Transcript Forensic Collection

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Ideally a SANE or specially trained
physician for consultation and the
services of a local sexual assault victim’s
advocate are available
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The Sex Crime Victim Services Fund was
designed to reimburse Indiana hospitals
for the emergency care and treatment
they provide to sexual assault patients
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If a patient of sexual assault arrives with
acute medical or psychological
concerns treat these immediately
Although patients may not have signs of
physical injuries, they will, at the very
least, be suffering from emotional
trauma.
 Every minute spent waiting may cause
valuable forensic evidence to be lost
and undue stress to the patient
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Minimize potential embarrassment to the
patient.
 Avoid terms such as “rape” or “sexual
assault” to identify the patient verbally
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If the patient must wait due to other
emergencies, allow the responding
officer to begin gathering pertinent
information in a safe and secluded area.
The importance of having a support
person available to sexual assault
patients cannot be overemphasized.
 Whenever possible, one person should
be assigned to stay with the patient
throughout the entire emergency
department visit.
 Call the victim’s advocate as soon as
the patient arrives in the ED
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Reporting on adult patients should be
encouraged, but is NOT required
 They may opt to still have a medical
forensic examination performed and a
sexual assault kit completed.
 Other patients may only wish to receive
medical treatment with no forensic
examination, no evidence collection
and not report to law enforcement.
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If the patient is under age 18, healthcare
providers MUST report the sexual assault
to the Indiana Department of Child
Services
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If the patient is over 65 or considered an
endangered adult, the sexual assault
MUST be reported to the Adult Protective
Services
All procedures should be explained as
much as possible
 This allows the patient to understand
what is being done and why
 Having a sense of control is an important
part of the healing process for the
patient.
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Evidence should be collected promptly
to minimize the loss of evidence
 Evidence may be collected 72-120 hours
after the assault
 Certain extenuating circumstances may
warrant that evidence collection could
extend beyond 72-120 hours and should
be made on a case-by-case basis and
vary due to factors of the situation
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Prior to any evidence collection, the
area should be documented and
photographed
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A medical examination should be
performed on all cases of sexual assault,
regardless of the length of time that may
have elapsed
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Sexual assault patients are trauma
patients and a complete head to toe
assessment should be conducted
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If the patient consents to prophylactic
antibiotic treatment, cultures for
Gonorrhea, Chlamydia and Trichomonas
vaginalis do NOT need to be obtained.
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Non-Latex Powder-Less gloves should be
worn at all times when coming in
contact with the patient and/or
evidence and the gloves should be
changed frequently throughout the
exam to prevent cross-contamination
Prior to the clothing collection, determine if
the patient is wearing the same clothes
during or immediately following the assault
 If so, all clothing should be collected
 If the patient is not wearing the same
clothing, inquire as to the location, such as
at home in the laundry
 HOWEVER THE UNDERWEAR THE PATIENT IS
WEARING SHOULD ALWAYS BE COLLECTED
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To minimize loss of evidence, the patient
should disrobe over a sheet of paper
(contained in the sexual assault
evidence collection kit) that is laid out
over a cloth or paper sheet.
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If patients cannot undress on their own,
or if it is necessary to cut off items of
clothing, be sure not to cut through
existing rips, tears, or stains
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If the patient arrived via EMS and was
wrapped in or resting on a sheet, this
sheet should be collected also
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Prior consent should be obtained from
the patient before collecting relevant
clothing as it is unlikely the clothing will
be returned
1. Any wet stains should be allowed to
AIR DRY before being placed into paper
bags
 2. After air drying, items such as
underwear, hosiery, slips or bras should
be placed in smaller bags and items
such as slacks, dresses, blouses or shirts
should be put into larger bags.
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Each item should be placed separately
in it’s own paper bag to prevent cross
contamination from occurring
 (This includes items such as socks)
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Should be collected within 24 hours
 Collect 2 cotton swabs together and swan
the mouth with close attention to the upper
and lower lip and gum
 Another tool is the 6-8 inch un-waxed
dental floss, provided in the collection kit.
 Once air dry, the floss should be placed into
a piece of paper, folded and placed into
the appropriate envelope labeled “floss”,
seal and label the envelope with the
collector’s initials, date and time
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Comb the top, back, front, and sides of
the patient’s head hair over a piece of
paper to collect all loose hair and debris.
