1. When to call the Forensic Nurse Examiner Betsy Vick, RN, FNE, CEN

2. Background on the Forensic Program The Forensic Nurse Program started at St. Mary’s Hospital in 1993 There is 24/7 coverage Forensic NurseExaminers (FNE) provide highly specialized care to patients of all ages, from infants to the elderly, as well as the deceased where abuse and/or neglect is reported or suspected. Patients may include victims of sexual assault, child abuse, family violence, elder abuse, physical assault and workplace violence.

3. What is a forensic exam and how does it get started? Exams begins with a medical evaluation by a provider in the emergency department (ED) to ensure all emergent medical needs are addressed. The forensic nurse is notified and responds to the ED. If indicated an advocate is paged and responds as well to the ED to see the patient and will stay with the patient throughout her exam Forensic nurse discusses with patient the options of reporting the assault to law enforcement or having anonymous evidence collection.

4. When to call Forensics Any time a healthcare provider contacts CPS or APS they should start thinking about calling forensics. If a child discloses physical or sexual abuse If there are suspicious injuries If you have a “feeling” you can always call, it is never wrong to call. Forensic nurses can help you talk through situations.

5. Types of Suspicious Injuries Any injury that is not consistent with the story Patterned injuries. For example skin discoloration that could be consistent with finger marks, or a belt strap. Unreported injuries discovered on x-ray

6. After a consult with a forensic nurse what happens? After a call is made to the forensic team, the patient may warrant a transfer to the emergency department, because that is how the patient’s are registered and seen. If the patient is out of the window for evidence collection (Sexual assault 120 hours and strangulation as long as no one has touched their neck with an ungloved hand and they have not showered, evidence can be collected) an appointment can be made to be seen at a convenient time for the patient and family. If it is an acute injury/assault CPS must be called and law enforcement can be notified and the patient would be seen through the emergency department. The patient may not have to be seen, it is always best to call and talk it out with the FNE.

7. The Forensic Exam Regardless of the type of assault any patient over 4 years old (that is able to communicate effectively) is seen and a history is obtained from the patient (without leading the patient). The FNE’s are specially trained on techniques to speak with children All patients get a thorough physical exam, including photographic evidence of all injuries including measurements of the injuries. The bill goes to the a victims fund, if the patient can not pay the remainder of the bill, the hospital absorbs the bill. A victim will never have to pay for treatment associated with an assault.

8. Forensic Exam Continued After the examination, the FNE advises the MD on any testing that may be recommended based on injuries or history. STD testing is completed and prophylaxis medication is given for all sexual assault patients. HIV testing and prophylaxis medications is offered to all sexual assault patient’s. A voucher is also provided to cover the cost of the 28 day regimen.

9. Conclusion The FNE will complete the patient’s chart and have it reviewed with in 7 days. A copy will be sent to CPS, and law enforcement is authorized. The FNE is often contacted by The Commonwealth Attorney's office to testify as to their findings.

10. Final Thought ALWAYS ALWAYS ALWAYS...trust your gut instinct!!! Make the call—it is never wrong to call—you could be the one to stop the violence for your patient!!