Protocol for treating sexual assault victim?

Law and Order: SVU seems to have the proceedure down rather well and as accurately as can be. Usually other injuries are treated first so the patient can have a chance to calm down and collect themselves before going through the ordeal of the rape exam.

You treat whatever is threatening to kill her first.

Her consent will be needed for evidence collecting. Probably pre-plastering her arm but probably post arm x-ray. Nobody is going to go "We need a rape kit, STAT!"

I work in an ER. Sex assault victims usually spend at least a few hours there. Do you have the person arriving by ambulance or just coming in through the entrance?

A nurse would do the initial triage (medical history, current vital signs, allergies). If there's chance of neck injury, a neck brace might be applied until the doctor can clear it.

We usually try to get the patient into a room quickly, although if we're busy, it could take awhile. We have a couple of rooms that we like to use, that are a little larger than some others and have private bathrooms. Keep the curtains and doors shut to protect privacy. Limit visitors. Sometimes the patients ask that we mark them as "no info" on the patient roster so if someone calls or comes in for them, we say we have no information on anyone by that name. (Occasionally the accused comes in looking for the accuser).

Warming blanket for hypothermia. An IV for fluids and in anticipation of pain or anxiety meds.

Then doctors do a medical check and order the treatment. In this case, probably x-ray for arm and ct for head and neck. Only doctors can order meds so nothing given until then.

Then police would be called in (if patient wants) and a SANE (sexual assault nurse examiner), who would be asking the questions about the assault and doing the actual gyno exam.

We don't do casts in our ER but apply splints and refer to orthopedists, unless the patient is going up to surgery right away (major fractures). Concussions, patients usually go home, unless a bleed is seen on the ct or patient is obviously acting "off." Then held overnight for observation and usually released next day.

The victims vary in their emotional states - from anger to anguish. Each case is different.

I've done ER work as a counselor for rape victims through a crisis center that had agreements with all the local hospitals so they didn't have to hire staff for it, and I think it probably depends on the hospital if that happens or they have on-site social worker or rape nurse or no one at all. I'd be called the instant they got her, get out of bed, rush down. She'd only be partway through treatment (for the important stuff--evidence isn't the top priority of medical people, her health is) and I'd arrive and stay, with her permission, through the rape kit. As juniper said, there is a variety of responses, but mostly they are 1) shocked (terrible to know, but the worst of the psychological effects often come at about 1 year after the event when most victims think they're going nuts, have many nightmares, what they see as irrational fears); 2) happy to be alive; and 3) worried about a loved one's response. (My mother told me this would happen/my husband will kill him and I'll lose him/etc.)

I had a victim who was stabbed 17 times in the belly (somehow, he missed every single important thing) and the least of the concerns was the rape kit. It got done in surgery; she was totally out for it and never specifically consented to it. I had a retarded epileptic victim who seized every fifteen minutes. The medical staff was busy with a major car wreck and they said, "call if she isn't breathing," and left me there to watch seizure after seizure. But that wasn't important enough for them to stick around and deal with, considering their other patients.

Back then, if the victim was white, a homeowner with a good address, the police would be there fast. They'd be there if they brought her. Everyone else--teens, the poor, black women, the police took their sweet time and the victim was often discharged or it was even the next day. Maybe that's changed, but if 911 wasn't called, there's a chance the police won't be there for hours.

LimaHeights said:

What would be treated first when a rape victim is brought to the hospital? I know there's the rape kit and everything, but in the story I'm writing the character also has mild/moderate hypothermia, a broken arm, a concussion and she was choked. She's awake and fairly lucid when she gets to the hospital.

Click to expand...

Physical problems first: set and splint the arm, make sure she's warmed up, do the concussion work-up, take the pics of the choking site, make sure the larynx isn;t damaged, and notify the rape team to be ready to interview and do their thing.

The only trick part is going to be the pain relief for the arm, which will be minimal because of the concussion. She will HURT but that's better than respiratory arrest,.