Assault



Management of assault victims

  • Victims of various violent and/or sexual crimes may attend Emergency Departments for treatment
  • Young children may be brought up to the department as the result of alleged child abuse
  • Sexual abuse should be considered as a possible component of the non-accidental injury syndrome.
  • Accurate description of injuries using body maps and recorded injuries where possible
  • Balance
    • Need competent medical treatment for the victim
    • Personal, legal and social needs to investigate the crime, detect the perpetrator and prevent further offences
    • Garda duties - meticulous attention to detail in the collection, retention, recording and presentation of evidence
  • Victim after-care is an important duty of the medical and nursing attendants

For most victims the foremost consideration is the need for treatment. No process, legal, social or otherwise, should be allowed to get in the way of this. However, there may be circumstances where hospital staff may be involved with information and samples which become important in a subsequent Garda enquiry, particularly if the patient should die and the crime become one of murder. Staff should be aware of the evidential needs, therefore, and ensure that their actions do not inadvertently or deliberately obstruct any criminal investigation.

National Helpline for victims of crime

The National Helpline www.crimevictimshelpline.ie provides information and support to victims of crime.

Available includes information on:

  • The Criminal Justice system
  • Criminal Injuries Compensation Tribunal#
  • Local & specialist services available to victims of crime.

The helpline also offers invaluable emotional support by telephone.  If requested they will liaise with the Gardaí and other services on behalf of callers.

Further information at: info@crimevictimshelpline.ie.


When should the Gardaí be involved ?

There is no problem if victims clearly do or do not wish the Gardaí to be involved.

  1. If the patient requests garda involvement then the local garda duty room should be notified without delay
  2. For sexual assaults this action is likely to result in two immediate sequelae.
  3. The mobilisation of a special Garda sexual offences unit. Most forces now employ specially skilled, non-uniformed ban Gardaí who have received specific training in the care of victims of sexual offences. They are particularly experienced in all the problems of rape.
  4. The involvement of the duty Garda surgeon. The Garda surgeon is a medical practitioner who will be trained and skilled in the subject of clinical forensic medicine. The Garda surgeon is not employed by the Gardaí, but is retained as an independent advisor in matters of medical evidence. The doctor is not 'on the Gardaí's side'. S/He will be the person who would normally carry out the forensic medical examination and obtain the necessary evidential samples.
  5. The fact that the Garda surgeon has been summoned does not absolve the ED staff from their normal duties of patient care.
  6. Where the victim states, categorically, that S/he does not wish the Gardaí to be involved there is no dilemma. 'A doctor should preserve secrecy on all he has learned about his patient in the course of his professional duties'.
  7. Injury where the victim dies, in which case all the evidential material becomes the property of the coroner.

Consent

Consent for emergency medical treatment is usually implied. Consent for the examination; for the acquisition of specimens for evidence and for retention of the patient's property for forensic analysis should be fully informed and obtained in writing. The victim should also understand that a comprehensive medical report, occasionally containing intimate details, may be required for the judiciary.

Consent for the examination of a juvenile, especially in cases of child sexual abuse, should be obtained according to the locally agreed Non-Accidental Injury Procedure. Where the alleged perpetrator of the crime is the nearest adult, then another family member might be required to give consent or, failing this, the Social Services Department may have to apply for a care order and/or a Wardship of Court, in which case the legal guardian will be the consentee.

Consent forms CUH

Where possible, patient in CUH should be informed about relevant procedures and the relevant admission consent form, consent for a photograph to be taken, consent for surgery and consent for tissue retention.


Forensic evidence.

Modern forensic science is based on the concept, known as Locard's Principle, that every contact leaves a trace. In assaults this contact trace material may be in the form of:

  • loose debris (textile fibres, hairs, fragments of paint, glass and metal)
  • powder (gun-shot residues) or
  • stains of body materials (blood, semen, saliva, faeces, urine and vomit)

The contact trace material may be on the victim's clothing, hair or skin, be deposited in a body orifice or be left in a wound. It is important to retrieve this contact trace material as soon as possible as it may disappear or be removed and discarded in ignorance. Any debris which falls from the person's clothing or body is also important and should be retrieved.

The preservation of contact material: the description and interpretation of wounds, injuries and wounding instruments and the acquisition of body fluids (blood and/or urine samples for alcohol analysis, drugs assay and serological typing) will normally be the responsibility of the attending garda surgeon (national policy). For sexual offences many garda forces employ a sealed 'sexual offences kit' for the use of the garda surgeon containing the appropriate specimen tubes and examination materials. Spares of these, together with the accompanying forensic laboratory check-list 'sexual offenders form' could well be held in the Emergency Department.


Urgent considerations

There are rarely occasions when consideration of the evidence should take precedence over the treatment of the patient. However:

  • When cutting off or removing clothing during a resuscitation procedure hospital staff should avoid cutting through damaged areas such as stab holes and bullet holes.
  • When the patient is to be cross-matched for blood transfusion, a separate pre-transfusion blood sample should be retained as a control sample for the forensic science department.

Preservation of clothing

Where the victim of a serious assault and/or sexual abuse has to be undressed - if conscious he or she should stand on a piece of clean brown paper whilst stripping and each garment packed up separately into a brown paper bag. If unconscious the paper couch liner should be retained also. Wet or bloodstained garments should not be put into a plastic bag as this will lead to decomposition rendering forensic analysis very difficult.

Continuity of evidence

It is important in criminal investigations to be able to establish who first took possession of items of evidential value and to trace their subsequent chain of possession and storage, until they are made a court exhibit. All items have to be packed and sealed and a court exhibits label is affixed to show details of from whom or where the sample came, when and by whom they were taken and who has subsequently handled them.

National Helpline
for victims of crime

The National Helpline www.crimevictimshelpline.ie provides information and support to victims of crime.  

Available includes information on:

  • The Criminal Justice system
  • Criminal Injuries Compensation Tribunal#
  • Local and specialist services available to victims of crime.

The helpline also offers invaluable emotional support by telephone.  If requested they will liaise with the Gardaí and other services on behalf of callers.
 
Further information at: info@crimevictimshelpline.ie.

After care

The care of victims should not be confined to the treatment provided in the Emergency Department. Staff should consult to decide who is going to act as the liaison to ensure appropriate follow-up and after-care.

Normally this will be the General Practitioner's role but occasionally other agencies are involved, e.g. hospital specialists such as gynaecologists and paediatricians; community services such as family planning clinics and local venerology departments; social services agencies and voluntary agencies such as rape crisis 'help lines' and victim support schemes. Communication between caring agencies within the constraints of ethics and confidentiality is an important consideration.


Content by Dr Íomhar O' Sullivan 03/03/2004. Reviewed by Dr ÍOS 10/02/05, 03/03/2006, 23/05/2006, 28/05/2007, 14/08/2009.