Responders must consider the possibility that drugs and/or alcohol may have been used to facilitate an assault. They must know how to screen for suspected alcohol and drug-facilitated sexual assault, obtain informed consent of patients for testing, and collect toxicology samples when appropriate. (SEE PAGES 114-118) Recommendations for jurisdictions and responders to facilitate response in suspected alcohol- or drugfacilitated sexual assault: • Promote training and develop jurisdictional policies. • Plan response to voluntary use of drugs and/or alcohol by patients. • Be clear about the circumstances in which toxicology testing may be indicated. Routine testing is not recommended. • Toxicology testing procedures should be explained to patients. • Toxicology samples should be collected as soon as possible after a suspected drug-facilitated case is identified and informed consent is obtained, even if patients are undecided about reporting to law enforcement. • Identify toxicology laboratories. • Preserve evidence and maintain the chain of custody. 8. Sexually transmitted infection (STI) evaluation and care: Because contracting an STI from an assailant is of significant concern to patients, it should be addressed during the exam. (SEE PAGES 119-124) Recommendations for health care providers to facilitate STI evaluation and care: • Offer patients information in a language they understand. • Consider the need for STI testing on an individual basis. • Encourage patients to accept prophylaxis against STIs if indicated. • Encourage follow-up STI exams, testing, immunizations, counseling, and treatment as directed. • Address concerns about HIV infection. 9. Pregnancy risk evaluation and care: Patients may fear becoming pregnant as a result of an assault. Health care providers must address this issue according to facility and jurisdictional policy. (SEE PAGEs 125-126) Recommendations for health care providers to facilitate pregnancy evaluation and care: • Discuss the probability of pregnancy with patients who have reproductive capability. • Administer a pregnancy test for all patients with reproductive capability (with their consent). • Discuss treatment options with patients in their preferred language. A victim of sexual assault should be offered prophylaxis for pregnancy, subject to informed consent and consistent with current treatment guidelines. Conscience statutes will continue to protect health care providers who have moral or religious objections to providing certain forms of contraception. In a case in which a provider refuses to offer certain forms of contraception for moral or religious reasons, victims of sexual assault must receive information on how to access these services in a timely fashion. 11 10. Discharge and follow-up: Health care personnel have specific tasks to accomplish before discharging patients, as do advocates and law enforcement representatives (if involved). Responders should coordinate discharge and follow-up activities as much as possible to reduce repetition and avoid overwhelming patients. (SEE PAGES 129-131) Recommendations to facilitate discharge and follow-up: • Address issues related to medical discharge and follow-up care. • Advocates, law enforcement representatives, and other involved responders can coordinate with health care providers to discuss a range of other issues with patients prior to discharge. 11. Examiner court appearances: Health care providers conducting the exam should expect to be called on to testify in court as fact and/or expert witnesses. (SEE PAGES 133-135) Recommendations for jurisdictions to maximize the usefulness of examiner testimony in court: • Encourage broad education for examiners on testifying in court. • Promote prompt notification of examiners if there is a need for them to testify in court. • Encourage pretrial preparation of examiners. • Encourage examiners to seek feedback on testimony to improve effectiveness of future court appearances. 12 Introduction Sexual assault is a prevalent crime in our society that has a devastating and long-term impact on individuals from all walks of life. Although an assault can be traumatizing in and of itself, it can result in a range of problems for the victim, such as acute and chronic mental health problems, physical injuries, pregnancy, and sexually transmitted infections (STIs).12 It is essential that communities offer assistance to victims in the immediate aftermath of an assault. Communities must also work to hold offenders accountable for their actions and stop them from committing further sexual violence. Elements of response typically include the following: • Provision of a prompt medical screening exam and treatment, including stabilization and/or referral for medical care for victims as needed; • Collection of evidence from victims and documentation of findings, which may aid investigation and prosecution; • Responding to, documenting, and investigating sexual assault, which generally includes collection of evidence from the scene of the sexual assault, which may lead to charges against suspects and prosecution; • Support, crisis counseling, information and referrals for victims, as well as advocacy to ensure that victims receive appropriate assistance; and • Support and information for victims’ families and friends. This document focuses on elements of immediate response that are the