Sexual Assault Forensic Examinations in USAREUR

1. Sexual Assault Forensic Examinationsin USAREUR Allyson Cordoni, CNP , SANE- A, SANE- P

2. Objectives • Locations within Europe with trained medical personnel • Personnel performing Sexual Assault Forensic Examinations (SAFE) • Purpose of a Sexual Assault Medical Forensic Examination (SAMFE) 4. Components of a Sexual Assault Medical Forensic Examination and follow up procedures

3. Where Victims can obtain a Sexual Assault Exam within USAREUR

4. Who can do an Exam? • RN’s, NP’s, PA’s, DO’s and/or MD’s who are trained as a Sexual Assault Forensic Medical Provider and are credentialed by MTF. • SAMFE training course • Standardized SAMFE course material being presented and instructed within the military treatment facility. • 40 hour didactic, 24 hour clinical component • Often referred to as the Sexual Assault Care Provider (SACP) • MEDCOM Regulation 40-36 • Based on US Department of Justice Protocol • MTF SOP/Memo

5. Why Do an Exam? 1. Provide Medical Care • Assess and Treat any injuries 2. Provide Prophylactic Medications 3. Test for potential disease 4. Asses safety, suicide, homicide 5. Collect Forensic Evidence • Sexual Assault Evidence Collection Kit (SAEC)- NOT RAPE KIT • Toxicology testing for drug facilitated sexual assault (DFSA)

6. Why do an Exam? Research shows that once victims get support, they’re more likely to cooperate with the criminal justice system.

7. When to do an Exam? • Within 24 hours? • Within 96 hours? • Within 120 hours? • Within 168 hours? • Whenever a victim requests one?

8. When to do an Exam? • Within 24 hours? • Within 96 hours? • Within 120 hours? • Within 168 hours? • Whenever a victim requests one?

9. When to collect a Sexual Assault Evidence Collection Kit? A. Within 24 hours? B. Within 96 hours? C. Within 120 hours? D. Within 168 hours? E. Whenever a victim requests one?

10. When to collect a Sexual Assault Forensic E A. Within 24 hours? B. Within 96 hours? C. Within 120 hours? D. Within 168 hours? E. Whenever a victim requests one?

11. The Medical Exam 1. Detailed Medical History 2. Detailed Assault History 3. Head to Toe examination • Ultra violet light, photo documentation, collection of blood, saliva, secretions etc. • External Genital Exam • Specimen collection, photo documentation, treatment

12. The Medical Exam 4. Sexual Assault Evidence Collection Kit 5. Documentation DD2911 AHLTA Note • Total Time for exam: • Victim= 3-4 hrs • Provider= 6+ hrs

13. The Medical Exam 6. Safety and Discharge -Quarter slip 4-5 days Pregnancy? HIV? Family? Chlamydia? Boyfriend? Friends? Future sexual relations? Work? Injury? Sleep? Nightmares? Flashbacks? What if I see him? Safety? WHAT IF MY BOSS FINDS OUT?????

14. The Medical Exam 7. Follow up • Comprehensive individualized plan of care • Specialty care and referrals • Behavioral health referrals • Sexual Assault Provider- within 24-48 hours then in 2-4 weeks • Counseling regarding STI lab results • Counseling regarding Pregnancy • Counseling regarding HIV risk, testing and prophylaxis • Follow-up care of injuries sustained during assault • Every effort is made for the victim to see the same SACP and Sexual Assault Care Coordinator (SACC) to establish trust, ensure continuity of care, and enable appropriate evaluation of emotional status and coping • Support continues until the victim decides to terminate or leaves the geographic area

15. Result of Sexual Assault • "Being a victim of sexual assault is far more damaging in many ways than even combat injuries," he said. "You don't see the visible wounds. When we talk to commanders and senior non-commissioned officers and the leadership at the junior level, we have to help them understand that after somebody is sexually assaulted, it has a huge impact, just as you would see with an improvised explosive device injury, a brain injury or post-traumatic stress disorder. Those have the same signs an symptoms that many of our sexual assault victims experience.“ - Russell Strand

16. Questions?????