# Sexual Assault - Scenario Posed in my class, What would you do?



## WuLabsWuTecH

This was a scenario that was posed in my EMT-B Class.  I'll give you the beginning information as it was given to me and my 2 partners.  I was running charge EMT as you will be.  I want to see, whether anyone does the same thing I did or if my instructor was right in saying my actions were poor.  Most of the students in my class agreed with him, a few agreed with me.

What would you do?

You are called from quarters from a Sexual Assault.  PD is already on scene, your response time is 3 minutes.  It is about 1AM on a friday night.  You arrive outside a nightclub where 3 cruisers and 5 officers are on scene.  An officer motions you over.  He tell you that the victim is not talking but from what they gather she was raped in the alley way behind the club.  They point to the cruiser in which the victim is sitting.  You walk past the assailant who is laying on his side and cuffed.  You are in charge, your partner is also an EMT-B and lucky your driver is also an EMT-B.

Unsure of what difference this makes, but we were doing this in Ohio so you can use CPAP, intubate, and run a 12-lead EKG should you need it.

All right, you're on scene, take over from here!


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## fma08

Have my female partner try and talk to the pt. and I would get the story from the officers as far as what they know and how they got called, etc... (there's my start).


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## WuLabsWuTecH

Sorry. forgot to mention that both your partners are male.  I wanted to do that too, but the instructor told me i couldn't change the sex of the classmates that were assigned to me my partners.


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## BossyCow

WuLabsWuTecH said:


> You are called from quarters ***from*** a Sexual Assault.  All right, you're on scene, take over from here!



Do you want to rephrase that????


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## CFRBryan347768

You are called from quaters TO a sexual assault? 

Any way, get her in the bus and secure all of her clothing that could have DNA/Sperm/and all that stuff. I would also have a cop come in the back of the rig, and if their is a femal cop even better. Then I would start assesment. I don't know how correct or accurate this is so some one please feel free to fill in my gaps.


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## WuLabsWuTecH

BossyCow said:


> Do you want to rephrase that????


sorry should have read: "for"

The female officer and you escort the patient to the back of your truck.  The female officer was the one who tried to question her in the first place but was unable to get any response.
Meanwhile your partner gets some info from the officers: officers state that some patrons leaving the bar heard screaming in the alley and then muffled yells.  They arrived and found the man who is now on the sidewalk running away from the scene as they arrived and the woman quietly sobbing.

The female officer give her a set of clothes and asks her to change out of her old clothes and into her new clothes; she follows those orders but is still quiet. While she is doing this your partner steps out to give her privacy and you see that she has some brusing consistent with assault, there is no uncontolled bleeding, just some minor cuts and scrapes.

Your partner comes back in asks of he can take her vitals just to see how she's doing.  She nods yes.

Respiratory rate is 28
Radial Pulse of 100
BP is 140/100

Right now your partner decides its best not to asculatate lung sounds but you can change this if you want to.  Your other partner comes back at this point with his report from the officer and her handbag that they just found but haven't looked through yet.  He also reports a can of pepper spray was found in the area but can't tell if it was used or not.


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## akflightmedic

A lot of writing and details to simply provide compassion and transport.

I notice several people saying have a female partner or female cop talk to the patient. Having had the misfortune of being on several of these calls, I can make an unscientific observation that the sex of the medical provider is sometimes (and in my cases always) was irrelevant.

It requires confidence, compassion and communication. You need to prepare yourself for how you will talk to these patients after these horrific events. If they do not wish to speak, then you don't. You simply let them know you are there should they change their mind. If they do not want to be touched, you do not touch them. It is pretty simple and straightforward.

I do not have to get vitals, I can justify that the pt appears to be fine and explain why I did not get any. No superior with a clue would ever challenge me in that regard as it would be totally asinine. Above statement is on a case by case basis of course with a lot of possible variances.

Do not be afraid to talk to the patient. Do not treat her as if she has done anything wrong or is bothering you. Do not be afraid to make eye contact because of your own insecurity over how to deal with the situation. Ask if there is anything you can do to make her more comfortable (temp, blankets, lights, music), anything.

Do not offer your own stories or experiences with rape or past rape cases.
Tread lightly if at all with any attempt at humor. It is NOT needed.
Think about what you are going to say BEFORE you say it.

Other than providing compasion and understanding, there is not much to do for this patient as you have stated there is no major bleeding, trauma, etc.

If the patient states anything related to the rape, you better be listening as you may be the only one she says it to and you need to document properly as you may be called later in regards to the case.

As far as the clothes changing goes, if the officer is requesting that on scene, fine as long as it is done in a tasteful manner and lots of privacy is afforded to the patient. Otherwise, I would not be securing any clothes until arrival at the ER when the forensic nurse or specially trained nurse takes over the case.


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## MMiz

Some words advice from an old partner who had a call like this:
1.  Write *everything down* immediately.  If the patient says something, write it down!
2.  Wear gloves!  I guess the police ended up scraping from under the patient's nails for DNS, and also taking the sheets on the stretcher.
3.  Talk very little, but be a good listener!
4.  Be confident and compassionate.


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## WuLabsWuTecH

So are we ready to transport to the hospital?  Are we sure there is nothing else we need to do on scene?


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## akflightmedic

Well I thought your scenario was how to handle the female victim.

If you are referring to the fact that you have three crew members all EMTs and only one of you is needed to establish rapport and care for the female...then most certainly the other two need to go check out the other "potential patient".


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## WuLabsWuTecH

akflightmedic said:


> Well I thought your scenario was how to handle the female victim.
> 
> If you are referring to the fact that you have three crew members all EMTs and only one of you is needed to establish rapport and care for the female...then most certainly the other two need to go check out the other "potential patient".


There we go!

The way I tackeled it, as following the NR sheets: Scene Size up: Applied BSI and ensured scene was safe.  Determined MOI was Assault and defered considering C-Spine until more was learned about the victims.  Determined number of patients was AT LEAST 2 due to the MOI so called for additional help.  Both my partners called good catch at that point, and I assigned them to deal with the SAS and i took an LEO to deal with the guy laying on his side.  Since my instructor had not considered that (I was the only one all day that thought of 2 pts) he told me to ignore the other pt and that we'd come back to him later (assume the backup arrived right now and they'll deal with him) and we finished the SAS pt with no further remarkable incidents.

In evaluation later, he claimed I had made the WRONG decision to treat the assailant.  Claiming that he was the guy who caused all of this so it was his own damn fault and that he was breathing so it wasn't my issue.  I believe the quote was "It doesn't matter, leave him in pain on the sidewalk, he's scum anyway.  Let the PD deal with him."

My view was that it was more important to do a quick triage and if for some reason one was in arrest or hacing issues with ABC, we would need to focus our attention on that pt first.  But we needed to at least do a quick triage and if no immediate life threats, we had enough resources to treat both pts so why not?  I am a healthcare provider and it is not my job to determine who is at fault, but to treat pts based on serverity.  For all we know, she could have attacked him first and is faking a rape to get him in trouble!  My instructors point was that who was at fault or morally wrong is very relavant and that should ALWAYS be taken into consideration when treating patients.

