armed forces center for child protection child abuse in the er roles and goals
TRANSCRIPT
Armed Forces Center for Child Protection
The SetupThe Setup
The ER Physician or Nurse becomes suspicious of abuse
The ER cannot or does not want to deal with it
The Pediatric Resident is called
Armed Forces Center for Child Protection
Are You Alone?Are You Alone?
Resources Family advocacy Children’s protective services Law enforcement
Consultants Pediatric attending AFCCP
Armed Forces Center for Child Protection
ResourcesResources
Who should you call? Who should come in?
Case match with the goals of the resource
Armed Forces Center for Child Protection
Pediatric Roles and Pediatric Roles and GoalsGoals
Primum non nocere Always hard when abuse is the concern
Treat the injury Return the child to the best home
environment available
Return the child to the best home environment available Determine if there is abuse Identify who or where the abuser is Arrange for the child to be elsewhere
Armed Forces Center for Child Protection
Family Advocacy Roles Family Advocacy Roles and Goalsand Goals
Treat military abused and abuser Substantiate / Unsubstantiate abuse Identify abuser and abused Provide treatment Inform command
(no power without the support of the command)
Armed Forces Center for Child Protection
CPS Roles and GoalsCPS Roles and Goals
Protect children from maltreatment Substantiate / Unsubstantiate abuse Identify abuser and abused Identify ongoing risks to the child Separate high risk children from their abuser Take action to decrease risk over time Re-unify separated families
Armed Forces Center for Child Protection
Law Enforcement Law Enforcement Roles and GoalsRoles and Goals
Maintain public order Detain fleeing families with abused children Controlling disorderly people
Investigate possible crimes for possible prosecution Process rape kits Investigate crime scenes Interviews witnesses / suspects
Armed Forces Center for Child Protection
Back to our heroBack to our heroIn the ERIn the ER
What can you do by yourself? History Physical examination Labs and Radiographs Treat the patient Admit to the hospital
Armed Forces Center for Child Protection
HistoryHistory
Interview each verbal person separately Record the first explanation Press for high level of detail Identify the source of all information Point out inconsistency Record changes and additions
Armed Forces Center for Child Protection
Physical ExaminationPhysical Examination
Complete Not problem oriented Hidden skin surfaces (ears, scalp, palms,
soles, buttocks, genitals) Oral cavity (frenulae, lips, alveolar ridges) Palpate the skeleton Look at the eye grounds Examine genitals (supine and knee chest) Neurological / Abdominal injuries
Armed Forces Center for Child Protection
LaboratoriesLaboratories
? Bleeding involved -- PT, PTT, INR, CBC, Family history vs. Von Willebrand’s panel
Recent or significant trauma -- AST, ALT, Amylase, Urinalysis
Armed Forces Center for Child Protection
RadiographsRadiographs
Under age 2 -- Skeletal survey Altered consciousness plus
unexpected trauma in an infant -- CT scan
Armed Forces Center for Child Protection
The Admission The Admission DecisionDecision
Medical indication to admit Provide a safe environment while
question of abuse and abuser is evaluated
Allows monitored contact with a possibly innocent family
Armed Forces Center for Child Protection
When Do You Need When Do You Need Help?Help?
Abuse in the home Parents uncooperative with
hospitalization Hospital bed unavailable Urgent exam beyond your ability Rape kit
Armed Forces Center for Child Protection
ReportingReporting
UCMJ mandated report to family advocacy
MD, VA, DC law mandated report to appropriate agency Abuse in home -- CPS In the county where the child lives Out of home rape or assault -- Police In the jurisdiction where the crime occurred