Major Gwen Foster CNM
Travis AFB, CA

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Governing Policies
Reporting Rules
Role of Sexual Assault Examiner
SAFE KIT

Sexual Assault Policies
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Department of Defense Directive 6495.01
Department of Defense Directive 6495.02
Army Regulation 600-20, Chapter 8 and
Appendix 1
AFI 36-6001, Sexual Assault Prevention and Response Program

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Restricted (Confidential)
Unrestricted

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Diagnosis and treat within scope of practice
Head to toe assessment
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ID, collect, preserve and document evidence and maintain chain of custody
Refer for appropriate treatment and follow-up
Provide expert testimony in a court of law

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PRIMARY ASSESSMENT
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Physical, mental and emotional care
SECONDARY ASSESSMENT
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ID, collect, preserve and document evidence
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Determine if evidence consistent or inconsistent

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Within 72 hours
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Yields the highest quality evidence
After 72 hours
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Significant healing of trauma
Trace evidence may be lost through natural processes and or actions of the individual being examined
But…

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Sperm heads - 19 days post-assault
Epithelial cells - 3 weeks post-assault

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Locard’s Principle of Evidence Transfer
 partial transfer of material from one to the other
Minimum of Three Crime Scenes
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Victim
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Suspect
Location of crime
Use physical evidence to tie the scenes together

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Trace Evidence: small pieces of evidence
Direct (Primary) Transfer
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Direct contact between suspect/victim/scene
Indirect (Secondary)
Transfer
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Carried from location to other locations

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Forensic interview
A sexual assault examination kit

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Ensure safe and supportive environment
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Influences –
 quality of the history
 cooperation during the exam
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Patient attitude toward legal proceedings

Primary/Secondary Assessment
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Head to Toe
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Inspect/photograph
Collect
Palpate
Document

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During examination:
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Camera
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Colposcope/anoscope
Toluidine Blue
Woods lamp
Swab dryer
After examination:
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Clothing
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Medications

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Step 1
Authorization
Victims: Must agree to exam
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If refuse, encourage to have medical exam
Subjects: Not necessary if taken under search authority or warrant
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AFI 44-102 2.35.2.4.

Step 2
History and Assault Information
VICTIM’s statements are placed in quotations

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Interview
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History is critical
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Guides subsequent examination for forensic evidence
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Corroborates physical findings
Use open-ended questions - avoid yes and no
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Tell me what happened.
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What happened next?
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Tell me about the bruise on your face.

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Information to include:
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Identifying data
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Date and time of assault
Number of attackers, weapons used, restraints exact threats,
Location of the assault
Position of VICTIM during assault
Sequence of contact and penetration

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Information to include:
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Vaginal/Anal contact
Oral contact
Ejaculation
Injuries inflicted upon SUBJECT
Actions following assault

Step 2 (cont.)
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Pertinent past medical history:
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Last Menstrual Period (LMP)
Last consensual sexual contact (identify partner)
Medication use
Alcohol and drug use by SUBJECT and VICTIM

Step 3
Clothing/Foreign material
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Seal each bag and label it
One paper bag for each piece of clothing
VICTIM will completely disrobe
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Have a gown ready
Inspect/Photograph
Examine with a Wood lamp

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Camera Photography of trauma
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Macro ability
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Use in same plane of injury

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Use of Wood lamp
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Fluoresces semen stains
Augment marks and pattern injuries
Detect saliva and vaginal fluid

Step 4
Debris Collection
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Collect any debris detected, i.e. clumps in hair, grass on body, etc.
Collect any swabs taken from dried secretions

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Collect scrapings from underneath the victim’s fingernails
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Useful if the victim fought off the offender
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Recommended to collect even if no report of having fought back

Step 5
Pubic Hair Combings
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Combed to collect any debris
Paper is placed beneath victim

Step 6
Pulled/cut pubic hairs
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Purpose is to serve as control
Recommended by some law enforcement agencies

Step 7
Vaginal swabs/smears
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Inspect/Photograph
Colposcopy
Toluidine Blue dye application
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Completed before speculum insertion

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Colposcope photography
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External genitalia
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Injuries
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External internal anal
Toluidine Blue dye (injury enhancement)
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Apply last
Repeat injury pictures

Step 8
Rectal swabs/smears
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Anus should be visualized to ensure there is no trauma

Step 9
Oral swabs/smears
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Non-invasive procedure, always collect

Step 10
Pulled/cut head hairs
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Minimum of 5 fulllength hairs from each section: center, front, back, left and right sides

Step 11
Known Blood Samples
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In addition to collecting blood for
DNA comparison, blood may be collected for toxicological analysis

Step 12
Anatomical Drawings
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Document location of all injuries
Narrative descriptions should corroborate documentation

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Pre-testing is not advised, results may be admissible in court
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STD cultures are not part of forensic exam
Treatment Protocols
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Vary from program to program
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Not 100% effective
Give information on how and when to follow-up for care and STD testing
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Signs and symptoms to report

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CDC Recommendation
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Ceftriaxone 125 mg IM in a single dose
PLUS
Metronidazole 2 g orally in a single dose
PLUS
Azithromycin 1 g orally in a single dose
OR
Doxycycline 100 mg orally twice a day for 7 days

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Refer to counseling
HIV and HBV testing are recommended and are available free of charge at appropriate locations
All patients should be urged to follow-up with testing if symptoms develop

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This is prevention not pregnancy termination
Emergency contraception used to prevent pregnancy following unprotected intercourse

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Should be given within 72 hours of assault for effective prophylaxis
Medication given in two doses 12 hours apart
Should be advised to follow up if regular periods do not resume
Instruct patient to contact ER if any severe side effects
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Common
Dangerous

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Victim should follow up with medical provider if anything just doesn’t “seem right”
Follow up information for counseling services
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SARC/Victim Advocate

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After patient has left
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Write report
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DOCUMENT, DOCUMENT, DOCUMENT
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Do not draw legal conclusions
Allow specimens to dry
Give evidence to investigator
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Proper chain of custody

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Patient is the Crime Scene
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“Evaluation must be documented…for possible use in future legal actions”
“Consequence to patient, accused, hospital and provider may result from a failure to do so”
(Smock ,2006)

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http://www.brooksidepress.org/Products/Military_
OBGYN/Textbook/Assault/Assault.htm
http://www.cdc.gov/std/treatment/2006/sexualassault.htm
http://www.safeta.org/ http://www.sapr.mil/
Distress and Pain During Pelvic Examinations:
Effect of Sexual Violence. Obstetrics &
Gynecology. 112(6):1343-1350, December 2008.
Olshaker, J., Jackson, C., Smock, W. Forensic
Emergency Medicine (2 nd ed). Lippincott, Williams
& Wilkins. Philadephia, PA 2006.