Most of the FF's and the LEO in my class agreed with the instructor.  I disagreed along with a psych/premed major, another premed, and a firefighter.

Can we open the floor to some friendly debate on either sides of the issue?  I'm not saying I'm right, i could be wrong in my view, but if so, I want to know why!


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## akflightmedic

Just trying to figure out where you are attempting to go with all of this. Aside from what I already mentioned, the offhanded comment of pepper spray and not checking lung sounds, do not know if you are trying to lead us down a road of possible reaction (normal or allergic) to the spray. Regardless, based on patient's presentation and vitals you have provided, this is not a concern of mine.

Are we getting warm or is there more info you are holding out on?


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## WuLabsWuTecH

Treating the patient was never a concern of mine.  The pepper spray was added to try and hint that there could be another patient, but the main idea was to see whether anyone would think of evaluating the assailant, especially b/c the scenario our instructor gave us has him laying on his side.  I was surprised that no one in my class even bothered to assess him quickly.

I guess i don't understand why most people don't classify the assailant as a patient?  If you arrive on scene for an Ped struck and the ped is in stable condition (low speed impact) and you find that the driver of the car seems to be in pain you would at least assess the driver right?


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## reaper

You treat all Pt's, does not matter who they are. Tell your instructor he has no business teaching students. That attitude is what gives good EMT's and Medic's a bad name.


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## gradygirl

I would give the assailant some "O2 therapy" for starters...maybe I would give him some "IV bag therapy" too...


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## WuLabsWuTecH

TCERT1987 said:


> I would give the assailant some "O2 therapy" for starters...maybe I would give him some "IV bag therapy" too...


Sorry.  You'r a basic.  O2 is OK, IV is no go!


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## gradygirl

Hahaha, oh I wish you could _hear_ what I was saying (most of the older guys and gals probably got this). 

The quotation marks were there for a reason, and here's why:

firstly, I was talking about the assailant, not the patient
secondly, "O2 therapy" means beaming the guy in the side of the head with an O2 tank
"IV bag therapy" is just like "O2 therapy," only with the use of an IV bag, which arguably leaves less of a mark than an O2 tank does


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## WuLabsWuTecH

Hahaha!  Yep, i'm still a measly teenager whos been licensed for about a week!  Didn't teach those therapies in class!

I assume you agree with the view of not treating the pt then?


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## gradygirl

Nope, that was just the first thing that went through my head when I saw the title "Sexual Assault".


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## reaper

How will you feel when you find out later, that this guy did nothing wrong? Maybe he was running from the scene, because he found the girl and got scared.

Now, if he is convicted of the crime and you transport him as an inmate, with medical problems, then the IV therapy could work!


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## gradygirl

reaper said:


> How will you feel when you find out later, that this guy did nothing wrong? Maybe he was running from the scene, because he found the girl and got scared.
> 
> Now, if he is convicted of the crime and you transport him as an inmate, with medical problems, then the IV therapy could work!



HAHAHA! Fair enough. Especially because it seems like incarceritis cases are popping up more and more...


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## Foxbat

> Sorry. forgot to mention that both your partners are male. I wanted to do that too, but the instructor told me i couldn't change the sex of the classmates that were assigned to me my partners.


I've heard that actually female rape victims often prefer to talk to *males* about what happened. They find them less judgemental than females. Go figure.


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## gradygirl

Foxbat said:


> I've heard that actually female rape victims often prefer to talk to *males* about what happened. They find them less judgemental than females. Go figure.



As a female who has been assaulted, yes, I preferred talking about it to men over women. I don't think it's because I found them less judgmental, but rather it's almost that they served a protector role, at least on a subconscious level.


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## Ridryder911

Okay here is an opinion from a Forensic Sexual Assault Nurse Examiner. First, ask if there are any physical injuries, if unaware be careful but treat accordingly. Do *NOT* disrobe the patient unless you have evidence bags (must be paper) with proper chain evidence tape/seal on them and secured by investigators. 

If there is NO serious physical injuries the victim should NOT be transported by EMS but by an officer, so any statements and discussion can be noted. As well * PLEASE STOP THE MYTH OF THE FEMALE IS THE BEST TO OFFER!!!* It has been proven over & over, that in real life, many rape victims prefer to discuss the event with a male in lieu of a female. Most feel that they are being "judged" by another woman. So please let's STOP THE MYTH!

Each community should have a rape crisis center. Most of the time it is NOT in the ER, rather a designated area. As well, very little of the examination is performed by a physician but rather a Forensic Sexual Assault Nurse Examiner. We are specially trained and certified in performing rape and sexual assault examinations and given statements, and testimonies in trials. 

The examination of a rape victim usually lasts 2-4 hours and is VERY detailed and accurate. As well, questions of what to ask, and NOT to ask and proper documentation of each. 

In regards to your Instructor, if what you have described is true then he is a dumbarse! I suggest asking for your money back, your getting cheated by an  jaded and unprofessional person. Time to not only revoke teaching credentials, but medical cert as well. 

I invite them to debate the issue here if they would like to attempt to disapprove my opinion... 

Good luck, it appears you will need it!

R/r 911


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## MMiz

Rid,

I've worked with countless partners, and usually the female EMT will work as a tech on a female patient in emotional distress.  Not only for the patients own well-being, but for the male medic's as well.


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## Ridryder911

MMiz said:


> Rid,
> 
> I've worked with countless partners, and usually the female EMT will work as a tech on a female patient in emotional distress.  Not only for the patients own well-being, but for the male medic's as well.



I do understand but it has been found and well documented that many female patients prefer male personnel again because of the judgemental persona that may be given even if unintentional or just on what the patient may perceive. 

What is primary important is the patients psyche should be considered no matter whom is giving care.. After experience the provider should recognize the possibilities of awkwardness but again realize they are just as capable of providing emotionally and physical treatment. 

R/r 911


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## WuLabsWuTecH

Ridryder911 said:


> Each community should have a rape crisis center. Most of the time it is NOT in the ER, rather a designated area. As well, very little of the examination is performed by a physician but rather a Forensic Sexual Assault Nurse Examiner. We are specially trained and certified in performing rape and sexual assault examinations and given statements, and testimonies in trials.
> 
> The examination of a rape victim usually lasts 2-4 hours and is VERY detailed and accurate. As well, questions of what to ask, and NOT to ask and proper documentation of each.



Yep!  We learned of where a couple of these are in our city during our class when they were going over specialty centers, it was on the list we had to know--Trauma is either downtown or at the university, psych is riverside, peds is childrens, burns is OSU, Sexual assault are here and here, etc...




