Sexual Assault & ED Patients

1. Sexual Assault & ED patients
SARC respectfully acknowledges the Traditional Custodians of this land and we pay our respects to Elders, past and present.

2. Copyright / Disclaimer
© Department of Health, State of Western Australia (2014)
Copyright to this material produced by the Western Australian Department of Health (DoH) belongs to the
State of Western Australia, under the provisions of the Copyright Act 1968 (Commonwealth Australia).
No part of this material may be used or reproduced by any person, either within, or external to, the
Department of Health without written permission of the Sexual Assault Resource Centre (SARC),
Western Australian Department of Health. SARC is under no obligation to grant this permission.
Please acknowledge the WA Department of Health when quoting material from this source.
Important Disclaimer:
All information and content in this material is provided in good faith by the WA Department of Health, and
is based on sources believed to be reliable and accurate at the time of development. The State of
Western Australia, the WA Department of Health and their respective officers, employees and agents, do
not accept legal liability or responsibility for the material, or any consequences arising from its use.

3. SARC
Dr Helga Weaving

4. Prevalence

5. Statistics
► Higher rates of sexual assault for females than males,
irrespective of age.
► 45% of women sexually assaulted since the age of 15 had
experienced more than one incident.
► Females 15 - 19yo: most at risk of being sexually assaulted,
(over 4x higher than overall female rate), least likely to report it.
► Aboriginal women experience higher rates of sexual assault (2 -
4 times higher ABS study 2006).
► Reported sexual assaults in Australia increased by 51%
between 1995 & 2007 at an average of 4% each year.

6. Strong links
Sexual abuse &
assault
Alcohol & drug issues
Mental health issues

7. SARC: demographics
 Between 320-370 emergency cases per year
 95% female, 5 % male
 Approx 60% are under 24 years old
 8-12% clients are Aboriginal
 15-20% current or ex-partner is alleged
assailant
 80% assailants known to the complainant
 Approx 60% involve the police initially

8. SARC
 Based at KEMH in Subiaco
 Provide advice to calls from the whole of WA
 Provide assessment for metropolitan patients
 Receive referrals from Police, hospitals, agencies, GPs, friends,
relatives or patient.
 SARC 13 years +, <13 year: CPU, 13-15 years either
 Patients presenting following a recent sexual assault are seen
together by a doctor and counsellor
 Counsellor to speak with the patient for a phone assessment
 Can contact the on call Doctor via switchboard (local/KEMH)
 Counsellor contact via MEHRL

9. Definition of Sexual Assault
WA Criminal Code
• Sexual penetration without consent
• Aggravated sexual penetration without consent
•
‘Aggravated’ can include: causing injury; using a weapon;
detaining the complainant; the complainant’s age; if the
complainant had a disability .
• Indecent assault
• Aggravated indecent assault
• Consent freely and voluntarily given without force or threat

10. Consent
What divides legal from illegal sexual interaction
Legal age of sexual consent in WA is 16 years
A “free agreement” – which cannot be given if
intoxicated, frightened, asleep, unconscious,
forced or coerced, don’t understand what is
happening
Can be withdrawn at any time

11. Concerns post sexual assault

12. Concerns post sexual assault
Medical
Forensic
Pyscho-social

13. Mandatory Reporting
 Doctors must report a belief, formed on reasonable grounds in
the course of their work, paid or unpaid, that a child or young
person (under 18 years old) has been the subject of sexual
abuse or is the subject of ongoing sexual abuse on or after
1/1/2009
 Includes circumstances where child or young person (under
18 years old) has less power than the other person, and
where there is a significant disparity in developmental function
or maturity
Free phone: 1800 708 704
www.mandatoryreporting.dcp.wa.gov.au

14. Medical
Triage form
Triage: open/not open presentation

15. Injuries
Injuries / hospital setting
• Prioritise injury management
• Acute medical issues take priority over forensic
concerns
• Moderate (5%) to severe (1%) general physical
injury such as head injuries, strangulation,
fractures and widespread soft tissue injury.
• Likelihood of genital injury in pre-pubertal girls and
post-menopausal women – otherwise significant
injury is uncommon.

16. Medical
• Injuries
• STI
• Pregnancy prophylaxis
• Follow-up

17. Forensic: DNA persitence
• In the mouth
• 6 hours usually
• Up to 24 hours possibly
• Effected by oral intake
• In the vagina
• Up to 24 hours usually
• Up to 3 days is likely
• 5 to 10 days possibly
• In the anal canal
• Up to 24 hours
• Up to 48 hours possibly
• Affected by bowel actions
• On skin
• Only require 46 cells to ID DNA
• Up to first shower

18. Forensic
Within 2 weeks
 Collection and storage of specimens and
clothing (swabs, scrapings, debris, photos)
 Injury documentation
 Reports, expert witness testimony
 Provision of information, advice and forensic
kits to regional centres

19. Forensic exam may still be worthwhile even if:
► the person has showered, bathed or been for a swim
► the person has had consensual sex with another
person before or
after the assault
► the assailant wore a condom
► the complainant doesn’t think the assailant ejaculated
If the complainant is unsure if they want to involve the
Police, forensic samples may be able to be collected and
stored for up to 6 months

20. Forensic
 Early Evidence Forensic Specimens
 DNA contamination
 Clothing
 Toxicology
 Injury Documentation

21. Wee + Wipe

22. DNA Contamination
Awareness of risks
Clean environment

23. Clothing
• Separate bags to prevent contamination
• Paper bags
• Document if clothes stored in a bag
together
• Sometimes a drop sheet is required, but a
SARC doctor will direct about this

24. Toxicology
• Blood - grey top (or x2 purple)
• Urine
• Document time taken and who
collected it from the patient
• Often have to take it when patient
unable to consent

25. Evidence
•Maintain a ‘chain of
evidence’
•Document times and events
•Note down who, what is done,
when and where

26. Injury Documentation

27. Injury Type
Bruise
Abrasion
Laceration
Incised wound
Mixed injuries
(not tenderness, redness, finger-pad
bruising, bite-mark)

28. Abrasions

29. ? Fingerpad Bruising

30. Ageing of Bruises

31. Strangulation

32. Ageing of bruises: Langlois &
Gresham

33. Laceration

34. Mixed injuries

35. Not injuries
Redness – non-specific finding which
may result from infection,
inflammation or trauma
Tenderness - subjective symptom /
complaint of a client / patient rather
an objective sign / finding of a doctor

36. Genital-anal examination
• External and internal (vaginal speculum)
components
• Some people decline an internal
examination
• An internal examination of a female who
had not been previously sexually active
would generally NOT be conducted
• External peri-anal and internal
(proctoscope) components
• Proctoscopic examination is NOT routine
• SARC does not take genital
photography/videography

37. Genital-Anal injuries

38. Pyscho-social
Support
Counselling
Safety
Mental health assessment
Risk of self harm

39. The End
Questions?