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View Full Version : Scene Research: What's the NYC hospital and police procedure for treating sexual assault victims?



ayesha
03-21-2017, 09:03 PM
Hello everyone,
I need help regarding a scene that I'm writing. I have done some research about the procedure to treat sexual assault victims but I'm a little confused.
In my story, the victim wasn't raped - no penetration - but the assailant leaves her injured and in unconscious state. She wakes up sometime later to find herself locked in a dark room which leads to psychological trauma for she has an acute of nyctophobia due to childhood abuse - she gets severe panic attacks. She's found an hour or so later by her husband and passes out again and is brought to the hospital in an ambulance in unconscious state. Her injuries include a concussion, dislocated shoulder, bruised/broken ribs as well as several glass incision wounds, some serious enough to require stitches. She's also lost blood - enough to require a transfusion.

How would a case like hers be treated? Will the forensic exam and medical treatment of her other injuries happen together? Which will be given priority? And what about consent? Since she's unconscious, can her husband provide consent for her forensic exam? Are her injuries serious enough to warrant that or will the docs wait for her to gain consciousness? I'm assuming here that since she's lost consciousness twice, the doctors are going to want to keep her in overnight. Is that right?
And assuming that after she's regained consciousness, she wants to press charges and file a complaint, how will that process take place? Can the police interview her separately at her home, after she's discharged that is? Or does that interview need to happen in the presence of SANE (Sexual Assault Nurse Examiner)?

As you can see I have a lot of questions and I would be really great full for any help that any one of you can offer me. I don't need every technical detail but just enough to make the scene look as real as possible.
Thank you.

cornflake
03-21-2017, 09:35 PM
Why is she so unconscious, and for so long? That twigs as odd.

Anything life-threatening is priority, obviously. You've got a bunch of weird stuff -- unconscious will likely triage her to the front of the line to figure out why, and likely CT and such and blood work.

She's also presumably been assaulted, though by whom is unclear, so detectives responding would, I'd guess, be questioning the fuck out of her husband. Why would someone suspect she'd been sexually assaulted? From what I get from this, her husband calls an ambulance because she's unconscious, beaten up, bloodied and with shards of glass in her. He says he just came home and found her like that, so there are probably cops in the house and taking pics of her in the hospital but I dunno where someone is getting sexual assault unless she wakes up and says.

In any event, there are victim advocates in NY, on call, who will respond to the ER, who will be there if she wants, because presumably her husband is off being interviewed by cops.

No one is waiting for her to decide if she wants to file a complaint if she shows up like that; not up to her. Does she know who did it? Does she have some whole story? Some answers might change depending, as I think I'm a bit confused.

ayesha
03-21-2017, 10:20 PM
Why is she so unconscious, and for so long? That twigs as odd.

Anything life-threatening is priority, obviously. You've got a bunch of weird stuff -- unconscious will likely triage her to the front of the line to figure out why, and likely CT and such and blood work.

She's also presumably been assaulted, though by whom is unclear, so detectives responding would, I'd guess, be questioning the fuck out of her husband. Why would someone suspect she'd been sexually assaulted? From what I get from this, her husband calls an ambulance because she's unconscious, beaten up, bloodied and with shards of glass in her. He says he just came home and found her like that, so there are probably cops in the house and taking pics of her in the hospital but I dunno where someone is getting sexual assault unless she wakes up and says.

In any event, there are victim advocates in NY, on call, who will respond to the ER, who will be there if she wants, because presumably her husband is off being interviewed by cops.

No one is waiting for her to decide if she wants to file a complaint if she shows up like that; not up to her. Does she know who did it? Does she have some whole story? Some answers might change depending, as I think I'm a bit confused.

Thank you for responding so quickly.
To be a bit more clear, she's ambushed at her place by an old colleague - in a building that she's renovating. She loses consciousness first due to a head injury during the assault but wakes up quickly. By that time the assailant has locked her away and left. The second time is more due to her nyctophobia - even in a normal situation, her panic attacks during darkness are extremely severe. She loses all sense of present and goes back to being the child, the memories sort of take over her and she doesn't return to normal until lights are back on. In this case, due to the assault and injuries, I believe that the panic attack would massively amplified, all but leaving her incoherent.
As for her husband, he knew that that was the last place she was going to visit so he goes after her and finds her delirious, bleeding and cowering in the dark. She passes out soon afterwards. Sexual assault is suspected due to the condition of her clothes - shredded blouse, torn skirt plus the an assortment of bruises (bite/nail marks).
Does that make sense?
My apologies, I'm still trying to think through the scene myself so please forgive the confusion. And thank you once again.

cornflake
03-21-2017, 10:53 PM
Thank you for responding so quickly.
To be a bit more clear, she's ambushed at her place by an old colleague - in a building that she's renovating. She loses consciousness first due to a head injury during the assault but wakes up quickly. By that time the assailant has locked her away and left. The second time is more due to her nyctophobia - even in a normal situation, her panic attacks during darkness are extremely severe. She loses all sense of present and goes back to being the child, the memories sort of take over her and she doesn't return to normal until lights are back on. In this case, due to the assault and injuries, I believe that the panic attack would massively amplified, all but leaving her incoherent.
As for her husband, he knew that that was the last place she was going to visit so he goes after her and finds her delirious, bleeding and cowering in the dark. She passes out soon afterwards. Sexual assault is suspected due to the condition of her clothes - shredded blouse, torn skirt plus the an assortment of bruises (bite/nail marks).
Does that make sense?
Thank you once again. I'm still trying through the scene myself so please forgive the confusion.

