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ASSESSMENT OF INJURIES
Accurate and thorough assessment is the first step in establishing a trusting relationship with the victim of domestic violence. The assessment process is the first step in documentation of the injuries. Your assessment also allows you to provide information on resources and services available while you determine how lethal the situation is through sensitive questioning. A survivor of domestic violence must be assessed in private, away from the partner. Assessment of injuries in front of the partner endangers the victim. Battering is a crime of silence and the EMS assessment of the injuries threatens the silence. It may help to maintain eye contact with the victim; however, this may be inappropriate for some individuals or cultures. Trust is a necessary component of the assessment: do not badger or push the victim into disclosing what she may not be ready to share. In an environment of privacy and safety, allow the patient to describe her situation. At the same time you are establishing trust, you are responding to the patient’s injuries. Injuries that should raise suspicion of domestic violence include those that follow a certain pattern to the face, chest, or abdomen. Perpetrators often, quite knowingly, strike areas of the body that are covered by clothing. Other suspect injuries include bruises or fractures to the forearm, suggesting a defensive posture. Be suspicious of isolated bruises to the abdomen or a “blowout” fracture of the face, especially if attributed to running into household furniture. A blowout fracture, which involves a fracture of the fragile bone under the eye, typically indicates a direct blow to the face.
Documented studies of domestic violence generally report the following physical sites and percentages of injuries:
33% Face and neck
16% Arms
14.5% Head
12% Back and buttocks
10% Breasts
5.5% Abdomen (Increases during pregnancy)
4% Genital
Another important aspect of injuries from domestic violence refers to victims who are repeatedly abused. Keeping this in mind, you may encounter injuries in different stages of healing. It may help to review how to estimate the age of a bruise:
COLOR AGE
Red to Reddish Blue Less than 24 hours
Dark Purple/Dark Blue 1 to 4 days
Greenish/Yellow Green 5 to 7 days
Normal tint/Disappearing 1 to 3 weeks
DOCUMENTATION
Throughout the delivery of medical care, EMS personnel need to be sensitive to preserving or documenting evidence that may be used in bringing charges against a perpetrator. Successful prosecution of the case depends to a great extent on the quantity and quality of evidence gathered at the crime scene. Well-documented cases are more likely to be pursued by public prosecutors and are more likely to result in appropriate legal actions against the offender. Besides the obvious evidence of medical and police reports, documentation includes descriptions of damage to the house and statements from witnesses who heard or saw the abuse. If law enforcement has been called to the scene, the information in the EMS medical form supports the police documentation. If, however, EMS is called to a scene without police being present -- for example, if the victim is denying or minimizing the injuries as a result of domestic violence -- then the documentation collected by EMS is especially critical in supporting a future charge. The documentation you put in your report may be the most important piece of information when it comes time to support charges of domestic violence. Your report could be used in criminal prosecution, and you could be subpoenaed as a witness. Make sure you document details when responding to a known or suspected domestic violence call. Specifically, document inconsistencies between the victim’s injuries and the history or description of mechanism of injury. Provide descriptive detail of injuries. If, for example, a bruise to the face has the imprint of a hand and fingers, make note of this. Also of note are the conditions of the residence, including broken furniture, holes in walls or doors, disarray, or broken glass. Make note of comments from the suspected perpetrator or the demeanor.
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