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Role of AED in managing sexual violence cases Dr Paulin Ng FRCSEd, FHKAM (Emergency Medicine) Senior Medical Officer Tuen Mun Hospital.

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Presentation on theme: "Role of AED in managing sexual violence cases Dr Paulin Ng FRCSEd, FHKAM (Emergency Medicine) Senior Medical Officer Tuen Mun Hospital."— Presentation transcript:

1 Role of AED in managing sexual violence cases Dr Paulin Ng FRCSEd, FHKAM (Emergency Medicine) Senior Medical Officer Tuen Mun Hospital

2 Sexual Violence ( 性暴力 ) Indecent Assault (IA)Indecent Assault (IA) Sexual Assault (SA)Sexual Assault (SA)

3 Sexual assault (rape) A man commits rape if he has unlawful sexual intercourse with a woman who at the time of the intercourse does not consent to it; and at that time he knows that she does not consent to the intercourse or he is reckless as to whether she consents to it. # penetration of labia

4 SV cases in TMH (NTWC) Information Source: AEIS

5 SA cases in TMH Sexual intercourse (rape) cases:Sexual intercourse (rape) cases: –13 (32.5%) in

6 Roles of AED Treatment of acute injuriesTreatment of acute injuries Prevention of pregnancyPrevention of pregnancy +/- Prophylactic Treatment of STD+/- Prophylactic Treatment of STD Psychological rehabilitationPsychological rehabilitation Forensic examination and collection of evidenceForensic examination and collection of evidence

7 Management of Sexual Assault case in AED PrinciplesPrinciples –Confidentiality –Minimize interview by different professionals –Avoid unnecessary traumatizing procedures –Ensure privacy and comfort Clear explanation to the patient to minimize stressClear explanation to the patient to minimize stress

8 Resuscitation and stabilisation ABCABC Treatment of acute injuries, e.g. Head injuryTreatment of acute injuries, e.g. Head injury

9 Patient Flow (1) RegistrationRegistration

10 Patient Flow (2) TriageTriage Category 1-5Category 1-5 Designated nursing staff of same sex assigned to take care of the patientDesignated nursing staff of same sex assigned to take care of the patient

11 Role of the designated nursing staff (Nurse coordinator) Keep the patient companyKeep the patient company Explanation of the anticipating procedures and workflowExplanation of the anticipating procedures and workflow Liaison workLiaison work Psychological supportPsychological support

12 Scenario 1 Patient approaches AED on her ownPatient approaches AED on her own Social Worker (case manager) is not presentSocial Worker (case manager) is not present

13 Introduce the available social services Designated workers of SWD and the Crisis Centre as case managerDesignated workers of SWD and the Crisis Centre as case manager Obtain consent and call the 24-hour designated referral lineObtain consent and call the 24-hour designated referral line

14 Introduce the available social services In the meantime, the Nursing Coordinator may enlist assistance of the medical social workerIn the meantime, the Nursing Coordinator may enlist assistance of the medical social worker

15 If patient refuses, The Nursing Coordinator should give reassurance to the victim and address the victim ’ s concernThe Nursing Coordinator should give reassurance to the victim and address the victim ’ s concern Introduce other NGOs e.g. RainLilyIntroduce other NGOs e.g. RainLily

16 Scenario 2 Case manager accompanies the victim to AEDCase manager accompanies the victim to AED A call to the NO ic of the A&E Dept beforehand may helpA call to the NO ic of the A&E Dept beforehand may help

17 Role of the designated nursing staff (Nurse coordinator) Keep the patient companyKeep the patient company Explanation of the anticipating procedures and workflowExplanation of the anticipating procedures and workflow Liaison workLiaison work Psychological supportPsychological support

18 After triage The wait will depends on how busy the dept is at the timeThe wait will depends on how busy the dept is at the time A quiet place will be arranged by the nurse coordinator while waitingA quiet place will be arranged by the nurse coordinator while waiting

19 Patient Flow Evaluation in cubicle with nurse coordinator as chaperoneEvaluation in cubicle with nurse coordinator as chaperone

