Chapter 18. Learning Objectives. Learning Objectives 9/18/2012. Abuse and Assault

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Clifton Stafford
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1 Chapter 18 Abuse and Assault Learning Objectives Discuss incidence of domestic violence Describe categories of abuse Describe cycle of violence Identify profiles of at-risk partner/spouse, at-risk elder, at-risk child 2 Learning Objectives Discuss examples of child abuse, neglect (maltreatment) Discuss examples of elder abuse Discuss examples of partner/spousal abuse 3 1

2 Learning Objectives Describe characteristics associated with following: Typical abuser of partner/spouse Typical abuser of elderly persons Typical abuser of children Typical assailant of sexual assault Discuss examples of sexual assault Discuss assessment, management of abused patient 4 Learning Objectives Identify community resources that assist victims of abuse, assault Describe priorities for crew safety at scene of possible domestic violence/abuse Discuss legal aspects associated with abuse/ assault situations Discuss documentation associated with abused, assaulted patients 5 Psychological, emotional, physical, sexual, economic abuse In the last 4 decades the family home in the United States has been extensively documented as common location for domestic violence For many women, children and elderly persons the home is not secure environment 6 2

3 Psychological, emotional, physical, sexual, economic abuse Cause of many social problems Assault Murder Robbery Drug, alcohol abuse Almost any type of pathology present in U.S. culture 7 Psychological, emotional, physical, sexual, economic abuse Common targets Children Wives or intimate partners Younger or female siblings Adolescents Elderly persons Gay, lesbian couples 8 Psychological, emotional, physical, sexual, economic abuse Emotional and physical dominance over the abused individual; most common unifying characteristic of abuse Children and women most frequently targeted 9 3

4 Psychological, emotional, physical, sexual, economic abuse EMS providers play critical role in identification and referral of individuals who are suspected of sustaining abuse In position to enter homes where evidence of abuse or neglect may be present Have ability to gather information not available to other health care professionals 10 Psychological, emotional, physical, sexual, economic abuse Report abuse to proper authorities Police State department of health Child protective services Hospital 11 Psychological, emotional, physical, sexual, economic abuse You have legal responsibility to report abuse, be familiar Actions to take when abuse identified or suspected Referral of abused patients to authorities requires knowledge of scope and nature of problem 12 4

5 Historical perspective Historical factors have provided foundation for current acts of domestic violence and abuse Child corporal punishment supported by many 13 Historical perspective Protections for abused women, children, elderly persons originated in 1960s Wife-battering 1st appeared in medical literature 1st battered-women s shelter opened in London, 1971 Historically, spousal abuse of men noted, women more often victims Women are less likely to report violence Abusers isolate victims from friends and family Violence among gay, lesbian couples underreported 14 Role of EMS call, access point for abused victims Often only medical personnel to encounter victims Frequently refuse medical attention at scene Police, EMS often safety net for victim 15 5

6 Prevalence Domestic, family violence widespread Not confined to one socioeconomic, ethnic, religious, racial, or age group 16 Prevalence Violence against women More likely to be assaulted, injured, raped, or killed by male partner 17 Prevalence Cycle of violence Tension phase Violence phase Honeymoon phase Promise to stop abuse 18 6

7 19 Prevalence Pregnant women Increased risk of physical violence inflicted by partners CDC estimates violence during pregnancy ranges from 4% to 8% AMA study showed, women with unwanted pregnancies were more likely to experience physical violence Homicide is leading cause of death in pregnant women More likely to be struck in abdomen than nonpregnant women Abused women are less likely to seek prenatal care 20 Prevalence Child abuse Common target group for family violence According to DHHS, 2.4 million children abused each year in United States Parent(s) may abuse one or all children Children with battered mothers 2x more likely to be abused Witness violence in home have many of same symptoms as children who are directly abused 21 7

8 Prevalence Elder abuse Vulnerable to mistreatment Physical assault Psychological or emotional abuse Sexual abuse Exploitation Financial manipulation Neglect 22 Abuse is associated with: Need to control Dependency Stress Ignorance Frustration Desperation Inability to provide adequate care 23 Abuse variables, conditions Domestic and family violence encompasses all acts of violence Negative effects on all family members First role of EMT is to identify signs or symptoms of violence, abuse, or neglect You are expected to recognize abuse situations when they represent themselves May develop a consciousness when encountered trauma that may serve as a trigger in unusual or suspicious circumstances Not all injuries are related to abuse 24 8

$healing Patterned bruises Black eyes, lacerations, welts Defensive injuries to arms Broken bones, fractures Burns Cuts or open wounds Sprains, dislocations, internal injuries Broken eyeglasses Signs$

9 Physical abuse Any physical injury inflicted on another person Usually recurrent, escalates in frequency and severity 25 Physical abuse Signs of physical abuse Multiple bruises, different stages of healing Patterned bruises Black eyes, lacerations, welts Defensive injuries to arms Broken bones, fractures Burns Cuts or open wounds Sprains, dislocations, internal injuries Broken eyeglasses Signs of restraint

10 Psychological & emotional abuse Underestimated, trivialized and difficult to define Method of control consisting of verbal attacks and humiliations 28 Psychological & emotional abuse Purpose of abuse Destroy self-confidence Increase perpetrators feelings of superiority Maintain control of behavior, attitude 29 Psychological & emotional abuse Isolation occurs when perpetrators try to control the victims time, activities, and contact with others Abusers often use manipulation of important possessions to coerce to behave a certain way Abuser may threaten family s children, abuse them, or force the woman to watch or participate in abuse Abused may not be able to work outside of home and not have access to money Victims may not be ready to communicate their fears 30 10

