Rape / Sexual Assault National Guidelines 2009

Rape / Sexual Assault National Guidelines 2009
Rape/Sexual Assault:
National Guidelines on
Referral and Forensic Clinical
Examination in Ireland
An Garda
Síochána
Forensic
Examiner
(SATU)
Psychological
Support
Sexually
Transmitted
Infections
Forensic
Science
Laboratory
General
Practitioner
AUTHORS
An Garda Síochána
Inspector Mary Delmar, Blackrock Garda Station/ Domestic Violence Sexual Assault
Investigation Unit (DVSAIU), Harcourt Square, Dublin.
Detective Inspector Eamonn O’Grady, Domestic Violence Sexual Assault
Investigation Unit (DVSAIU), Harcourt Square, Dublin.
Forensic Science Laboratory
Dr. Martina McBride, Forensic Scientist, Forensic Science Laboratory, Garda
Headquarters, Phoenix Park, Dublin.
Medical
Dr, Mary Holohan, Obstetrics and Gynaecology Consultant, Medical Director, Sexual
Assault Treatment Unit, Rotunda Hospital, Parnell Square, Dublin.
Nursing
Ms Moira Dolan, Clinical Midwife Manager 2, Sexual Assault Treatment Unit, Rotunda
Hospital, Parnell Square, Dublin.
Ms Anne Flood, Director, Centre of Nursing & Midwifery Education, Education Centre
Donegal, St. Conal’s Hospital, Letterkenny, County Donegal.
Ms Anne McHugh, Clinical Nurse Manager 2, Nursing Practice Development Unit,
Letterkenny General Hospital, County Donegal.
Rape Crisis Network Ireland (RCNI)
Dr. Susan Miner, Services Support Co-ordinator, RCNI, The Halls, Quay Street,
Galway.
Ms Fiona Neary, The Executive Director, RCNI, The Halls, Quay Street, Galway.
General Practitioners
Dr. Rita Galimberti, Assistant Director, Women’s Health Programme, Irish College of
General Practitioners, Lincoln Place, Dublin 2.
Dr. Ailish Ní Riánn, Director, Women’s Health Programme, Irish College of General
Practitioners, Lincoln Place, Dublin 2.
Sexually Transmitted Infections Personnel:
Dr. Fiona Lyons, Consultant in Genitourinary Medicine, St. Thomas’ Hospital,
Lambeth, London.
Dr. Gráinne Courtney, Associate Specialist in Genitourinary Medicine, GUIDE Clinic,
St. James’ Hospital, Dublin 8.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
OTHER CONTRIBUTORS
3
4
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
FOREWORD
I welcome this comprehensive set of guidelines for the referral,
forensic examination and support of victims of alleged rape
and sexual assault. This is a complex and sensitive area
which provides vital services and support to people in crisis.
It is essential, therefore, that these services are accessible and
responsive to the needs of people who are subjected to such
a traumatic experience.
The response to sexual assault involves close collaboration
between the Gardaí, health services and the wider criminal
justice system. These detailed guidelines set out clearly their respective roles and
the co-operation required between them which will ensure that in the collection of
the necessary evidence, victims are treated in a sensitive and caring way and are
provided with the necessary emotional and psychological support and counselling
services.
The use of these guidelines by the various agencies involved in the investigation and
treatment of victims of alleged sexual assault will ensure uniform standards in the
provision of care to those who come in contact with these services at a time of
crisis.
I commend the authors who took time out from their demanding jobs to write,
compile and review these guidelines and the staff of the Women’s Health Policy Unit
in my Department who provided the secretariat for the authors.
Mary Harney, TD
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Tánaiste and Minister for Health and Children
5
6
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
CONTENTS
List of Figures
List of Tables
11-12
13
14-15
List of Appendices
16
Introduction to the Guidelines
17
How to use this Book of Guidelines
17
Literature Review
19
Quick Reference Sheets/ Flowcharts for:
21
•
•
•
•
•
A Person Who Does Not Want to Report the Incident to An Garda
Síochána
Flowchart of Referral Pathways to a Clinical Forensic Examiner
A-F Guide for Referral for a Forensic Clinical Examination
A Guide to Help Preserve Forensic Evidence which may be Available
Consent or Refusal
Integrated Inter-Agency Response Approach
22
23
24
25
89
26
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Glossary of Terms/ Abbreviations/ Operational Definitions.
7
Section 1: AN GARDA SÍOCHÁNA GUIDELINES
29
1:1
Role of An Garda Síochána in the Irish Criminal Justice System.
30
1:2
Actions by An Garda Síochána on Receipt of a Complaint of a
Sexual Offence.
31
1:3
Statement Taking from the Complainant.
32
1:4
Early Evidence Kits – Oral or Drug/Alcohol Facilitated Rape/Sexual
Assault.
33
1:5
Continuity of Evidence (Chain of Custody of Evidence).
35
1:6
Collection of Clothing from the Complainant.
35
1:7
Transfer and Storage of the Completed Sexual Offences
Examinations Kit.
37
Section 2: CLINICAL FORENSIC EXAMINER GUIDELINES
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
2:1
8
39
Role of Clinical Forensic Examiner and the Forensic Clinical
Examination.
40
2:2
Reception of the Patient.
41
2:3
Consent to Forensic Clinical Examination.
44
2:4
History Taking.
45
2:5
Classifying and Documentation of Wounds and Injuries.
47
2:6
Photographic Evidence.
47
2:7
Female Patients: Genital Landmarks.
49
2:8
Male Patients: Genital Landmarks.
50
2:9
General Physical Examination.
51
2:10
Genital Examination.
53
2:11
Examination of the Alleged Perpetrator.
54
2:12
Forensic Sample Taking.
55
2:13
Possible Pregnancy Management.