> In regards to your Instructor, if what you have described is true then he is a dumbarse! I suggest asking for your money back, your getting cheated by an  jaded and unprofessional person. Time to not only revoke teaching credentials, but medical cert as well.



We had about 8-9 instructors all of whom were fabulous except this guy.  He was getting married the day after our class ended, but during our practical exam, he was always on the phone.  I remember him answering his phone while I was doing my BVM/intubation assessment, and it caught me off guard I forgot to mention Sellick, but it was irrelevant at that point as he already finished off my sheet and put it in the done pile with a perfect score and was already halfway across the room as i was talking to myself and my partner through the procedure!  Yes, he had seen me do it correctly a hundred times before, but it still struck me that he really doesn't care about his job.  Sadly, he received his medic card 4 days prior to this incident and luckily he doesn't work near my city!  Don't get me wrong, I still have respect for all the knowledge he has as he is light years ahead of me in that respect, I just have little respect for him as a person.


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## BossyCow

WuLabsWuTecH said:


> There we go!
> 
> In evaluation later, he claimed I had made the WRONG decision to treat the assailant.  Claiming that he was the guy who caused all of this so it was his own damn fault and that he was breathing so it wasn't my issue.  I believe the quote was "It doesn't matter, leave him in pain on the sidewalk, he's scum anyway.  Let the PD deal with him."



Triage states treating pts in an order determined by the severity of their injuries. Since the man had not be convicted of a crime and could have been an innocent bystander hurt by the rapist, I'm not going to make that call but will follow protocols regarding triage.

By the same logic, would you treat the broken arm over the multi-system trauma at an MVA if the worst injured was suspected of being under the influence? Would you fail to treat the severe burns of a suspected arsonist and instead treat the minor injuries of the ff called to put it out? 

Slippery slope here. I would think that the only defense for your instructor's position is that you were called by LE for assistance with the victim. So, I suppose a case could be made for the other guy not being your patient yet. But again, slippery slope.


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## newbie

Your instructor's verbiage underpins an indefensible attitude of judge and jury.  That being said if this assailant is hand cuffed because they have been arrested then the LEO placing this assailant under arrest has assumed the right and responsibility to make health care decisions on behalf of the assailant. What that translates to in simple terms is the officer has the right (at least where I work) to tell you the assailant is fine and in no need of medical attention.


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## reaper

So the LEO where you work are all medics? If not, then they are not going to be telling me that he is fine, until I check him out!


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## ffemt8978

reaper said:


> So the LEO where you work are all medics? If not, then they are not going to be telling me that he is fine, until I check him out!



This is actually a separate topic so I'd suggest that you think about starting a new thread on it.

Basically, you stated that you're going to check him out WITHOUT obtaining consent first...in my area, that's a no-no.


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## WuLabsWuTecH

ffemt8978 said:


> This is actually a separate topic so I'd suggest that you think about starting a new thread on it.
> 
> Basically, you stated that you're going to check him out WITHOUT obtaining consent first...in my area, that's a no-no.


The LEO in this case, at least for my area, has the ability to consent for (or provide non-consent) the detainee.  They have their own set of protocols they have to follow in allowing access to medical care.


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## BossyCow

I'd be interested in hearing thoughts on this. Who is the pt? The one that the law enforcement called on, or anyone at the scene? Was the unit called to attend to only the victim or was the call to the scene itself?

Was the alleged rapist visible only peripherally or part of the scene as a whole? Knowing how likely people are to sue, I'd want to cover my liability ten ways from Sunday on this one. Is the perp going to sue because he didn't get care? Is the vic going to sue because we took care of her rapist first. What if the alleged rapist was only a bystander caught in the violence? Who wants to defend that lawsuit?

I think if I asked and was told that he was fine, I would probably mention in my report that I was denied access to properly assess the other potential pt at the scene due to law enforcement, safety concerns etc. It definitely deserves some clarification. 

I'm known for calling up agencies after a call and asking them to clarify what is expected in similar situations. Dealing with potential 'what ifs' is easier than dealing with the aftermath of guessing wrong.


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## WuLabsWuTecH

My though is that scene size up is the ENTIRE scene.  That is why the "Determine the number of pts" line is in there.  An Assault automatically registeres in my mind as at least one person injured, but most likely at least two unless the guy getting assaulted was knowcked unconscious and unable to fight back, and even then there is possibly minor injuries to assailant.

I think its easier when I ignore who may be at fault.  I try to take care of the sickest patient first.  If I am unable to do so due to other barriers outside of my control, he runs away from me, an LEO stops me from doing so, I document that and move on.  The person who was assaulted can try and sue me if he really wants to, but I followed procedures and if I did triage correctly, the victim was not in as bad of shape and was able to wait a few mor eminutes for treatment.  in my case though, she received treatment at the exact same time.


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## traumateam1

Well here is what I would do. I would first attempt to talk to the patient and establish some contact. At least tell her my name, partners names and who we (local EMS). After that I would tell her that we would like to take her into the back of the ambulance for privacy and to make sure she is ok. Ask the patient if she wants to be taken over on the stretcher and if no reply get it anyways and take her into the back of the ambulance. Once in there let her know that we are here to help her. I wouldn't allow myself or partners to do to much talking.. let her do the most talking, and if she doesn't want to talk I wouldn't offer up any stories or anything. In terms of vitals and what not I would beging by doing my primary. ABC. Ask her if she hurts anywhere and if she is in serious distress give her some O2 via nasal prongs at 4 lmp unless p/t doesn't want that. The last one I did, she threw up so keep a bio bag near by. I tried to get as much clothes for forensics but knew that the hospital would get that when she got changed into a gown so I left mostly everything on, as the sperm/DNA etc was already there and not going anywhere. Keep the p/t as calm as possible, transport to the hospital and en route fix up and cuts or scrapes. Of coures constantly telling your p/t what you are doing. I covered my last p/t with a blanket just so she didn't feel so exposed and she later told me she really appreciated that. 
There's not a whole lot you can do (from my levels perspective) just clean up any minor wounds. Obviously take care of any major emergencies. Transport to the hospital, and if you advised the ER before arriving you will have a private room.. so hand off patient to the hospital and your done.
I got a recommendation for the last Sexual Assault/Rape call I attended as Primary Attendant.. and that's basically what I did.
As far as my partner not wanting to listen to the lungs. ADVISE the patient of what you are doing.. tell them and ask them if it's ok. If yes then go ahead. If no than don't. And if no answer try it and if your hand gets smacked away then don't try again. I find that many EMS providers get so caught up in the emotions of these calls and while thats no completely bad.. we need to realize and remember we need to do our job, and that includes vitals, listening to the lungs and other things like a Rapid Body Survey.


