient needs to use restroom, collect the urine and request that they do not wipe genitalia until after evidence has been collected.
4. Consider collecting urine if drug/substance-facilitated sexual assault (DFSA) is suspected. Maintain chain of custody of specimens.
5. Contact a Child Advocacy Center (CAC) or rape crisis center, depending on community protocols, for a sexual assault advocate to provide hospital accompaniment. Advise patient and caregivers (when applicable) of advocate’s expected arrival time and role as support for the patient and family. Contact a Commercially Sexually Exploited Youth (CSEY) advocate, depending on community protocols. A comprehensive network of experts to provide critical wrap-around care and support for commercially exploited children is available.
6. Contact forensic health care professional and notify of patient’s arrival. Advise patient and support persons (when applicable) of expected wait times.