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

2. 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

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

4. 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

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

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

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

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

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

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

11. 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

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

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

14. 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

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

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

17. 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

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

19. Jeanne Parrish DNP, LNP, FNP-C
University of Virginia Health System
Forensics Coordinator/Nurse Practitioner
Office: (434)
Work Cell: (434)