58
2:14
Follow-up Referrals.
59
2:15
Discharge.
60
Section 3: PSYCHOLOGICAL SUPPORT GUIDELINES
61
3:1
Role of Psychological Services.
62
3:2
Setting up Links with the SATU/Clinical Forensic Examiner.
63
3:3
Making a Referral for Immediate Psychological Support
63
3:4
Role of a support worker.
64
3:5
Role of a support worker in a SATU or with a Clinical Forensic
Examiner.
65
When a Victim/Survivor Leaves the SATU/Clinical Forensic
Examiner.
65
If a Victim/Survivor Chooses not to have a Forensic Clinical
Examination.
66
Future Contact with the Victim/Survivor
66
3:6
3:7
3:8
Section 4: SEXUALLY TRANSMITTED INFECTION FOLLOW-UP
GUIDELINES
67
4:1
Epidemiology and Demography.
68
4:2
Screening at Forensic Clinical Examination.
68
4:3
High-risk Indicators.
70
4:4
Sexually Transmitted Infection Follow-up.
71
Section 5: FORENSIC SCIENCE LABORATORY GUIDELINES
73
5:1
History and Role of the Forensic Laboratory.
74
5:2
Key Objectives of the Forensic Laboratory.
75
5:3
Cases of Sexual Assault.
75
5:4
Risk of Contamination.
77
5:5
Prevention of Contamination.
77
5:6
Instructions and Information for Using the Sexual Offences
Examination Kit.
78
5:7
Analysing Samples for the Presence of Semen.
79
5:8
Time Frames for Detecting Semen.
80
5:9
Specimens for Toxicology.
82
5:10
Early Evidence Kits (see also An Garda Síochána Guideline1:4.
(Page 33)
83
5:11
Trace Evidence.
83
5:12
Damage to Clothing.
86
9
Section 6: GENERAL PRACTITIONERS (GPs)/ GP CO-OPERATIVES
GUIDELINES
6:1
6:2
References
10
87
Care of a Patient Who Presents as a Result of Rape/Sexual
Assault.
88
Contact with a General Practitioner Following Evaluation in a
SATU.
88
126
Glossary of Terms / Abbreviations / Operational
Definitions
In devising this book of guidelines, the diversity of language used by each discipline/agency
has been recognised. In order to facilitate the readers, the correct terminology used by the
different professionals is reflected in the section relevant to them. For further clarity a
glossary of terms, abbreviations and operational definitions have also been included.
Glossary of Terms
Clinical Forensic Examiner: In the context of these guidelines, the term Clinical Forensic
Examiner is deemed to be an appropriately trained health care professional who undertakes
the Forensic Clinical Examination and collects forensic evidence from the patient, following
the alleged rape or sexual assault. This health care professional may be a Medical Doctor, a
Registered Nurse or a Registered Midwife.
Complainant: The person making a complaint of a crime to An Garda Síochána - in this
instance the crime being rape/sexual assault.
Evidence: The word "Evidence" includes all the legal means exclusive of mere argument
which tend to prove or disprove any matter of fact, the truth of which is submitted to judicial
investigation.
The principal Categories of Judicial Evidence are:
1. Testimony.
2. Hearsay Evidence.
3. Documentary Evidence.
4. Real Evidence.
5. Circumstantial Evidence.
Health Care Professionals: professionals, who provide health services, for example,
doctors, nurses and other professionals, who have specific training in the field of health care
delivery.
Intimate Partner: a husband/wife, boyfriend/girlfriend or lover, or ex-husband/wife, exboyfriend/girlfriend or ex-lover.
Patient: individuals, who are receiving a service from, or are being cared for, by, a health care
worker.
Sexual Offences Examination Kit: Specifically designed kit for use with either male or
female complainants, or alleged perpetrators during a Forensic Clinical Examination, for the
purpose of taking forensic samples.
Sexual violence: a term covering a wide range of crimes, including rape, sexual assault,
incest and buggery. (see - Appendix 1, page 93)
support worker: A rape crisis centre volunteer or staff person trained and available to
provide advocacy and support to a sexual violence victim/survivor in a Sexual Assault
Treatment Unit.
Victim/Survivor: A person who has lived through a rape or sexual assault.
11
Abbreviations
ASAP:
As Soon As Possible.
EHB:
Eastern Health Board.
GP:
General Practitioner.
HIV:
Human Immunodeficiency Virus.
HSE:
Health Service Executive.
LCT:
Lysomal Chain Transcription.
LMP:
Last Menstrual Period.
NAATs:
Nucleic Acid Amplification Tests.
PCC:
Postcoital Contraception.
PEP:
Post-Exposure Prophylaxis.
RCC:
Rape Crisis Centre.
RCNI:
Rape Crisis Network Ireland.
SATU:
Sexual Assault Treatment Unit.
SAVI:
STI:
WHO:
Sexual Assault and Violence in Ireland.
Sexually Transmitted Infection.
World Health Organisation.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Operational Definitions
12
Adult Forensic Clinical Examination: In law a person is an adult when they reach the age
of 18 years. For the purpose of carrying out an adult Forensic Clinical Examination, 14 years
of age is taken as the age where physical maturity has been reached in the average young
person. NB. For a person under the age of 18, Children First guidelines (DOHC,1999)
reporting mechanisms should be followed. (Appendix 2, page 99)
Recent Rape/ Sexual Assault: In the context of carrying out a Forensic Clinical
Examination, for the purpose of retrieving forensic evidence, recent rape/sexual assault is
categorised as up to and within seven days following the rape/sexual assault.
List of Figures
Figure 1:
Guideline Formation Fostering Integrated Inter-Agency Teamwork.
26
Figure 2:
Female Patients: Genital Landmarks.
