WolfmanHarris Posted December 22, 2008 Posted December 22, 2008 I think that's an excellent idea ruff, in principle. This is an area outside my expertise, but I wonder how much training is necessary to adequately prepare someone for that situation and how much of that is practical in EMS education? For example in fourth semester we take a course called "Crisis Management." Part of the course includes abuse and sexual assault, but this is only 2 hours of lecture and a few hours of reading and prep on this in a course that covers topics from critical incident stress to nonviolent crisis intervention. This is obviously not enough to be any sort of expert in this, but I wonder how much is adequate. The problem I see with doing more than familiarization is that it could be enough to be dangerous. Could a provider be given enough training that they get in over their head's by attempting too much "counseling" (that they're not qualified to do) and they can potentially make it worse? A close friend of mine is a sexual assault crisis counselor. She underwent more than a hundred hours of training just to be a volunteer that answers the phone and provides a compassionate ear as well as to help facilitate and encourage access to resources. Her role isn't to provide counseling in any definitive or long term way and she says she sometimes finds herself over her head. I'm not saying we get enough training, I'm just wondering what the best way to approach this might be to ensure that we as health care providers are doing the best for our patients? It's my lack of knowledge about how best to handle these situations (along with my lack of experience) that worries me about treating these patients when/if it happens.
Just Plain Ruff Posted December 22, 2008 Posted December 22, 2008 all my ideas are excellent in principle it seems All I'm saying is that with the 2 hours of rape education that most providers have and maybe the only education that they have is the 2 pages in the paramedic/emt book that anything is better than nothing. I'm not advocating that we train our people to be able to counsel and if a medic takes the training that my suggestion proffers and begins to counsel the victim then that medic is wrong. We are not rape counselors but the education provided can mean the difference between saying the right thing and saying the wrong thing. Each specific rape or sexual assault is different and you take each one on it's own merits but wouldn't it be nice to have the foundation to be able to begin to make the victim feel like someone cares. To make the victim no longer feel like a piece of meat but a person who just underwent a terrifyingly traumatic experience??? I've not dealt with a rape victim in many years and I've not had the education to begin to help these people out but I do know that I can be a ear and shoulder for them to cry on, a sounding board and someone who is absolutely non-judgemental about their ordeal. There are many times that we as providers can either make a positive difference/impression or be the most destructive instrument post rape. My wife was raped in college, a girl who I had romantic intentions with was raped and killed in her apartment one night(they caught the guy and ruled me out as a suspect ha ha) , and I have taken care of a 5 year old rape victim. That is my experience.
DwayneEMTP Posted December 22, 2008 Posted December 22, 2008 A what? :?: In the Springs the jail calls when they have minor wounds or injuries from fights, etc, for a "paramedic clearance" where we go in and make sure it's nothing serious. We can bandage small wounds, transport if we feel it's necessary, or not if we don't. Turns out the dude that attacked this girl tried to hit one of the cops arresting him with a beer bottle and they were offended by that. He was in significant pain, but didn't have, in my opinion, significant injuries, so I left him sit in jail. Dwayne
Dustdevil Posted December 22, 2008 Posted December 22, 2008 ....but before the night was over I was at the jail, inside a cell, doing a paramedic medical clearance on the prick that had allegedly given her pain. Fixed that for ya.
firedoc5 Posted December 22, 2008 Posted December 22, 2008 We had a similar thread several months ago. I forget how many pages there were, but it was many. I think rape is one of the most difficult calls to respond to. No two are alike. It takes a lot of tact and professionalism towards the pt. It's a fine balance of medical treatment and psychiatric, which unfortunately we are rarely trained with enough of. Most of what I picked up through experience on many rape calls. It's something I know to handle, but I can't explain it or teach it. Pretty sorry, huh?
toutdoors Posted December 23, 2008 Posted December 23, 2008 I have only dealt with a couple of rape victims, and each of them were different. I think that it comes down to how you read your patient, and if they feel chatty or not. I agree with others on here in regards to the hugs. I have, and will steer clear of them, for the main reason that I would not want to contaminate her with any trace evidence I may leave on her such as a hair or fiber from my uniform. I would hate to think that I was doing the right thing, only to learn that my act of compassion may one day leave a trace that could be used to cast a shadow of doubt into a jury's mind. A little far fetched I know, but I would hate to take that risk. I think that by explaining everything to the pt, in regards to wrapping her up in a blanket, and even asking her not to pick at her fingers or toss her hair is hopefully part of her healing process that is sure to be long and arduous. I hope that by explaining these things to her, we are letting her know, that we are concerned about her and that we want her to be able to begin to cope with what has happened. For some of these people, it will help them to know that by taking some of these simple precautions, we (EMS, hospital, and even the pt) are helping to preserve evidence that may be collected and hopefully used to help the police identify the attacker, so that this may be one more stepping stone on her path to what some would name recovery.
spenac Posted December 23, 2008 Posted December 23, 2008 every medic and emt should have education on how to deal with Rape victims and other people who have been sexually assaulted. This should be a mandatory requirement. A qualified person from a rape crisis center should be doing the education rather than just a social worker. Rape crisis center where I used to live gave free training to those interested in assisting rape victims. Perhaps there are programs like that out there that could become part of all EMS education programs.
rat115 Posted December 23, 2008 Posted December 23, 2008 It's a difficult set of questions to answer without knowing the exact situation and the mental state of the patient. I would stick to what I need to know as far as Hx goes and as caringly as I can explain to her that there will be people there for her, healthcare staff here to care for her. I wouldn't push for conversation. If she wants to talk, I'll listen and acknowledge her fears and concerns. iMac hit what I'd do on the head to a large extent. I would tell the pt that the extent of conversation was up to her. As for touching, I know that the clothing that the pt is wearing would be examined for DNA so I would have her wrapped in a sheet. I would limit touching anywhere not covered by the sheet. I would explain the reasons for this to her. As for a hug or such, I'd be more than willing to give her a hug, with the sheet in place, to comfort her.
fallout Posted December 23, 2008 Posted December 23, 2008 As a general rule I only touch patients as necessary to do my job. I guess this is a side effect of working where most of my patient population has never heard of a bar of soap. In rape cases I like to keep contact to a minimum to avoid interfering with evidence. I have treated two rape patients. The first could not talk as the result of a TBI. The second was in a catatonic state. She would just stare straight ahead with absolutely no reaction. I was basically talking at her for the entire call. "I am taking your vital signs." or "I am starting an IV now." etc. It felt weird but I have no illusions about being a counselor of any sort. I just speaking in calm voice tones and listen. People will talk if they want to.
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