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## SCFD8REZ

The very first thing i would do is offer the female a blanket beause she is probably feeling very vulnerable and blankets always seem to compfort people, its also 1AM and probably chilly outside, i would then compassionately start the sample process explaining to her that we are here to help her. i would obviously ask her if anything hurts and if so where specificly, i would then act accordingly to her response " if her head hurt from being punched or something give her an icepack." i would then ask her if she had noticed any blood, if there is i would then do a trauma assesment based upon symptoms, if her spo2 is ok, her core is stable and she has no symptoms, all you can really do is talk with her and try to provide the best compfort you can in this situation, if S.O. is already on scene then the crime scene is probably already well protected, if you must remove clothing make sure it is placed in an evidence bag, always use BSI in this situation to protect her as well as your self and the evidence against the perpitrator, also, make your own report based on what she tells you and write it down, you may be called in to court better to be safe then sorry if you rely only upon what the sherrif tells you. and she is obviously going to need to be transported to be checked out for internal injurys, have bloodwork done, possibly stitches et... at the hospital.


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## Somedude

Like I saw in one post before, ive done a small handful of cases like this. They are never fun for anyone and usally everyone takes a quiet trip back to the station. The best and only advise I can give is be professional. This is may be very difficult but retain every bit of professionalism you have. Second speak softly but confidently. Remind the pt. she did not deserve what happened. This will help establishing short relationship with the pt. for the trip to the hospital. Do not lie to the pt. and say it is all ok. Finally, as for the test, if you went to check out the other pt. then good for you being viligent. If not, the ambulance didnt get called for him so he didnt need medical help. If he is a rapist...he has plenty worse coming to him.


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## WuLabsWuTecH

Yeah, this is not a case i would ever want to run on, but I was just appalled at how some people can say a human life is not important, everyone screws up, some really f**k up, but they are still human right?


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## ride2k

So you transport the girl because she is your patient and the reason you were called, obviously. But you leave without the assailant and later find that he did in fact have some form of injury, who knows, maybe he bumped his head and had a minor concussion... now what? Sure he is in police hands but wouldn't you consider that neglegence to not even do some sort of assessment? 

I agree with you in saying that you _do_ in fact, have two potential patients. Unfortunatly, EMS is an opening for a ton of potential lawsuits. I say, err on the side of caution and check him out.


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## emt19723

i would probably acknowledge the turd in custody, laugh at him and say "you got tore the f*** up by a girl" then let the PD take him to the hospital to get checked out.  UNLESS.....for some reason his ABCs were compromised. then my conscience would probably kick in.   then id go in to the hospital after he got out of the ICU and then laugh at him!!    lol


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## papyrusman2000

just a thought: Given the circumstances (R: 28, and the fact that she was just raped), wouldn't you try calming her down with a bit more oxygen than a Nasal Cannula could offer? 

15 lpm mask?

yes... no... maybe so?


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## Bosco578

papyrusman2000 said:


> just a thought: Given the circumstances (R: 28, and the fact that she was just raped), wouldn't you try calming her down with a bit more oxygen than a Nasal Cannula could offer?
> 
> 15 lpm mask?
> 
> yes... no... maybe so?



No. What is a NC or NRB  going to do for her? Why does she need oxygen to begin with? She is upset, perhaps hyperventilating due to the stress and anxiety.


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## mikie

Bosco578 said:


> No. What is a NC or NRB  going to do for her? Why does she need oxygen to begin with? She is upset, perhaps hyperventilating due to the stress and anxiety.



wouldn't hurt...perhaps it might calm her down.  as we discussed in a different thread about its therapeutic benefits (as some called it 'placebo' affect)


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## Bosco578

mikie333 said:


> wouldn't hurt...perhaps it might calm her down.  as we discussed in a different thread about its therapeutic benefits (as some called it 'placebo' affect)



So your going to slap on a NRB because hey, why not. Nice.


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## papyrusman2000

IDK... going by the books I guess thats what you would do... plus like I said she just got friggin raped... I'd want some O2 if I was a girl that just got raped...

but since I'm just a guy I'd probably be good with a cigarette.


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## papyrusman2000

You know what... come to think of it... if there isn't a risk for hypoxia, then WHY THE F##K NOT?!

I think it would be worth the extra few words I'd have to right out on the run report to calm the pt nerves and help her out in really the only way possible in this case. Shes not wanting to talk much, so let her just suck on some O2 and relax on the way to the hospital.

Besides if you look at it from the "technical" stand point, I'm pretty sure your supposed to deliver O2 to a patient with an R rate of 28... generally not always 15 via mask, but like I said in this case: WHY THE F##K NOT?!

Hey screw me, right? I'm just an EMT-B.


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## Ridryder911

Treat the patient appropriately. Slapping oxygen onto a anxious, nearly hyperventilating patient will probably have no physical benefits. As well, why administer the wrong treatment? 

Really, think what happened.... what just occurred? Does this patient really need improved oxygenation? Or is it since you feel you cannot provide anything else, you slap on the oxygen to make yourself feel better that you did something. 

Maybe the best treatment is to be sure that the most appropriate health care team has been notified and to make sure no life threatening injuries occur. Making sure the arrangements has been made for the continuation of care and then removing yourself from the scene. 

Sometimes, *we are not *the best providers for certain conditions and definitely oxygen is *NOT* the magic pill to cure all problems. Remember, oxygen is a *MEDICINE/DRUG!* Would you administer any medications without the need to? 

R/r 911


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## BossyCow

I'm not likely to give oxygen to this patient. I've seen too many pts hyperventilating into a NRB because some well meaning soul thought it 'might help'. An anxious pt who has just been through a trauma needs your attention, your calm, your professionalism, your discretion but does not need O2. Putting a mask on the pt may help you distance yourself from their pain or their situation but will do little to address the emotional impact of the event. 

If someone is bleeding, apply pressure to the bleed. If someone is hypoglycemic, give them sugar. If someone is emotionally upset give them oxygen???? The treatment should have some benefit to the patient.


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## Bosco578

Ridryder911 said:


> Treat the patient appropriately. Slapping oxygen onto a anxious, nearly hyperventilating patient will probably have no physical benefits. As well, why administer the wrong treatment?
> 
> Really, think what happened.... what just occurred? Does this patient really need improved oxygenation? Or is it since you feel you cannot provide anything else, you slap on the oxygen to make yourself feel better that you did something.
> 
> Maybe the best treatment is to be sure that the most appropriate health care team has been notified and to make sure no life threatening injuries occur. Making sure the arrangements has been made for the continuation of care and then removing yourself from the scene.
> 
> Sometimes, *we are not *the best providers for certain conditions and definitely oxygen is *NOT* the magic pill to cure all problems. Remember, oxygen is a *MEDICINE/DRUG!* Would you administer any medications without the need to?
> 
> R/r 911



Thank you Rid. Well said.


