Recent Rape/Sexual Assault: National Guidelines on Referral and Forensic Clinical Examination in Ireland

3rd edition 2014

An Garda Sochna

Psychological Support Services

Sexually Transmitted Infections

Forensic Science

Laboratory

Legal

satu Sexual AssaultTreatment Units

Sexual Assault Treatment Unit

SATU

General Practitioner

Irish Sexual Assault Response Services

Strategic Vision, Working Philosophy and Mission Statement

Strategic VisionWe envisage all agencies working effectively together to provide the optimum response in a manner which reflects the core values of the mission and working philosophy of the National Sexual Assault Response Services.

The strategic vision will be realised by:

Each individual being informed of their options and supported in their decisions.

Engaging in preventing and reducing the incidence of sexual violence.

Continuous quality improvement embedded in all national sexual assault response services.

Education and professional development of the service providers being core to enhancement of service delivery.

Accountability to each person availing of sexual assault services and society as a whole, with each organisation also accountable for their participation in an inter-agency response to sexual violence.

Working PhilosophyThe multi-agency team believe that by understanding and appreciating the particular dynamics and sensitivities involved in responding to sexual violence, we can provide individualised, timely, person-centred services.

An ongoing commitment to the strategic vision and mission is demonstrated by continuous quality improvement and services development, including work on prevention and reduction of sexual violence.

Mission Statement Our mission is to provide a range of specialist multi-agency responses following rape/sexual assault.

These services are delivered in a respectful, non-judgemental and supportive manner by skilled, competent professionals.

The above were developed, through collaborative inter-agency input from all the different agencies, which together make up the Irish Sexual Assault Response Services.

Recent Rape/Sexual Assault: National Guidelines on Referral and Forensic Clinical Examination in Ireland

3rd edition 2014

How to Access and Reference this Document

National SATU Guidelines Development Group. Rape/Sexual Assault: National Guidelines on Referral and Forensic Clinical Examination in Ireland. 3rd edition; 2014. Available at www.hse.ie/satu.

Acknowledgments and Thanks

The Irish SATUs Logo

Following a consultative process with the Staff of the Irish SATUs, Ms. Andrea Mears, developed and donated the Irish SATUs Logo which appears on the front cover of this document. For an explanation of the Logo please see the inside back cover.

Funding

Acknowledgement and thanks to The National Social Inclusion Office, Primary Care Division, Health Service Executive, for partial funding received towards the production of this document.

An Garda Sochna

Psychological Support Services

Sexually Transmitted Infections

Forensic Science

Laboratory

Legal

Sexual Assault Treatment Unit

SATU

General Practitioner

http://www.hse.ie/satu

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National SATU Guidelines Development Group 2014 Group Co-ordinator Ms. Anne McHugh, Project Manager Higher Diploma in Nursing (Sexual Assault Forensic Examination), Health Service Executive/Rotunda Hospital, Parnell Square, Dublin 1. An Garda Sochna Garda Sergeant Marie Daly, Garda Training College, Templemore Co. Tipperary. Inspector Michael Lynch, Blanchardstown Garda Station, Main St, Blanchardstown, Dublin 15. Detective Sergeant Mike Smyth, Domestic Violence Sexual Assault Investigation Unit (DV-SAIU), National Bureau of Criminal Investigation, Harcourt St, Dublin 2.

Forensic Science Ireland Ms. Marce Lee-Gorman, Forensic Scientist, Forensic Science Ireland, Garda Headquarters Phoenix Park, Dublin 7.

General Practice Dr. Kieran Kennedy, General Practitioner, Lecturer in Clinical Practice (NUI Galway) and Forensic Medical Examiner (Child, Adolescent and Adult Sexual Assault), Sexual Assault Treatment Unit, Hazelwood House, Parkmore Road, Galway.

Medical Dr. Maeve Eogan, Obstetrics and Gynaecology Consultant, Medical Director, National SATU Services, Rotunda Hospital, Parnell Square, Dublin 1.

Dr. Roswitha Junold-Martin, Forensic Medical Examiner, Sexual Assault Treatment Unit, Midlands Regional Hospital, Mullingar, Co. Westmeath.

Midwifery/Nursing Ms. Deirdra Richardson, Clinical Midwife Specialist (Sexual Assault Forensic Examination), Sexual Assault Treatment Unit, Rotunda Hospital, Parnell Square, Dublin 1.

