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Heartland Regional Medical Center
Emergency Services Policies and Procedure
Policy/Procedure Title
Initial Management of Sexual Assault or Suspected Sexual Assault
Policy/Procedure #
Effective
Department Generating Policy
Nursing Administration
Affected Departments
Emergency Department
Prepared By
Nursing Policy Council
Page
1 of 7
Dept/Title
Date/Title
ED Medical Director Approval
ED Director Approval
10/02
A. Throgmorton
Chief Nursing Officer Approval
Date/Title
12/12 ED Manager
Date/Title
Purpose:
In caring for victims of sexual assault or suspected sexual assault, Heartland Regional
Medical Center is committed to meeting their physical, psychological, emotional, social and
spiritual needs with respect and compassion for the person who has been sexually assaulted
and mindful of his/her emotional fragility.
Policy:
Responsibilities:
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The Hospital has the following responsibilities:
 Comply with the Crime Victims Compensation Act
 The Consent by Minors to Medical Procedures Act and any local ordinances,
municipal codes, rules, or regulations that may apply to the health of sexual
assault survivors.
 Reporting for sexual assault survivors as required by the Criminal Identification
Act.
The RN has the following responsibilities:
 Respond within minutes to move the patient to an environment that ensures
privacy.
 Facilitates emergency treatment of sexual assault or suspected assault survivor in
accordance with the guideline of the State of Illinois.
 Enters the patient into the Promed™ system, which facilitates
identification of medical records of the sexual assault or suspected
sexual assault survivor.
 Maintains constant attendance with the patient by the same RN (or designee)
until room placement, opening of evidence kit and specimens are obtained are
collected.
The Physician has the following responsibilities:
 Conducts the examination and treatment of the patient in accordance with the
Policy and Procedures and the State of Illinois Rules and Regulations for the
treatment of sexual assault survivors as presented in the Physician Standard of
Review: 12/11, 12/12, 02/13; 07/14
Revised: 09/22/2009; 11/2009
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Practice. This is to include evaluation and treatment of Sexually Transmitted
Diseases, HIV and potential pregnancy in females of childbearing age.
 The Rape Action Committee volunteer has the following responsibility:
 Provide emotional support.
Procedure:
Upon admission the nurse will:
 Triage as urgent all sexual assault or suspected sexual assault survivors. Maintain
constant attendance by the same RN (or designee) during the exam in order to provide
emotional support, protect the patient confidentiality and to maintain the chain of
evidence. Assess level of anxiety and attempt to calm and reassure the patient.
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Obtain the patient’s medical history. If the patient is female, obtain a detailed
gynecological history which should include but not limited to:
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Last and previous menstrual periods.
Patient’s knowledge of or belief in existing pregnancy.
Prior gynecological procedures such as hysterectomy or tubal ligation.
Use of contraceptives.
Cervical or uterine cancer.
Prior genital injury or trauma.
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After admission the nurse will notify:
 ED Physician.
 Law enforcement authorities, regardless of patient’s or significant other’s intent
to press charges, if the patient is not accompanied by a law enforcement officer
call:
 Marion City Police, if crime occurred within the city limits.
 Williamson County Sheriff, if crime occurred outside city, inside county.
 Department of Children and Family Services if: Sexual assault survivor
is a minor and/or incest is suspected.
 Clergy on call for Spiritual Care.
 Rape Action Committee – The Women’s Center, Carbondale, Illinois
(618-529-2324 or 800-334-2094).
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After admission, the nurse will obtain appropriate consents.
 Explain the procedures to the patient and repeat explanation as needed.
 Obtain appropriate written consents.
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Where the minor is the victim of a predatory criminal sexual assault,
criminal sexual assault, aggravated criminal sexual abuse or criminal
sexual abuse, the consent of the minor’s parent or legal guardian
need not be obtained to authorize a hospital, physician or other medical
personnel to furnish medical care or counseling related to the diagnosis
or treatment of any disease or injury arising from such offense.
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Evidence collection kit or pictures may not be released by a hospital
without the written consent of the sexual assault survivor. In the
case of minor 13 years of age or older, evidence and information
Review: 12/11, 12/12, 02/13; 07/14
Revised: 09/22/2009; 11/2009
Page 2 of 7
concerning the alleged sexual assault may be released at the written
request of the minor.
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A minor who is under 13 years of age, evidence and information
concerning the alleged sexual assault may be released at the written
request of the parent, guardian, investigating law enforcement
officer, or Department of Children and Family Services.
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Photographs may be taken if the patient is a minor under the age of 13
and can be released to law enforcement personnel only with the consent
of the parent or guardian. If consent is refused, the photographs will be
destroyed.
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If the patient is an adult who has a guardian, a health care surrogate, or
an agent acting under the health care power of attorney, then consent of
the guardian, surrogate, or agent is not required to release evidence
and information concerning the sexual assault. If the adult is unable
to provide consent for the release of evidence and information and a
guardian, surrogate, or agent under a health care power of attorney is
unavailable or unwilling to release the information, then an
investigating law enforcement officer may authorize the release.