49
Figure 3:
Male Patients: Genital Landmarks.
50
Figure 4:
Indicating when DNA profiling may be carried out.
80
Figure 5:
Inter Agency/Discipline Professional Team/ Individual
Development.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
103
13
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
List of Tables
14
Table 1:
Some Do’s and Don’ts when receiving the patient.
43
Table 2:
Useful descriptive terms when documenting injuries.
47
Table 3:
Female patient genital landmarks.
49
Table 4:
Descriptive terms for the vagina.
49
Table 5:
Male patient genital landmarks.
50
Table 6:
Guidelines for the collection of forensic samples.
56
Table 7:
Time Frames for Postcoital Contraception.
59
Table 8:
Possible Follow-up Referrals.
59
Table 9:
Appropriate STI Screening Tests.
71
Table 10:
Appropriate STI Screening Tests at 4-6 months Post-Incident.
71
Table 11:
Sites and time frames for presence of semen.
81
Table 12:
The persistence of different drugs in blood/urine.
83
Table 13:
Contamination of evidence.
85
Table 14:
Precautions to avoid contamination of evidence.
85
Table 15:
Criminal Law (Rape) Act 1981.
93
Table 16:
Criminal Law (Rape) Amendment Act 1990.
93
Table 17:
Rape under Section 4.
94
Table 18:
Aggravated Sexual Assault.
94
Table 19:
Sexual Assault.
94
Table 20:
Criminal Law (Amendment) Act 1935.
95
Table 21:
Incest.
95
Table 22:
Unlawful Carnal Knowledge of Girl under 15 years.
95
Table 23:
Unlawful Carnal Knowledge of Girl under 17 years.
96
Table 24:
Buggery with Persons under 15 years.
96
Table 25:
Sexual Intercourse or Buggery with Mentally Impaired Persons.
97
Table 26:
Anonymity.
97
Table 27:
Restriction of Public Access – In Camera Rule.
98
Table 28:
Criminal Justice Act 1990 (Forensic Evidence).
98
Table 29:
Children First: Standard Reporting Procedure.
99
Table 30:
Breakdown of Calls to Dublin Rape Crisis Centre 2004.
101
Table 31:
Dublin Rape Crisis Centre Statistics – Types of Assault.
101
Table 32:
Dublin Rape Crisis Centre Statistics – Gender Breakdown.
101
Dublin Rape Crisis Centre Statistics – Gender Breakdown of
Clients Receiving Counselling.
101
Dublin Rape Crisis Centre Statistics–
Types of Assault/Abuse for which Clients are Receiving Counselling.
101
Table 35:
An Garda Síochána Statistics 2003.
102
Table 36:
Structure, Process and Outcome Audit.
104
Table 37:
Furniture, Equipment and Supplies for a Sexual Assault Treatment
Unit.
108
Table 38:
Costs Associated with Providing an Advocacy Service.
116
Table 39:
Support Organisations: Contact Details.
117
Table 40:
Contact List for Rape Crisis Centres in Ireland.
120
Table 34:
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Table 33:
15
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Appendix List
16
Appendix 1
The Law in Relation to Sexual Crime in Ireland.
93
Appendix 2
Children First: National Guidelines for the Protection & Welfare
of Children, standard reporting mechanism.
99
Appendix 3
Sexual Assault Statistics in Ireland.
100
Appendix 4
Continuous Professional Development.
103
Appendix 5
Monitoring & Evaluation.
104
Appendix 6
Sexual Assault Treatment Units in Ireland.
105
Appendix 7
Commissioning a Sexual Assault Treatment Unit.
107
Appendix 8
Sample Consent Form.
112
Appendix 9
Copy of Sexual Offences Examination Kit Instructions.
113
Appendix 10
History & Role of Rape Crisis Network Ireland (RCNI).
116
Appendix 11
Support Groups’ and Agencies’ Contact Details.
117
Appendix 12
Outline of Medical Report of Forensic Clinical Examination.
122
Appendix 13
Critical Readers.
123
Appendix 14
Acknowledgements.
125
Introduction to the Guidelines
Developing a National Integrated Inter-Agency
Response to Sexual Crime
The care of the adult victim of recent sexual crime relies on the expertise of many
disciplines. In the initial evaluation, the services of An Garda Síochána, nursing,
medical, counselling and scientific professionals may be needed.
First and foremost, the purpose of the initial assessment is to ensure the welfare of
the person – achieved by skill in observing and assessing the physical and
psychological needs of each INDIVIDUAL.
The Forensic Clinical Examination is an integral part of the services for the adult
victim of sexual crime. The professional who is undertaking such an examination
must have appropriate training, in order to maximise the information which can be
gathered, follow appropriate procedures to safeguard the evidence, and have the
ability to interpret the information objectively.
These guidelines have been developed to enable the care-givers to deliver a service
of the highest quality, in line with best international practice in this field and to assist
the Health Service Executive (HSE) and the Criminal Justice System in the Local,
Regional and National development of the infrastructure required for the delivery of
an appropriate response and care.
Glossary of Terms / Abbreviation / Operational Definitions.
To assist you, a section–outlining glossary of terms, abbreviations and operational
definitions–is included. When you first encounter a word/term, abbreviation or
operational definition, the text on the page is in bold print, indicating that further
clarification is included under this section.
Quick Reference/ Flowcharts
Quick reference pages/ flowcharts have been devised, in order to enable
practitioners to quickly access information.
The quick reference/ flow charts are:
•
A Person Who Does Not Want to Report the Incident to An Garda
Síochána. (Pages 22)
•
Flowchart of Referral Pathways to a Clinical Forensic Examiner. (Page 23)
•
A-F Guide for Referral for a Forensic Clinical Examination. (Page 24)
•
A Guide to Help Preserve Forensic Evidence which may be Available.