Ms. Aideen Walsh, Clinical Nurse Specialist (Sexual Assault Forensic Examination), Sexual Assault Treatment Unit, Rotunda Hospital, Parnell Square, Dublin 1.

Office of the Director of Public Prosecutions (ODPP) Ms. Kate Mulkerrins, Head of the Prosecution Policy & Research Unit, Office of the Director of Public Prosecutions, Infirmary Road, Dublin 7.

Rape Crisis Network Ireland (RCNI) & Dublin Rape Crisis Centre (DRCC) Ms. Angela McCarthy, DRCC, Head of Clinical Services, 70 Lower Leeson St., Dublin 2.

Dr. Susan Miner, Services Support Co-ordinator, RCNI, 1st Floor, 4 Prospect Hill, Galway.

Sexually Transmitted Infections Personnel: Dr. Grainne Courtney, Associate Specialist in Genitourinary Medicine, GUIDE Clinic, St. James Hospital, Dublin 8.

Dr. Andrea Holmes, Medical Director, Sexual Assault Treatment Unit, Hazelwood House, Parkmore Rd. Galway.

Dr. Fiona Lyons, Associate Consultant in Genitourinary Medicine, GUIDE Clinic, St. James Hospital, Dublin 8.

Acknowledgement of Contributions Many different agencies and individuals gave of their time, knowledge and expertise during the formation of this document and the National SATU Guidelines Development Group thank them all for their invaluable collective and individual contributions.

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CONTENTS PageIntroduction 10

Using the Guidelines 12

Response to a History of Rape/Sexual Assault 13

Considerations for Referral of Younger Persons to Services 15

Sexual Assault Treatment Units 16

Psychological Support 24/7 Contact 16

Preservation of Forensic Evidence 17

Section 1: AN GARDA SOCHNA 19

1:1 Role of An Garda Sochna. 20

1:2 Initial Actions on Receipt of a Complaint. 21

1:3 Interviewing the Complainant. 23

1:4 Specialist Victim Interviewers and Dedicated Interview Suites. 24

1:5 Early Evidence Kits - Oral or Drugs/Alcohol Facilitated Rape/Sexual Assault. 25

1:6 Continuity of Evidence. 27

1:7 Collection of Clothing from the Complainant. 28

1:8 Transfer and Storage of the Completed Kits. 29

1:9 Collection and Storage of Forensic Evidence Without Immediate Reporting to An Garda Sochna - See Section 2:21. p. 100 30

Section 2: SEXUAL ASSAULT TREATMENT UNIT (SATU) 31

2. Sexual Assault Treatment Units. 36

2:1 Pre-requisites for all SATU Staff. 36

2:1.1 On-going Commitment to SATU. 36

2:2 Forensic Clinical Examiner Role. 37

2:3 SATU Support Staff. 38

2.4 Evaluation of Patients with Serious Injury. 41

2:5 Consent to Forensic Clinical Examination. 44

2:5.1 Special Considerations Regarding Consent. 45

2:5.2 Capacity. 46

2:5.3 Patient with Serious Injury/Unconscious Patient. 48

2:5.4 Intoxicated Patients. 48

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2:5.5 Communication Difficulties and Informed Consent. 49

2:5.6 Use of Interpreters. 49

2:5.7 Deaf/Hard of Hearing. 50

2:5.8 Blind or Vision Impaired Patients. 51

2:5.9 Patients with Disabilities. 51

2:5.10 Patients with Intellectual Disabilities. 52

2:5.11 Patients with Mental Health Conditions/Disorders. 52

2:5.12 Ward of Court. 52

2:5.13 Refusal of a Forensic Clinical Examination. 53

2:6 Forensic Clinical Examination. 56

2:6.1 History Taking. 56

2:6.2 General History. 58

2:6.3 Forensic History. 58

2:6.4 Prior to Commencing a Forensic Clinical Examination. 60

2:6.5 Collection of Clothing. 60

2:6.6 General Physical Examination. 61

2:6.7 Collection of Forensic Samples. 62

2:7 Female External Genitalia 67

2:7.1 Hymen: Definition, Anatomical Variations and Terms. 68

2:7.2 The Vagina: Definition and Descriptive Terms. 69

2:7.3 Anal Canal: Definition and Descriptive Terms. 70

2:8 Male External Genitalia. 70

2:9 Male Patient. 70

2:9.1 Obtaining a History f