Sexual assault pts & gender of tech

[Epi-do]

I recently was dispatched for a sexual assault. We arrive onscene and find out that a closer ambulance had been disregarded because it was an all male crew. The officer onscene decided that since the pt was female, and since my ambulance was available, that we needed to be dispatched so I could tech the run into the hospital. So, what do you think? Would you request a specific ambulance because of the gender of the crew?

I can tell you this girl wasn't anymore comfortable with me than she was with any of the guys onscene. She just wanted her mom with her, and to go home and take a shower. (A typical response for some, possibly alot, of victims) She didnt' want anything to do with anyone she did not know, regardless of gender. Personally, I think it is crap that they disregarded the othe ambulance, but there is nohing I can do about it. In fact, it isn't the first time my truck has been requested because I was working.

I have never requested a different truck because my pt would prefer a male tech. It just seems like it would be a slippery slope to start on. What are we going to allow the pt to demand/request next? "I want a medic that is male, Asian, 5'10", graduated top of his medic class, and has at least 5 years experience." We can't be special ordering ambulances based upon the crew. You call 911, you get whoever shows up.

 

[akflightmedic]

Search button
Sexual Assault and male pulled up this one.
I remember it, lot of good discussion there for ya.

http://emtlife.com/showthread.php?t=8370&highlight=Sexual+assault+males

 

[exodus]

It's common sense, if someone is a victim of SA they need a same-gender crew, or same-gender tech. This isn't asking for prefernce. This is to reduce stress on the patient. The pt was not in a life threatening situation.

 

[akflightmedic]

Read the thread I linked. It is not common sense and it is silly to request a specific unit.

Page 3 gets real good.

 

[exodus]

I digress then, and go with what was said in that thread. We were taught in school, to let the same sex partner handle it... But then again, I went to an EMT-B Mill....

 

[Seaglass]

I don't think my county has an official protocol about it, and if it's a really critical call, they'll send whoever's closest regardless of gender. But if they think the patient is likely to have problems with men, they'll try to send a woman. We're not usually very busy, and we've got lots of women. These combined with some local protocols about how many providers get called mean that some women will usually show up anyways.

We've got a large and conservative immigrant population, and I could see some of them refusing to allow male medics to see female patients, too. I don't know what dispatch does for that.

I'm of mixed opinions. I can see not wanting to further traumatize an unstable patient, and wanting to not waste time if a patient needs care but won't let men see her. But I can also see it really sucking in a department with only a few women...

 

[Sapphyre]

I recently was dispatched for a sexual assault. We arrive onscene and find out that a closer ambulance had been disregarded because it was an all male crew. The officer onscene decided that since the pt was female, and since my ambulance was available, that we needed to be dispatched so I could tech the run into the hospital. So, what do you think? Would you request a specific ambulance because of the gender of the crew?

At the moment, I'm frequently the only female on during at least half my shift, every night. There've been more than a few times where I've passed several units en route to a call, because they wanted a female tech, even on my driving nights. BUT, these were all me getting pulled out of 911 for an IFT, female psych.

Once got pulled into the back to tech a 911 call, while I was driving. It was pure chance that I happened to be the closest unit sent to a pt who had a history of hitting on her techs and then making accusations later (and while we were on scene she hit on my partner, all 6 ff and all 3 SO)....

 

[reaper]

I digress then, and go with what was said in that thread. We were taught in school, to let the same sex partner handle it... But then again, I went to an EMT-B Mill....

Once you get more experience, you will see that most SA victims do not want a same gender medic. A female Sa pt will feel more comfortable with a male medic.

This has been discussed many times over and over!

 

[medicdan]

There are patients that my company transports often (dialysis, or pateint requests), that in their notes on the computer, always require a double male, or single female crew. Sometimes it has to do with lifting, and is stereotypical (double male), sometimes because the patient is known to accuse male techs of various things.
______

I heard a fascinating lecture from a SANE Nurse (Sexual Assault Nurse Examiner) earlier this year, that argued against some of the practices mentioned in the earlier discussion, (and echoed by Rid, a SANE nurse himself). I want to reiterate some of them here:

-- Try not to remove clothing. It will be removed by the SANE nurse carefully, placed in a paper bag, and sealed as evidence.

--Be careful where you transport this patient to. There are designated receiving facilities in my area for SA patients. These ERs have kits and supports all set up. By law, every ER has kits that can be used for collection (they are free from the state DPH), and regular RNs can ostensible collect the evidence, but again, it takes upwards of 2-3 hours, and requires expertise. Most ER RNs cant take that kind of time with one patient, undisturbed. The SANE RN is only called once all of the patient care and stabilization is complete, because the process takes so long, and often cannot be interrupted. Bottom line: if the patient is not critical, try to take them to a designated SANE facility. Of course, if it is life threatening, evidence collection is secondary, or even tertiary.

-- If you are required to call in a report on your patients, consider calling this in on a cell phone, rather then a radio that can be heard by others, or a system which is broadcast all over the ER. Use discretion when describing the chief complaint, and note that the ER may want the patient in a specific private room, so be patient, as they have to do some moving around.

