Classification of the type of violence

1. Classification of the type of violence • Physical • Psychological • Economic • Stalked • Sexual violence • Sexual harassment • bullying

2. Domestic Violence Dr. MAURIZIO TALLERINI MEDICAL DIRECTORFirst Aid

3. Europe for Citizens2007 - 2013

4. TOWN COUNCIL of FORMIAProvince of Latina ITALY Department of social services

5. Domestic violence in the emergency room

6. Domestic Violence Domestic violence means that "it takes place inside the couple relationship. It has as the most prevalent characteristic: verbal, sexual, psychological and physical violence.

7. Domestic Violence THE THEME OF VIOLENCE AGAINST WOMEN IS ENCREASING IN OUR SOCIETY NOWDAYS '. IN ITALY 1 WOMAN OUT OF 3 IS AFFECTED BY THIS PHENOMENON AT THE AGE BETWEEN 16 AND 70 YEARS. Indagine ISTAT 2007

8. FIRST AID is an"neutral”institution, where victims of violence are addressed and ask for help or shelter, whose number is higher than the one which turns to social services and police stations.

9. The emergency room is important not only for its ability to fulfil the health emergency, but first of all the staff can contribute to the study and monitoring of domestic violence.In particular it disclose both the "established“ and “overwhelmed" cases with the help of information means, by valuation methods, (frequent access to the emergency room).It is important the timely report of suspected abuses and ill-treatments, then the competent authorities will verify its existence.

10. Schools, institutions, social and health services, voluntary organizations and the First Aid are the rings of an anti-violence "network" as a form of interventions in the area of prevention and support to women victims of violence.

11. Very often the consequences of acts of violence brought to the attention and care of the emergency department are justified as the product of accident.

12. OUR AIMS ARE: BE ABLE TO ACCOMMODATE THESE WOMEN, ASSIST, CURE, RELATING THEM WITH THE "NETWORK“SERVICES; MONITOR THE PHENOMENON FOR THE SERVICE GIVEN BY THE FIRST AID, BORDERLINEEXPRESSION OF A DEEPLY UNQUIET SOCIETY. Formia Ancient ...

13. PROPOSED PROIECTBuilding an observation point in theemergency room: Turning to the emergency room is often the last episode in a history of ill-treatment The staff of the emergency department is often not trained or shaped to treat these subjects.

14. In the rooms of the first aid it is necessary to plan: A suitable information, tactfully visible and usable by leaflets and posters. Keep in mind that, at this stage, the person is seeking attention, understanding, human support and protection.

15. Point of observation in theemergency room: Recognizing and treating the serious or slight injuries suffered Identifying domestic violence even when it is presented as accidental injury or motivated in a different way.

16. Point of observation in the emergency room: Project Objectives: To evaluate the sensitivity of hospital reception and assistance staff (or triage) about how to face the situation immediately and in perspective.

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19. Training Project aiming to prepare First Aid Staff to: "Violence in the emergency room" The project consists of specially trained staff making a working group with the women health care, every 6 months - 1 year.

20. Training Project aiming to prepare First Aid Staff to: "Violence in the emergency room" carrying out training courses open to all staff of the emergency department (doctors and nurses) with information, elements of forensic medicine, psychology and criminology.

21. Training Project aiming to prepare First Aid Staff to: "Violence in the emergency room" Training hospital staff to raise the perception of the phenomena and provide theoretical and practical tools that can help to accommodate the victims of violence, both when it is declared and when the victim doesn’t state it.

22. EMERGENCY STAFF TASKS 1) Carryng out of the necessaryoperating protocols. 2) Identify the violence from all pointsof view and support the victim. 3) Assess the risk at the endof her protection.

23. EMERGENCY STAFF TASKS 4) Domestic violence is a crime and the emergency operator has got definite duties to observe (he/she must file a written medical report) 5) Inform and guide the victim to the competent authorities or Social Services giving: names, phone numbers and addresses of facilities which she can decide to go

24. The first approach is in the acceptance area (triage). The victimof the violenceasks nurse, in a way notalwaysexplicit, with a sense of fear, pain, humiliationifshe can speakwithoutbeingheardand seen by the others. . . Itis a right of her.

25. IT IS IMPORTANT:

26. Evaluate,beside the health side, the condition of weakness and emotional state, too.Isolate the victimletherwaiting in the reserved room inside the emergency station.Letherfree relievingher feelings or crisis of crying.Anticipateduring the first interview, the content of whatitwillhappenduring the followingphases of the medicalexamination. Reassurethe victimabout the respectof privacy informingherthatdoctors and nurses are obligedto keepthe professional secret and respect the right to privacy. Preventthe woman isgivingaway the cares of the case.

28. The waiting time before the first visit It is important because it keeps on the acceptance (or triage) way and goes on by a uniform behavior and a peculiar attention from every health worker: “making oneself responsible of her” along all the hospital path until the discharge of the patient, to prevent the rising of a feeling of dejection, isolation and negligence.

29. During first visit Ensuring and perceiving constantly the victim: Inform about the duty to keep professional secret. Respect the deontologocal code and privacy rules. The victim must feel safe, monitored and treated in a particular way. Sending her to specialist advices if necessary (gynaecologist, expert in infectious diseases, psychiatrist). Respect for her person Professionalism Privacy

30. Suspicion of Domestic Violence People with symptoms suggesting the suspicion of family violence very often arrive in the Emergency Room . The patient doen’t give willingly any particular information fearing repercussions on herself or her relatives, or lack of trust in health workers or institutions.

