Sexual Assault Forensic Examiner (SAFE) Centers. Ambulance Destinations in New York City

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1 Sexual Assault Forensic Examiner (SAFE) Centers Ambulance Destinations in New York City

2 Sexual Assault Forensic Examiner (SAFE) Centers The Mayor and the New York State Department of Health have defined Sexual Assault Forensic Examiner (SAFE) Centers of Excellence in New York City

3 Sexual Assault Definition Sexual Assault is any sexual contact without consent Sexual Assault is Penetration is not a criterion Sexual contact by force Sexual contact with a person that is physically helpless (including people who believe they may have been sexually assaulted while drugged or intoxicated) Sexual contact with a person that is mentally disabled or mentally incapacitated Sexual contact with a person who is under 17 by an adult even if seemingly "consensual"

4 Sexual Assault Definition Sexual assault can be perpetrated by anyone, to anyone, and anywhere. Different or same sex attack by a male or a female Adult, child, senior citizen, disabled, even infant all are at risk It could happen to you

5 Sexual Assault Definition While associated with rape, sexual assault is more comprehensive inappropriate touching of sexual or intimate body parts ; vaginal, anal, and oral penetration; sexual intercourse to which one says No ;; rape, attempted rape; child molestation; fondling; licking; biting

6 Sexual Assault Definition Sexual assaults of all kinds, including rape, are not acts of sexual passion; they are crimes of control, domination, and degradation.

7 Pre-Hospital Role Non-judgmental professional attitude during focused assessment Be aware of your own feelings, reactions, and prejudices Universal precautions Rape is not a reportable crime (except in children); do not automatically report it to the NYPD

8 Pre-Hospital Role Assess for, and treat any injuries Do not perform any physical examination to identify or confirm sexual assault or abuse

9 Pre-Hospital Role Advise the patient to accept transport to an ED defined as a SAFE facility Expert and caring staff and services will be available at the SAFE center

10 Pre-Hospital Role Act as an advocate for your patient Your patient may feel overwhelmed, angry, embarrassed, afraid, numb, in a state of disbelief, or have a sense of profound loss

11 Pre-Hospital Role Assume a non-authoritative, non-controlling attitude and allow your patient to begin to regain control of her/his body Ask permission to take a history and examine your patient; ask permission to touch your patient Explain all parts of the exam and all procedures Respond to your patient s s wish to talk or not to talk Maintain your patient s s modesty and privacy

12 Pre-Hospital Role Tell the patient that you are there to help I I am sorry for what happened to you. No one deserves to be treated as you were. Nothing that you could have done or said could possibly justify what has happened to you. Use a same sex EMT/paramedic for care whenever possible Be patient; move and act slowly

13 Pre-Hospital Role Evidence collection crime scene protection The NYPD will collect evidence at the scene as appropriate; it is not your primary responsibility

14 Pre-Hospital Role If your patient has changed clothing or underwear since the assault, ask her/him to bring this with them in a paper bag (plastic allows degradation of evidence). If possible, ask her/him to bring a change of clothing

15 Pre-Hospital Role Evidence collection crime scene protection Discourage your patient from bathing, voiding, or douching as it will destroy evidence If the patient must void, ask them to use a container and bring the urine with them to the hospital Do not allow your patient to drink, brush their teeth, or smoke Do not clean wounds unless necessary

16 Pre-Hospital Role Document carefully; use a diagram to show the location of wounds Keep the written history brief; let the SAFE examiner do the majority of the documentation The slightest misstatement (such as saying boyfriend rather than husband )) could cause significant difficulties at a trial and hurt the legal case Use patient s s statements, if possible NYPD and the SAFE examiner will ask the difficult questions and document them well

17 Pre-Hospital Role Make certain that the triage nurse understands that your patient is a states she was sexually assaulted Be sure to inform staff if weapons and/or other evidence has accompanied the patient to the ED (condom, tampon, clothing) You may be asked to take your patient to the SAFE Room

18 Sexual Assault Forensic Examiner Trained as a SAFE examiner and certified by NYS Department of Health RN, Nurse Practitioner, PA, or MD

19 Sexual Assault Forensic Examiner Comprehensive and high quality medical care Speculum examination Assessment of injuries in conjunction with Emergency physician Special equipment: Colposcope,, Alternate Light Source, anoscope

20 Sexual Assault Forensic Examiner Collection of forensic evidence for serology, DNA or trace evidence examination Collection of forensic evidence body fluids (semen, saliva, blood or other secretions) hairs (the patient s s and hair transferred from the assailant hairs from head and/or pubic region) Fingernail (assailant s s skin cells) trace evidence or debris (fibers, leaves, grass)

