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!

 

[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).

 

[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.

 

[BossyCow]

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????

 

[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.

 

[WuLabsWuTecH]

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.

 

[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.

 

[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.

 

[WuLabsWuTecH]

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

 

[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".

 

[WuLabsWuTecH]

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!

 

[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?

 

[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?

 

[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.

 

[gradygirl]

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

 

[WuLabsWuTecH]

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!

 

[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

 

[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?

 

[gradygirl]

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

 

[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!