11 Psychological & emotional abuse Signs & symptoms Visible signs difficult to find Hidden scars manifest behavior Insecurity Poor self esteem Destructive behavior Angry acts Withdrawal Poor development of basic skills Alcohol or drug abuse Suicide 31 Sexual abuse Victim is forced to have intercourse with abuser or take part in unwanted sexual activity Large range of behaviors Pressured sex that victim does not desire Forced or coerced sex by manipulation or threat Physically forced sex Sexual assault with violence Forced or coerced to perform type of sex not desired or wanted at that time 32 Sexual abuse Use extreme sensitivity with victims Preserve evidence until exam at hospital, encourage patients not to Bathe or shower Urinate or defecate Douche Brush teeth Change clothes May not be receptive to advice, feel unclean, violated, want to wash away all traces of the incident Many hospitals have teams specially trained in treating patients 33 11

12 Economic abuse Control and access to victim s resources Time Transportation Food Clothing Shelter Insurance Money 34 Economic abuse Financial abuse Changes in banking practices Unauthorized ATM withdrawals Addition of name to bank signature card Sudden changes in will 35 Economic abuse Financial abuse Disappearance of funds or possessions Unpaid bills despite adequate finances Relatives suddenly claiming rights to elder person s possessions Sudden transfer of money to relative or nonfamily member 36 12

13 Neglect Common type of abuse found in elderly population & childhood Failure to fulfill duties, obligations Pay for necessary care Provide food, water, shelter, medicine, clothing, necessities for daily living 37 Neglect Indicators Untreated wounds Poor personal hygiene Untreated medical conditions Unsanitary living conditions Harmful living conditions Failure to thrive Weight loss Constant demand for attention from EMT 38 Approach to or Scene safety utmost importance Identification of abuse requires systematic and measured approach Create safe environment while collecting history Encourage victims to communicate abuse to you and other authorities 39 13

14 Approach to or Scene safety To be cooperative and honest, patient must be assured protection To have an objective interview; attempt to separate patient from abuser Expressing need for privacy during assessment often accomplishes this 40 Approach to or Scene safety Gain confidence through communication style Calm Caring Reassuring Must feel they can trust you 41 Approach to or Scene safety Abuse victims volunteering information exception, not rule Chief complaints evasive and vague or completely unrelated to issue 42 14

15 Approach to or Scene safety Subtle clues Victim s story is rehearsed Individual appears fearful or tentative Unable to sustain eye contact Excessively cautious in presenting information Frequent hospitalizations, surgeries, claimed or apparent disabilities, and transfusions are also vital clues Describe injury that is inconsistent with wounds or bruises Delayed access to EMS should raise suspicion 43 Approach to or Scene safety Information you gathered surrounding the occurrence of an incident is extremely important, but it would be unwise to undertake investigation Careful observation without accusation or confrontation allows transportation with least delay 44 Approach to or Scene safety Relay suspicions/observations to emergency department (ED) physician Alerts to possible abuse: Repeated call to same address Story not consistent with injury Changes in history, depending on who s giving it Witnesses giving contradictory histories Patient reluctant to give history Delay in obtaining medical attention 45 15

16 Approach to or Scene safety Relay suspicions/observations to ED physician Alerts to possible abuse: Timing of injury not consistent with clinical findings Spouse or parent response not appropriate to severity of injury Obvious alcohol or drug abuse by patient or partner Patient afraid to discuss how injury occurred Conflicting stories Fresh burns 46 Approach to or Scene safety Relay suspicions and observations to ED physician Pay particular attention to environment, sanitary state of home, evidence of struggle Time of incident Presence of witness History of recent illness Condition of clothing 47 Approach to or Reporting requirements Laws vary from state to state Local area may not be legally mandated to report abuse Morally and professionally responsible to set investigation in motion if you suspect abuse 48 16

17 Approach to or Reporting requirements Laws written to report suspicions, protected from litigation for false accusations EMS providers, physicians, nurses mandated to report suspected abuse Failure to report suspicion can be subject to prosecution 49 Summary Abuse affects persons of all races, ages, socioeconomic status, both genders Most assault victims are women, men can fall victim to assault Only estimated 40% of rape cases reported Abuse can be physical, psychological, emotional, financial or sexual 50 Summary Abuse stems from assailant s need to establish, maintain control EMTs have moral, ethical, often legal obligations to report cases of abuse 51 17

18 Summary Signs of abuse Repeated calls at same address Story not consistent with injury Changes in history, depending on who is giving it Witnesses giving contradictory histories Patient reluctant to give history Delay in obtaining medical attention Timing of injury not consistent with clinical findings 52 Summary Signs of abuse Spouse s or parent s response not appropriate to severity of injury Obvious alcohol or drug use by patient or partner Patient afraid to discuss how injury occurred Conflicting stories Fresh burns In some cases, direct questioning may be best form of history taking when dealing with victims of assault 53 Summary Calls involving abuse present safety concerns for EMS personnel Domestic violence usually follows cycle Tension phase Violence phase Honeymoon phase ( wine and roses phase) 54 18

19 Questions? 55 19

BEHAVIORAL EMERGENCIES

LESSON 21 BEHAVIORAL EMERGENCIES 21-1 Behavioral Emergencies Process of giving first aid may be complicated by victim s behavior Many injuries or illnesses can cause altered mental status or emotional