(Page 25)
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
How to use this Book of Guidelines
17
Discipline/Agency Guidelines Colour Coding
For ease of reference throughout the guidelines section of the book, each
discipline/agency is located under a specific colour code.
An Garda
Síochána
Forensic
Examiner
(SATU)
Psychological
Support
Sexually
Transmitted
Infections
Forensic
Science
Laboratory
General
Practitioner
Boxes with Key Points
Key points relevant to the guideline are emphasised, not only because of their
importance, but also for ease of reference when skimming through a particular
guideline.
The key points are portrayed in a colour coded box relevant to the discipline/agency
within which the guideline appears.
An Garda Síochána
Forensic Examiner (SATU)
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Psychological Support
18
Sexually Transmitted Infections
Forensic Science Laboratory
General Practitioner
Rape & Sexual Assault in Ireland
Review of the Literature
According to The World Health Organisation (WHO, 2003), rape is ubiquitous and
occurs in every culture, in all levels of society and in every country in the world. Data
from country and local studies indicate that, in some parts of the world one woman
in every five has suffered an attempted or complete rape by an intimate partner
during her lifetime. Although the vast majority of victims are women, men and
children of both genders also experience sexual violence. Sexual violence can thus
be regarded as a global problem, not only in the geographical sense but also in
terms of age and sex (WHO, 2003).
Research studies conducted over the last two decades support the WHO (2003),
suggesting that there is a high prevalence of sexual violence within the general
population. Studies from the United States, the United Kingdom, Ireland and
elsewhere suggest that 25% of women and 10% of men have experienced a lifetime
history of sexual assault (Koss et al, 1987, Petrack et al, 1995, Bewley et al, 1997).
Results from this study found that in women 1:5 (20.4%) experienced contact sexual
assault, 1:20 (5.1%) experienced unwanted non-contact sexual experiences and
over a quarter of cases of contact abuse in adulthood (i.e. 6.1% of all women)
involved penetrative sex. In men, 1:10 men (9.7%) experienced contact sex assault,
2.7% experienced unwanted non-contact sex experiences, 1:10 cases (i.e. 0.9% of
all men) involved penetrative sex (See Appendix 3 for additional Irish statistics). One
concern, voiced in this report, was the silent majority of victims not reporting rape
and sexual assault; 47% of those who disclosed sexual violence to the researchers
had told no one else. These victims had been subjected to contact sexual assault as
well as non-contact sex experiences.
Minister Micheál Martin, TD, Minister for Health & Children, introduced the SAVI
Report (McGee et al, 2002) with the statement " …the impact of rape and sexual
assault can have a traumatic effect on victims, and services must be in a position to
respond appropriately", and Minister John O’Donoghue, TD, Minister for Justice,
Equality and Law Reform stated that "..research projects give us important
information to help all involved respond better to the special needs of victims."
Survivors present with both acute and chronic physical and psychological
manifestations following sexual assault. Such individuals are frequent users of a
variety of medical services, including accident and emergency departments, genitorurinary medicine clinics, general practice, psychiatry and gynaecology. Rape is a
legally defined crime, not a medical condition, but "as health care professionals, we
can acknowledge its traumatic effect and offer good care to anyone who needs it."
(Hennerby, 1998). This is supported by Lenehan (1991) cited by Crowley (1999), with
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
The Dublin Rape Crisis Centre (RCC) commissioned The Royal College of
Surgeons of Ireland to undertake research and produce a report on Sexual Abuse
and Violence in Ireland in 2002. The resulting publication was the SAVI Report
(McGee et al, 2002). The sample for this study was taken from the general
population in Ireland. Anonymous telephone interviews were conducted with
randomly selected participants at home telephone numbers. The study ran from
March / June 2001. Ethical & Safety considerations were addressed in the study
design. Over 3,000 Irish adults (n = 3,118) participated with a 71% participation rate.
The main aim of the study was to estimate the prevalence of various forms of sexual
violence among Irish women and men across the lifespan from childhood through
adulthood.
19
some reservation that "even when emergency staff want to help rape victims,
services can be inconsistent and problematic." Crowley (ibid) further states that this
has led to "a victim in crisis being cared for by a staff in crisis."
The Report of the Taskforce on Violence against Women (Oifig an Tánaiste, 1997)
identified that "...it is more usual for victims of sexual assault and rape, outside of the
EHB region, to access local general hospital services for medical examination and
treatment." The report expressed concern, regarding the timely and efficient
collection of forensic evidence, which was hampered because of insufficient numbers
of General Practitioners (GPs) with the requisite training, and a lack of available staff
in hospitals at particular times, who are fully trained in the necessary procedures.
(Oifig an Tánaiste, 1997).
Ireland has been active in promoting research to address the issues faced in
providing a service to meet the needs of victims of rape and sexual assault. Many
reports have influenced the development of services throughout the country: Report
On The Task Force On Violence Against Women (Oifig an Tánaiste, 1997), the Legal
Process And Victims Of Rape (Bacik et al, 1998), A Framework For Developing An
Effective Response To Women And Children Who Experience Male Violence In The
Eastern Region (ERHB, 2001), Attrition In Sexual Assault Offence Cases In Ireland
(Leane et al, 2001) and The SAVI Report (McGee et al, 2002).
In the Irish context, there can be no doubt that "the question arises, as to whether a
need exists for the establishment of additional specialised units throughout the
country. In this context, the Task Force recommends that this issue be specifically
examined by the Department of Health." Report of the Task Force on Violence
against Women (Oifig an Tánaiste, 1997).
