Case Conclusion

You sit down at the patient’s level, confirm name and preferred pronouns, and introduce yourself. You ask if she would like to have a friend, family member, or the rape crisis advocate present during the ED encounter. After obtaining a history, you describe the physical examination and evidence collection. The patient is anxious about the speculum examination and genital swabs, so you show her the equipment and answer her questions. After obtaining consent for the examination, you do the exam and evidence collection, talking through each step, and providing draping for the patient’s privacy. You confirm that she does wish to have evidence turned over to the police. You engage the patient in decisions regarding post-exposure prophylaxis and post-coital contraception. All her questions are answered, and she is discharged with outpatient resources, including contact information for the rape crisis center.

Dr. Rozzi is an emergency physician, director of the Forensic Examiner Team at WellSpan York Hospital in York, Pa., and chair of the Forensic Section of ACEP.

Dr. Riviello is chair and professor of emergency medicine at the University of Texas Health Science Center at San Antonio.

References

1. SAMHSA’s Concept of Trauma and Guidance for a Trauma-informed Approach. Published July 2014. Accessed November 3, 2024.
2. Purkey E, Davison C, MacKenzie M, et al. Experience of emergency department use among persons with a history of adverse childhood experiences. BMC Health Serv Res. 2020;20(1):455.
3. Ashworth H, Lewis-O‘Connor A, Grossman S, et al. Trauma-informed care (TIC) best practices for improving patient care in the emergency department. Int J Emerg Med. 2023;16(1):38.
4. Greenwald A, Kelly A, Thomas L. Trauma-informed care in the emergency department: concepts and recommendations for integrating practices into emergency medicine [published correction appears in Med Educ Online. 2023 Dec;28(1):2206681]. Med Educ Online. 2023;28(1):2178366.