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
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