1. Sexual Assault
CAPT Mike Hughey, MC, USNR

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

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

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

5. 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.

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

7. Make up 25 Labels
SN Susan Sailor, USN Jan 93, 0400 Fingernail Scrapings, Right Hand

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

9. 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)

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

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

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

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

14. 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

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

16. 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

17. 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

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

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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

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

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