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At first, you may find it difficult to ask these questions. You may think them to be intrusive or that you are being nosy. However, these kinds of questions should be part of your patient assessment. It may help to explain that questions of this sort are asked of all injured patients and that these questions are part of your protocols. Practice, and learn which ones work best for you.
The series of questions to ask can be easily remembered with the “SAFE” acronym.
S Do you feel SAFE in your relationship? Should I be concerned for your SAFETY?
Are there situations in your relationship where you have felt
A AFRAID?
What happens when you and your partner disagree or ARGUE?
Are your FRIENDS aware that you have been hurt?
F Do your FAMILY members know about the abuse?
Would FAMILY or FRIENDS be able to help or support you?
Do you have a safe place to go in an EMERGENCY?
E If you needed to leave now, do you have an ESCAPE plan? Would you like to talk with an advocate to develop an EMERGENCY safety plan?
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
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