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Evidence or information provided by a health care professional (nurse or
doctor) to a law enforcement officer pursuant to a written request is
immune from any civil or professional liability that may arise from those
actions.
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Treatment of Alleged Sexual Assault Survivors
 Medical examination and laboratory testing required to ensure the health, safety,
and welfare of an alleged sexual assault survivor, may be used as evidence in
criminal proceedings and made available to law enforcement officials upon
request.
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The gathering of evidence of the sexual assault shall include:
 Verification of the intact seal on the EVIDENCE COLLECTION KIT
provided by the Illinois State Police, Division of Forensic Services.
 Step 1: Patient Consent and Authorization to Release
 Step 2: Medical/Forensic Documentation Form
 Step 3: Miscellaneous/Debris Collection from paper on which patient
undressed.
 Step 4: Clothing – can be collected for up to one month from date of
incident, provided the item has not been altered, laundering.
 Identify if clothing worn now is same as worn during or
immediately after assault.
 Note the condition of clothing (rips, tears, presence of foreign
material)
 Follow detailed instructions regarding securing and
storage of clothing.
 Step 5: Oral Specimens
Review: 12/11, 12/12, 02/13; 07/14
Revised: 09/22/2009; 11/2009
Page 3 of 7
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Using two swabs at a time only, swab the interior of the mouth
with four cotton swabs. Be certain to swab the recessed areas of
the oral cavity, especially between the lower lip and gum, along
the gumline of the teeth, and the top and side surfaces of the
tongue.
Allow swabs to air-dry
Insert swabs into one cardboard tube and fold in the tube end
flaps.
Provide data on the pre-labeled swab box.
Enclose the swab specimens in this envelope, complete data on
envelope and seal.
Step 6:
 Vaginal/Cervical Specimens;
 Do not irrigate or aspirate the vagina
 Swab vaginal vault simultaneously with four cotton
swabs. If not possible use one/two at a time.
 Allow to air-dry
 Insert swabs into one cardboard tube and fold in the tube
and flaps.
 Provide data on the pre labeled swab box.
 Enclose the swab specimens in this envelope, complete
data on envelope and seal.
 Penile Specimens
 Slightly moisten four cotton swabs with distilled water
and thoroughly swab the external surface of the penile
shaft and glans. Do not swab the urethra.
 Allow to air-dry.
 Insert swabs into one cardboard tube and fold in the tube
and flaps.
 Provide data on the pre labeled swab box.
 Enclose the swab specimens in this envelope, complete
data on envelope and seal.
Step 7: Anal Specimens
 Slightly moisten four cotton swabs with distilled water and swab
the anal canal simultaneously with the four swabs. If it is not
possible to use four swabs simultaneously, one/two swabs at a
time may be used. Avoid contact of the swabs with the area
surrounding the anus. If the assailant’s mouth touched this area,
use a Miscellaneous Stains/Bitmark Evidence swab (step 8) to
collect any saliva.
 Allow to air-dry.
 Insert swabs into one cardboard tube and fold in the tube and
flaps.
 Provide data on the pre labeled swab box.
 Enclose the swab specimens in this envelope, complete data on
envelope and seal
Step 8: Miscellaneous Stains/Bitemark Evidence
 Slightly moisten a single swab with distilled water and swab the
stain, concentrating all the material onto the swab. If a bitemark,
swab the perimeter of the bitemark and the interior of the mark
Review: 12/11, 12/12, 02/13; 07/14
Revised: 09/22/2009; 11/2009
Page 4 of 7
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to collect any saliva from the assailant’s mouth which may be on
the patients body.
 Allow to air-dry.
 Insert swabs into one cardboard tube and fold in the tube and
flaps.
 Provide data on the pre labeled swab box.
 Enclose the swab specimens in this envelope, complete data on
envelope and seal.
 If a bitemark is present, take a close up color photograph,
preferably with a 35 mm camera, including a scale to give
accurate dimension to the injury. Tell the investigator about any
bitemark.
Step 9: Pubic Hair Combings
 Loose pubic hairs should be combed onto the enclosed piece of
white paper with the comb provided.
 Place the comb on paper with hairs and carefully refold paper
and place in the envelope.
 Complete data on envelope and seal.
Step 10: Head Hair Combings
 Lightly comb the head with the comb provided over the enclosed
piece of white paper so that loose hairs, fibers and other debris
fall onto the paper.
 Place the comb on paper with hairs and carefully refold paper
and place in the envelope.
 Complete data on envelope and seal.
Step 11: Fingernail Specimen
 Collect fingernail scrapings from all patients. Scrapings should
be collected from beneath each fingernail using the stick
provided. When scraping the fingernails, hold the hand over the
unfolded paper which is provided in the envelope to prevent loss
of debris.
 The scrapings and stick should then be wrapped up in the paper
to prevent loss of possible evidence, and then placed in the
protective envelopes marked right or left hand.
 Seal the left/right envelopes and enclose the envelopes in the
envelope provided, complete data on envelope and seal.
