2025-12-16 イェール大学
<関連情報>
- https://news.yale.edu/2025/12/16/improving-medical-and-forensic-care-sexual-assault-survivors-emergency-department
- https://onlinelibrary.wiley.com/doi/10.1111/acem.70179
An Electronic Health Record-Integrated Clinical Pathway Improves Care of Sexual Assault Survivors 電子健康記録を統合した臨床パスウェイが性的暴行被害者のケアを改善
David H. Yang, Raphael Sherak, Megan Chin, Emelia Pagano, John D. Tyrrell, Tami Sullivan, Rachel Henderson, Karen Jubanyik, James Dodington, Deborah Rhodes, Marcie Gawel, Rohit B. Sangal
Academic Emergency Medicine Published: 28 October 2025
DOI:https://doi.org/10.1111/acem.70179
ABSTRACT
Objective
To determine if the utilization of an Electronic Health Record-integrated clinical pathway increased the provision of recommended medical and forensic care to adult sexual assault survivors in the ED.
Methods
This was a retrospective chart review of 552 adult survivors of sexual assault who received care at a health care system in the Northeast between January 1, 2020, and December 31, 2022. Our six outcomes were the proportion of patients who were offered a consultation with a sexual assault advocate, the proportion of patients who had the sexual assault forensic evidence kit collected, pregnancy test ordered, emergency contraception ordered, HIV post-exposure prophylaxis ordered, and sexually transmitted infection prophylaxis ordered. Primary analysis compared the impact of the pathway on outcomes before and after the implementation. Secondary analysis included the impact on outcomes of pathway use compared to non-pathway use after implementation.
Results
The pathway was used in 128 (51%) patient encounters after it was implemented. Offering consultation with a sexual assault advocate and ordering HIV post-exposure prophylaxis improved post-implementation compared to pre-implementation. In the post-implementation period, there was an improvement in recommended medical and forensic care across all outcomes, including offering an advocate, collecting forensic evidence, ordering STI prophylaxis, HIV PEP, pregnancy tests, and emergency contraception. Patients were less likely to have a SAFE kit collected if the pathway was not used compared to pre-implementation.
Conclusions
Pathway usage led to improved medical and forensic care of sexual assault survivors. Implementation of Electronic Health Record-integrated clinical pathways requires active use of the pathway rather than indirect learning from the presence of the pathway.
性的暴行被害者への救急医療 – NAEMSPの立場表明とリソース文書 EMS Care of Survivors of Sexual Assault – A Position Statement and Resource Document of NAEMSP
David H. Yang,Lauren K. Friend,Christie L. Fritz,Zita I. Konik,Niloufar Paydar-Darian,Mikaela T. Middleton
Prehospital Emergency Care Published:18 Nov 2025
DOI:https://doi.org/10.1080/10903127.2025.2579074
Abstract
Caring for sexual assault survivors requires interdisciplinary collaboration, pre-planning, and education. The purpose of this document is to guide emergency medical service (EMS) agencies and clinicians in the patient-centered management of survivors of sexual assault.
The National Association of EMS Physicians Recommends:
- Trauma-Informed Care: EMS clinicians should recognize that sexual assault is a traumatic event, and we recommend a trauma-informed care approach. Some recommended actions include, but are not limited to, asking questions that validate a survivor’s experience, asking permission before doing an exam to acknowledge a patient’s choice, and allowing a support person during the physical exam.
- Physical Injuries after sexual assault: EMS clinicians should assess for serious traumatic injuries associated with sexual assault including strangulation.
- Collaboration with Sexual Assault Forensic Examiner Organizations: EMS clinicians should understand general forensic guidelines and state-specific regulations relevant to prehospital care. Indications for forensic exams vary by state, thus partnerships between EMS and sexual assault forensic examiner organizations can facilitate access to forensic examiners who can provide clear guidance on available forensic resources.
- Transport to Sexual Assault Forensic Examiner-resourced facilities: EMS systems should identify local facilities that are resourced to care for sexual assault survivors or systems designed to provide these resources to the survivor and preferentially transport stable survivors to these destinations for medical and forensic evaluation. If there is concern for a life-threatening injury, patients should be transported to a trauma center for evaluation.
- Documentation: In addition to awareness of local regulations, EMS clinicians should be complete, accurate, and culturally competent in their documentation. They should minimize bias in their documentation.
- Evidence Preservation: EMS clinicians should be aware of best practices for evidence preservation and be trained in evidence collection in the prehospital setting, including avoiding showering, eating, changing clothes before the forensic exam, and maintaining chain of custody.
- Consider other special populations: EMS clinicians should be aware of high-risk special populations for sexual assault with unique medical, cultural and/or regulatory considerations including, but not limited to, the pediatric, elderly, transgender, gender diverse, LGBTQ (lesbian, gay, bisexual, transgender, queer), pregnant, and male survivors.
