It’s not something anyone wants to consider, much less prepare for. But sexual assault threatens women and men of all ages. According to the Rape, Abuse and Incest National Network, someone in the U.S. is sexually assaulted every 98 seconds.
Some, but not all, go to the emergency department (ED), where health care providers will treat, provide counseling and involve law enforcement to support survivors through their healing process.
Many survivors may not know what to do after sexual assault — and what to expect at the ED. We asked Stephen P. Wood, MS, ACNP, an emergency department nurse practitioner at Winchester Hospital in Massachusetts.
1. What Will Doctors Ask When a Victim Comes Into the ED?
We’re first going to ask if they’ve reported this to law enforcement. If they haven’t, we can still collect evidence that can be used at a later time, so they don’t necessarily have to have notified law enforcement. They’re not required to do that, but we strongly encourage they do.
We would also ask them some questions that can be quite personal, like about the type of assault [oral, anal or vaginal, for example], and we’ll also ask when the assault happened, how it happened, and if there were any other injuries or trauma.
2. Will Police Come to the Hospital?
It can depend on many things, including how remote of a location the assault happened. In most cases, where it happens nearby, we’ll ask the victims if they’d like law enforcement to come and speak with them then, or if they’d rather talk to them after they leave the hospital. If there are issues involving a restraining order or anything else they’d want to talk to the authorities about immediately, we’d offer to have the police come in.
3. What Type of Care Is Provided?
It varies depending on the case. But most of the time, we’ll do a medical examination and test them for sexually transmitted infections and offer treatment for gonorrhea, chlamydia, HIV and, for women, pregnancy (which would be Plan B).
We have crisis counselors such as social workers or nurse practitioners who work in mental health. We’ll also offer for patients to speak to an outpatient counselor. Beyond that, we’ll also give them a number of different resources and helplines to call.
4. What’s in a Sexual Assault Kit?
In the state of Massachusetts, we’ll do a sexual assault kit, or a rape kit, at the hospital. It’s for forensic evidence. We’ll get hair and skin samples, blood tests to look at their liver functions and urine samples or swabs, depending on their sex. They can do the rape kit even if they don’t want to prosecute. The kit has multiple parts, so it can take an hour and a half to two hours to collect and process it all.
We do have people who don’t want to do the kit. We’ll talk to them about the importance of doing it to collect evidence, even if they decide not to prosecute right away. That way, they can have the evidence in safekeeping for a couple of years if they change their mind and decide to prosecute someday.
5. Do Sexual Assault Victims Have to Pay for Their ED Visit?
If we’re doing the sexual assault kit, then it’s paid for by the state. If they decline the kit, that cost becomes theirs.
6. Are Doctors Legally Required to Report the Assault?
We’re required to report an incident if it involves a minor. But even if they’re not a minor, there are some cases (like human trafficking) where we may feel that the person faces a significant risk (like homicide or suicide) and would need to contact law enforcement, even if they say no. That happens quite rarely.
7. What Follow-Up Care Happens After a Victim Leaves the ED?
We’ll follow up with their test results, but we strongly encourage patients to see their primary care physician or to follow up with an outpatient clinic. They need to have someone they can see in the weeks and months afterward who is a more permanent physician.
8. If Someone Waits to Go Into the ED for a Few Days or Weeks, Can They Still Come In?
Absolutely. After several days, the forensic data is probably lost, so getting things like hair and skin samples may not be viable. But from a medical standpoint, we still want people to come in because there’s still a chance they were exposed to HIV, hepatitis C or B, gonorrhea, chlamydia or there could be an unwanted pregnancy.
Throughout the physical and emotional trauma, we’re there to help, and law enforcement is too. While it can be emotionally difficult to do the exam and answer so many questions, the information victims give in that moment is so helpful — not only to help them in their time of crisis but also to help others who have experienced it too.
It’s OK to not know what to do after sexual assault. If you need to speak with someone confidentially, call the Department of Psychiatry and Behavioral Medicine at Lahey at 781-744-8013 to make an appointment.