Clinical Notes from the CNIO – October 2024

This month is Domestic Violence Awareness month. As clinicians, we play a critical role in helping the victims of domestic violence, sexual assault and human trafficking receive the care they vitally need. Sometimes, we may be all that stands between someone’s survival and continual abuse.

The numbers are frightening, but every year, more than 12 million people are victims of domestic violence — an average of 24 people per minute. Equally scary are the number of crimes involving human trafficking. In the U.S., sex trafficking is the most common type of trafficking (being the second most profitable illegal industry in the U.S., next to the arms trade, and above illicit drugs) with 49.6 million people in modern slavery worldwide and 12 million of them being children.

This year’s Pathway to Unparalleled sessions included a video highlighting the heroic work of Houston Methodist’s SANE (sexual assault nurse examiner) team. These forensic nurse examiners focus on caring for and supporting victims of sexual and/or physical assault, including domestic violence and human trafficking.

While they’re specially trained to complete a comprehensive medical/forensic examination, SANE team members also collect evidence, including photographs and documented histories, which may be used for expert testimony in a court of law. They’re also trained to provide trauma-informed care and share additional resources that can help these patients for better long-term recovery.

The work of these special nurses is critical, but we all share the responsibility of identifying and reporting these cases. Make sure you’re aware of the warning signs, and contact a supervisor or complete a Forensic Nurse Consult in Epic, if you notice anything suspicious.

Warning signs may include one or more of the following:

• Signs of physical/sexual abuse, medical neglect or torture.

• The patient avoids eye contact and may present as submissive or fearful. They may also be accompanied by someone who doesn’t let them speak.

• Scripted or inconsistent history, a confusing or conflicting story or an unwillingness to answer questions about their injury or illness.

• Vague or unable to share their address or provide a sense of time (like when they arrived or are departing the area).

• Poor physical health, including bruises, malnourishment, STDs, mental health concerns, substance abuse, multiple unwanted pregnancies or vaginal/rectal trauma.

When completing the Forensic Nurse Consult order, provide as many details as possible and notify ED charge nurses that a forensic consult order has been placed. They’ll need to notify the SANE team and a forensic nurse should arrive at the bedside within one hour. Do your best to ensure the patient remains safely in your area until the forensic nurse arrives.

By being aware and remaining alert, we’ll be better prepared to keep our patients, and our community safe.