31. Suspicion of Domestic Violence The triage nurse is the first person called to pay particular attention on any clues leading to suspect a case of domestic violence,hidden by the victim in the guise of a casual fact.

32. Suspicion of Domestic Violence 1)The kind, the place of harms or its features. 2)The confused and / or contradictory story. 3)Her Posture, attitude. 4)Her mood. 5)The recurrence of similar episodes may require a widening by health professionals. 6)Take all the strategies for listening and attention that can facilitate the emergence of violence.

33. Clues or Alarm Bells that should stimulatea more careful investigation 1) Partner too much protective, delay in seeking help. 2) Injuries not connected with the anamnesis. 3) The patient does not speak before her partner. 4) Repeated medical examinations (perhaps for "domestic accident"). 5) Hematomas in different stage of recovery. 6) Lesions on different parts of the body or in different. developmental stages, lesions during the pregnancy. 7) Crying bout with amnesia about specific issues, questions or problems. 8) Frequent visits to the emergency room. 9) Suicidal ideation. 10) Assaults of sexual nature.

34. Effects of violence • Physical injuries - caused at different times and stages of healing. • Psychic injury - decreased self-esteem, panic or fear attacks, the mood variations in depression and / or euphoria way.Headaches or sleep disorders Palpitations, dizziness, feeling of chocking (stifling).

35. The lesions observing outside by medical inspection are typical: Scrupulous objective examination - Haematomas, wounds or fractures in areas covered by clothes - Bruises, lacerations, abrasions, wounds - Acupressure evokes pain without any obvious physical injury - The lesions are at different stages of healing. - Bilateral lesions

36. The physician should worry about the safety of their patients and risk factors through signals: Repeated violences Serious injuries Use of weapons Abuse of chemical substance Pathological jealousy Threats of suicide Children Abuse Fear to come back home

37. Safety Plan What to do in a critical phase: 1) Every time they denounce these crimes we must explain them how they could activate a possible protection, moreover they must know how to behave in these situations and where to go afterwards. 2) She must have gathered evidence (medical reports) or involved witnesses. 3) To know where to denounce the violence, and how long it takes

38. Advice for operators in the emergency room (things to do) After careful questioning, we must inform the woman about possible solutions and a network of psycho-social services which can provide expert assistance, even from a legal aspect. Provide immediate safety to womenExplain them that violence is a crimeThe victim-patient has no responsibility for the violence. Investigate the causes of her injuries or disorders. Assessing the state of her health by identifying injuries to her face, neck, breast, chest, abdomen. Establish a relationship of confidence

39. Advice for operators in the emergency room (things not to do) Think that the problem does not exist. Minimize the problem, excuse her husband or partner. Take decisions instead of the woman. Judge the survival strategies chosen by the woman, who must feel be protected and assisted. Judge the path that she wants to run. Make comments on the accident.

40. Domestic Violence is: “Visible”: physical violence, made ​​of humiliations, slaps, kicks leaving wounds on the body, contusions, lacerations, abrasions, signs of strangulation around her neck. “Invisible” - psychological, made ​​of humiliations, deprivations, lack of affection, atmosphere of constant tension, fear and threat.

41. Forms of physical violence Violent slaps. Torsion of an arm. Bites and scratches. Wrenches, shoves, punches, kicks. Burns by cigarettes or hot water. Abrasions on the lips. Twisting of an ear. Tearing one’s hair, choking. Punch on the nose with fractured nasal bones.

42. Injuriesfrom maltreatment Ferita da difesa Ecchimosi da “strattonamento” Aggressione sessuale compiuta su una superficie ruvida Escoriazioni a binario da uso di cintura WHO, Guidelines for medical-legal care of victims of sexual violence, 2003

43. Lesioni tondeggiantidiametro 0.8-1 cm,bordi netti. shoe print cigarette burn BRUCIATURA SIGARETTA IMPRONTA DI SCARPA injuries from bites bruise LESIONE DA MORSI ECCHIMOSI DI 7 gg.

44. ETA’ DI UN’ECCHIMOSIAge of a bruise • Rosso cupo : <24 ore dark red • Viola : 4 giorni violet • Bluastro : 6 giorni bluish • Verde : 7 giorni green • Giallo : 2 settimane yellow

45. International data assert that domestic violences are present in all ages, ethnic, religious and socio-economic groups,races and professions.There aren’t protective or aiding factors of cultural, social or economic kind.Violence against women has no time or boundaries.It does not save any nation: industrialized or developing country.Victims and aggressors belong to every social class.According to OMS one out of five women has suffered, physical or sexual abuses by a man in her life.

46. do not be afraid you are not alone

47. Guidelines in firtstaid station • Creation and activation of antiviolence centres in the emergency department of every hospital. • Network connection among the antiviolence centres of the Hospitals and territory, listening centers , refuge houses and the Red Cross.

48. Guidelines in the first aid station • Introduction of a “pink track" in the emergency room, reserved to women victims of violence, which provides a path of assistance to ensure, besides emergency medical cares, emotional support and privacy protection,too.

49. Guidelines in emergency station The help to the victims will be granted by a particular reception code (triage) which, since women will arrive at the emergency station, will start up a pool of experts: magistrates, health workers, psychologists and specialized police teams, who will attend in a close cooperation among them.

50. Guidelines in emergency station • Training courses for traffic warders, police, department of emergency staff. • Drafting of guidelines for violence management and prevention. • Direct link with the police and the magistrature.