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Forensic Examinations of Sexual Assault Victims and Suspects Part 1: Types and Purposes of Evidence

This training module is designed to improve the use of forensic examinations to collect evidence from the bodies and clothing of both victims and suspects during a sexual assault investigation. The module goes beyond simply explaining the procedures that are used during victim and suspect forensic examinations. It also explores the different types of evidence that may be gathered during these examinations and describes how this evidence can be used to advance a sexual assault investigation. It also gives participants an opportunity to apply what is learned through case study activities. Ultimately, the goal of this module is to encourage professionals involved in these cases to push past traditional ways of thinking about evidence, to critically analyze how each piece of information gathered fits into the complicated puzzle of a comprehensive investigation.

National Protocol

For detailed information on the medical forensic exam, please see the National Protocol for Sexual Assault Medical Forensic Examinations (2013) (adults/adolescents) which is published by the Office on Violence Against Women.

In 2017, the National Institute of Justice (NIJ) published National Best Practices for Sexual Assault Kits: A Multidisciplinary Approach, a compilation of recommendations with a corresponding online glossary of terms. Specifically, NIJ’s expert working group created 35 recommendations to guide victim-centered approaches for responding to sexual assault cases and better supporting victims throughout the criminal justice process. The recommendations emphasize the use of collaborative, victim-centered, and multidisciplinary approaches to improve evidence collection and preservation, increase consistency and provide uniformity for the prioritization and transferal of evidence, enhance laboratory process efficiencies for DNA testing, and advance investigative practices and agency protocols for: evidence inventory, tracking and audits, and communication systems.

Template Forms

The International Association of Forensic Nurses (IAFN) offers an online library that includes forms to be used as templates by community professionals seeking to create or adapt tools for their own medical forensic exams.

Presence of Advocates

A legal compilation has been prepared by AEquitas: The Prosecutors’ Resource on Violence Against Women, to summarize the statutes pertaining to the presence of a victim advocate during the medical forensic examination. Please visit their website to request the most up to date compilation.

Mandated Reporting

A legal compilation on reporting requirement for competent adult victims of sexual violence is available from AEquitas: The Prosecutors’ Resource on Violence Against Women. Please visit their website to request the most up to date compilation.

Documenting Injury

The publication entitled, “Absence of Anogenital Injury in the Adolescent Adult Female Sexual Assault Patient” by AEquitas, discusses the absence of injury in sexual assault cases. After reviewing 43 studies, the author determines that lack of injury is common, though a lack of studies on anal penetration and injury makes it difficult to determine how frequently that type of assault results in injury.

Mobile SANE Project

The West Virginia Foundation for Rape Information and Services (FRIS) has led efforts to develop a regional mobile SANE project in its state. This project allows the sharing of SANEs among five participating hospitals in a five-county area; an on-call SANE goes to the hospital where the sexual assault patient presents.

Victims with Disabilities

Detailed guidance for conducting forensic interviews with victims who have a disability can also be found in a video and companion guidebook available from the Office for Victims of Crime.

Statewide Assessment

The Maryland Coalition Against Sexual Assault (MCASA) has published a “State of the State Report” on Sexual Assault Forensic Examiner Programs, based on the findings of a 2011 survey of SAFE program coordinators. It is an excellent example of a statewide assessment offering guidance to programs and policymakers alike.

Do You Snip or Pluck a Victim’s Head and Pubic Hair?

In this article in Sexual Assault Report, author Sgt. (Ret.) Joanne Archambault examines the question of whether a victim’s head and pubic hair should be snipped or plucked. While many programs have historically plucked hairs, Sgt. Archambault argues that this uncomfortable procedure is not justified because of the extremely low possibility that they will be used in the prosecution of a sexual assault.

Timelines for Conducting a Medical Forensic Exam

Many community protocols specify a certain timeline for how many hours after a sexual assault incident a medical forensic examination will be conducted. The timeline is commonly in the range of 72, 96, or 120 hours. While the longest of these (120 hours) can be used as a general guideline, best practice is for each sexual assault to be evaluated on a case by case basis. The question of whether or not to conduct an exam should be based on the facts of the case, the victim’s history, the likelihood of recovering evidence, and the types of evidence that will be needed for successful prosecution. This issue is discussed in detail in a Promising Practices article from the e-newsletter for Sexual Assault Training & Investigations (SATI), Inc. The article was also published in Sexual Assault Report, Volume 10, Number 3, January/February 2007, p 33-47.

The issue of timelines for evidence collection is also discussed in the A National Protocol for Sexual Assault Medical Forensic Examinations (2013) (adults/adolescents), published by the U.S. Department of Justice, Office on Violence Against Women.

Exam timelines are also discussed in an article in the New England Journal of Medicine, entitled Care of the Adult Patient after Sexual Assault. It was written by Judith A. Linden and appeared in the September 2011 edition, Volume 365, Number 9, p. 834-841.

Forensic Exams for the Sexual Assault Suspect

This EVAWI training bulletin addresses the critically important (but all too often overlooked) source of evidence in a sexual assault investigation, the suspect examination. In our experience, we have found that most law enforcement agencies have failed to establish appropriate policies and procedures for obtaining comprehensive forensic examinations for sexual assault suspects which is unfortunate, given the potential for recovering probative evidence from the body as well as the clothing of suspects.

When to Conduct an Exam or Interview

This EVAWI training bulletin addresses the difficult question of when to conduct the interview of a sexual assault victim. In it, we argue that communities can go a long way toward improving our response to sexual assault by operating from the premise that we want victims to be involved in our response systems, so we should do whatever we reasonably can to help them do so. Sometimes we get so focused on our own policies and procedures that we forget to make accommodations that would encourage victims to participate, even if they entail some compromises that are less than ideal.

Use of Alternate Light Source/Negative Invert Filters to Improve Visibility of Injuries Under the Skin

During this EVAWI webinar, presenters Diana Faugno, Rachell Ekroos, and Debra Holbrook discuss alternate light source (ALS) technology, negative invert filter software, and digital photo documentation as each relates to patients/victims who have been strangled or physically abused. These technologies can be used by medical professionals at the time of an exam or by law enforcement professionals with assaulted persons who do and do not seek medical treatment. In addition to physical injury visualization, ALS technology may be used to identify dried fluids (e.g. semen, blood, urine) and other evidence (e.g. fingerprints) that can be collected for forensic analysis. Without these technological tools many of the samples might otherwise go undetected under standard lighting.

Sexual Assault: An Acute Care Protocol for Medical/Forensic Evaluation, Ninth Edition, 2018

New Hampshire offers this statewide protocol on the care of patients who have experienced sexual assault. This protocol is a statutory mandate for all hospitals and physicians in the state of New Hampshire providing medical forensic exams to victims of sexual assault. The Protocol is continually being revised in an effort to improve evidence collection outcomes for patients who have experienced sexual assault, to maximize the continuity of care for patients who have experienced sexual assault.

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