Goals of the National Protocol for Sexual Assault Medical Forensic Examinations

Sexual assault is a crime of violence against a person’s body and will. Sex offenders use physical and/or psychological aggression or coercion to victimize, in the process often threatening a victim’s sense of privacy, safety, autonomy, and well-being. Sexual assault can result in physical trauma and significant mental anguish and suffering for victims. In some communities, sexual violence is considered a form of oppression. Victims may be reluctant, however, to report the assault to law enforcement and to seek medical attention for a variety of reasons. For example, victims may blame themselves for the sexual assault and feel embarrassed. They may fear their assailants or worry about whether they will be believed. Victims may also lack the ability or emotional strength to access services. For example, they may not have their own transportation or access to public transportation. They may also not speak English well or fear that reporting the assault may jeopardize their immigration status.1 They may lack health insurance and believe it would be too costly to get the medical care they need. They may not be aware that as a crime victim, they are eligible for financial reimbursements for certain services. Their budgets may not allow them to pay out-of-pocket expenses and then await reimbursements. Those who do have access to services may perceive the medical forensic examination as yet another violation because of its extensive and intrusive nature in the immediate aftermath of the assault. Rather than seek assistance, a sexual assault victim may simply want to go somewhere safe, clean up, and try to forget the assault ever happened.2 It is our hope that this protocol will help jurisdictions in their efforts to respond to sexual assault victims in the most competent, compassionate, and understanding manner possible.

This protocol was developed with the input of national, local, and tribal experts throughout the country, including law enforcement representatives, prosecutors, advocates, medical personnel, forensic scientists, and others. We hope that this protocol will be useful in helping jurisdictions develop a response that is sensitive to victims of sexual assault and that promotes offender accountability. Specifically, the protocol has the following goals:

  • Supplement, but not supersede, the many excellent protocols that have been developed by states, tribes, and local jurisdictions, as well as those created at the national level. We hope that this protocol will be a useful tool for jurisdictions wishing to develop new protocols or revise their existing ones. It is intended as a guideline for suggested practices rather than a list of requirements. In many places, the protocol refers to “jurisdictional policies” because there may be multiple valid ways to handle a particular issue and which one is best should be determined by the jurisdiction after consideration of local laws, policies, practices, and needs.
  • Provide guidance to jurisdictions on responding to adult and adolescent victims. Adolescents are distinguished in the protocol from prepubertal children who require a pediatric exam. Pediatric exams are not addressed in this document. This protocol generally focuses on the examination of females who have experienced the onset of menarche and males who have reached puberty. Legally, jurisdictions vary in the age at which they consider individuals to be minors, laws on child sexual abuse, mandatory reporting policies for sexual abuse and assault of minors, instances when minors can consent to treatment and evidence collection without parental/guardian involvement, and the scope of confidentiality that minors are afforded. If the adolescent victim is a minor under the jurisdictional laws, the laws of the jurisdiction governing issues such as consent to the exam, mandatory reporting, and confidentiality should be followed.
  • Support the use of coordinated community responses to sexual violence, such as Sexual Assault Response Teams (SARTs) or Sexual Assault Response and Resource Teams (SARRTs). Although this document is directed primarily toward medical personnel and facilities, it also provides guidance to other key responders such as advocates and law enforcement representatives. This type of coordinated community response is supported by the Violence Against Women Act and subsequent legislation. Such a response can help afford victims access to comprehensive immediate care, minimize the trauma victims may experience, and encourage them to utilize community resources. It can also facilitate the criminal investigation and prosecution, increasing the likelihood of holding offenders accountable and preventing further sexual assaults.
  • Address the needs of victims while promoting the criminal justice system response. Stabilizing, treating, providing social and legal services, including knowledge of immigration protections, and engaging victims as essential partners in the criminal investigation are central aspects of the protocol. Thus, this protocol includes information about concepts such as “anonymous reporting,” which may give victims needed time to decide if and when they are ready to engage in the criminal justice process. An anonymous report may also provide law enforcement agencies with potentially useful information about sex crime patterns in their jurisdictions.3 The objective is to promote better and more victim-centered4 evidence collection, in order to provide better assistance in court proceedings and hold more offenders accountable.
  • Promote high-quality, sensitive, and supportive exams for all victims, regardless of jurisdiction and geographical location of service provision. The protocol offers recommendations to help standardize the quality of care for sexual assault victims throughout the country and is based on the latest scientific evidence. It also promotes timely evidence collection that is accurately and methodically gathered, so that high-quality evidence is available in court.

