Beyond the sexual assault: A comprehensive service model for forensic and medical care

Abstract

Background

To describe the characteristics of patients, the elements of medical care, evidence collection and service provision in a forensic medical sexual assault service.

Method

A retrospective observational study of 2329 patients aged from 12 years presenting after sexual assault over an 18-year period.

Results

Most victims were females of reproductive age. Perpetrators were males in 88 % with single assailants in 80.5 % of cases. Reported alcohol and substances consumed were 53.9 % and 14.2 % of cases respectively. Forensic and medical examination was undertaken in 75.1 %, with forensic evidence collected in 72.2 % and forensic photography in 23.2 %. On-site storage of the medical evidence kit occurred in 61.2 % of cases. Healthcare provision included STI screening (79.4 %), and emergency contraception (33.7 %). Delayed presentation after 7 days occurred in 11.4 % of cases, with over 86 % of cases seen within 7 days of the sexual assault. Most consultations (85 %) took under 3 h, 55.4 % of assessments were callouts out of business hours. Support persons attended the examination in 66.2 % of cases.

Conclusions

In a well-resourced setting, both medical and forensic elements of care can and should be provided following sexual assault. However, medical needs must take priority with consideration for the collection of forensic evidence. Some victims present to a medical setting after sexual assault which should minimise barriers to reporting. However, this service should be provided in a DNA minimal clinical space, by forensically trained clinicians ideally in an Emergency Department. Data collection and analysis are critical in auditing for continual service improvement.