Intimate Partner Violence, Sexual Assault, and Child Maltreatment

1

What patterns should EMS watch for in trying to identify intimate partner violence?

• Mismatch in the explanation of the injury and the reported mechanism, a delay in seeking care, or a pattern of repeated EMS use.

2

What patient symptoms should EMS watch for that can be suggestive of intimate partner violence?

• Bruises in various stages of healing, particularly over nonbony surfaces like the abdomen or trunk, bite marks, abrasions, and defensive injuries over the forearms.

• Pregnant women are at higher risk of being victims of intimate partner violence, with rates as high as 9% of all pregnant women experiencing violence. This number is even higher for single, pregnant women of low social economic status.

3

How should EMS approach a case where intimate partner violence is suspected?

• Prehospital personnel should attempt to build rapport with all involved and normalize separating the patient and the suspected abuser to allow questioning of the victim without the suspected abuser in the same space. This can often be accomplished by saying that some part of the exam needs to be performed privately.

4

I am worried my patient will immediately shut down if I ask about intimate partner violence. How do I bring up the subject?

• Try normalizing the question by saying, “I don’t know if this is a problem for you, but many of my patients are dealing with abusive relationships. Some are too uncomfortable to bring it up themselves, so I’ve started asking routinely.” Framing the question as if it is a question asked of every patient helps break through the stigma associated with intimate partner violence as, frequently, patients are embarrassed to come forward themselves as a feeling of isolation is inherent to the cycle of abuse.

• Remember that EMS is in a unique position to see into the lives of our patients that clinic and hospital staff usually do not get to see. Trust your instincts, and ask regularly.

5

What should I do if I suspect intimate partner violence, but the patient denies that they are being abused?

• Respond with supportive language. Remember that your patient may not be ready to ask for help yet, but your response can be instrumental in building their confidence in healthcare providers for future interactions with the healthcare system.

• Avoid judgmental responses such as “I don’t know why you’d stay in a relationship like that,” as this may further dissuade the patient from asking for help during this and future encounters.

• You may consider discussing local resources anyway by framing intimate partner violence as a common problem that a friend may face.

6

How should I respond when a patient does admit that they are a victim of intimate partner violence?

• Respond with supportive language such as “no one deserves to be treated this way,” “you are not alone,” or “thank you for telling me.”

• Gently encourage transport to the hospital particularly if the patient is unsafe at home, and avoid criticizing their willingness to stay with the partner.

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