----------



## reaper

papyrusman2000 said:


> You know what... come to think of it... if there isn't a risk for hypoxia, then WHY THE F##K NOT?!
> 
> I think it would be worth the extra few words I'd have to right out on the run report to calm the pt nerves and help her out in really the only way possible in this case. Shes not wanting to talk much, so let her just suck on some O2 and relax on the way to the hospital.
> 
> Besides if you look at it from the "technical" stand point, I'm pretty sure your supposed to deliver O2 to a patient with an R rate of 28... generally not always 15 via mask, but like I said in this case: WHY THE F##K NOT?!
> 
> Hey screw me, right? I'm just an EMT-B.




I think you answered your own question in that last sentence!


----------



## papyrusman2000

ok ok hate on the rook'. thats all fair and wonderful. whatever. 

I guess I didn't state my question/point (if there is such a thing) in a manner that only the most INTELLIGENT and PROFESSIONAL EMS provider could answer.

1. Of COURSE you would handle the call via protocol. Call it in to the receiving hospital, prepare for the hand-off of pt, etc etc. PROTOCOL PROTOCOL!

2. Since this is just a scenario, many "what ifs" and so-ons could be thrown in. duh. 

3. How *HARMFUL* would it be to administer O2 to a pt in this condition? We all tried O2 on ourselves. We ALL know it (in the smallest way) helps calm you down. AFTER the necessary assmts. and actions taken to ensure competent and efficient care, safety, and comfort to this pt, would it truly be an ignorant and (at the very least) morally unnecessary action to follow through with? SHE JUST GOT RAPED. O2 *MAY* be a nice thing. 
"Ms. So-and-so, would you like us to administer supplemental oxygen to you to help you calm down/relax/whatever?" I can't tell you what I would really say, but I'm good at improv, even in delicate situations.

Before you respond after reading this, just know that this is -I guess- my way of learning. If I have a different understanding of something, I will present that aspect until somebody convinces me otherwise. 

I AM IN NO WAY AT ALL TRYING TO UNDERMINE OR QUESTION YOUR EXPERIENCE, NOR AM I TRYING TO BE A SMARTA55. Im a n00b at this whole thing, so please help me become a pro... preferably without being a d1ck...

Thank you all for being active members on this website. I have learned so much from all of you in the last few days it's phenomenal .

on another note....


----------



## mikie

Bosco578 said:


> So your going to slap on a NRB because hey, why not. Nice.



I didn't say I had no reason to "slap it on her."  If I find it doesn't help her anxiety (as it affects her breathing), I can cease it at anytime with no harm done.  This is of course being done while attempting other means to comfort the patient and provide care.

Why not have her breathe into a paper bag?  (not seriously, although I am interested into its actual 'use')


----------



## reaper

First, You need to learn to write your posts as questions. To me, (and many others) you came across as a smart ars new EMT that learned all there is to know, in EMT class. I know that sounds harsh, but that is how your posts sound.

You can learn a lot from the people here, that have years and decades of experience. Most of us were doing EMS before you were born. We have seen these situations over and over again.

We are trying to tell you that a NRB at 15 lpm is not a justified treatment for this pt. You have a female pt that was forcibly raped. She is scared and anxious. Placing a confining mask over her face is not going to help her. It will make her anxiety worse.

As you learned in class( I hope), hyperventilation leads to inadequate gas exchange. The pt is unable to blow off Co2 and is retaining O2. Placing her on high flow O2 is not going to help her blow off Co2. Yes, some people will calm down some, with O2. But, I have seen them pass out from the same treatment. This is not what the pt needs at this time.

The best thing you can do for her is let her calm down. Talk to her in a calming voice. Do not ask questions of the event. Just use a little empathy. This can be one of the hardest parts of the job, but it is a part of it. You learn how to deal with a pt like this over time and from advice from people that have been there all ready. Go to your larger ED and talk with the sexual assault RN, they can give you advice on how to best deal with the Pt's.

So, don't be cocky, don't be a smart ars and ask all the questions you want. These people are on this forum to offer advice to the noobs. Hopefully to help you become a great professional.


----------



## mikie

I wish I knew it all.  I know I am new, well kinda.  I didn't mean to make my threads sound as if "this is the only option."  And by no means am I trying to be a smart 'ars,' it's just my take on it.  I guess (being late at night, at least for me at the moment and tired of studying for A & P), I made my post sound as if it is the end-all-be-all as opposed to a question (probably lack of solid grammar at the moment too, hindering my question-making sentences)

However, where was the question in your post? 

My goal for this patient would not be to solve her problems, but to provide treatment and care for what I come across.  I want to get her to the hospital and let the rest of the medical community take great care of her and let the PD throw his ars behind bars.  

Perhaps she is hyperventilating because she is trying to compensate for lack of O2 (if that made anysense)?  That would be my reason for using a NRB (perhaps not even using 15lpm or strapping it on, rather use at her discretion).  Maybe step down to a NC.  Was there any evidence of physical trauma suggesting O2 (vaginal bleeding?  DCAP-BTLS...) be necessary? 

And maybe...use nothing at all (airway-wise) except trending vitals and continuing care.   

Thankfully this is a SCENARIO and I am grateful to learn what others take on the proper treatment would be.

and on that note...good night!


----------



## reaper

Mikie333,

That was not for you. Your posts always come across as wanting to learn. You are doing great!


----------



## VentMedic

Okay. Another lesson on hyperventilating, hypoventilating, hyperoxygenating and hypo-oxygenating.

Not all hysterical people "hyperventilate". Some actually hypoventilate because the breaths they take are ineffective. 

Sidenote: This is why we don't do nebulizer treatments on crying or screaming children.

Thus, oxygenation can also be affected.

Sidenote: I hate doing an ABG on a crying or hysterical patient, be it an adult or child, because the PaO2 always looks bad as does the PaCO2 (which can be low or high). 

Hyperventilation and hyperoxygenation can truly only be determined by an ABG. 

A patient can also be on a NRBM and have a large A-a gradient for many reasons. Their SpO2 might even be 100% but you don't know where the PaO2 is on the oxyhemoglobin dissociation curve or what is the actual value of the PaO2. 

If nothing else it can be distraction in an otherwise uncomfortable situation. 

I've even been asked by a physician to give an Albuterol neb to a rape victim n the ED because the vocal cords quivered. Right? No. Did any harm? No. You have to weigh the odds and alternatives for each situation.

It is just that it is understood why you are doing it which could or could not be for a medical benefit. You may not know in the field and you will be with that patient for only a short time. 

There are alot of things that can be debated in medicine. We give O2 for migraines. Another teaching hospital might be trying to disprove the effectiveness. We run 95 - 100% FiO2 as part of the sepsis protocol which contradicts ARDSnet if both protocols are in place. We still will do a "nitrogen washout" as treatment for a pneumo. Some think that is crap. The hypoxic drive has been debated for 40+ years. It even has a 3 day international conference dedicated to it. CPAP is now even being debated as to its effectiveness in some literature. Albuterol for hyperkalemia? Albuterol for beta blocker OD? Nebulized lasix? Flolan or Nitric Oxide for pulmonary hypertension? Hypercapnia or Subambient O2 for ductal dependent lesions in babies? Morphine or fentanyl? Dealer's choice. 

