INDEX

Sexual Assaults & Trafficking

Sexual Assault Victims

For patients reporting sexual assault, the following should be considered...

Did the assault occur within the last 72 hours?

  • If NO, then a rape kit or SANE exam is not indicated.

  • If YES, then rape kit or SANE exam may be indicated. Instruct the patient to keep clothing on and do not undress the patient.

BASIC GOALS:

  • Efficiently exclude/identify injuries that require ED interventions.

  • Preserve as much evidence as possible.

  • Have nursing staff or social work help coordinate discharge to SANE.


Documentation/History: Do not be a detective regarding the alleged sexual assault. Limit questions to those that are pertinent to screening for medical issues that would require ED intervention (e.g. injuries). Use terminology such as "The patient states..." if you document alleged details of the assault that are provided by the patient.


Physical Exam: Only undress the patient as much as necessary to investigate possible injuries that require ED interventions. Avoid pelvic exam unless there is concern for injury that would require intervention (e.g. laceration).


Labs: Do NOT order labs unless medically necessary. This includes urine. Urine collection can be performed by SANE and collecting urine in ED may compromise evidence collection.


Disposition: Once all necessary ED interventions are excluded/addressed, inform bedside nurse (or charge nurse) that SANE will need to be contacted and transportation for the patient needs to be verified and/or made. If SANE is NOT available or patient will not be able to be discharged to SANE, then a rape kit may need to be performed in the department.

  • If there are difficulties reaching SANE through the standard hotline, you can contact the SANE staff direct: Kristin Rezek (205-458-8984) or Shay McKay (205-458-8983)


Prophylaxis: STD prophylaxis can be given by SANE if the patient is going there. If not, give basic STD prophylaxis (see below). Effective HIV PEP needs to be started within 72 hours.


Young Age:

  • If patient is under 14-yrs-old, transfer to Children's for pediatric SANE.

  • If patient is over 14-yrs-old, patient has right to consent/refuse evaluation (i.e. overrule parents).

 

Post-Exposure Prophylaxis

STI Prophylaxis

  • Ceftriaxone 250mg IM

  • Azithromycin 1000mg PO


Emergency Contraception

  • Outpatient options:

    • Plan B

      • Within 3 days

      • levonorgestrel 1.5 mg, 1 tab, PO, Once

    • ELLA

      • Within 5 days

      • ulipristal 30 mg, 1 tab, PO, Once

  • Inpatient option:

    • Offer up to 5 days after

    • Ethinyl estradiol norgestrel 30mcg-0.3mg 4 tabs BID x 2 doses


HIV Prophylaxis

Please see the HIV PEP referral guide below for consideration of administering HIV PEP in the emergency department:

To be given in ED after negative UPT:

  • Raltegravir 400mg PO

  • Emtricitabine 200mg PO

  • Tenofovir 300mg PO

To be given as prescription:

  • Truvada (200/300) 1 tab PO once daily x 30 days

  • Raltegravir 400mg 1 tab PO BID x 30 days

 

Suspected Sex Trafficking

Only contact the police/FBI if the patient wishes/consents to it. The ED social workers and case managers can assist with this process.


Contacts if victims are MINORS/JUVENILES:

  • Birmingham PD - Detective Valentine, cell 826-7052, office 297-8443

  • FBI Special Agent - Steve Ferguson, 205-279-1280

  • FBI Special Agent - Helen Smith, 205-533-0980

  • DHR: The DHR office in the County where the juvenile has been victimized must be contacted.


Contacts if victims are ADULTS:

  • Birmingham PD - Sgt. Self, cell 205-767-2136

  • FBI Special Agent - Eric Salvador, cell 205-767-2151, office 326-6166

KEYWORDS: sex, sexual assault, trafficking, PEP, prophylaxis