21 Sexual Assault Forensic Examiner NYS Sexual Offense Evidence Collection Kit; Drug Facilitated Sexual Assault Kit Maintain chain of custody; collect forensic evidence Documents injuries with photographs labeled and dated; documents force Prevents STDs, HIV, and pregnancy Provides court testimony as a fact witness

22 Sexual Assault Forensic Examiner Respectful and sensitive treatment Dedicated professional provider with specialized training Ensures that the services of a trained rape crisis advocate in addition to a SAFE examiner have been offered Prompt evaluation with no competition for provider s s attention

23 Sexual Assault Forensic Examiner Respectful and sensitive treatment Maintains patient confidentiality and privacy Provides prophylaxis for STDs, HIV, and pregnancy prevention, if desired and appropriate Refers the patient to follow-up medical, psychological, and further emergency medical care, as needed

24 Intellectual/Developmental Disabilities Patients Speak directly to the patient, even if accompanied by some one else. Make every attempt to speak to the patient privately. Those accompanying could be abusers. Take things slowly; use simple, concrete sentences. Allow the patient time to respond. Use age-appropriate appropriate language; the patient may not know the correct words for body parts. These patients are often taught to be compliant. Be aware of yes-ing.

25 SAFE Program Provides a qualified SAFE examiner as well as a Rape Crisis Advocate Private designated SAFE room with special equipment and access to a shower Replacement clothing, as needed Medical and psychological follow-up Works with ED staff to provide a safe discharge to a safe place

26 SAFE Program Required equipment Colposcope,, magnifying examination tool that can produce photographs for evidence Camera and film (delete film: programs are moving towards digital cameras) appropriate for evidence collection Evidence collection kits Alternate Light Source Pelvic Exam Table with stirrups

27 SAFE Program Crime Victims Board will reimburse $800 per exam to the Hospital of full payment; the patient will not be billed for the forensic portion of the ED visit Information about emergency contraception, STD & HIV PEP, and providing these services, as requested by the patient

28 Transport Statistics NYC About 50% of sexual assault patients triaged at EDs arrive by ambulance The remainder are transported by NYPD, by cab/private car, or walk in

29 NYC Transport Statistics About a third of NYC EDs are defined as SAFE centers There are designated centers in all boroughs Within one month of the initiation of this program the percentage of patients transported to designated centers rose from 42% to 72%; it is even higher now

30 REMAC NYC Advisory REMAC of NYC has worked with advocates for victims of sexual assault in order to promote the use of Sexual Assault Forensic Examiner Programs (SAFE) in New York City Emergency Departments (ED). SAFE Programs allow expert medical management of victims of sexual assault and expert forensic examinations for evidence collection and expert testimony.

31 REMAC NYC Advisory The 24-hour availability of trained sexual assault examiners, specialized equipment to detect and document injury, dedicated examination and shower rooms, trained advocates and full-time social workers for follow-up counseling services and emotional support allow for seamless integration of all medical, forensic, and counseling care.

32 REMAC NYC Advisory Effective immediately, all New York City ambulances will offer stable patients, identified as being survivors of sexual assault, transportation to an emergency department with a SAFE Program.

33 REMAC NYC Advisory Owners/operators of Ambulance and ALS First Response Services providing prehospital medical treatment within the five boroughs of the City of New York are responsible to provide copies of the NYC REMAC Prehospital Treatment Protocols to their personnel, and to ensure that Service Medical Directors and EMS personnel are informed of all changes/updates to the NYC REMAC Prehospital Treatment Protocols.

34 REMAC NYC Advisory Identification of a stable adult (12 years or older) sexual assault patient Based on patient self-report, or Bystander/police report

35 REMAC NYC Advisory Provide appropriate treatment for any injuries/illnesses in accordance with REMAC Prehospital Treatment Protocols. Physical examination to identify or confirm sexual abuse shall not be performed by EMS healthcare providers.

36 REMAC NYC Advisory Advise the patient that transportation to an emergency department with a SAFE Program is available and encourage the patient to accept transport to the nearest SAFE facility.

37 REMAC NYC Advisory If a stable patient accepts transport to a SAFE facility, transport the patient to the nearest/closest) SAFE hospital. REMAC Advisory can be downloaded at: 7&intArticleID=387

38 Summary Encourage transport to a SAFE Center Advocate for your patient Allow your patient to feel in control Be patient and calm Be mindful of potential evidence Document carefully Transfer care and information Understand your own prejudices and feelings You will be performing a great service

39 Additional Information For more information, go to the NYC Alliance Against Sexual Assault website:

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