Sexual Assault: Forensic Nursing in the ER


A 10-year-old female presented with her mother to the emergency department. The little girl was in no apparent distress. Her mother claimed that the young girl had been staying overnight with a family friend. During her visit, the man was repeatedly sexually abusing her. She brought her to the emergency room as soon as the patient reported what had happened to her mom.

As an ER nurse, sometimes it is difficult to take complaints like this seriously. Typically with cases similar to this, there is no need to do a rape kit or an extensive interview as the case does not fit the criteria.

The young girl was able to give a consistent history to the nurse, to doctor and also to the state trooper who came to take a statement. This young girl talked about repeated acts of penetration by the perpetrator’s fingers as if this were normal behavior and supposed to happen. She stated that at multiple times, the family friend touched, massaged and inserted his finger inside her.

The doctor determined that he was going to do a visual inspection of the external genitalia. With the doctor on one side of the bed and the RN on the other side of the bed, a visual inspection was done.

After one quick look at the introitus, I proceeded to pull out a rape kit. Despite the fact that I may not be able to gather much evidence, this was the real thing. The entrance into the vaginal area was grossly edematous and erythemic. Multiple contusions were noted to the inner thigh areas.

I gathered vaginal swabs and rectal swabs and processed them for the kit. While continuing to do visual inspection, there happened to be one lone dark hair found directly inside the vaginal vault. This hair was clearly not the patients and should not be present where it was found. The hair was collected, placed into an envelope and labeled accordingly. After the genital exam was complete, I finished the evidence collection of oral swabs, oral scrapings, etc.

Because I took this child seriously and took the time to do the rape kit, this perpetrator was caught and convicted. It makes me shudder to think that if the rape kit and extensive genital exam had not be done, this child may continue to be violated by a person that was once considered a friend. In addition, the perpetrator may never have been caught and could have potentially violated other children as well.

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