Recommendations at a Glance

B. Operational Issues

1. Sexual Assault Forensic Examiners: These are the health care professionals who conduct the examination. It is critical that all examiners, regardless of their discipline, are committed to providing compassionate and quality care for patients disclosing sexual assault, performing the physical examination, collecting evidence competently, documenting all findings, and testifying in court as needed.

Recommendations for jurisdictions to build the capacity of examiners performing these exams:

Encourage the development of specific knowledge, skills, and victim-centered approaches in examiners.
Encourage advanced education and supervised clinical practice of examiners, as well as certification for all examiners.
Provide access to experts on anti-sexual assault initiatives who can participate in sexual assault examiner training, mentoring, proctoring, case review, photograph review, and quality assurance.

2. Facilities: Health care facilities have an obligation to provide services to sexual assault patients. Designated exam facilities or sites served by specially educated and clinically prepared examiners increase the likelihood of a state-of-the-art exam, enhance coordination, encourage quality control, and increase quality of care for patients.

Recommendations for jurisdictions to build capacity of health care facilities to respond to sexual assault cases:

Recognize the obligation of health care facilities to serve sexual assault patients in a culturally and linguistically appropriate manner.
Ensure that exams are conducted at sites served by examiners with advanced education and clinical experience, if possible.
Explore possibilities for optimal site locations.
Communities may wish to consider developing basic requirements for designated exam sites.
If a transfer from one health care facility to a designated exam site is necessary, use a protocol that minimizes time delays and loss of evidence and addresses patients’ needs.

3. Equipment and supplies: Certain equipment and supplies are essential to the exam process (although they may not be used in every case). These include a copy of the most current exam protocol used by the jurisdiction, standard exam room equipment and supplies, comfort supplies for patients (e.g., changes of clothes, food, and water), sexual assault evidence collection kits, an evidence drying device/method, a forensic imaging system, testing and treatment supplies, a purified water source, an alternate light source, an anoscope, and written materials for patients. A microscope and/or toluidine blue dye may be required, depending on jurisdictional policy. A colposcope or other magnifying instrument may also be used. Some jurisdictions are also beginning to use advanced technology (telemedicine), which allows examiners offsite consultation with medical experts by using computers, software programs, and the Internet. Jurisdictions using such technology should be careful to protect patient confidentiality.

Recommendations for jurisdictions and responders to ensure that proper equipment and supplies are available for examinations:

Consider what equipment and supplies are necessary to conduct a medical forensic exam.
Address cost barriers to obtaining necessary equipment and supplies.

4. Sexual assault evidence collection kit (for evidence from victims): Most jurisdictions have developed their own sexual assault evidence collection kits or purchased premade kits through commercial vendors. Kits often vary from one jurisdiction to another. Despite variations, however, it is critical that every kit meets or exceeds minimum guidelines for contents: broadly including a kit container, instruction sheet and/or checklist, forms, and materials for collecting and preserving all evidence required by the applicable crime laboratory. Evidence that may be collected includes, but is not limited to, clothing, foreign materials on the body, hair (including head and pubic hair samples and combings), oral and anogenital swabs and smears, body swabs, blood and urine samples for possible alcohol and/or toxicology testing, and a blood or saliva sample for DNA analysis and comparison. The instruction sheet and/or checklist should guide examiners on maintaining the chain of custody for evidence collected.

Recommendations for jurisdictions and responders when developing/customizing kits:

Use kits that meet or exceed minimum guidelines for contents.
Work to standardize sexual assault evidence collection kits within a jurisdiction and across a state or territory, or for federal cases.

5. Timing considerations for collecting evidence: Although many jurisdictions have traditionally used 72 hours after the assault as the standard cutoff time for collecting evidence, a large number of jurisdictions have moved toward longer time frames as cut off points. Many jurisdictions have now extended the standard cutoff time (e.g., to 5 days or 1 week). The use of such time frames is supported by empirical evidence. Advancing DNA technologies continue to extend time limits because of the stability of DNA and sensitivity of testing. These technologies are even enabling forensic scientists to analyze evidence that was previously unusable when it was collected years ago. Thus, it is critical that in every case where patients are willing, examiners obtain the pertinent medical forensic history, examine patients, and document findings. Not only can the information gained from the relevant history and exam help health care providers address patients’ medical needs, but it can guide examiners in determining whether there is evidence to collect and, if so, what to collect.

Recommendations for health care providers and other responders to maximize evidence collection:

Recognize the importance of gathering information for the medical forensic history, examining patients, and documenting exam findings, separate from collecting evidence.
Examine patients promptly to minimize loss of evidence and identify medical needs and concerns.
Make decisions about whether to collect evidence and what to collect on a case-by-case basis, guided by knowledge that outside time limits for obtaining evidence vary due to factors such as the location of the evidence or type of sample collected.
Responders, examiners, and law enforcement representatives should seek education and resources to aid them in making well-informed decisions about evidence collection.

6. Evidence integrity: Properly collecting, preserving, and maintaining the chain of custody of evidence is critical to its subsequent use in criminal justice proceedings.

Recommendations for health care providers and other responders to maintain evidence integrity:

Follow jurisdictional policies for drying, packaging, labeling, and sealing evidence.
Make sure transfer policies maximize evidence preservation.
Make sure storage policies maximize evidence preservation.
Document the handling, transfer, and storage of evidence.

Go to next section- Recommendations at a Glance- The Examination Process