News (2013)

The United States Department of Justice updated the National Protocol for Sexual Assault Medical Forensic Examinations (SAFE protocol), taking a coordinated, victim-centered approach to caring for these patients in the emergency department. The updated guidelines provide suggested practices rather than a list of requirements for jurisdictions to follow, reflecting significant forensic medical advancements since the original protocol was published in 2004. This updated edition aims to reflect current technological developments and to improve the criminal justice system's response to victims of sexual assault. The guidelines help health care professionals address victims' health concerns, minimize trauma, promote healing, and maximize the preservation of evidence for potential use in the judicial system. The DOJ said the protocol is built on the belief that it is possible to address the health needs of victims while efficiently collecting evidence that can help bring perpetrators to justice. It calls for an increase in the quality level of care and for minimizing delays and loss of evidence while also addressing patients' needs. “It is quite comprehensive,” said Cameron Crandall, MD, PhD, a professor and the vice chair for research in emergency medicine at the University of New Mexico. “The most recent version certainly addresses the most pressing issues in sexual assault care. It's important to have some consistency across the country so that individuals will get a consistent quality and type of care, and it is important to inform doctors of what the standard of care is in these situations.” The revised SAFE protocol emphasizes a timely, appropriate, and respectful response to victims. Recommendations are provided for necessary measures to be taken in ensuring patient privacy and adapting the exam to address the specific needs and circumstances of each patient. It also reflects knowledge learned since implementation of the Violence Against Women Act of 2005, specifically that the best way to stop violence is to hold offenders accountable. Sensitive yet thorough evidence collection is promoted by the SAFE protocol to help improve criminal justice response to sexual assault. Better evidence collection often results in significantly higher prosecution rates, convictions, and guilty-pleas, according to the DOJ. The updated protocol provides recommendations for conducting efficient, high-quality exams while being sensitive and dignified and reducing trauma for victims.Part of the system is recognizing and promoting a victim-centered reporting process. The protocol explains that patients must be told that they make the decision to report sexual assault to law enforcement, except in situations covered by mandatory reporting laws, but even in those cases, it says health care professionals should tell patients they are not obligated to talk with law enforcement officials. Advocates, forensic scientists, law enforcement representatives, and other responders have a direct impact on sexual assault and rape victims' medical examination process. Many sexual assault victims choose not to seek medical attention; 54 percent never report their attack to law enforcement, the DOJ reported. The protocol also includes increased information on drug- and alcohol-related sexual assault, pregnancy, confidentiality, and demographics with specific needs, such as patients with limited English proficiency; lesbian, gay, bisexual, or transgender victims; and victims in specific cultural groups, the military, and with disabilities. “The original also did not address issues such as emergency contraception,” Dr. Crandall added. “Physicians and residents need to read the protocol. These cases are very challenging. They need to understand the details of the protocol. They need to understand the best practices so they can help their patients become well, as they would in any other circumstance.” This national protocol was created by the Office of Violence Against Women in accordance with the Violence Against Women Act. Many of the revisions from the original are based on recommendations made by consulted experts, including forensic nurses, doctors, prosecutors, law enforcement, advocates, civil attorneys, and the National Institute of Justice, while other changes are based on research. Read the complete SAFE protocol at http://1.usa.gov/ZPrwTR.