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Human Rights Watch (Brown, 2001), in its background paper prepared for the WHO
(2001), made a number of recommendations to the medico-legal sector for services
to those who had sustained sexual violence. These recommendations include:
20
•
"Rape victims should have access to medico-exams. . . . Twenty-four
hours a day, seven days a week, including on holidays. States should
ensure that there are sufficient numbers of trained staff and clinics through
the country to ensure the timely access to exams for all the people living
within its borders."
•
"In countries where services are rendered by medico-legal examiners at
specialized medico-legal centers, the services should be expanded beyond
collection of medical evidence to the provision of basic medical treatment.
Furthermore, they should make referrals for additional medical treatment
where necessary and to non-governmental organizations providing. . . .
counseling to victims of sexual….violence."
•
"Manuals should be developed for health professionals responsible for
examining rape victims that outline the relevant laws for their work, review
specialized medico-legal techniques, and provide detailed descriptions of
injuries specific to sexual assault." (p. 17)
The provision of an adequate number of SATUs and the following of these guidelines
will ensure that standards in Ireland substantially meet the Human Rights Watch
Recommendations.
1.
A Person Who Does Not Want to Report the Incident to An Garda Síochána.
22
2.
Flowchart of Referral Pathways to a Clinical Forensic Examiner.
23
3.
A – F Guide for Referral for a Forensic Clinical Examination.
24
4.
A Guide to Help Preserve Forensic Evidence which may be Available.
25
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Quick Reference Pages / Flowcharts
21
A person who presents with a recent history of Rape/Sexual Assault who does
not want to report the incident to an Garda Síochána
Medical needs always take priority and should be dealt with appropriately
•
•
•
Reporting to An Garda Síochána is encouraged.
It is possible to seek advice from An Garda Síochána without
making a complaint.
RCC personnel are available to support any person with her/his
decision making.
In order that an informed decision can be made by the person the following
information should be given:
• For a possible prosecution to proceed, a complaint must be made to
An Garda Síochána. Forensic evidence, which might be available, will
deteriorate or be lost if the person chooses not to report promptly.
• For a person under the age of 18, Children First (DOHC, 1999)
reporting procedure should be followed. (Page 99).
Yes – Person wishes to report to
an Garda Síochána
Proceed to: A-F Guide of Referral for
Forensic Clinical Examination. (Page 24)
YES - Person wishes to be Medically Examined
but without reporting to An Garda Síochana
Medical Examination
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
•
22
Person examined for injury and
injuries documented.
• *Forensic specimens (using the
Sexual Offences Examination Kit)
may be taken and stored.
• Appropriate care given.
No – Person does not want to
report to An Garda Síochána
Person informed that she/he can
contact the Gardaí at any time in the
future.
No – Person does not wish
Medical Examination
Information should be available
regarding where to get help and
support with the following
The following should be discussed and information/ care given
•
•
•
•
Possible pregnancy / Postcoital contraception (PCC) (Guidelines, page 58)
Relevance of Sexually Transmitted Infection (STI) review in two weeks’ time. (Guidelines, page 67)
If the RCC/psychological services has not already been contacted, initial contact may be
made if the person wishes, if not contact details and an information leaflet should be
provided. (Guidelines, page 63, App. 9)
Benefits of Primary Health Care Professionals for additional support emphasised.
(Guidelines, pages 20, 88)
Prior to leaving
• Offer to contact relative / friend / significant other.
• Is the person’s home environment safe? NO – consider alternatives.
• Consider transport home.
FLOWCHART: REFERRAL TO A CLINICAL FORENSIC EXAMINER /
SEXUAL ASSAULT TREATMENT UNIT
SEXUAL ASSAULT TREATMENT UNIT (SATU) FLOWCHART
VICTIM – THEIR FAMILY OR FRIEND MAY MAKE THE REFERRAL
Forensic
Science
Laboratory
Sexually
Transmitted
Diseases
2 Weeks follow-up
Rape Crisis
Social Worker
Others
GP/GP Co-op
Clinical Forensic Examiner/
Sexual Assault Treatment
Unit (SATU)
Primary Health Care
Professionals
Emphasise with the patient
the benefits of using The
Primary Health Care
Professionals
for additional support.
Rape/Sexual Assault: National Guidelines on
referral and examination in Ireland (2005)
An Garda Síochána
Guidelines Pages: 29 - 37
Clinical Forensic Examiner / SATU
Guidelines Pages: 39 - 60
Psychological Support
Guidelines Pages: 61 - 66
Sexually Transmitted Infections (STIs)
Guidelines Pages: 67 - 71
Forensic Laboratory
Guidelines Pages: 73 - 86
GPs/GP Co-operative
Guidelines Pages: 87 - 89
Hospital
Physical Injuries
The individual’s physical/
psychological well-being
should always take
precedence. Depending
on the circumstances the
Clinical Forensic
Examiner may carry out
the Forensic Clinical
Examination at the
referring Hospital
Is the Person’s Home
safe to return to?
If No –– Consider
alternatives.
Consent
NB. In an adult, their
consent is obtained
before involving other
agencies / disciplines.
For Further Details
Page 24
A – F of Referral for
Forensic Examination
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
An Garda
Síochana
23
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
A – F of Referral
for Forensic Clinical Examination
24
A.
ANY person, or any of the following may contact the Clinical Forensic Examiner /
Sexual Assault Treatment Unit (SATU):
• The Victim.
• An Garda Síochána.
• GP/ or GP Co-operative.
• A Hospital e.g. Emergency Dept / Gynaecology Dept.
• Social Worker / Psychological Services / Other Institutions.
• The RCC.
B.
BEFORE contacting the Clinical Forensic Examiner / SATU establish that:
• The person consents to contact being made.
• Medical needs, which take priority over Forensic Clinical Examination, are dealt with.
• In the case of Hospital referrals – consider should the Clinical Forensic Examiner be
requested to carry out the Forensic Clinical Examination at the referring Hospital.