20 Medical Consultation Build up rapportBuild up rapport –Usually by a female doctor if available Obtain consentObtain consent History takingHistory taking Physical examinationPhysical examination +/- collection of evidence+/- collection of evidence

21 History taking Be tactful and non-judgmentalBe tactful and non-judgmental Detailed history concerning the gynae history and the event will be takenDetailed history concerning the gynae history and the event will be taken Prepare the patient psychologicallyPrepare the patient psychologically

22 History taking Gynae historyGynae history The eventThe event

23 Gynaecology history Marital statusMarital status Last menstrual periodLast menstrual period Any contraceptionAny contraception Date of last intercourseDate of last intercourse Delivery historyDelivery history

24 The event Time, locationTime, location Type of sexual violenceType of sexual violence Details of the eventDetails of the event –Number of assailants –Restraint used –Acts committed –Penetration/Ejaculation/?Condom –Loss of Consciousness

25 Other relevant history Drug historyDrug history –substance of abuse, alcohol Drug allergy and current medicationsDrug allergy and current medications Past medical historyPast medical history –esp. recent surgery/injury around anogenital region

26 Physical examination General examinationGeneral examination –General appearance –Clothes –External injuries e.g. face, lips, medial thigh, perineume.g. face, lips, medial thigh, perineum lacerationslacerations bruises (color)bruises (color) pattern of abrasionspattern of abrasions

27 Physical examination Pelvic examinationPelvic examination –External genitalia, perineum –Vaginal examination, collection of specimens (preferably left to Forensic pathologist)

28 For patients suffering from rape Unstable patientsUnstable patients –Admission after initial stabilisation –Examples: significant head injury; vaginal bleeding Stable patientsStable patients –Baseline investigations –Offer emergency contraception –Medical follow up services

29 Baseline investigations Urine for pregnancy testUrine for pregnancy test Blood forBlood for –urgent HbsAg/HbsAb –hepatitis C –VDRL or Syphilis(RPR) –HIV (consent) STD screening after forensic examination (not indicated in most cases)STD screening after forensic examination (not indicated in most cases)

30 Emergency contraception Risk of pregnancyRisk of pregnancy –Around 8% for unprotected intercourse Check urine for pregnancy testCheck urine for pregnancy test Earlier the betterEarlier the better Up to 5 days: LNG 1.5mg PO statUp to 5 days: LNG 1.5mg PO stat >5 days: FU for pregnancy test>5 days: FU for pregnancy test Refer SV/gynae clinic for FURefer SV/gynae clinic for FU

31 PEP for Hep B Transmission risk ( %)Transmission risk ( %) Check blood for HBsAg/ AntiHB AbCheck blood for HBsAg/ AntiHB Ab FU AED 2 days laterFU AED 2 days later

32 PEP for HIV Transmission risk (0.1-3%)Transmission risk (0.1-3%) Current QEH special medical service recommendation: not for PEPCurrent QEH special medical service recommendation: not for PEP

33 PEP for STD Overall risk: 5-10%Overall risk: 5-10% Immediate PEP is offered if perpetrator is known to be infective or the victim has S/S of infectionImmediate PEP is offered if perpetrator is known to be infective or the victim has S/S of infection Refer SV/gynae clinic for FU 2 weeks laterRefer SV/gynae clinic for FU 2 weeks later

34 Medical follow up services Hepatitis BHepatitis B –AED follow up service within 48 hr Pregnancy, STD, AIDSPregnancy, STD, AIDS –Sexual violence clinic follow up in ~2 weeks ’ time

35 Medical follow up services Sexual violence clinicsSexual violence clinics –4 designated sexual violence clinics in different clusters –A referral letter is provided with consent –The patient or case manager, as patient advocate, could make an appointment in any one clinic subjected to her wish

36 Psychosocial support Case managerCase manager Medical Social WorkerMedical Social Worker RainLily hotlineRainLily hotline Other NGOOther NGO

37 Report to police Advise patient to report to policeAdvise patient to report to police Police will decide on whether or not to refer to forensic pathologist for evidence collectionPolice will decide on whether or not to refer to forensic pathologist for evidence collection

38 Thank you Question time later


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