 Patients may prefer to do this themselves
 The combings and the comb are to be
folded into the piece of paper and
inserted into the envelope marked
“head hair combings”, Seal and label
the envelope with the collector’s initials,
date and time.
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A separate comb is used to collect any
loose hair or fibers from the pubic area
This is done over a piece of paper
Patients may prefer to do this themselves
The combings should be folded in the
paper with the comb and placed into the
envelope marked “pubic hair combings”,
sealed and labeled with the collector’s
initials, date and time
**The absence of head and/or public hair
should be documented**
Collect if fibers or other material is observed
under the patient’s fingernails
 The nails should be scraped with the
scraper provided in the kit
 If damage is present, the nail should first be
photographed, and the nail should be
clipped proximally to the damage, placed
in paper, and packaged in an envelope.
 Seal and label with the collector’s initials,
date and time
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Scrapings for each hand should be over a
separate piece of paper
If swabs are obtained, air dry and package
Be certain to differentiate between “right
hand” and “left hand”
The labeled and sealed paper folds should
then be placed in an envelope labeled
“fingernail scrapings”
Seal and label with the collector’s initials,
date and time
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Collect within 72-120 hours
Swan the labia majora using 2 swabs simultaneously
Allow to air dry then package in the envelope
labeled “external genitalia”
Seal and label with collector’s initials, date and time
Consider: swabbing the perineum, inner thighs,
and/or behind the knees with 2 moistened swabs
(using preservative free sterile water)
Allow to air dry, then package in an envelope and
label the location from where the specimen was
obtained, seal and label with the collector’s initials,
date and time
Swan labia minora using 2 swabs
simultaneously
 Allow to air dry then package in a blank
envelope and MANUALLY label the
envelope “labia minora”
 Seal and label with collector’s initials,
date and time
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Swab anal folds using 2 swabs
simultaneously (using preservative free
sterile water) even if anal penetration
did not occur during the assault
 Allow to air dry, then package in an
envelope labeled “anal swabs”.
 Seal and label with the collector’s initials,
date and time
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Speculum insertion should be used with
pubertal patients ONLY
 DO NOT aspirate the vaginal vault or
dilute the secretions in any way prior to
vaginal swab collection
 Use ONLY preservative free saline for
speculum insertion
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Use 4 swabs (2 at a time) to collect
additional material from the vaginal
vault (2 swabs) and the cervix (2 swabs)
 Make sure to collect from the cervical
OS
 Allow the cotton swabs to air dry, place
them into the envelope labeled
“vaginal/cervical swabs”
 Seal and label with the collector’s initials,
date and time
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Any medical cultures should be taken if
prophylactic treatment is not intended
or for other reasons deemed necessary
by the healthcare provider.
 All cultures are to be processed by the
hospital and NOT included in the
evidence collection kit.
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The vaginal wash should now be collected
 Use 5-10 ml of preservative free sterile water
and a pipette, syringe or catheter to
aspirate the fluid and then place it in the
red topped collection tube
 Label and place the tube in bubble wrap
that is provided in the collection it and then
into the plastic bag labeled “vaginal
washing”
 Seal and label with the collector’s initials,
date and time
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Swab the speculum with 2 sterile cotton
tipped applicators
 Allow to air dry, place into envelope
labeled “speculum swabs”
 Seal and label with the collector’s initials,
date and time
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These must be thoroughly dried, which
may take days, by air
 During this time the evidence must be in
a secure area
 Call the local crime lab to take care of
this
 Once dry, the items are to be placed
into an envelope or bag and labeled
appropriately
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Slightly moisten 4 cotton swabs, 2 at a
time with preservative free sterile water
 Thoroughly swan the external surface of
the penile shaft and glans (do not swab
the urethra)
 Follow culture procedures as mentioned
in Female Collection
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Swab the anal areas by using 2 sterile
cotton swabs moistened with
preservative free sterile water, one at a
time, swabbing just inside the anal
opening and around the anal fold.
