Interview: Why Getting Medical Help After Abuse and Assault is Important
For a victim of abuse or assault, having a life after the event starts with getting to safety and then getting physical, emotional and psychological care. Often, that starts in the emergency room or at a doctor’s office. The victim may or may not be aware of the physical impact of an assault, but it is important to get a medical evaluation to ensure that the patient does not suffer longer term physical consequences of the abusive episode.
The following is an excerpt from my with interview Dr. Ralph Riviello. Ralph Riviello, MD, MS, FACEP is a professor in the Department of Emergency Medicine at Drexel University College of Medicine and is Chair of Emergency Medicine for the Crozer Keystone Health System. He is the medical director of the Philadelphia Sexual Assault Response Center (PSARC). He also serves as a reviewer for Annals of Emergency Medicine and is former chair of the Forensic Medicine Section of the American College of Emergency Physicians.
The full episode will be available in the upcoming podcast series.
Is sexual assault “Trauma”?
“When we talk about patients who have been sexually assaulted, trauma comes in several forms. The most obvious is any physical trauma that might've occurred. Some of these cases involve physical violence, slapping, hitting, punching. “
“We see a large number of cases that involve strangulation as a way to to do subdue the victim, or to render the victim unconscious. A sexual assault is facilitated by the perpetrator, because the victim may be out of it or unconscious.”
“The other piece of the trauma that we see is the psychological trauma and those effects could be immediate. So things like fear or concern for safety [are] immediate responses, but can then progress to the Rape Trauma Syndrome, and leading all the way up to PTSD or post traumatic stress disorder where the survivor has reliving and retelling of the assault.”
How do victims present to the ER?
“There is a whole spectrum of how they present to us, from patients who have no physical injuries, no general injuries or trauma all the way up to people with horrific physical injuries.”
“When it comes to sexual assault behaviors and presentations, there is no normal, there is no typical response. Everybody's response is different, unique and personalized. It's based on your own previous life experiences—and what makes you who you are.”
“That's why one victim may be very tearful, others may be very calm, others may use humor to try to diffuse the situation for them.”
Why should a victim come to the ER?
“It does provide some safety. Especially if you're leaving from where the crime happened or you're not even sure where you are at the time or what to do. Patients feel safe there with the nurses and the physicians. They know they have access to equipment to help them, as well as access to other things— which are just as important— like rape crisis advocates and the police department should they want to report.”
“You may need, or you may have, alternative places to go within your town or county. There are often specialized clinics that are available and accessible 24/7 to victims where they could seek treatment to discuss what their options are around a medical, forensic examination, medication prophylaxis, evidence collection, reporting options, linkage to rape crisis counselors , etc. It helps to know what's available in your community.”
What happens when a victim comes into an ER after an assault?
“You'll be taken to the triage area where a nurse will talk to you very quickly to assess how injured you are. We'll ask you what resources you would like. Would you like a rape crisis counselor called? Would you like to speak to somebody about a medical forensic examination?”
“Usually because of the sensitive nature of what happened, you will be in a private area or in a room that's very private with a door. You'll most likely get a medical screening exam by a physician or an advanced practice clinician. That's mostly done to ensure that there are no medical or life threatening emergencies that need to be dealt with.”
“They probably would have called in a rape crisis counselor if you asked for it. These are advocates who are there to help support the patient through the process. Depending on what the policies and protocols are for that agency, they usually will stay with the patient throughout the examination. They'll talk to them. In almost all jurisdictions, their conversations are protected and they really provide a lot of emotional and psychological support for the patient.”
“I collect the evidence as well as [enact] protocols for care related to disease and pregnancy prophylaxis (prevention), follow up care and other linkages to services in the community.”
If you come to the ER do you have to talk to the police?
“You're never required to speak to law enforcement. That's actually codified in federal law. The Violence Against Women Act states that women should be provided ER services regardless of their desire or willingness to cooperate with law enforcement or involve law enforcement.”
“I can tell you that in the years of doing this, I've had very, very good police officers who have come and provided a little bit of guidance. And I've had numerous women who have, after talking to a police officer, decided to then file a police report to try to get justice for what happened.”
What one thing would you like for victims of abuse or assault to know?
“That no matter what anybody says, whatever anybody says about you, it is never the victim's fault. This is clearly the fault of the perpetrator and nobody should ever try to place that blame back on the survivor.”
If you know a victim, please urge them to get into a safe environment and help them access medical care. It’s the start of helping them to live a healthy life after abuse.
