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Evaluation and Management of the
Sexually Assaulted or Sexually Abused Patient
Swabs should be dried prior to packaging. There are commercially available swab driers at multiple price points.
Alternatively, swabs can be placed upright in a block of modeling clay or an inverted Styrofoam cup (disposable
and easily available). Swabs should be labeled prior to being placed in the swab drier.
Sterile collection is not necessary (sterile refers to the absence of microorganisms; DNA is neither bacteria nor
virus); however, it is necessary to change gloves, replace paper platforms, and use disposable tools between sites
to avoid cross‑contamination.
Core evidence collected is determined by the patient’s history of the events; this may consist of scrotum, breast, neck,
penis, abdominal, genital, perianal, and rectal specimens.
Evidence collection changes as technology changes. Consult your local forensic laboratory
and work with their scientists to ensure that the evidence you collect is feasible to test and
that your protocol is in step with the newest technology and collection practices.
Evidence Collection Kits
Evidence collection kits are commercially available from several sources (for example, TriTech and Sirchie). In the
event that a prepackaged kit is not available, evidence can be collected utilizing supplies readily available in most
emergency departments. Recommended supplies include:
Sterile cotton swabs
Blood tubes
Sterile urine cups
Evidence tape
Paper bags of varying sizes
Paper envelops of varying sizes or paper to use as bindles
Use and Quality Control of Desiccant Packs1
Multiform desiccant packs are used to dry swabs that have been used to collect biological evidence; this includes items
such as blood, semen, and saliva stains. The desiccant rapidly dries the sample so as to prevent microorganism growth
and sample degradation.
If dessicant packs are used, follow all manufacturer’s recommendation for storage, use and quality control.
Wilson JT. Desiccant drying of physiological fluids. Presented at Midwestern Association of Forensic Scientists, Kansas City, MO, 1991.
Chapter 20
Cultural and Linguistic Aspects
of Sexual Assault Care
Michael L. Weaver, MD, FACEP
Our country and indeed our health care systems are becoming increasingly diverse. Patients and providers present
from a variety of culturally and linguistically different backgrounds, which can have a significant effect on various
aspects of health and health care. As a consequence, health care providers have found it more challenging to provide
safe, quality, efficient, effective and equitable patient care outcomes (IOM 2003).* As emergency physicians, we can
consciously or unconsciously affect the perceptions, behaviors and satisfaction of our patients, which can contribute
to health care disparities. Not surprisingly these changing demographics also impact the forensic subset of patients
that are victims of gender-based violence.
Cultural and linguistic discussions, even narrowly focused around sexual assault issues, are too expansive for any
single review. However we need to be knowledgeable about how these competencies can have a significant impact
on our patients. Most diversity/inclusion educators feel it is better to provide general concepts about cultural
sensitivities, respect, competency which can be broadly applied rather than focus on a list of generalities about
behaviors of any specific culture e.g. race/ethnicity, age, sexual orientation, persons with disabilities, etc. Again, such
an approach would be beyond this summary. Instead, this review will be divided into four parts. We will discuss
important background cultural and linguistic information that sexual assault forensic examiners (SAFEs) and
medical directors of SAFE programs should be knowledgeable about the medical forensic examination (MFE). Then
we will discuss some specific concepts to be applied during and after a MFE, and conclude with a summary of seven
recommended universal principles.
I. Pre-Medical Forensic Exam Background Considerations
a) Definitions
There has been an explosion of terminology in the literature around cultural aspects of care (e.g.
ethnocentrism, cultural congruence ethnopharmacology, etc). The definitions of cultural and linguistic
competence have also evolved over time. Most recently, Bentancourt JR, and Green AR (2010) from the
Disparities Solution Center- Massachusetts General Hospital, have defined clinical cultural competence as “the
ability of health care professionals to communicate with and effectively provide high-quality care to patients
from diverse sociocultural backgrounds.” This definition is gaining wide acceptance. The National Center for
Cultural Competence has defined linguistic competence as “the capacity of an organization and its personnel to
communicate effectively, and convey information in a manner that is easily understood by diverse audiences
including person of limited English proficiency (LEP), those who have low literacy skills or are not literate,
individuals with disabilities, and those who are deaf or hard of hearing.”(Goode T., Jones W. 2009).
Although many speak of cultural and linguistic competence…in reality most acknowledge that “competence”
can never be actually achieved as one could never be truly competent in all aspects of a culture or communica­
tion skills. These types of discussions are generally considered part of a life long journey where clinicians
continually strive to provide what should be better identified as culturally and linguistically “appropriate care
or services.” These concepts are also applicable to care for adult and adolescence victims of sexual assault.
Their vulnerability enhances the need for culturally and linguistically appropriate health care services.
b) Regulations, Licensure and Guidelines/Standards
(At 0200 hours on a Saturday night, you get a call from EMS that they are bringing in a patient who is
confused, doesn’t speak English but friends feel she may be a victim of a drug-facilitated sexual assault. The
paramedic specifically recalls that a couple of the bystanders at the party repeating the words “intoxicado.”
Neither paramedic spoke Spanish, but on arrival told the ED physician that the patient was a drug overdose.
100 Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient | ACEP
Cultural and Linguistic Aspects of Sexual Assault Care