Rape is not an easy issue and EMTs or Paramedics are not trained well enough for such traumatic emotional events. There are times when you just have to go with whatever you have to offer to get through a bad situation. Yes, O2 is a med but you may have to give it a try just to get this patient through a very uncomfortable ride to the hospital if you think it might have some benefit.

I, myself, have not been raped. However as the female partner, I have been placed in the back with many rape victims through the years, both male and female. Each patient has different needs and different ways of expressing them. We still must not lose sight that the body has just endured a cascade of emotions, HR increases and stress. We don't know how each "body" will respond and each may respond differently. Trying to put all patients into the same cookbook recipe under Rape does the patient more injustice.


----------



## reaper

Very well written Vent.

All Pt's are different, that is why you learn over time how to deal with different situations. That is why I advised him to talk with a sexual assault RN. They go through the training to be able to best deal with the Pt's. They can be very helpful and a wealth of information on the subject.


----------



## VentMedic

reaper said:


> As you learned in class( I hope), hyperventilation leads to inadequate gas exchange. The pt is unable to blow off Co2 and is retaining O2. Placing her on high flow O2 is not going to help her blow off Co2. Yes, some people will calm down some, with O2. But, I have seen them pass out from the same treatment. This is not what the pt needs at this time.


 
Gotta clean this up a little reaper.

Hyperventilation is blowing off CO2 and can be determined by an ABG. 

If the patient is feeling "air hungry" or "can't catch their breath" the O2 may help saturate remaining Hb or psychologically give them some security. Once they calm, the O2 can be removed. It the patients get more hysterical with the mask, it can be removed. If they pass out, it could be from other reasons also since the body is responding to a wide range of physical and psychological reactions.  If they pass out, you're probably going to give O2.


----------



## reaper

No problem, That's why you are the RRT!!


----------



## papyrusman2000

reaper said:


> First, You need to learn to write your posts as questions. To me, (and many others) you came across as a smart ars new EMT that learned all there is to know, in EMT class. I know that sounds harsh, but that is how your posts sound.
> 
> You can learn a lot from the people here, that have years and decades of experience. Most of us were doing EMS before you were born. We have seen these situations over and over again.
> 
> We are trying to tell you that a NRB at 15 lpm is not a justified treatment for this pt. You have a female pt that was forcibly raped. She is scared and anxious. Placing a confining mask over her face is not going to help her. It will make her anxiety worse.
> 
> As you learned in class( I hope), hyperventilation leads to inadequate gas exchange. The pt is unable to blow off Co2 and is retaining O2. Placing her on high flow O2 is not going to help her blow off Co2. Yes, some people will calm down some, with O2. But, I have seen them pass out from the same treatment. This is not what the pt needs at this time.
> 
> The best thing you can do for her is let her calm down. Talk to her in a calming voice. Do not ask questions of the event. Just use a little empathy. This can be one of the hardest parts of the job, but it is a part of it. You learn how to deal with a pt like this over time and from advice from people that have been there all ready. Go to your larger ED and talk with the sexual assault RN, they can give you advice on how to best deal with the Pt's.
> 
> So, don't be cocky, don't be a smart ars and ask all the questions you want. These people are on this forum to offer advice to the noobs. Hopefully to help you become a great professional.



ok... so i guess these sentences:

"I AM IN NO WAY AT ALL TRYING TO UNDERMINE OR QUESTION YOUR EXPERIENCE, NOR AM I TRYING TO BE A SMARTA55. Im a n00b at this whole thing, so please help me become a pro... preferably without being a d1ck...

Thank you all for being active members on this website. I have learned so much from all of you in the last few days it's phenomenal."

weren't really needed to be typed by me, since you were so eager to jump on my "smart ars" and criticize me on being such a "smart ars."

I'm well aware of how I sounded, HENCE the last few sentences I typed in my post.

whatever man. no matter how dumb I sound, please don't cut me down and try to make up for it by using the same dumbass smiley face I used to try and make it look innocent. thanks.


----------



## reaper

I know what you wrote in your last post. I was referring to your previous posts! 

I am trying to help you. Many have come on here and made posts, that were taken wrong. they learned from it and became great members that have grown into excellent health professionals.

You seem to want to keep up the attitude. This will only get you to a point where no one will want to answer your questions.

Start fresh, ask great questions and learn all you can. You will find that this can be a great place to learn about things you would never think about.


----------



## Ridryder911

The main point. Oxygen is a drug. Alike any other medication there are great benefits to the use and as well there are severe risks associated with it as well. Yes, even oxygen. Again, alike any other medication unless you are quite aware of these things, one should not be "slapping" or administering anything half hazardously. 

Would one give aspirin (ASA) as well? Again, one should be able to justify your reason for treatment, not because "its not going to hurt" or "why not" answers. The patient needs psychological first aid much more than physical treatment. Hence, as discussed that EMS does not have enough or not even taught pyschological treatments.  

Even as a trained and certified sexual assault nurse, I recognize and realize my limitations. I can initially perform a psychological debriefing, and the detailed rape exam up to the internal examination. There are many medications and treatment one could do or administer that would not cause harm, but again alike any other treatment(s) we have to ask ourselves on each case and patient. Is it needed? Is it warranted? Can we justify performing or administering it? Not just because we can; or believe it might help. 

I see this even in medics starting IV lines. Many use the "my protocols described I could" or "it won't hurt" statements. One should be able justify using those protocols. Was there a need for an IV? For there are only two reasons for an IV: fluid replacement or administration of medications. That's it, no other reason can be justified in the prehospital arena. Yet so many treat their protocols NOT the patients just because they can. 

We need to pull back and do what is the best for our patient at the time. This maybe means doing nothing more than projecting yourself as a good empathetic caring professional. Providing reassurance, projecting safety: both physical and emotional, and displaying non judgemental expressions or statements. This can be performed by a medic of either sex, again another myth that one is more preferred or is better than another. 

Treating accordingly and appropriately to the patient is the key. Very few patients fits the exact categories of protocols or treatment regimes. That is why protocols should be written as suggestions not exact. 

R/r 911


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## VentMedic

Rid,

I respect your opinions. But, not everyone who is raped will be the healthy 18 y/o female. That was the initial topic. Just because a person is "only raped" by your cookbook standard does not mean there can not be other medical issues also that must be treated. Just because rape is the only in your face complaint does not mean other things can not also be occuring within the body from pre-existing conditions or new conditions that have stemmed from a violent assault. Don't put blinders on just because you do not consider rape to be a medical problem also. An assessment should still be done if possible. And if the person is short of breath or has irregular breathing one should be able to use some judgement. Don't discount that a rape doesn't warrant O2 because it is "just a rape". I've had all age groups and gender on ventilators in the ICU following a rape with many medical issues. Some are caused by the rape itself and others from medical problems that were exacerbated from pre-existing problems. One punch to the face, head, chest or abdomen can do some damage that is not immediately detectable by either the health care provider or the patient who may still be too emotional or "numb". Again, using the cookbook and placing all rape victims under one heading and not allowing each patient to be assessed for their own individual needs is dangerous also. 

