University of Virginia Forensics Team Jeanne Parrish DNP, LNP, FNP-C, EMT-P

UVA Forensic Team Services Child Physical Abuse/Neglect Child Sexual Abuse Domestic Violence Elder/Dependent Adult Physical Abuse/Neglect Sexual Assault Adult/Adolescent Male Perpetrator Strangulation

Pediatrics Services Child Physical Abuse/Neglect Emergent Non-emergent Child Sexual Abuse Emergent Non-emergent Adolescent Sexual Assault Emergent Non-emergent *Strangulation *Perpetrator

Purpose of Examination 1. To obtain evidence for use in the legal process 2. To minimize potential lasting effects of event 3. To reassure both patient and parent of physical well-being

Emergent Exams Acute injury Time-sensitive evidence collection History may be unclear Must be authorized by CPS or LEO

Emergent - Physical Abuse Acute injury Head-to-toe physical examination Photographs of injuries ED Collaboration Pre-verbal & Non-mobile

Emergent – Sexual Abuse Contact event within 120 hours Head-to-toe physical examination Photographs of injuries Photographs of genitalia Evidentiary swabs ED Collaboration

Evidence Timelines Vaginal swabs (penile penetration) – 120 hours Saliva – 96 hours Anal swabs (penile penetration) – 72 hours Touch – 48 hours Oral (fellatio)- 24 hours

Coordinated with interview Non-emergent exams History established Coordinated with interview Forensics care only

Non-Emergent Exams Physical Head-to-toe examination Photographs of injuries Sexual Photographs of genitalia

Proposed Referral Protocol Medical evaluation should be part of interview process Presented to parent as taking 3 hours (2 interview, 1 medical) Interview first, then sent to ED for medical evaluation Minimizes confusion and travel Higher compliance

Pediatrician/PCP No photographs No evidence collection Not as familiar with STD testing/treatment for younger children Risk of Bias

Adolescent Sexual Assault Not a mandatory reportable event Age of consent Parental involvement

Testing and Prophylaxis Pregnancy Tanner stage 3 – with or without menarche 120 hour time limit Gonorrhea / Chlamydia Genital, Rectal, Oral Specificity & sensitivity Syphilis Hepatitis HIV Gardnerella, Candida, Trichomoniasis

(Modified from http://doctorlib.info/physiology/medical/297.html)

Data from www.cdc.gov/hiv/policies/law/risk.html

Key Points UVA now offers comprehensive forensic services Emergent exams Acute physical injury Sexual contact event within 120 hours Non-emergent exams Physical - if visible injuries or no PCP ALL sexual abuse cases with contact, if no emergent exam

Forensic Nurse Examiner On call 24/7 Happy to answer questions Call the hospital operator at (434) 924-0000 and ask that the FNE on call be paged (PIC 1542)

Jeanne Parrish DNP, LNP, FNP-C University of Virginia Health System Forensics Coordinator/Nurse Practitioner Office: (434) 297-5022 Work Cell: (434) 760-4820 E-mail: jrd4e@virginia.edu