Sexual Assault Evidence Collection(Archived)

Sexual assault evidence collection is the process of collecting specimens and documenting injuries of sexual assault victims to be used in a court of law. Forensic examination for evidence collection is performed in emergency departments 90% of the time and 10% in other locations such as urgent care, OBGYN, and primary care offices. Sexual Assault Nurse Examiners (SANEs) often perform evidence collection.  The protocol for evidence collection is as follows: 1. Completion of consent and forms in the Sexual Assault Evidence Collection Kit (SAECK). 2. A thorough history involving recent genital procedures, symptoms since the assault, details of the assault, number of assailants, specific threats, type of penetration, nongenital acts, loss of consciousness, amnesia, and activities after the assault. 3. Control swabs. 4. Toxicologic testing within 72 hours, especially if there is a loss of consciousness, to determine what drugs the patient used or ingested. 5. Blood or saliva swabs for patient’s DNA. 6. Oral swabs/smears if <24 hours since oral penetration. 7. Fingernail scrapings if the patient was able to scratch the perpetrator. 8. Foreign material collection is material that falls off patients when undressing. Collect sheets on the exam table and from an ambulance as evidence may be in the debris. 9. Clothing collection. If cutting clothes off the patient, providers should pay special attention to preserving holes in clothing and stains that would corroborate the use of force against the patient. 10. Examine the full body for injuries, lesions, and secretions. Document with photos when possible. If bite marks are present, swab the area twice. 11. Head-hair combings. 12. Pubic hair combings. 13. For female patients, examine for anogenital injuries in the lithotomy position. Take external genital swabs, vaginal swabs, and perianal swabs. 14. For male patients, examine penile and anal injuries. Take penile swabs, urethral swabs, and anorectal swabs. 15. Complete forms and seal envelopes inside the sexual assault evidence collection kit with specimens. The examiner should go through each step with the patient before performing them and then allow the patient to decline individual steps. The patient must provide written and verbal consent to the forensic exam, and this becomes problematic in the case of minors, elderly patients, and intoxicated patients. The exam's primary focus should be treating injuries before collecting evidence. The evidence collection process could take up to 6 hours by a trained professional. The optimal time frame for a forensic evaluation is within 72 hours of the assault to be able to collect as much DNA evidence as possible. However, a kit can still be useful in gathering evidence after this period, up to 7 days, due to advancements in DNA technology. Only physical and medical treatments are possible after this window of time, or if the patient does not give consent.