Harbor:Sexual assault

Background

• See Sexual assault for general evaluation and management details. Details below are Harbor-specific.
• Harbor SART Protocol https://www.wikem.org/wiki/File:SART_ED_Protocol_Recommendations.pdf
  • Closest SART Center is in San Pedro
• Pediatric sexual assault protocol http://pemsource.org/wp-content/uploads/2017/09/Suspected-Child-Abuse-and-Neglect.pdf

Coming Soon

• Sexual assault order set in Orchid for all the medications, labs, consults, communication orders
• Working on policy with pharmacy for giving NPO patients their prophylactic medications to-go to take at SART center after forensic exam

Management

Forensics Logistics

• If a patient wants a forensic exam or evidence to be collected, please treat the patient medically first, and if otherwise medically clear, keep in mind the following recommendations.
• In addition to the instructions found on the Sexual assault page, the San Pedro SART has the following policies to preserve forensic evidence
  • Place patient's clothes and belongings into a paper back (NOT the usual plastic patient belongings bags)
  • If patient has had oral trauma within past 6 hours, place patient on strict NPO (no medications, no ice chips or swabs, no rinsing mouth)
  • Have nursing call hospital police. The hospital police will coordinate to find the correct police department that needs to be contacted to file a report. The hospital PD will not take a report.
  • Specimens that PD will take to SART center with the patient
    • Dirty catch urine. Label specimen cup with patient's name, time of collection, and who collected

ED Consults

• Consult to Social Work
  • Also speak to social work about arranging a ride home for the patient. Police will bring patient to the SART center, but some patients have no way to get home from the SART center.
• Consult to Violence Intervention Team
• If patient meets criteria for HIV post-exposure prophylaxis, consult HIV
  • Need approving ID fellow/attending name to order medications in ED or to prescribe medications
  • Speak to ID fellow about arranging 2 week follow up appointment for DHS patients

Pediatric-Specific Modifications

• Consult SCAN team
  • Pubertal patients will go to SART center after medical evaluation complete, but SCAN team can follow up with patient
• Speak to social work about calling DCFS

Disposition

• PD from jurisdiction where assault occurred will take patient to SART center
• See "Consult to Social Work" above to arrange a ride home for the patient
• If patient receives HIV PEP, provide a 2 week supply of medications and patient needs follow up appointment in 2 weeks

See Also

• Sexual assault
• Emergency contraception
• HIV post-exposure prophylaxis
• Child abuse
• Occupational exposure