Who to Screen in the ER
- ideally everyone
- Institute of Medicine recommends screening women once a year
- in the ER, screen females with:
- reproductive age
- signs/symptoms of mental health issues
- chronic abdominal pain
- any female with any injury
- especially injuries in a central pattern:
- head, face, neck, thorax, abdomen
How to Screen
- excuse all the family or friends from room
- "I'm going to ask a few quick questions that I ask all of my patients and then I will bring you back in the room to help with the care in a few minutes"
- "I'm going to ask you some questions that I ask all of my patients because violence against women is such an issue."
- "Has anyone hit, kicked, or punched you within the past year?"
- If they say yes: "how often?", "have they spoken to anyone about it?", "do they feel unsafe at home because of it?"
- you should refer them to social work in house or contact 800-799-SAFE
- if you're suspicious, but they do not say anything: "your injuries do not seem to fit the story, can you go through how this happened?"
- if still not forthcoming: "here are resources we give all patients as this might be an issue for you or a friend at a later time"
- thank them for sharing such difficult information
- in California, physicians are required to make a report if they provide medical services to a patient whom they suspect is suffering from a physical injury due to a firearm or assaultive or abusive conduct
See Also: Mandatory Reporting
Who is high risk?
- anyone with a significant injury
- threats by their partner to kill them
- strangulation injuries
- suicidal partner
- refer to social services
- advise them to keep some money separate, notify a friend, and have an escape plan
- if they are in imminent danger you may need to admit them
Muelleman RL et al. Battered woman: injury locations and types. Ann Emerg Med. 1996 Nov;28(5):486-92. http://www.futureswithoutviolence.org/userfiles/file/HealthCare/mandatory_calif.pdf