Information
Editors
Examination of Maltreatment Victims
Essentials
- In the examination of maltreatment victims, a physician's role involves both providing treatment and preparing a medical statement for any court proceedings.
- Treatment should be provided according to medical assessment.
- Psychological first aid should also be provided How to Approach Maltreatment Victims and Provide Psychological Support.
- All findings suggestive of maltreatment must be accurately and systematically recorded.
- The statement should be written in plain language (avoid Latin and medical jargon), and should be objective and impartial.
- Consult also local guidance concerning such examinations and medical statements.
Observations
- The examination should be done by a doctor and a nurse in cooperation.
- Task division can be agreed as required (locally).
- Always examine the whole body, systematically from head to toe, for instance. Have the patient take off their clothes from one part of the body at a time (first the upper and then the lower body, for instance).
- Record essential normal findings and the examinee's behaviour.
- Record all injuries carefully on a locally used maltreatment form or body map (examples from the Finnish Institute for Health and Welfare: adults http://thl.fi/documents/155392151/190466635/THL_Kehokartat_Aikuinen_Kooste.pdf, children http://thl.fi/documents/155392151/190466635/THL_Kehokartat_Lapsi_Kooste.pdf).
- Record at least the location, size, form and colour of any injuries, as well as other indications of the timing and mechanism of injuries.
- Recording absence of injury may also be essential; compare the patient history to the findings.
- Take photographs of the injuries.
- Full-body photographs are important to locate the injuries and to document negative findings. The different parts of the body can also be photographed separately.
- Details of injuries should be photographed before and after cleaning, as necessary, and including a ruler or tape measure. At least one picture should be taken of each injury in such a way that its anatomic location can be clearly seen.
- Record any intoxication from alcohol or other intoxicants. Take samples to evidence intoxication as requested by the police or as directed by your institution.
- The description should enable a statement to be written and provide an impression of the injuries.
- A statement should be written if requested by the police or the maltreatment victim. If the police request a statement, they will make sure that legal requirements are met and/or secure the victim's consent for providing such a statement. Check also local regulations.
Sampling
- Take samples to evidence intoxication as requested by the police or as directed by your institution.
- The police may request DNA samples. The police usually have specific evidence collection kits for sampling in health care; such a kit may included, for example, the following:
- Sharp cotton swabs for taking under nail samples
- Dry cotton swabs are used to take samples from under nails, and the samples are sealed in evidence bags according to the kit's instructions.
- Cotton swabs for additional samples from stains, for example
- Moistened cotton swabs are used to take samples from dry stains and dry cotton swabs for taking samples of wet stains. The swabs are then sealed and put in bags according to the kit's instructions.
- Sterile water
- Evidence bags
- Sample release document
- Instructions
- Investigation and sampling forms
- Paper tape measure
- The kit does not necessarily contain protective clothing.
- The protective clothing recommended is a freshly laundered working outfit or disposable jacket, a hair cap, a surgical mask and two pairs of disposable gloves, of which the top layer must be changed for handling different types of samples. Check also local guidance.
Confidentiality, and duty and right to report
- Health care professionals are bound by confidentiality that can only be broken with the patient's consent or as defined by local law.