I have the greatest respect for O2 but I also respect what rape victims tell me or how they present. Emotionally traumatized patients are the most difficult to assess. The hysteria can also mask other symptoms. Women also do not always present as men do with pain initially, especially CP. I'm not going to discount anything because a cookbook says it is a "rape". Thus, "no O2 is warranted". If you are not able to determine the severity of the person's injuries or do a thorough assessment immediately,yet the patient appears to be "air hungry" there is nothing haphazard about giving O2. If the person is truly have difficulty breathing but you write if off as hysteria or "not warranted" because it is just a rape by the cookbook, that will be a problem. 

Nor should a hysterical person be denied O2 because you think they "might be hyperventilating". I've seen very young patients coming in with some pretty bad PNAs that were hysterical on RA and a PaO2 of 40 with no supplemental O2 because the Paramedics thoght they were suffering from hysteria and didn't bother to assess further. With new resistant strains of bacteria and now increasing numbers in AIDS, this will be more common again unfortunately. There are times when you have to assess the patient or listen to their symptoms and not make a doorway diagnosis. 

I know this is hard for you to imagine yourself, but picture being a woman, clothes ripped off, vulnerable and 6 FireMEN with 2 PoliceMEN (typical FL response) walk into your bedroom. This also occurs in cases of domestic violence when the male EMS providers start talking and laughing with the husband (alledged attacker) in the room about football in front of the patient. "He seems like a nice guy and is sorry, you really don't want to press charges against him?" Scene control with the person the patient feels the most comfortable with should be considered. They could also feel comfortable or more secure with a male. However, there are reasons why male, and sometime female, doctors have a female RN or other professional present when women are intimately examined. It is protection for themselves and the patient's protection and/or comfort.

For a 10 minute ambulance ride, the risks with O2 is minimal. One must weigh risks versus benefits. If the patient calms with a little O2, it will be difficult in the ambulance to determine if it is physiological or psychological. The O2 can always be removed. Is O2 always warranted for every medical condition? No. But in those that you can not truly determine if there are any other underlying conditions besides "just the rape", it may be of benefit. At the Paramedic or EMT level there is little psychological counseling you are qualified for except to provide supportive care/treatment and scene security. While you, Rid, might have had more training with this as an ED RN, others here have not.


----------



## Ridryder911

If the patient warrants oxygen it is not usually the "rape" itself; rather the medical conditions associated with the violent act or associated injuries. Again, Rape is a legal term that is only determined by prosecution; we need to remember potentially sexual assault victims in perspective usually does not have the extreme physical trauma as in comparison to the emotional and psychological trauma . We also need to remember that sexual assault occurs in both genders, and it is predicted is much higher in males than reported but not reported. 

I agree on some aspect but respectfully disagree with you on other factors:

Yes, oxygen can and should be part of the treatment regime but it self if it is determined to be justifiable. True, it may not hurt; but installing philosophy of administering oxygen is better than doing nothing was where I disagree. Again, treat the patient accordingly and appropriately. When we are treating for serious illnesses or injuries the assault itself is secondary. If they need oxygen, then by all means administer it. Those conditions that you illustrated are much more involved than the just occurrence of the sexual assault itself, true they maybe induced by such but not all assault victims have such responses. Again, these injuries and illnesses should treated aggressively because of what they are, not just the mechanism of injury. If one wants to treat prophylatically then know that is what we are doing and be able to justify it.

Yes, sexual assault patients definitely should be assessed and treated for physical injuries, never described or stated differently. One needs to assess as well the patients history for predicting indicators such as medical history, age, and other potential underlying problems such induced toxins (drugs, alcohol), medications, and other substances. As well, a good a brief physical exam to detect life threatening injuries should be performed, but this is where I differ and teach to use caution. A detailed secondary assessment examination needs to be very careful not to destroy or even remove evidence. Yes, again let me point out, life threatening injuries should always be treated immediately but to perform a detailed secondary assessment just for the sake to perform one should be differed if possible. This again is if the patient appears to be stable (physically) and no apparent life threatening wounds, injuries r/t MOI.  Even physicians will only briefly examine an apparent stable sexual assault victim leaving a detailed sexual assault exam for the Forensic Nurse to perform. Nothing is more discouraging to the victim to have learn later that evidence was destroyed, not obtained, or be able to be obtained due to the poor system of treatment. That the chain of evidence was not carried through, changes of linen, clothes, cleansing of lacerations, bites, can drastically be challenged in the legal system.  

As you know, but many may not, that a sexual assault examination is a very, very detailed complicated examination. They usually take over four hours for me to perform. From examining and documenting every scratch, bruise, torn fingernail, to performing and obtaining STD, DNA swabbing. A good forensic nurse will detect any secondary trauma if it is presentable at the time. Again emergency treatment should never be withheld.  

It is even recommended that most sexual assault victims not even be seen most ED's.  I know in my area, very few ED's are prepared to see such cases. A designated ED to care for all such cases or an off site clinic is usually preferred. When I am notified, I will meet with other team members including a crisis team member, psychologist or specially trained sociologist, a member of the D.A., and possibly a trained former sexual assault victim counselor. The location of the center is only known by those that need to know for privacy and protection as well as the Forensic Nurses (formerly SANE) in my area are deputized through the District Attorney's with privileges of such. 

I also disagree that the gender for the immediate response and rescue is a importance as much as we first thought. Much research has disproved different ideas, and thoughts. In fact some research has described that males may present a more non-biased demonstration and empathy than usually expected. I myself as I also teach attempt to ask the victim if possible (conditions allowed) if they prefer a female. Usually, I have seen it is the rescuers that is much more uncomfortable than the victim themselves. 

Unfortunately, in any of the ED's I have worked at the staff  never get to choose the gender they treat. Unless the patient specifically request, either gender is expected to perform all treatment and procedures. I am in the room with physicians performing pelvics as much as the females. I do understand the emphasis you are describing and one has to be extremely wise and cautious. This now includes the same for all sexes, nowadays.

As much as I hate spin off classes, I do think this is an area that a either good CEU or course should be developed in association and cooperation with other specialized organizations. There is much more than the initial treatment that has to be considered in this delicate and horrible tragedy. Long term effects not just in regards to medical care but to the crime scene, careful documentation and well planned organization for prosecution needs to be considered. 

R/r 911


----------



## VentMedic

Ridryder911 said:


> I also disagree that the gender for the immediate response and rescue is a importance as much as we first thought. Much research has disproved different ideas, and thoughts. In fact some research has described that males may present a more non-biased demonstration and empathy than usually expected. I myself as I also teach attempt to ask the victim if possible (conditions allowed) if they prefer a female. Usually, I have seen it is the rescuers that is much more uncomfortable than the victim themselves.


