The Case: You’re working the overnight shift in a rural emergency department. The charge nurse says, “Tag, you’re it,” and hands you the chart of a 19-year-old female who reports that she has been sexually assaulted. There are no sexual assault nurse examiners at your hospital, but the department does have a stash of sexual assault evidence collection kits. Do you know how to proceed?
Explore This IssueACEP Now: Vol 35 – No 10 – October 2016
The type of sexual assault evidence kit (SAEK) your hospital uses may vary. The photos below are of the kit commonly used in Pennsylvania, but most commercially available kits contain similar contents. States or jurisdictions often mandate the contents of the SAEK to be used. Here’s what should be in a standard SAEK:
- Consent form
- Chain of Custody form
- Foreign material bags and envelopes
- Oral assault collection swabs/slide/envelopes
- Fingernail clipping envelopes
- Pubic hair combing envelopes
- Vaginal/penile assault collection swabs/envelopes
- Rectal assault collection envelopes
- Buccal swab collection envelopes
Always obtain consent prior to beginning a sexual assault examination. Depending upon where you practice, you may also be required to notify law enforcement as dictated by state and local laws. In addition, there are often jurisdictionally mandated chart forms that should be used. Some of the steps listed below may not be required depending on your practice location; it’s important to know the requirements in the jurisdictions where you practice.
Patients presenting after sexual assault, like all other patients, must have a medical screening exam upon presentation to the emergency department. Although serious physical injury following sexual assault is rare, if serious injury is present, medical care takes precedence over evidence collection.
Once you’ve begun collecting evidence, the kit must remain in your direct line of sight or securely stored until collected by law enforcement. Most kits include a Chain of Custody form, often on the outside of the box, to document transfer of evidence. Failure to maintain the chain of custody may result in collected evidence being inadmissible in court.
Although commercial swab driers are available, specimens can be air-dried by inverting swabs into a lump of clay, a rack of test tubes, or inverted Styrofoam cups. The cups and tubes are single use to prevent cross-contamination. The other surfaces should be thoroughly cleaned before and after use with a 10 percent bleach solution. Carefully label each swab immediately after collection.
Last but certainly not least, after placing the evidence in separate envelopes, seal the envelopes with tape or a label. Do not lick the envelopes!