C.
COMMUNICATION
• Contact is made with the nearest Clinical Forensic Examiner / SATU.
With the person’s consent the Clinical Forensic Examiner / SATU activates an
Integrated Inter-Agency Response by contacting:
• An Garda Síochána.
• The RCC/ Psychological Support should be made available.
• Others as requested by person or dictated by individual circumstances.
D.
DISCHARGE – prior to discharge by the Clinical Forensic Examiner / SATU the
following are discussed and information given:
• Possible pregnancy / Postcoital Contraception. (PCC) (Guideline, page 58)
• Appointment for Sexually Transmitted Infection review in two weeks’ time. (Guideline,
page 67)
• Leaflet with names and contact details of SATU and attending Team.
• If not already contacted, details and an information leaflet for the RCC/ other relevant
approved Psychological Services are given. (Guidelines, pages 61-5 and Appendix 9)
• The use of Primary Health Care Professionals for additional care/support. (Guideline,
pages 20, 88)
• Discharge home to relative / friend / significant other.
• Transport home arrangements.
E.
ENVIRONMENT
• Is the person’s home environment safe – if not, consider alternatives.
F.
FORENSIC SCIENCE LABORATORY
The Forensic Science Laboratory Supplies
• Sexual Offences Examination Kits to the Clinical Forensic Examiner / SATU / An Garda
Síochána.
• Early Evidence Kits to An Garda Síochána.
In order to maintain the Continuity of Evidence
• An Garda Síochána deliver the sealed completed Sexual Offences Examination Kit
from the Clinical Forensic Examiner / SATU to the Forensic Science Laboratory, also, if
used, the sealed Early Evidence Kit.
Guide to help Preserve Forensic Evidence which may be available
NB. Medical Stability always takes priority
The points below are followed, if possible, depending on individual circumstances and if they do
not interfere with the person’s safety, and the person feels they can follow the advice,
until after a Forensic Clinical Examination and collection of forensic evidence has been carried out.
For all types of Rape/Sexual Assault
• The type of seat the person sits on should be plastic, leather or leatherette type
covering.
• The person should not change clothing / bathe / shower / douche.
• If a condom was used, it should be retained.
• The person should not consume alcohol after the assault.
Vaginal & Anal Rape/Sexual Assault
The person should not if possible:
• Pass urine, open their bowel.
• Wipe the genital/anal area if they have to go to the toilet.
If possible:
• Save any sanitary protection worn at the time of the assault or afterwards.
Oral Rape/Sexual Assault
The person should not if possible:
• Brush their teeth or gargle their mouth.
• Take fluid or food.
• Smoke.
Clothing
The person should if possible:
• Change out of the clothes worn at the time of the rape/sexual assault ASAP, to
preserve evidence.
• Place the items of clothing in separate paper bags (not plastic) and label immediately.
• Underwear, worn after the incident, should also be collected and placed in a separate
paper bag.
If clothing has to be cut from a victim
• It should be cut along the seams of the item.
• Do not cut through any breaks in the garment e.g. caused at time of assault or
bullet / knife holes.
• Do not cut through blood, semen or fluid marks.
Wounds and Blood / Saliva / Semen Stains
• Blood, saliva or semen stains should have forensic swabs taken prior to cleansing.
• If possible forensic swabs should be taken from any wound area prior to wound
cleansing.
Forensic Specimens e.g. weapons, restraints, tape, bullets, paint, glass, soil.
• Do not talk, cough or sneeze over any specimens.
• Do not handle specimens, if specimen must be handled then do so with gloved hands.
• If bullets are handled then use gloved hands – metal forceps should NOT be used.
• Package specimens in a sealed paper bag and label immediately. (Guideline,
pages 33-36, 75-79)
(For further information: Giardino et al, 2004, Crowley 1999)
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Personnel if possible:
• Do not handle clothing - if clothing is handled then it should be with gloved hands.
25
Integrated Inter-Agency Response
The person who is raped/sexually assaulted needs an Integrated Inter Agency Team response
from the different disciplines/agencies involved. In the immediate period, the response may
include An Garda Síochána, Nursing, Medical, Rape Crisis Personnel and/or other Psychological
Services, with follow-up by General Practitioners and Sexually Transmitted Infection Personnel.
Occasionally, depending on individual circumstances, other personnel e.g. Emergency
Department or Gynaecology Teams may be involved. The Forensic Science Laboratory plays a
unique and invaluable role in the criminal proceedings when a rape/sexual assault is reported,
by both supplying in advance the Sexual Offences Examination Kits and in the subsequent
processing of the Kits as part of the criminal investigation.
The formation of an Integrated Inter-Agency Team response approach to rape/sexual assault will
be aided and assisted by, increased dialogue involving all the disciplines/agencies.
Consultative Collaborative Guideline Formation
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
The process of formulating the individual and collective guidelines was one of consultation and
collaboration between the disciplines/agencies. The lead in forming the individual guideline was
taken by the relevant discipline/agency, with input from the other disciplines/agencies where
appropriate. This fostered an ethos of dialogue, understanding and co-operation. (Figure 1)
26
An Garda
Síochána
SATU
Guidelines
Guidelines
Psychological
STI Clinics
Forensic
Science Lab
GP’s
Guidelines
Guidelines
Guidelines
Services
Guidelines
Guideline Development a Consultative/Collaborative Process
Regular Local Inter-Agency Meetings
Guideline Development a Consultative/Collaborative Process
BIANNUAL NATIONAL CONFERENCE
Figure 1: Guideline Formation Fostering Integrated Inter-Agency Teamwork
Regular Local Inter-Agency Meetings
Regular meetings between local key personnel, who respond to rape/sexual assault,
would promote, enhance and support the concept of a team and an Integrated InterAgency Response approach, when a person makes a report of rape/sexual assault.