S'ok, you're presumably trying to clarify it to make sense. The bolded doesn't make sense to me, especially for an extended period, like into the ER and beyond. I'm just going to go with that she's not perpetually unconscious, sorry, at least for the moment, because I don't see that happening outside some serious injury, and if there is, that changes stuff otherwise.

If she's not unconscious, just panicky/incoherent with non-life threatening injuries, she's going to be in the ER for a good while, like hours and hours. There will be detectives who likely came from the scene to there, and a forensic person.

As above, they'll likely call an advocate for her. It's also SAFE here, not a nurse, btw (I dunno if that's anyplace else, but you said this is in NYC). That's not the advocate, the advocate is different, and not involved in the process on the forensic or medical side. As above, complaint isn't really up to her, but she knows who did it, so it's not a giant investigatory deal, likely, though they're cops, so they're still talking to people, getting footage, etc., to nail down their case. They'll talk to her there, but given she knows who it is, and presumably has an explanation, they'll take it and go find him. Yes, sure might go speak to her later at home or wherever.

Keeping her overnight seems overkill, but depends on the concussion and blood loss (btw, that's a LOT of blood loss to require a transfusion; I'd think about that maybe), given what you've said about her injuries.

ayesha
03-21-2017, 11:10 PM
S'ok, you're presumably trying to clarify it to make sense. The bolded doesn't make sense to me, especially for an extended period, like into the ER and beyond. I'm just going to go with that she's not perpetually unconscious, sorry, at least for the moment, because I don't see that happening outside some serious injury, and if there is, that changes stuff otherwise.

If she's not unconscious, just panicky/incoherent with non-life threatening injuries, she's going to be in the ER for a good while, like hours and hours. There will be detectives who likely came from the scene to there, and a forensic person.

As above, they'll likely call an advocate for her. It's also SAFE here, not a nurse, btw (I dunno if that's anyplace else, but you said this is in NYC). That's not the advocate, the advocate is different, and not involved in the process on the forensic or medical side. As above, complaint isn't really up to her, but she knows who did it, so it's not a giant investigatory deal, likely, though they're cops, so they're still talking to people, getting footage, etc., to nail down their case. They'll talk to her there, but given she knows who it is, and presumably has an explanation, they'll take it and go find him. Yes, sure might go speak to her later at home or wherever.

Keeping her overnight seems overkill, but depends on the concussion and blood loss (btw, that's a LOT of blood loss to require a transfusion; I'd think about that maybe), given what you've said about her injuries.

Okay, so if we make those changes - meaning that she's not unconscious when she arrives plus no transfusion - will they still treat her injuries before the forensic exam? Maybe it can happen together? Also, does the procedure allow for the husband to be present during the treatment and/or the exam?
And you mentioned that the detectives will arrive from the scene as the complaint isn't really up to her anymore - does that mean that 911 will dispatch the call to both EMS and Police when the husband calls it in?
Thank you once again. You've been a great help.

jclarkdawe
03-22-2017, 01:48 AM
Her entire exam will be a forensic exam. Pictures will be taken, samples obtained, fingernails check, clothes preserved. This is different then a rape kit, which is a particular type of forensic exam. All of the glass shards will be preserved, and ideally marked with the location that they were removed from her body. Most likely a tape recorder will be run during the exam. If a forensic medical examiner is available, they'll be called in. Cuts will be measured in three dimensions.

Injuries that require immediate attention will be dealt without worrying as much about preserving evidence, but anything that is not a priority will be dealt with due consideration to preserving evidence. The doctor is well aware that his or her medical report will be evidence at the trial, and the doctor may even be called as a witness.

Preferably her consent will be sought, but if she's confused, the police and doctors will work with implied consent. Big question as to how much of a suspect the husband will be and his availability.

Jim Clark-Dawe

cornflake
03-22-2017, 06:02 AM
Okay, so if we make those changes - meaning that she's not unconscious when she arrives plus no transfusion - will they still treat her injuries before the forensic exam? Maybe it can happen together? Also, does the procedure allow for the husband to be present during the treatment and/or the exam?
And you mentioned that the detectives will arrive from the scene as the complaint isn't really up to her anymore - does that mean that 911 will dispatch the call to both EMS and Police when the husband calls it in?
Thank you once again. You've been a great help.

Cops are pretty much always sent with (not with like they go together, but if EMTs are sent cops are too) EMS. Beat cops are calling detectives and someone to work the scene, the detectives will then likely go to the hospital, where she's likely not been seen yet.

As above, it's not one or the other -- the stuff has to be photographed and someone has to fix it and etc.; it's likely fairly concurrent. Yeah, if there's room, he's probably still there, unless the cops take him out to question him (just because she says someone else did it doesn't mean he's not a suspect, but if she says someone else did it, the both of them are acting normal, and the cops know they can get footage or something, they'll probably not go too hard on him).

ayesha
03-29-2017, 03:30 PM
Thank you so very much everyone for your help.