Sexual Assault CAPT Mike Hughey, MC, USNR

Outline of Management Serious injuries first Brief history/consent Gather supplies Examine Treat (VD, Pregnancy)

Assign Staff Member Same sex Similar rank Remains with patient Psychological support Witness/Chaperone

Notify the Command CO, XO Officer of the Day Officer of the Deck Master at Arms NIS

Obtain Consent For: Exam and Treatment Collecting Evidence Releasing Reports & Evidence Taking Photos (if indicated) If consent is withheld, defer to higher authority. While you may have the right to order an examination, that is not always the wisest decision.

Supplies Gather your supplies before starting the exam. The patient will find delays in performing the exam to be tiresome. Sexual Assault Kit

Make up 25 Labels SN Susan Sailor, USN 123-45-6789 1 Jan 93, 0400 Fingernail Scrapings, Right Hand

Laboratory Requisitions Pregnancy Test VDRL or RPR HIV Hepatitis B 3 Gonorrhea Cultures Chlamydia Screen

Laboratory Specimens You will never remember all this, so make sure to look it up. 2 pieces of filter paper 2 red-top tubes 2 wooden toothpicks 2 pieces plain white paper 3 Gonorrhea plates Chlamydia Screen Kit 3 glass slides/slide holders 1 tongue blade 2 combs 9 paper envelopes 6 twin-packs of Q-tips 5 ml distilled water (not saline)

Exam Equipment 1 vaginal speculum 1 pair latex exam gloves KY jelly Flashlight Camera and color film

Supplies: Patient Comfort Fresh clothing Mouthwash and cup Toothbrush and toothpaste Betadine douche Emesis basin Balboa Naval Hospital, San Diego

History Patient states she was raped at 0100 in Storage Room #3 today. X Patient was raped by Senior Chief Antlerdance at 0100 today.

Gynecologic History LMP Use of contraceptives Significant past gyne history Sexual History: -First IC? -Last prior IC

Clothing Let any stains dry Place in PAPER bag Seal & Label the bag Give to MAA or NIS Chain of Custody Form Property Receipt to patient

Photographs YOU are the photographer Abrasions, lacerations, contusions Color film May need 24 hours for contusions

Head Combings Lightly comb patient's hair over white paper Fold comb and hairs into paper Place in envelope Label and seal it Chain of Custody

Mouth Exam Tongue blade & Flashlight (trauma) GC (swab and GC plate) Saliva swab and smear Glass slide (air-dry) Swab air-dry and seal in envelope Filter paper Soaked with saliva air-dry don't touch it with your fingers

Inspect and Palpate for Lacerations, Bruises, Abrasions Neck Back Abdomen Arms Legs

Fingernail Scrapings Have patient collect fingernail scrapings and place them in envelopes (right hand & left hand)

Pelvic Exam Chlamydia Culture Gonorrhea culture Vaginal Swab Glass slide smear, air-dry Swabs air-dry, seal in envelope Don't look for motile sperm unless you have been trained to do this

Toluidine Blue Dye Very helpful for identifying fresh trauma Apply, then rinse with vinegar Dye is taken up by metabolically active cells. Without Dye With Dye

Blood & Urine Tests VDRL or RPR Hepatitis B - (+ 1 month) HIV - (+ 1 month and 6 months) HCG - (weekly until next menses) 1 Extra red-top tube for MAA or NIS 4-5 drops of patient's blood on filter paper and let dry

Risk of Acquiring STD Risk of GC is 6-12%% Risk of Chlamydia is a little higher Risk of syphilis is about 3% Risk of pregnancy from single exposure during the middle 2 weeks of the menstrual cycle is 8% Risk of AIDS unknown but very small

Antibiotic Ceftriaxone 125 mg IM, plus Spectinomycin 2 gm IM, plus Doxycycline 100 mg PO BID #14 Zithromax 1 gm PO Flagyl 2 gm PO Spectinomycin 2 gm IM, plus Pregnancy: Substitute Erythromycin 250 mg PO QID x 7 days for Doxycycline

Emergency Contraception Within 72 hours: 2 Ovrals 12 Hours Later 2 Ovrals No abnormal bleeding. 50% have nausea and vomiting. Reduces pregnancy risk by 75%. (8% to 2%) Theoretical concern over exposure. We don't know how it works. May use 4/4 LoOvral, 4/4 Nordette, 4/4 Levelen

Followup Exam 1-2 weeks: -Assess psychological adaptation -Repeat pregnancy test if no menses 4 weeks: -VDRL -Hep B -HIV -Physical exam

Release from Medical Department Never go home alone Accompanied by someone she knows and trusts Goes to a safe place