Introduction

In a little over nine seconds an elite male sprinter can run 100 meters. From the time his lightening speed propels him from the starting block to the time he breaks through the tape at the finish line, one woman is being beaten and assaulted in the United States of America. The same urgency that a sprinter feels to run a race from start to finish, is the same urgency that America should feel on having a serious discussion on domestic abuse. However to frame the dialogue effectively, the women and men who are on the front lines of combating violence against women must be thoroughly educated. Doctors, counselors, law enforcement officials, and lawyers are the gatekeepers when it comes to identifying abuse. To raise an even higher level of consciousness of violence and assault against women in America, these gatekeepers must learn to operate within the proper framework in order to share with the public the proper information of her plight. One may think that the onset of labor in a pregnant woman would be the top cause of emergency room visits by women. Unfortunately, according to the Women’s Rural Advocacy Programs, domestic violence is the number one cause of emergency room visits by women. Broken bones, lacerations, and gunshot wounds are just some of the injuries that are seen in women in hospital emergency rooms. Besides treating the patient for her injuries, what else should be examined during the initial contact in the emergency room?

Indentification by History

When medically treating battered women, Centre Community Hospital of Centre County, Pennsylvania developed an entire model used to identify if a patient has indeed been abused. Oftentimes a woman experiencing domestic violence will put of seeking treatment for her injuries without explanation. The delay in reaching out for treatment could be due to embarrassment or fear of further abuse by her partner. Secondly, a doctor or law enforcement officer should anticipate a woman’s explanation of her injuries to be inconsistent with the actual injury. For instance multiple fractures and broken bones would not match up with a trivial fall on a sidewalk. Next a history of injuries pointing to trauma should be researched in the patient’s records. Since up to 64% of hospitalized female psychiatric patients have been abused as adults, a helping professional should check for a history of substance abuse, suicide attempts, and depression. Following this, a history of nonspecific physical and somatic complaints should be assessed. Finally if a woman has an overly attentive and aggressive partner, this is a key indicator of domestic violence and assault.The second diagnostic category that Centre Community Hospital uses to identify a domestic violence case is by the actual physical signs on a woman‘s body. Injuries typical of abuse include those to the face, head, neck, breasts, abdomen, or genitals. “Spontaneous abortions” and injuries during pregnancy are also key indicators of domestic violence. Abuse escalates with pregnancy. Studies indicate that 37% of pregnant women were physically assaulted during their pregnancies. Finally, because of the cycle of violence during which there is a “honeymoon phase” where the abuse stops for a short amount of time, it is common to see multiple injuries at different stages of healing.

How to Document Abuse

As with any case within the human services field, documentation of the client’s history is a must. Centre County Hospital urges professionals to preface patient’s statements with “patient states”. With the documentation of the injuries, a thorough and extensive evaluation is needed. When taking notes, once is urged to be as complete and descriptive as possible. Although a patient may be reluctant due to modesty, she should completely undress for the examination. Furthermore, photographs should be taken for further evidence should the perpetrator be taken into custody and prosecuted.The final part of the documentation should be the actual diagnosis of abuse. Centre County Community Hospital suggests that during the course of the initial interview if a patient states that she has been abused to add in the case notes “alleged abuse”. If the woman firmly denies abuse and the interviewer is not convinced, she or he should add “suspected abuse” or “injuries suggestive of battering” in the case notes. Non injurious evidence of assault and battery should be noted. Broken jewelry, torn clothing, and damage to other personal property can be used as evidence.

The Danger Assessment

Helping a patient assess her immediate danger from the abuser is the critical aspect of the interview and examination. Law enforcement should separate the woman from her partner during the entire interview and examination. During this time she should be given the chance to making phone calls in isolation. Afterwards it should be asked if she has a safe place of refuge to go, whether it’s her own home or the home of a friend or family member. Unfortunately, according to the Women’s Rural Advocacy Program, women who are in the process of leaving their abusers are at a 75% higher risk of being killed then women who stay with their partners. Since 50% of homeless women and children in the United States are running from abuse, the interviewer should assess whether the patient needs boarding at a shelter, or police/legal intervention. If the patient has children, their whereabouts should be known. An assessment on their safety should be made since they are likely to have been abused as well. Studies indicate that 70% of men who abuse their partners sexually or physically abuse their own children.

Support is Crucial

After the patient leaves the hospital she will need an entire support system to break the cycle of violence. Interviewers should have a working knowledge of resources and local agencies. Centre Community Hospital implores helping professional to educate battered women of special services and make the referrals that exist to help women. Counseling, 24 hour hotline numbers, emergency shelter, support groups, legal advocacy and prevention education are just some of the resources that will be urgently needed. Her life may very well depend on the amount of support that she is given after her discharge from the hospital.