accomplished if it is built into multidisciplinary coordination planning. For example, involved agencies can together determine how to utilize existing resources, seek new funding, maintain victims’ privacy, and systematically obtain data. Jurisdictions considering such databases should take into consideration the fact that pooling empirical data (such as patient age, Zip Code, or use of a weapon) is likely to be reliable while use of pooled interpretive data(such as blunt cervical trauma or findings of strangulations) is risky and may be unreliable because of uncontrollable variables in examiner training and experience. 36 Bulleted section partially adapted from the County of San Diego Sexual Assault Response Team Systems Review Committee Report: Five-Year Review, 2005, San Diego County, California. http://www.sdcounty.ca.gov/hhsa/programs/phs/documents/EMS-SARTReportJuly2005.pdf. 28 29 2. Victim-Centered Care Recommendations at a glance for health care providers and other responders to facilitate victim-centered care during the exam process: • Give sexual assault patients priority as emergency cases. • Provide the necessary means to ensure patient privacy. • Adapt the exam process as needed to address the unique needs and circumstances of each patient. • Develop culturally responsive care and be aware of issues commonly faced by victims from specific populations. • Recognize the importance of victim services within the exam process. • Accommodate patients’ requests to have a relative, friend, or other personal support person (e.g., religious -and spiritual counselor/advisor/healer) present during the exam, unless considered harmful by responders. • Accommodate patients’ requests for responders of a specific gender throughout the exam as much as possible. • Prior to starting the exam and conducting each procedure, explain to patients in a language the patients understand what is entailed and its purpose. • Assess and respect patients’ priorities. • Integrate medical and evidentiary procedures where possible. • Address patients’ safety during the exam. • Provide information that is easy for patients to understand, in the patient’s language, and that can be reviewed at their convenience. • Address physical comfort needs of patients prior to discharge. It is critical to respond to individuals disclosing sexual assault in a timely, appropriate, sensitive, and respectful way.37 Every action taken by responders during the exam process should be useful in facilitating patient care and healing and/or the investigation (if the case was reported). Give sexual assault patients priority as emergency cases. This includes a prompt medical screening exam. Recognize that every minute patients spend waiting to be examined may cause loss of evidence and undue trauma. Individuals disclosing a recent sexual assault should be quickly transported to the exam site, promptly evaluated, treated for serious injuries, and offered a medical forensic exam. (For more discussion on this topic, see C.2. Triage and Intake.) Have plans for what to do, if the examiner is not available right away. For example, is there a quiet, private place the patient can wait? Is there a phone available so the patient can talk to an advocate or a friend or family member while waiting? Jurisdictions should consider policies and training for facility staff and administration regarding what to do while sexual assault patients are waiting. Provide the necessary means to ensure patient privacy. Exercise discretion to avoid the embarrassment for individuals of being identified in a public setting as a sexual assault victim. Some health care facilities use code plans to avoid inappropriate references by staff to sexual assault cases. Also, do not leave sexual assault patients in the main waiting area at the exam site. Instead, give them as much privacy as possible (e.g., a private treatment room and waiting area) and be cognizant of their sense of safety (e.g., do not examine suspects in same location at the same time). Make sure that the first responding health care providers attend to patients’ initial medical needs and arrange for an on-call advocate to offer onsite support, crisis intervention, and advocacy. It may be useful to give patients the option of speaking with an advocate via a 24-hour crisis hotline (if one exists) until an advocate arrives. Health care providers should provide patients with access to a phone to contact family members and/or support persons as desired, and should promptly contact law enforcement, if not already involved, if patients want to report the assault. 37 The chapter was partially built on information from the North Carolina Protocol for Assisting Sexual Assault Victims, 2000. 30 Health care providers should explain, in a language the patients understand, the scope of confidentiality during the exam process and during communication with advocates. (For information on this topic, see A.4. Confidentiality.) Adapt the exam process as needed to address the unique needs and circumstances of each patient. Patients’ experiences during the crime and the exam process, as well as their post-assault needs, may be affected by multiple factors, such as: • Age. • Gender and/or perceived gender identity/gender expression. • Physical health history and current status. • Mental health history and current status. • Disability. •