- Sexual assault is any sexual act without consent. Legal definitions vary in different
states/territories
- You must know what is required under your state/territory legislation, including mandatory
reporting requirements
- Sexual assault services will provide expert advice, even if not making a formal referral.
Know your local sexual assault service contact numbers
- If under 18 years — see Child neglect, abuse and cumulative harm
Related topic — Assessing trauma — primary and secondary survey
Do first
- Contact doctor or sexual assault service for advice — available 24 hours a day
- Look for and manage life-threatening and major injuries straight away — urgent medical
treatment always takes priority over forensic matters
- If unconscious or has condition that impairs judgement (eg under influence of drugs,
intellectual disability) — medical consult
- Make sure victim and you are safe — arrange evacuation. Call police if needed
- Use same gender staff, if possible
- Ask if they want friends or family with them
- Be aware person may not have told partner, family, friends
- Consider privacy and confidentiality, especially in small community
Serious injuries
- Give urgent clinical care
- Only clean wound areas as needed for safe urgent treatment, eg wound edges before
suturing
- If need to do vaginal or rectal exam for a serious injury before forensic exam — look
carefully and document any external genito-anal injury before speculum exam
- Use warm water or only small amount of lubricant. If lubricant used — send name of
lubricant and sample in yellow top jar with person for comparison
- Give pain relief as needed
- Medical consult — to send to hospital
Talk with person about assault
- Believe person. Take allegation seriously and treat with dignity and respect. Acknowledge
the courage it has taken to tell you about assault
- Being believed is the single most important thing that contributes to a person’s recovery
- Be aware offenders may be family, leaders or trusted people in community
- Help person be in control of how much they have to talk
- Only ask for details needed for initial examination and clinical care
- Let them know they don't need to tell you all of the details of assault
- Ask open-ended questions where possible
- Record answers so you don’t have to ask again
- Listen and hear what person is saying
- Acknowledge their pain but don't get caught up in your own responses and emotions
- Reassure person their feelings and reactions are normal and OK — take care not to
minimise or discount them
- It is not your job to get a detailed medico-legal statement or verify accuracy of
information but your notes may be used in legal proceedings — make sure they are accurate
and legible
- Do not be judgemental or confrontational. Do not ask qualifying questions such as "Why were you there?", "Why did you do that?"
- Do not say anything that makes person feel responsible for or guilty about the assault
- A good statement can be "It's not your fault that this happened", "You might have
been vulnerable but that doesn’t make you responsible"
- Make sure person understands
- Assault can be reported at any time but forensic exam (collection of evidence) must
be done as soon as possible and is best within 72 hours
- State/territory legislation may mean you need to report assault to police or other
agency (eg mandatory reporting of domestic/family violence in Northern Territory)
- If no mandatory report needed — person decides whether or not to report to police
- Discuss with sexual assault service and get the person to talk with them if they can.
They can help explain all of the medical, counselling and legal options and are there
to support you and the person
- Assess safety — may be safety from alleged assailant or from self. Work with person
to develop safety plan, if appropriate
- Promote concept of future recovery — they have survived the assault. Talk with person
about what they need and how you can help them recover
Ask
- Do they want to talk to sexual assault service — tell the person sexual assault service
has nothing to do with police unless mandatory reporting is required
- Provides counselling and support regardless of whether or not they decide to have
forensic exam
- If forensic exam is done it can be held by the sexual assault service so that the
person will have time to decide if they want to go to the police or if they want the
examination results to be destroyed
- Do they want to talk to the police to report the assault. Tell person they can change
their mind at any time
- Police are the best people to take the formal statement
- If person thinks they may take legal action, are seriously injured, or safety is not
assured — strongly encourage and help to contact police as soon as possible after
injuries treated
Do
Arrange forensic examination if wanted by person
- Forensic exam assists a criminal investigation by
- Collecting physical evidence samples (eg traces of bodily fluids containing DNA) for
the police
- Thoroughly documenting injuries
- Staff without specific training in sexual assault assessment should not do forensic exam of sexual assault victim
- If no specifically trained staff available and travel declined — specialist sexual assault service consult
- A forensic exam does NOT mean that the person has to go to the police — it does mean that physical evidence
can be collected quickly and stored safely allowing for the person to have time to
think about what they want to do with it
- Determine where examination will take place and who will do it
- If going to hospital — forensic exam and assessment by sexual assault service may
be offered at hospital
- If not going to hospital — refer and support to attend sexual assault service in town.
Doctor will arrange appointment with most appropriate service
- Medical consult — talk with police (if involved) to arrange transport
- Best travel option (eg evacuation, mail plane, road) depends on urgency of referral
and availability — medical, social, safety factors all relevant
Preserving forensic evidence
- Obtain consent before collecting any specimens
- Wear gloves during any medical examinations and change between one injury and another
to prevent DNA contamination
- Get advice from sexual assault service on how to collect and store preliminary specimens
if needed — could include specimens before or after using toilet or removing clothing
- Advise it is best not to shower. If not possible — try not to wash areas involved
in assault (eg genitals, neck if suction mark, arm if fingertip bruising)
- If oral rape or injuries — ideally don't eat, drink, clean teeth, rinse mouth until
after forensic exam. Can be very difficult for person so talk with police or sexual
assault service about collecting these samples if there is a delay in transfer
- If sending to town for forensic exam — get advice from sexual assault service about preserving evidence while waiting and during transfer
- Depends on nature of assault, time delay, how much clinical care needed before appointment
- If available and skilled use a Preliminary Forensic Kit
- Allows you to support the person to collect their own specimens while trying not to
lose any forensic evidence
- Means they can eat, drink and go to the bathroom while waiting for evacuation
- Does NOT replace a forensic medical exam but helps when there is a delay to reach someone
who is qualified to do a forensic exam
Medical check — if staying in community
- If person decides not to have forensic exam — medical consult
- Doctor should talk with sexual assault service about management including routine
observations. Consider emergency contraception and pregnancy test
- For social or emotional reasons may be better for person to be referred to service
outside home community
Follow-up
- Review in a few days or as soon as person wants
- Be gentle but thorough. Ask about and check
- Physical problems and symptoms
- Injuries — oral, pelvic, genital, urinary, anorectal
- Contraception, pregnancy
- If positive STI test/s — see STI management
- If STI symptoms — see relevant protocol
- Coping responses — counselling, medicines, alcohol or drug use, cigarette use
- Mood, emotional wellbeing. If anxious, depressed, not coping — see Mental health assessment and offer referral to mental health service
- Current and relevant past medical, surgical, psychiatric history
- Social factors — relationships, housing, police investigation
- 2–3 weeks after assault
- 3 months after assault
- Repeat bloods for syphilis, HIV, hepatitis B
- If treatment given for positive STI results — test for reinfection
Long term follow-up
- Emotional problems may continue or get worse after sexual assault
- Anxiety, depression, post-traumatic stress are common and can affect relationships
(families, communities)
- Promote concept of recovery — plan together how this will happen
- Consider referral to counselling, sexual assault service, mental health service, social
and emotional wellbeing program
Strangulation
- Always ask about this, especially in intimate relationship assaults
- Non-fatal strangulation in intimate partner violence is a risk factor for later homicide
- Late onset oedema (delayed swelling) can cause breathing obstruction up to 36 hours
after strangulation
Ask
- What was used
- Loss of consciousness
- Memory difficulties
- Trouble swallowing or breathing
- Voice change
- Loss of bladder or bowel control
- Headache
- Pregnancy status
Check
- Calculate REWS — AVPU, RR, O2 sats, pulse, BP, Temp
- Weight, BGL
Do