-- Although it sounds counterproductive, it is actually in the best interest of the patient for us (prehospital care) to document very little about the assault or what the patient reports (subjective). Patients are known to be confused at first, and their descriptions not always completely consistent. At first, they may deny things they feel comfortable telling someone else later, etc. Having different reports (legal) that are inconsistent is very problematic if the case later goes to court, and while normal, makes it appear that the patient is lying. If you do include subjective information, put it in quotes. As Rid mentioned, there is a good chance the report will be subpoenaed, so check the report for spelling and grammar (it counts in the real world!)

In your report, focus on the physical exam. Avoid using "rape", consider using "possible sexual assault". There is no benefit to you expressing your skepticism that the patient was actually raped, because once a patient mentions it, they are entitled to an exam and investigation.

The kit, once collected, is sealed, and transferred to the police department where the assault occurred (maintaining the chain of evidence). From there, it is transferred to the state crime lab, and held for six months. The patient has the full legal right to refuse an investigation at the time of collection, but decide to pursue it within 6 months. At that time, the kit is opened and analyzed, and the police department where it occurred opens an investigation. If the patient does not want it, no legal action is taken.

Bottom line: Learn your SANE hospitals, be careful with documentation, avoid being judgmental, and dont worry so much about the gender of the crew. Consider approaching your local DPH or a SANE nurse, and ask them to come to your service to give a lecture, it is really fascinating to hear.

 

[Sasha]

It's common sense, if someone is a victim of SA they need a same-gender crew, or same-gender tech. This isn't asking for prefernce. This is to reduce stress on the patient. The pt was not in a life threatening situation.

That it based on the foolish assumption that the patient is an idiot and can't tell the difference between their attacker and the rest of the world.

 

[Ridryder911]

I digress then, and go with what was said in that thread. We were taught in school, to let the same sex partner handle it... But then again, I went to an EMT-B Mill....

Doubt that your instructor knew any better also. Most thoughts are based upon assumption and not real facts that has been described. It has been thouroughly studied that the victim rarely cares what gender tends to their crisis but rather whomever they are be empathetic and caring. Professionalism at its upmost is crucial and knowing how to preserve & proctect evidence is essential.

If one does not have a SOP or knowledge in evidence preservation and chain of evidence, then I highly recommend in service education and review of these procedures.

A review of how units are dispatched needs to be reviewed. Similar to priority dispatching females to O.B. calls is foolish.

R/r 911

 

[VentMedic]

No two patients are rarely the same and some defy the opinion of popular studies which may not address such issues as age, culture, living situations and conditions surrounding the assault.

You may not handle a situation such as the one a few years ago where the two Catholic nuns were sexually assaulted or those where female inmates are sexually assaulted by prison guards the same as you would another female in suburbia or the inner city with different backgrounds. For various factors they may or may not have issues with who comes close to them and that may include how violent the attack was. Many times a TBI is present which unfortunately gets overlooked or is not even considered as are many other injuries from the assault. However, the patient may not allow much physical examination especially at the scene of the attack. Once in an environment the patient perceives to be safer or at least without direct visualization of the scene, the gender of the healthcare providers will probably not be an issue.

We also have to consider sexual assault on boys and men in larger cities although it probably happens in rural America also. Gang initiations, spousal abuse and hate crimes or just violent crimes of a sexual nature do exist. We could also go into more discussion about sexual assault on the differences between a little girl or a little boy being sexually assaulted and who might they feel more comfortable with.

Too many variables and different situations to even consider making a blanket recipe for all sexual assaut patients.

So again, no two patients will be the same. What should be the same is your professionalism at scene and when with the patient. A lot will depend on your own maturity and ability to provide care in a manner that instills confidence and a feeling of security. If the patient sees or hears you make an inappropriate remark or some out of line gesture with other uniforms at scene, their confidence in you may be lost.

 

[Epi-do]

Can anyone help point me in the right direction to find some studies that show patients often times have no preference of the gender of the tech, or that females may prefer to have male techs? I have been searching the net the last couple days and am not able to quite find this. Maybe I just haven't hit on the right search criteria, so I am open to suggestions. Thanks!

 

[VentMedic]

You will find several studies here:

http://scholar.google.com/

Examples:
http://scholar.google.com/scholar?hl=en&lr=&q=rape+victims+health+care+professional+gender

http://scholar.google.com/scholar?hl=en&lr=&q=rape+victims+preference+health+care+

Again, this issue is multi-factorial. In the areas I work, we must respect the different cultures and their beliefs when it concerns male or female health care workers doing certain examinations or touching of the patient. The exception might be in a life threatening emergency.

You may be making the assumption that everyone raped will be heterosexual and not the victim of a hate crime. (I could make reference to this with recent events in Richmond, CA.) You may also be assuming everyone is white and all American female in the age range of 20 -30.

