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National Protocol--Table of Contents: National Protocol for Sexual Assault Medical Forensic Examinat
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National Protocol Table of Contents

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Goals

Recommendations at a Glance

Introduction

Background

About this document

Use of terms

Section A. Overarching Issues

1.    Coordinated Team Approach

Understanding the purpose of the exam

Key responders and their roles

Quality assurance measures

2.    Victim-Centered Care

Patient Priority as an emergency case

Patient privacy

Exam adapted to patients' needs and circumstances

Issues commonly faced by patients from specific populations

Importance of victim services within the exam process

Presence of personal support persons in the exam room

Requests for a responder of a specific gender

Explanation of procedures during the exam process

Respect for patients' priorities

Integration of medical and evidentiary collection procedures

Patient safety during the exam process

Information patients can review at their convenience

Physical comfort needs of patients

3.    Informed consent

 Seeking informed consent as appropriate

Obtaining consent from specific populations

4.   Confidentiality

 Scope and limitations of confidentiality

Building understanding of confidentiality issues

Impact of federal privacy laws

Resolving intrajurisdictional conflicts

5.   Reporting to Law Enforcement

 Making the decision to report

Consequences of reporting

Alternatives to standard reporting procedures

Promoting a victim-centered reporting process

6.   Payment for the Examination Under VAWA

VAWA provisions related to exam payment

Section B.  Operational Issues

1.   Sexual Assault Forensic Examiners

Specific knowledge, skills, and attitudes

Advanced education and clinical requirements

Access to experts

2.   Facilities

Obligation to serve patients

Use of specially educated and clinically prepared examiners

Optimal site locations

Basic requirements

Patient transfers

3.   Equipment and Supplies

Availability of specific equipment and supplies

Cost barriers

4.   Sexual Assault Evidence Collection Kit

Minimum guidelines for contents

Standardized kits

5.   Timing Considerations for Collecting Evidence

Importance of the history and exam finding

Prompt exam to minimize loss of evidence

Decisions made on a case-by-case basis

Resources for responders

6.   Evidence Integrity

Policies to dry, package, label, and seal evidence

Evidence transfer policies

Storage policies

Documentation of evidence

Section C. The Examination Process

1.  Initial Contact

Consensus among agencies regarding procedures

Essential activities

2.   Triage and Intake

Priority cases

Acute care needs

Alerting examiners

Contacting advocates

Safety concerns upon arrival of patients at the site

Immediate medical and mental health interventions

3.   Documentation by Health Care Personnel

Completion

Education for examiners

Mechanisms to ensure accuracy and objectivity

4.   The Medical Forensic History

Coordination of history taking and investigative interviewing

Presence of advocates during the history

Patient needs addressed prior to and during history

Obtaining the history

5.   Photography

Extent

Photographers and equipment

Patient comfort and privacy

Explanation of photography procedures

Initial and follow-up photographs

Photograph storage

6.   Exam and Evidence Collection Procedures

Evidentiary purpose of the exam

Collecting as much evidence as possible

Issues related to consent to sexual contact

Testing of biological evidence

Exposure to infectious material and evidence contamination

Importance of semen evidence

Addressing patients' needs and concerns

Explanation of exam and evidence collection procedures

Conducting the exam and documenting findings

Evidence to submit to the crime lab for analysis

Other evidence

Medical specimens separate from forensic specimens

7.   Alcohol and Drug-Facilitated Sexual Assault

Training and development of policies

Response to voluntary use of drugs and/or alcohol

Circumstances in which testing may be indicated

Explanation of testing procedures

Collecting samples

Toxicology labs

Preservation of evidence and chain of custody

8.   STI Evaluation and Care

Information on STIs

STI testing

Prophylaxis against STIs

Follow-up care

Concerns about HIV infection

 9.   Pregnancy Risk Evaluation and Care

Probability of pregnancy

Pregnancy testing

Treatment options

Facility policy

10.  Discharge and Follow-Up

Medical discharge and follow-up care

Coordination among responders prior to discharge

11.   Examiner Court Appearances

Broad education on court appearances

Prompt notification for examiners

Pretrial preparation

Feedback on testimony

Bibliography

Appendix A. Developing Customized Protocols: Considerations for Jurisdictions

Appendix B. Creation of Sexual Assault Response and Resource Teams

Appendix C. Impact of Crawford v. Washington, Davis v. Washington, and Giles v. California

Go to the next section- Goals of the National Protocol

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