This protocol discusses the roles of the following responders: health care providers, advocates, law enforcement representatives, forensic scientists, and prosecutors, as well as interpreters. Clearly, each of these professions has a distinct and complementary role in responding to sexual assault. But rather than dictate who is responsible for every component of the response or within the exam process, the protocol is designed to help communities consider what each procedure involves and any related issues. With this information, each community can make decisions for its jurisdiction about the specific tasks of each responder during the exam process and the coordination needed among responders. The following is a general description of the responsibilities with which each responder may assist:5

  • Advocates may be involved in initial victim contact (via 24-hour hotline or face-to-face meetings); offer victims advocacy, support, crisis intervention, information, language assistance services, including interpreters, and referrals before, during, and after the exam process; and help ensure that victims have transportation to and from the exam site. They often provide comprehensive, longer term services designed to aid victims in addressing any needs related to the assault, including but not limited to counseling, legal (civil, criminal, and immigration), and medical system advocacy.
  • Law enforcement representatives (e.g., 911 dispatchers, patrol officers, officers who process crime scene evidence, detectives, and investigators) respond to initial complaints, work to enhance victims’ safety, arrange for victims’ transportation to and from the exam site as needed, interview victims in a language they understand, collect evidence from the scene, coordinate collection and delivery of evidence to designated labs or law enforcement facilities, interview suspects, and conduct other investigative activities (such as interviewing suspects and witnesses in a language they understand, requesting crime lab analyses, reviewing medical and lab reports, preparing and executing search and arrest warrants, writing reports, and presenting the case to a prosecutor).
  • Health care providers assess patients for acute medical needs and provide stabilization, treatment, and/or consultation. Ideally, sexual assault forensic examiners perform the medical forensic exam, gather information for the medical forensic history, collect and document forensic evidence, and document pertinent physical findings from patients. They offer information, treatment, and referrals for sexually transmitted infections (STIs),6 and other nonacute medical concerns; assess pregnancy risk and discuss treatment options with the patient, including reproductive health services; and testify in court if needed. They coordinate with advocates to ensure patients are offered crisis intervention, support, and advocacy before, during, and after the exam process and encourage use of other victim services. They may follow up with patients for medical and forensic purposes. Other health care personnel who may be involved include, but are not limited to, emergency medical technicians, staff at hospital emergency departments, gynecologists, surgeons, private physicians, health care interpreters, and/or local, tribal, campus, or military health services personnel.
  • Forensic scientists analyze forensic evidence and provide results of the analysis to investigators and/or prosecutors. They also may testify at trial regarding the results of their analysis.
  • Prosecutors determine if there is sufficient evidence for prosecution and, if so, prosecute the case. They should be available to consult with first responders as needed. A few jurisdictions involve prosecutors more actively, paging them after initial contact and having them respond to the exam site so that they can become familiar with the case and help guide the investigation

This document is intended only to improve the criminal justice system’s response to victims of sexual assault and the sexual assault forensic examination process. It does not address the remedies that may be available to victims through the civil justice system, and does not create a right or benefit, substantive or procedural, for any party.

Go to the next section- Recommendations at a Glance


1 Carolyn Ham, Reducing Language Barriers to Combating Domestic Violence: The Requirements of Title VI, Battered Women’s Justice Project, October 2004, http://new.vawnet.org/summary.php?doc_id=1621&find_type=web_desc_GC.

2 Paragraph adapted in part from the Ohio Protocol for Sexual Assault Forensic and Medical Examination , 2004, p. 2.

3 States are responsible for ensuring that the costs associated with performing a medical forensic examination are paid and ensuring that all victims of sexual assault are provided the opportunity to have a medical forensic examination conducted, regardless of whether they choose to participate in the criminal justice system.

4 Please see the section on Victim-Centered Care” beginning on page 29 for more explanation of this term.

5 There are instances where a case may be prosecuted concurrently in two or more jurisdictions. For example, sexual assault cases occurring on Indian reservations can be prosecuted concurrently in tribal and state or federal court. In such situations, each sovereign will likely have its own victims’ advocate, law enforcement, prosecutor, and judicial/court officers. Coordination of services in multijurisdictional investigations and prosecutions is critical to the success of the criminal case and the well-being and healing of the victim.

6 STIs are also commonly known as sexually transmitted diseases (STDs).