Tasty Morsels of EM 079 – #FRCEM Sexual Assault Management

26 Jul

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

Both RCEM 2015 and BASHH 2011 have guidelines on this incredibly tricky subject. Of note the BASHH guidelines have an incredible level of detail that is probably beyond what we need to know.

Define some terms surrounding sexual assault

  • under the Sexual Offences Act 2003 the definition of rape is the non-consensual penetration of vagina, mouth or anus by a penis
  • Sexual assault by penetration is the non-consensual, intentional insertion of an object or part of the body other than the penis into the vagina or anus
  • Intercourse with a child under 13 is rape
  • Age of consent is 16

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When should we give PEPSE in sexual assault

(RCEM acknowledges this is not a straightforward decision)

  • assailant known HIV
  • has risk factors
  • anal rape
  • multiple assailants
  • bleeding

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What type of circumstances might allow us to share confidential patient info with for example the police

(RCEM)

  • Where the victim is a child. Any sexual assault of a child should trigger local safeguarding procedures.
  • Where there are concerns about the welfare of children of the victim.
  • Where the victim lacks capacity and is unlikely to regain capacity.
  • Where guns or knives have been used by the perpetrator.

RCEM Statements summarised as follows

  • Victims should ideally be assessed in a SARC (Sexual Assault Referral Centre)
  • Forensic examinations should only be conducted by those with the right training and performed in the right location
  • Any info that would identify a person should not be shared without consent unless in exceptional circumstances (in particular this includes the Police)
  • There is no requirement for ED clinicians to take blood for the police
  • PEP should be available for all

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