 Allow to air dry, place in the paper
envelope labeled “Anal Swabs”
 Seal and label with the collector’s initials,
date and time
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Examine the patient’s body for evidence of foreign matter
Swab each specimen separate
A wood’s lamp or UV light may be used at this time to
scan the patient’s body to locate any possible specimens
Collect the material by gently rolling the swab over the
area with a moistened swab with preservative free sterile
water
Place air dried swab in an envelope
Seal and label with the collector’s initials, date and time
Be sure to indicate on the envelope the location on the
patient’s body from which the specimen was collected
May be difficult to distinguish due to
variance of shape and size
 Take photographs and collect potential
saliva from the area and can be done prior
to cleansing the area
 Use a ruler when taking photographs to
determine the size of the mark (be sure not
to cover any portion of the mark)
 Photographs should be released to the
police investigator and made a part of the
medical chart and NOT placed into the
evidence kit
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To be used for subsequent comparison with stains and the
assailant’s blood standard
Check the expiration date on the blood tube
If it is expired replace with the hospital's equivalent tube
For adults 5-7 ml of blood should be collected in a purple
top EDTA blood tube, labeled with the identifying
information.
Label the blood tubes with the collector’s initials, date and
time
Seal the whole blood samples in bubble wrap, place them
in the provided zip lock bag and keep with the kit
refrigerated but not frozen
**DO NOT collect from children or adolescents unless
blood samples are needed for medical purposes**
Information and referrals for STD’s (STI’s)
should be provided to the patient as
part of their discharge instructions
 Additional testing should be done
according to the policy of the individual
healthcare facility.
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Do NOT package in plastic, this may
result in evidence contamination
 Always package using the paper bags, it
allows the evidence to “breathe”
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Chain of custody is VITALLY IMPORTANT
 Anyone who handles the evidence
should label them with their initials, ate
and time, source of specimen and the
name of the patient
 Each envelope should be labeled and
sealed with patient labels or tape
 DO NOT LICK THE ENVELOPES!!! Use tap
water to seal
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Document as completely as possible in the medical
record
A thorough complete and legible medical record
with accompanying body diagram will assist the
healthcare provider when recalling the case
Be careful not to include any subjective opinions or
conclusions
Avoid using the term “rape” or “sexual assault” on
the medical document-it is a legal conclusion
Avoid the term “allegedly”
It is acceptable to use “reported sexual assault or
Sexual assault by history”
Date and time of Collection
 Date and time of Assault
 Assailants
 Post Assault History
 Contraceptive / Menstruation
Information
 History of the assault
 Geographical Location of the Assault
 Physical Examination Details
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Contraception / Menstruation
Information
 History of the assault
 Geographical Location of the Assault
 Physical Examination Details
 Date of Last Consensual Sexual Activity
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Medical History
 Gynecological History
 Sexually Transmitted Infections
 HIV Testing
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MUST be kept separate both in terms of
collection and processing
 Required strictly for forensic analysis and
should be collected using the sexual
assault evidence collection it and
protocol
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Place all specimens back into the kit
 Make certain that everything is properly
labeled and sealed
 Include a copy of the Indiana Sex Crime
Victim Compensation Form
 DO NOT include any documentation in
the kit
 The kit should be in a locked, secured
area and refrigerated including any
bagged clothing
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Should be released to the jurisdictional
law enforcement agency representative
 The rep should date and time and sign
the form as well as complete the
information on the top of the evidence
collection box.
 The yellow copy of the Sex Crime
Application should be given to the law
enforcement and the hospital retains the
white copy and pink copy
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ONLY a law enforcement officer or duly
authorized agent should transfer physical
evidence from the hospital to the crime
lab for analysis
 Under no circumstances should the
patient be allowed to handle the
evidence after it has been collected

Never react negatively to a patient’s
choice to not release the evidence to
law enforcement
 The victim has one year to decide if they
wish to report the crime
 Law enforcement will store and
refrigerate the kit for the one year and
they will determine how to label and
identify the kit
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Medical and counseling follow up options
should be discussed before the patient is
discharged
Encourage the patient to pursue follow up
testing and seek treatment for symptoms
Include contact information for follow up
Provide informational brochures with the
same information
If possible, allow the patient to shower or
“clean up” after the procedures and
examinations are complete