Step 12: Blood on Filter Paper
 Using disposable gloves, remove the filter paper from this
envelope and place it on a clean paper towel Write the patient’s
name and date on the filter paper where indicated.
 If blood was collected for medical purposes, i.e., preexisting
pregnancy, fill the five circles on the filter paper with drops of
blood drawn from the blood collection tube with a syringe.
 If blood was not collected for medical purposes, use a medical
lancet and prick the patient’s finger. Fill the five circles on the
filter paper with drops of blood.
 Allow to the filter paper to air dry.
 Place the filter paper in the envelope provided, complete data on
envelope and seal. Discard the paper towel.
Step 13: Photographs of patient physician injuries, if appropriate
Step 14: Receipt of information by Law Enforcement Agency.
Review: 12/11, 12/12, 02/13; 07/14
Revised: 09/22/2009; 11/2009
Page 5 of 7
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Step 15: Patient Discharge Materials.
Close Evidence Collection Kit and seal with red “Evidence Tape”.
Fill out information on outside top of kit.
Notify appropriate law enforcement agency.
 If the collection kit is not collected by law enforcement promptly
after completion, hospital staff shall store it in a safe location for
at least two weeks. Additional evidence such as clothing, shoes,
etc., shall be stored with kit and released to police
simultaneously.
Blood:
 HIV testing (initial testing to be completed in the ER. Instruct patient
that follow up testing at 6 weeks, 3 months and 6 months) and document
in the medical record that verbal (oral) and written instructions were
given.
Pregnancy testing for all females of childbearing age;
Provision of Information
 Emergency Contraception:
 Ovral, an FDA-approved birth control pill has been shown to be up to
90% effective in preventing pregnancy after unprotected/unwanted
intercourse.
 The physician prescribes two (2) Ovral pills within 72 hours of
unprotected sex to be administered while the patient is in the Emergency
Room.
 The physician prescribes an additional two (2) Ovral pills to be taken 12
hours after the initial dose.
 If the patient has been discharged from the hospital and is unable
to obtain Ovral from a retail pharmacy, contact the Heartland
Regional Medical Center Pharmacy.
 IDPH hand out: “If you have been raped…What you should know
about emergency contraception”, will be given to the patient including
verbal instructions. (written/oral instruction).
 Oral and written information shall be provided:
 Concerning sexually transmitted disease, pregnancy and financial
assistance for crime victims.
 Concerning contraindications related to procedures and/or medication
provided or treatment of infection or disease resulting from sexual
assault. (This includes medications provided at the time of service and
at discharge.)
 Indicating the need for a follow up appointment two weeks after the
sexual assault.
 In the event the patient is incapable of receiving and/or understanding
the information, it will be provided to the responsible
surrogate/guardian.
 Counseling
 Emotional support, confidentiality, explanations of treatment and related
questions to ensure that the patient understands that such procedures are
necessary for his/her health, safety and welfare and the collection of
forensic evidence.
Review: 12/11, 12/12, 02/13; 07/14
Revised: 09/22/2009; 11/2009
Page 6 of 7
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Provide brochure “After Sexual Assault” – Illinois Coalition Against
Sexual Assault and the IDPH and “Financial Aid for Crime Victims” –
Illinois Office of the Attorney General
 Referrals may include rape crisis or other counseling center.
Date rape drug testing, including explanation of the comprehensive scope of
drug screen and the limited time frame within which such evidence can be
collected. (Date Rape Drugs – US Department of health and Human Services,
Office on Women’s Health)
An appropriate medical record shall be developed and shall include, but is not limited to
a complete documentation on Emergency Department Admission Form of:
 When the patient was moved from triage to examination area.
 Time the sexual assault occurred.
 If the patient changed clothes, bathed, douched, defecated, urinated, ate, smoked,
performed oral hygiene or vomited between the time of assault / suspected
assault and time of examination.
 Indication of all signs of major or minor trauma taken for evidentiary purposes
with written consent of the patient, or patient’s parent or legal guardian, if
patient is under 13 years of age. If the patient is under 13 years of age and the
parent or guardian is not immediately available, photographs may be taken and
shall be released to law enforcement personnel and State’s Attorney staff with
written consent of parent, guardian, law enforcement officer or Department of
Children and Family Services. If the parent/guardian refuses to sign consent after
pictures are taken the pictures are to be destroyed.
 Statement in quotes made by patient concerning assault without conclusions as
to whether a crime had been committed.
 Medical history shall include brief, general information concerning possible
injury and drug allergies, and for female patients a detailed gynecological history
must be obtained including:
 Menstrual history (last menstrual period)
 Whether the patient knows or believes that she is pregnant,
 History of prior gynecological surgery (hysterectomy or tubal ligation)
contraceptive use, cancer and any prior genital injury or trauma.
 Document presence of any and all persons during the examination process and
include that the patient was not left unattended.
 Document if a report was filed with the Department of Children and Family
Services (DCFS).
 Document whether or not an evidence collection kit was completed.
Review: 12/11, 12/12, 02/13; 07/14
Revised: 09/22/2009; 11/2009
Page 7 of 7