 
I don't know what the cultural make up is of Oklahoma but there are areas where we must be sensitive to many different customs for both men and women. This even goes for the many different cultures for the "all-American". There still must be some respect and it is not always okay to just say "the literature says". 



> including a crisis team member, psychologist or specially trained sociologist, a member of the D.A., and possibly a trained former sexual assault victim counselor.


 
All of these people, except the D.A., may have some training to recognize that more medical attention is required. They are also very well trained in providing the support and asking the right questions to calm a patient. 

Give the MDs and RNs in EDs some credit for knowing when not to destroy evidence. Not every ED is a non caring facility with ignorant employees. While taking care of the patient is their first priority, many have been trained, just as you have, in what is required for rape victims. 



> Those conditions that you illustrated are much more involved than the just occurrence of the sexual assault itself, true they maybe induced by such but not all assault victims have such responses. Again, these injuries and illnesses should treated aggressively because of what they are, not just the mechanism of injury. If one wants to treat *prophylatically* then know that is what we are doing and be able to justify it.


 
There are many degrees to sexual assault. I hope you are not saying this is just a passive act. Not all ambulances carry CT Scanners or X-Ray machines nor may the patient be immediately able say where it hurts. Give the victim the benefit of the doubt. 



> Yes, again let me point out, life threatening injuries should always be treated immediately but to perform a detailed secondary assessment just for the sake to perform one should be differed if possible.


 
Exactly. If you can not do a thorough assessment but may have reason to believe there is the potential for more injuries, one may have to make a judgement call about the oxygen. 

How many times have you given ASA and O2 to a man c/o chest pain and shortness of breath? How many times have they been discharged later when that hot dog digests? Do we "asume" it isn't an MI if we had prior knowledge of the hot dog or do we still continue to treat the symptoms just incase? How many times have we treated nonspecific EKGs until other diagnostics are done?

Should we assume that the rape victim just layed there and didn't experience any violence or that her/his body suffered no physical pain or responses? Does the woman or man have to be beaten to a pulp for it to be a "violent act"?

And that takes us back to your first sentence:


> the patient warrants oxygen it is not usually the "rape" itself; rather the medical conditions associated with the violent act or associated injuries.


 
My point is it is difficult to adequately assess the full extent of other conditons or injuries. Oxygen should not be withheld just because you can not see obvious injuries.


----------



## papyrusman2000

I think you guys need to take a vacation and hit the strip clubs.



Thank you for all of your time, brothas.

Im peacin on this one. Getting way to deep for me.


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## Bosco578

papyrusman2000 said:


> I think you guys need to take a vacation and hit the strip clubs.
> 
> 
> 
> Thank you for all of your time, brothas.
> 
> Im peacin on this one. Getting way to deep for me.



Try some O2, it might help....


----------



## VentMedic

papyrusman2000 said:


> I think you guys need to take a vacation and hit the strip clubs.
> 
> 
> 
> Thank you for all of your time, *brothas.*


 
Guess you didn't read my posts either.

Do you think I'd be kicking Rid around so unmercifully on some things if I was a man? 

I am a little disappointed about the strip club remark since this is a thread about sexual assault and part of our comments were about respect for women (or men) on a very sensitive issue. Not that strippers aren't respectable, but it just opens up a stereotyped view about women in certain occupations.


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## Ridryder911

Ahh.. it was not a bad kick. What many do not understand as a good intellectual debate, meaning we can agree to disagree and both can be right or wrong in various parts of the issue (although, I am right ) . 

Now, I what I emphasize was oxygen, ASA, or what ever that is a medication needs to be understood as such. That we should not be endorsing to immediately apply to most or almost every patient because the "what ifs?" In fact many sexual attacks occur without any major trauma and although I do not have the statistics in front of me, but I would describe EMS is hardly ever called in the majority of the cases. Fortunately and unfortunately many time there is not gross physical injuries and therefore many of the times the violation does not even get reported. 

I caution on those on documentation as well. Alike so many other subjective things; if documenting events write per " quoted as per patient" of description of event. Keep strictly to the facts. Avoid terms such as rape, sodomized, etc. as only and if the patient stated them. Writing exact statement of the chief complaint of history. The EMT is not trained to differentiate wounds as type seen with such occurrences. One can describe "response to a possible sexual assault" etc.  Even though, we all might agree of the occurrence, prejudging is one of the emphasis the defense attorneys love to use. Stick with the objective data such as abrasions, lacerations, bruising, etc making sure to describe location, size and other physical descriptions. This is a PCR that has a 99.9% chance probability to be subpoenaed so review with your partner for mistakes, spelling and grammar. 

R/r 911


----------



## Airwaygoddess

*Professionalism comes with empathy*



papyrusman2000 said:


> I think you guys need to take a vacation and hit the strip clubs.
> 
> 
> 
> Thank you for all of your time, brothas.
> 
> Im peacin on this one. Getting way to deep for me.




Dealing with human suffering is part of EMS, I would hope if you were responding to a assault call you would have empathy for the patient no matter what gender they are.............. -_-


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## papyrusman2000

dear god I guess no matter wtf I say there Is going to be some uptight self-righteous nerd schooling me on how wrong I am and this and that. 

I'm looking forward to meeting more people like you guys in the field. It will remind me how lucky I am to have a personality and a life... a FUN one at that.

get bent.


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## papyrusman2000

VentMedic said:


> Guess you didn't read my posts either.
> 
> Do you think I'd be kicking Rid around so unmercifully on some things if I was a man?
> 
> I am a little disappointed about the strip club remark since this is a thread about sexual assault and part of our comments were about respect for women (or men) on a very sensitive issue. Not that strippers aren't respectable, but it just opens up a stereotyped view about women in certain occupations.



*No, I didn't read your :censored::censored::censored::censored:in' post because I was sick of reading your crap. Sorry. There's the truth.

I give up. You win. I lost interest in this post a while ago, and I'm really not interested in figure 8ing with any one any more, so... I SURRENDER! Spare me you ridicule.

Leave me alone please, and I'll do the same.*


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## papyrusman2000

"blah blah blah if I was a man?"

I didn't know you were a chick, so get off your Hig-horse, lady. Trying to judge me and my moral standings and characteristics THROUGH AN INTERNET FORUM!? LOL. 

Sorry to burst your bubble, but I'm not a chauvinistic pig and I have PLENTY of respect and compassion for all humans on this earth, male/female/black/white/old/young/gay/straight (whats my Avatar?)....

and I LOVE THE STRIP CLUB.

Ok that's it I'm done. Enjoy your life.


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## VentMedic

papyrusman2000,
WuLabsWuTech started this thread and you hijacked it for your own agenda.   

So,  Bye Bye!


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## ffemt8978

That's way more than enough of this one.


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