The relevance of meetings encompassing managerial staff from the different
agencies/disciplines as well as front-line practitioners is vital in engendering a
problem solving approach to service response issues. This forum would also assist in
alleviating the isolation of many working in this area and assist in promoting
sustainability for practitioners. Local meetings would allow dialogue and the role of
partnership to be nurtured and support future planning and development.
Meetings and Communication across all Agencies
Meetings including all the different groups i.e. An Garda Síochána, Nursing, Medicine,
Psychological Services and Sexually Transmitted Infection Clinic personnel, General
Practitioners and the Forensic Science Laboratory would assist in:
•
•
•
•
•
•
Integrating the Inter-Agency Team Response.
Promoting a shared learning ethos. (Appendix 4: Ongoing Professional
Development)
Improving the quality of local and ultimately the national response to
rape/sexual assault. (Appendix 5: Evaluation & Monitoring)
Recruitment and retention of manpower and alleviation of the isolation of
practitioners.
Focusing on national needs relevant to service development.
Support the sustainability and growth of the service.
A way to assist and enable the above to be realised would be a biannual national
conference, focusing on a different relevant theme, with individual workshops relating
to individual disciplines/agencies. The workshops would be available to all
conference delegates. This would facilitate delivery of a national shared learning
forum. It would also help motivate the continued evolution and development of the
service countrywide and help put Ireland at the forefront of development of services
in responding to meet the needs of victims of recent rape/sexual assault.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
National Conference
27
28
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
CTION
E
S
1
1:1
Role of An Garda Síochána in the Irish Criminal Justice System.
30
1:2
Actions by An Garda Síochána on Receipt of a Complaint of a
Sexual Offence.
31
1:3
Statement Taking.
32
1:4
Early Evidence Kits – Oral or Drugs/Alcohol Facilitated Rape/
Sexual Assault.
33
1:5
Continuity of Evidence (Chain of Custody of Evidence).
35
1:6
Collection of Clothing from the Complainant.
35
1:7
Transfer and Storage of the Completed Sexual Offences Kit.
37
Recent Rape/Sexual Assault National Guidelines on Referral and
Forensic Clinical Examination in Ireland
An Garda Síochána
Guidelines
29
1:1
Role of An Garda Síochána in the Irish
Criminal Justice System
An Garda Síochána is the national police service of the Republic of
Ireland. It was established in 1922. An Garda Síochána is a community
based service organisation with over 12,000 gardaí and civilian
employees. Garda Headquarters is situated at the Phoenix Park, Dublin,
and there are 702 Garda Stations dispersed throughout the State.
The mission of An Garda Síochána is to achieve the highest attainable
level of personal protection, community commitment and state security.
The services provided by An Garda Síochána are determined and
delivered in consultation and partnership with the community. They are
constantly evolving to satisfy the requirements of the community. The key
service concerns include preventing criminal offences, investigating and
detecting criminal offences, supporting victims of crime, safeguarding
human rights and dignity, guarding the security of the State, preserving
the public peace, responding immediately to emergencies, contributing to
safety on the roads, improving the quality of community life and enforcing
anti-drug legislation.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
An Garda Síochána decide (subject to law) whether or not to initiate or
pursue an investigation of a complaint and they decide how any such
investigation is to be conducted. When a complaint of a criminal nature is
made, the gardaí have to address two main issues involving the question
of whether an offence was in fact committed and if the answer is yes,
then by whom. The gardaí are required to act not just with the single minded objective of creating a case against a particular suspect while
ignoring everything else, but with a view to getting the entire truth.
30
Once the formal investigation is complete, a file is sent to the Director of
Public Prosecutions, whose function is to decide, if there is sufficient
evidence to prosecute. In cases of breaches of the Criminal Law, gardaí
have a right of audience before the Courts. The gardaí prosecute cases at
District Court level. Cases heard in the higher courts are prosecuted
through the Chief Prosecution Solicitor’s Office. During trials, the gardaí
are merely witnesses for the prosecution. The adjudicative stage of the
system is totally independent of An Garda Síochána. The gardaí present
the facts to the Court and the Court decides on the innocence or guilt of
the accused person. If the Court does decide that an individual is guilty
beyond reasonable doubt, then the Judge when deciding the appropriate
sentence for the convicted person will request background information on
the culprit from the gardaí. To help the Judge make an informed decision
on the sentence, the gardaí supply this information, both favourable and
unfavourable, to the Court. The Judge will look for a Victim Impact Report
regarding the effect on the injured party. The penal stage of the system is
also independent of An Garda Síochána and they do not have an input
into where a prisoner is located or the category of the prisoner. An Garda
Síochána do give information to prison Governors on a particular
prisoner’s background, especially if the prisoner is unknown to the prison
authorities. An Garda Síochána is separate and autonomous from the
other elements of the Criminal Justice System, but there is a high degree
of good will and co-operation between the different agencies.
See also Appendix 1:
The Law In Relation To Sexual Crime in Ireland. (Page 93)
Actions by an Garda Síochána on Receipt of
a Complaint of a Sexual Offence
•
•
•
•
•
•
•
•
On receipt of a complaint of a sexual offence to a member of An
Garda Síochána, where a Forensic Clinical Examination is required,
the following steps are followed:
Immediate medical assistance should be sought, if
necessary.
Procedures of investigation are explained to the complainant.
It should be established if the complainant consents to a Forensic
Clinical Examination.
Contact is made with a Sexual Assault Treatment Unit/Clinical
Forensic Examiner to arrange an early Forensic Clinical
Examination. (Flowchart page 23)
Use an Early Evidence Kit where necessary. (Page 33)
Ensure that there is no contamination of evidence (Pages 35, 85)
by not allowing the alleged assailant to be in any place that the
complainant was.
