The Examination Process > Initial Contact

• Goals of the Protocol
  • Roles of Responsders
• Recommendations at a Glance
  • Goal of the Protocol
  • Overarching Issues
  • Operational Issues
  • The Examination Process
• Overarching Issues
  • Coordinated Team Approach
    • Dual purpose of the exam
    • Key responders and their role
    • Quality assurance measures
  • Victim-Centered Care
    • Patient priorty as an emergency case
    • Patient privacy
    • Exam adapted to patients' needs and circumstances
    • Issues commonly faced by patients from specific populations
    • Importance of victim services within the exam process
    • Importance of personal support persons in the exam room
    • Requests for a responder of a specific gender
    • Explanation of procedures during the exam process
    • Integration of medical and forensic exam procedures
    • Patient safety during the exam process
    • Information patients can review at their conveniance
    • Physical comfort needs of patients
  • Informed Consent
    • Seeking informed consent as appropriate
    • Obtaining consent from specific populations
  • Confidentiality
    • Scope and limitations of confidentiality
    • Building understanding of confidentiality issues
    • Impact of Federal privacy laws
    • Difficulties in maintaining confidentiality
  • Reporting to Law Enforcement
    • Making the decision to report
    • Consequences of reporting
    • Alternatives to standard reporting procedures
    • Promoting a victim-centered process
  • Payment for the Examination under VAWA
• Operational Issues
  • Sexual Assault Forensic Examiners
    • Specific knowledge, skills, and attitutes
    • Minimum standards for advanced educational and clinical requirements
  • Facilities
    • Obligation to serve patients
    • Use of specially educated and clinically prepared examiners
    • Optimal site locations
    • Basic requirements
    • Patient transfers
  • Equipment and Supplies
    • Availability of specfic equipment and supplies
    • Cost barriers
  • Sexual Assault Evidence Collection Kit
    • Minimum guidelines for contents
    • Standardized kits
  • Timing Considerations for Collecting Evidence
    • Importance of the history and exam findings
    • Prompt exam to minimize loss of evidence
    • Decisions made on a case-by-case basis
    • Resources for responders
  • Evidence Integrity
    • Policies to dry, package, label, and seal evidence
    • Evidence transfer policies
    • Storage policies
    • Documentation of evidence
• The Examination Process
  • Initial Contact
    • Consensus among agencies regarding procedures
    • Essential activities
  • Triage and Intake
    • Priority cases
    • Acute care needs
    • Alerting examiners
    • Contacting advocates
    • Safety concerns upon arrival of patients at the site
    • Immediate medical and mental health interventions
  • Documentation by Health Care Personnel
    • Completion
    • Education for examiners
  • The Medical Forensic History
    • Coordination of history taking and investigative interviewing
    • Presence of advocates during the history
    • Patient needs addressed prior to and during history
    • Obtaining the history
  • Photography
    • Extent
    • Photographers and equipment
    • Patient comfort and privacy
    • Explanation of photography procedures
    • Taking photographs
  • Exam and Evidence Collection Procedures
    • Forensic purpose of the exam
    • Collecting as much evidence as possible
    • Issues related to consent to sexual contact
    • Testing of biological evidence
    • Exposure to infectious materials and evidence contamination
    • Importance of semen evidence
    • Addressing patient needs' and concerns
    • Explanation of exam and evidence collection procedures
    • Conducting the exam and documenting findings
    • Evidence to submit to the crime lab for analysis
    • Other evidence
    • Medical specimens separate from forensic specimins
  • Drug-Facilitated Sexual Assault
    • Training and development of policies
    • Response to voluntary use of drugs and/or alcohol
    • Circumstances in which testing may be indicated
    • Explanation of testing procedures
    • Collecting samples
    • Toxicology labs
    • Preservation of evidence and chain of custody
  • STI Evaluation and Care
    • Information on STIs
    • STI testing
    • Prophylaxis against STIs
    • Followup care
    • Concerns about HIV infection
  • Pregnancy Risk Evaluation and Care
  • Discharge and Followup
    • Medical discharge and followup care
    • Coordination among responders prior to discharge
  • Examiner Court Appearances
    • Broad education on court appearances
    • Prompt notification for examiners
    • Pretrial preparation
    • Feedback on testimony
• Appendix A. Developing Customized Protocols: Considerations for Jurisdictions
• Appendix B. Creation of Sexual Assault Response Teams
• Bibliography
• Sexual Assault Forensic Examiner Technical Assistance Web Site