Triage and Intake

Recommendations at a glance for health care providers to facilitate a triage and intake process that addresses patients' needs: 

Consider sexual assault patients a priority, regardless of whether physical injuries are evident.[1] (For a discussion of this topic, see Victim-Centered Care.) 
 
Utilize a private location within the exam facility for patient intakes, as well as for a waiting area for patients' family members and friends and law enforcement interviews. (Also see Victim-Centered Care.)
 
Respond to acute injury, trauma care, and safety needs before collecting evidence.  In addition to promoting physical health, sensitive and timely medical care can help reduce the likelihood of acute psychological trauma and its aftereffects, support patients' existing and emerging coping skills, and set the tone for patients' resumption of normal functioning.
 
Acute medical needs take precedence over forensic needs. Patients should be instructed to not wash, change clothes, urinate, defecate, smoke, drink, or eat until initially evaluated by examiners, unless necessary for treating acute medical injuries. If drug-facilitated sexual assault is suspected, and patients need to urinate prior to the arrival of examiners, ensure that the urine sample is collected properly while maintaining the chain of custody. 
 
As soon as possible after the initial medical evaluation, management, and stabilization of acute problems and before treating nonacute injuries, the medical forensic exam can be conducted (with patients' permission). In circumstances in which patients are seriously injured, examiners must be prepared to work alongside other health care providers who are stabilizing and treating them. In such cases, examiners may need to perform exams in settings such as a health care facility's emergency department, an operating room, a recovery room, or an intensive care unit.
 
Alert examiners of the need for their services. The SART, if one exists, can work with exam facilities to identify acceptable timeframes to conduct a medical forensic exam after a patient's arrival and medical evaluation, management, and stabilization. If examiners are not based at the site or need to be dispatched, the facility should contact them immediately after identifying a sexual assault patient.[2] Examiners are often required to arrive at the exam site within a certain period of time (e.g., 30 minutes) after being dispatched. 
 
Contact an advocate, if not already done. (For a discussion of this topic, see Victim-Centered Care.) 
 
Assess safety needs upon arrival of the patient at the exam site. The facility should have procedures to assess safety concerns at the exam site, such as a threat to patients or staff, and to respond to such threats or dangerous situations. (For a discussion of this topic, see Victim-Centered Care.) 
 
Assess patients' needs for immediate medical or mental health intervention prior to the medical forensic exam, following facility policy. Seek informed consent of patients before providing treatment. (For more information on this topic, see A.3. Informed Consent.) Also, inform them that they have a right to receive medical care regardless of whether the assault is reported to law enforcement, and if and how their reporting decision will affect payment for medical care and exam. (For more information on this topic, see Reporting to Law Enforcement.) 

[1] Historically, sexual assault patients who came to a health care facility (namely hospital emergency departments) for medical care and forensic evidence collection had to wait a long time to be examined. Often, they were not considered priority cases because they lacked visible physical injuries or their physical injuries were less serious than others coming into the facility. The psychological trauma they were experiencing often was not taken into account, nor was the fact that evidence can be destroyed or contaminated if collection is delayed. Many communities are addressing this problem by establishing examiner programs. At busy health care facilities that make life or death decisions about prioritizing patients, these programs can help ensure that sexual assault patients are offered and receive a medical forensic examination promptly after being evaluated and treated for any serious or life-threatening injuries. 
[2] It is possible that examiners could also be dispatched by first responders at the crime scene or by health care staff after being alerted that a sexual assault patient will be arriving at their facility. Although activating examiners as early as possible seems like it would benefit these patients, such a procedure can potentially cause confusion. For example, after activating an examiner to go to a particular exam facility, there may be significant delays in getting the patient to the site or changes en route to the facility patients. Sexually assaulted individuals may also change their minds about care or evidence collection. 


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Download the full document: A National Protocol for Sexual Assault Medical Forensic Examinations (Adobe PDF)