Emergency Medicine

WOMEN’S MEDICINE CRISES

392 Obstetric and Gynaecological Emergencies

MANAGEMENT

1 Be accompanied by a senior female nurse escort at all times.

2 Record a careful history of exactly what occurred and when, and a descrip-

tion of the assailant.

3 Institute any urgent treatment to save life, e.g. cross-match and starting a

transfusion for haemorrhage.

4 Contact the police and inform the duty government medical officer or police

surgeon. He or she will perform the forensic examination with the patient’s

consent. This is aimed at meticulously collecting ev idence regarding:

(i) Proof of sexual contact.

(ii) Lack of consent.

(iii) Identification of the assailant.

5 Meanwhile, examine the patient for associated injuries, measuring bruises

or lacerations with a ruler. Request informed, written consent to keep all

clothing for later forensic analysis.

(i) Ask the patient to undress on a sheet to collect any debris.

(ii) Wear gloves and wrap each garment in a brown paper bag

fastened with tape and labelled with the patient’s name, the date,

the nature of the sample, and the name of the person taking the

sample.

6 Request a senior gynaecology doctor to perform the examination of the

external genitalia and vagina, only if the duty government medical officer or

police surgeon is unavailable.

7 Check whether the police have been able to arrange for a designated sexual

offences unit to attend (usually non-uniformed female police officers with

special training).

8 Call the duty social worker or give the patient written contact telephone

numbers/addresses if a social worker is not available immediately.

9 Offer admission to the patient if indicated and discuss the following issues:

(i) Post-coital pill to prevent pregnancy.

(ii) Exclusion of a sexually transmitted disease or to provide

prophylactic treatment and follow-up.

(iii) Specialist counselling from various external organizations based

in most regional centres, e.g. rape crisis lines.

10 Provide written aftercare instructions with details of all the tests performed,

treatments provided, and other arrangements made, as the patient’s memory

at t his time of intense stress will not be reliable.