3 R’s of Sexual Assault in Critical Care – Kari Sampsel
Sexual assault affects 1 in 3 women and 1 in 6 men during their lifetime worldwide. It is more common than most medical issues we are trained to look for, despite this being a patient population we are going to see by virtue of the “anyone, anytime” nature of an emergency and critical care. Generous estimates find than only 20% of survivors present for medical care and may not disclose this initially in their visit. Look for it during public holidays, large parties or concerts, college or university fresh week, particularly in young women. Other scene awareness clues that a sexual assault may have occurred include sedation that does not match the substances taken or clinical level seen, ripped or missing clothing, or being separated from their group.
Documenting your suspicions and findings is key – as this chart is more likely to go to court, but not for 2 years. Direct quotations of what was said by the patient or EMS, body diagrams for what was found, and your clinical decision making are the essentials. Physical findings may be absent or minimal; this does not mean that no assault took place! The discussion that you had with the patient around further treatment and legal options needs to be recorded.
Care of a sexually assaulted patient is complex and can have long-lasting detrimental psychological effects if not done well. Referral to a specialized care program to bridge the gap between medical and legal in a patient-centred trauma-informed manner is best. Treating survivors with belief, support and humanity as you assist them with making an informed decision as to the next steps in their care is vital as the first step in healing.
Dr. Kari Sampsel (@karisampsel) is a staff Emergency Physician and Medical Director of the Sexual Assault and Partner Abuse Care Program at the Ottawa Hospital and an Assistant Professor at the University of Ottawa.
She is board-certified in Emergency Medicine with a fellowship in Clinical Forensic Medicine at the Victorian Institute of Forensic Medicine in Melbourne, and is currently the only Canadian physician to hold this designation.She has been active in the fields of forensic medicine and medical education, with multiple international conference presentations, publications and committee work. Kari founded NightLight Consultants to help educate and prevent sexual assault and harassment at events and on campus.
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