Rape

A man, woman or a child may be brought or come to the ED alleging rape or indecent assault. It can be one of the most difficult emergencies to manage because of the physical, psychological and legal implications. Responsibility should be shared as quickly as possible with Gynaecology staff, or the Gardaí if the patient consents. The our role in the ED is dealing with:-

• Injuries or conditions requiring immediate attention
• The psychological emergency
• Preserving/recording evidence

It is the responsibility of the health professional to which they present to evaluate risk of pregnancy and either to prescribe emergency contraception or to ensure appropriate management.

The Gardaí should be involved as early as possible with the patient's consent. It is also important that a garda doctor is involved at the earliest opportunity so that important evidence is not inadvertently destroyed or overlooked. The Gardaí and their designated doctor will then involve care and follow up through the Sexual Assault Unit at the South Infirmary/Victoria Hospital.

If the person does not want the Gardaí to be involved

• Address any immediate concerns
• Note exact time of examination
• Note general state and demeanour of the patient
• Note whether there is a smell of alcohol
• Note the state of clothing and make-up
• Note any bruises, scratches or other injuries. It is wise to make a full general physical examination
• Engage the advice of the social worker
• Involve the patient's GP
• Do not attempt any form of pelvic examination
• The patient may later wish to report the matter to the Gardaí after the shock of the crisis, so it is important that evidence should be available if required later
• Offer CDU admission, as a "haven" to allow recovery
• Assess wish/need for referral for further assessment and screening particularly for sexually transmitted infections and counselling
• All victims should be referred to the Sexual Assault Treatment unit at the SIVUH

HIV prophylaxis.

In the unlikely event of a patient presenting early enough and giving a clear history of an assailant known to be HIV then clinical management should be implemented according to post exposure prophylaxis guidelines after discussion with a senior doctor.