It also depends on the attitudes of the health care providers and that will affect how they present themselves to the patient. This can apply to both male and female health care providers. Some do not believe women can be raped in various situations or "they were asking for it". " "Someone who hangs out there deserves it." "A prostitute can't be raped." "There is no way a wife can be raped or even abused by her husband." It wasn't that long ago when domestic violence was not taken seriously. When we showed up on scene, EMS would do first-aid to the wife and the LEOs would have a little chat with the husband about "not being so rough" next time and football. Nobody went to jail for that sort of thing. Even child predators got off easy as we saw with EMS' favorite author. (It might be interesting to see what the preference of people who had been abused in someway as children who they would want as a health care provider if raped as an adult.)

If the health care staff doesn't have adequate training, it may influence the patient's preference of gender the next time he/she gets raped. Hopefully, one will only get raped once in their lifetime and ideally not at all. So, how do you adequately research what their attitude is about preferences if they only have one experience to draw from? Before the fact, some might have a preference of male or female gyn doctors but there are also preferences and stereotyped attitudes toward that which may deal more with sexual preference. In the event of a rape by the gender of their sexual preference, that might change. As well, as one ages, they may change their preference for both their Gyn doctor and who is at their side after being sexually assaulted.

So, you have a lot of literature to sort through to adequately weigh all the variables: age, gender, family values, childhood environment, religious beliefs, cultural beliefs, sexual preference, past rape or predatory experience, victim of domestic violence, scene of the rape, etc.

Reading just one study won't do since you do not know that researcher of understand their reasonings and the way they want to tilt the study. Example: If I wanted to prove a large percentage of COPD patients were CO2 retainers, I would include only those with the type of COPD that most likely presents with CO2 retention and ignor the rest. I could get away with this by just using the term COPD and set up my study to use only the variables I see fit. However, it would depend on where the study would get published as to how harshly it is critiqued. An EMT and an RRT might each interpret the study totally different.

If you have taken a couple of psychology classes in college, you may also find some references in the textbooks. This is a degree in itself to just study gender issues and how their pertain to the way one perceives their sexual experiences both good and bad.

 

[VentMedic]

I will add one more comment about the gender of the EMT(P) providing care at scene to a patient who has been sexually assaulted. For the past 40 years, EMS providers have been mostly male especially in Fire Based systems as have the LEOs. It would again depend on the attitude of the provider who is providing the care. Since the person may not have had any other rape experience to compare with, there may not be an expectation of who should provide care or who might be the best person to provide the care. It also didn't make a difference because for EMS there was probably little chance for choice to compare the outcome for the female provider.

I know EMS providers, RNs and ED doctors, male and female, who I would not want touching me to take my BP and definitely not present if I am sexually assaulted. But then, I have formed an opinion from seeing many sexual assault victims and their interactions with various health care providers. I have also seen attitudes change among health care providers and the public over the past 30+ years as my own attitude has changed about many things.

 

[Ridryder911]

One might also contact Office for Victims of Crime and or International Association of Forensic Nurses (IAFN) publications for additional information.

R/r 911

 

[VentMedic]

the American Forensic Nurses

http://www.amrn.com/

 

[simpatico]

I'm not so sure we should be considering situations like this to be "tough luck" in terms of what the patient wants. I personally would not shy away or ask for another same-gender crew unless the patient specifically seemed to desire such a thing. I certainly would not ignore their request.

It's definitely a cultural thing and there is no way that I can force my ideals on a patient that may have just been sexually assulted and mentally traumatized because of it. I'm a firm believer in the, "do no harm" aspect of the job and forcing things to go your way on a call would be no different than the person who SA the victim forced themselves onto said victim.

If the patient does not care, I do not either, I am there simply to help them. But if the patient does care then I can at least ask them what would make them comfortable. ^_^

 

[Epi-do]

Thank you Vent & Rid. Looks like I have a lot of reading in my future. I am hoping that I can put together something to give to my officer to be sent up the chain so that some sort of SOP can be written. We just don't have anything in writing addressing this particular type of situation, and I personally don't think it should be automatically assumed that a specific type of provider needs to be dispatched re: gender or other similarly categorized traits. I do realize there are exceptions to every rule, and when it comes to these types of runs, every situation is different. That is why I am wanting to read the studies and look at the statistics. That way, a general guideline can be established, based upon the evidence and not some officer's notion of what is wanted/needed.

 

[VentMedic]

Does your PD not have a victim's service unit or one that provides advocates? If so, they can help you with the guidelines. Almost every county in Florida offers this service either through the municipal PD or Sheriff's Office. They meet the victim at scene or at the hospital and will follow them through the process including legal proceedings. Since we, unfortunately, have a fair amount of children who are victims, the advocate is usually female. It's a nurturing thing, and probably stereotyped, not that men can not also have those same qualities. There is also that thing where some male in the family may be the one who committed the assault on either the little girl or boy. Thus, some LEOs just expect a woman to show up at scene. It is difficult to accommodate everyone of every age and gender.

As for psych calls, we had the policy to use mixed crews for many years after a some of our EMT(P)s were accused of sexual assault. Mileage and radio contact was also a must as all times. Fortunately, at that private ambulance service only three of all of the accusations were proven to be true in 5 years.