Use an unmarked patrol car, where possible, in taking the
complainant to the Sexual Assault Treatment Unit/ Clinical Forensic
Examiner.
Re: Sensitivity to Complainant
KEY POINTS
•
•
•
•
•
•
•
•
Explain procedures.
Consent sought for Forensic Medical Examination.
Use unmarked patrol car where possible.
Gardaí should dress in plain clothes if possible.
Avoid areas where complainant may be identified if possible.
Use Early Evidence Kit if indicated. (Page 33)
Change of clothing brought with complainant to SATU.
Be aware and sensitive to the needs of the complainant.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
1:2
31
•
•
•
•
•
•
KEY POINTS
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
1:3
32
Different vehicles should be used to transport the complainant and
the alleged victim.
The Gardaí should dress in plain clothes (where possible) to avoid
identification of the complainant.
If possible avoid using areas of the Hospital where the complainant
could be identified.
Be aware of the needs of the complainant at all times.
Take a Sexual Offences Examination Kit and exhibit bags to the
examination area, if they are not already available.
A clothes change for the complainant should also be taken to the
SATU if possible.
Re: Prevention of Contamination of Evidence.
(Page 85)
•
•
Do not allow the alleged assailant to be any place that the complainant was.
Different vehicles should be used to transport the complainant and the alleged
assailant.
Statement Taking
Following a complaint of Rape or Sexual Assault, a member of An Garda
Síochána will take a statement from the complainant. The statement
should be taken at the earliest opportunity and in a suitable location for
the complainant and the gardaí.
The statement will contain a detailed account of the events leading up to
the incident, the incident itself and the events following the incident. It will
be the complainant’s account of what took place and any other salient
information that may assist the investigation. The statement will provide a
written record that will allow a decision to be made on the appropriate
action to be taken.
The complainant will be facilitated with a male or female garda, depending
on the wishes of the complainant. The investigation process will be
explained to the complainant. On completion of the statement, it will be
read over to the complainant and they will be asked to sign the statement.
The complainant will be offered a copy of their statement, as soon as it is
typed.
Re: Taking a Statement.
•
Take as early as possible.
•
Arrange a suitable location.
•
Complainant facilitated with male or female Garda.
•
The investigation process is explained to the complainant.
Detailed Account Taken of:
•
Events leading up to incident.
•
Incident itself.
•
The events following the incident.
On Completion of the Statement:
•
It is read over to the complainant.
The complainant is offered a copy of the statement, as soon as it is typed.
KEY POINTS
Early Evidence Kits
Sometimes it may not be possible for the complainant of an alleged
rape/sexual assault to see a Clinical Forensic Examiner immediately after
reporting the crime. Some complainants have to travel long distances in
order to be examined at the nearest Sexual Assault Treatment Unit, or a
Clinical Forensic Examiner may not be available until the morning, if the
incident occurs late at night. With every hour that passes, physical
evidence may deteriorate or be lost. Because of this, an Early Evidence
Kit is available to be used by An Garda Síochána in cases of rape/ sexual
assault.
Availability and Use of the Early Evidence Kit
•
The Early Evidence Kit should be available in all Garda stations so
that it can be accessed quickly.
•
The Early Evidence Kit is not a replacement for the existing Sexual
Offences Examination Kit, or for the Forensic Clinical Examination.
•
It is designed to be used in cases where there is going to be a
delay between the alleged rape/sexual assault and the Forensic
Clinical Examination.
•
It is to be used primarily in cases where oral sex (Page 56) is
alleged and/or where toxicological examination (Page 56) may be
required (e.g. a case where it is alleged that the complainant’s
drink was spiked.)
Procedure
•
The Garda who is present for the collection of these samples
should have no prior contact with the suspect.
•
Check the expiry date on the Early Evidence Kit.
•
After explaining the purpose of the Early Evidence Kit to the
complainant, their consent is obtained.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
1:4
33
•
•
To enable the Forensic Scientist to interpret any results obtained,
the garda must fill out the information form accompanying the Early
Evidence Kit.
If/when a Forensic Clinical Examination is carried out on the
complainant, the Clinical Forensic Examiner should be informed
that urine and/or oral swabs have already been taken.
Early Evidence Kits in alleged Oral Sex
If oral sex is alleged, the swabs should be taken at the earliest
opportunity. If the complainant wishes to have a drink, the mouth should
be swabbed before the drink is taken. At least three swabs should be
taken; an internal mouth swab, a gums/teeth swab and a swab from the
lips. It would be preferable if the Garda took these swabs rather than the
complainant.
•
Swabs should be pre-labelled by the Garda with the victim’s name
and the site the sample was taken from.
•
If the alleged sexual assault occurred more than twenty-four hours
previously, there is no need to take oral swabs, as semen does not
persist in the mouth beyond this time. (Pages 56 and 80)
34
•
•
•
KEY POINTS
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Re: Taking oral swabs.
Take swabs as soon as possible.
Take within 24 hours.
Take at least three swabs.
Swab sites
•
•
•
Internal mouth.
Gums/teeth.
Lips.
Early Evidence Kits in Drug/Alcohol Facilitated Rape/Sexual
Assault
•
If the complainant wishes to urinate and there is a delay getting a
Clinical Forensic Examiner, a urine sample should be collected at this
point.
•
A large container is available in the Early Evidence Kit for the
collection of urine. This can then be decanted into the smaller screw
cap container provided.
•
A Garda should witness the urine sample being taken and fill in the
accompanying information form. Standing outside the cubicle is
deemed adequate for witnessing.
KEY POINTS
1:5
Re: Time Frames
•
•
Blood - Take within 24hrs.
Urine - Take within 72 hrs.
Continuity of Evidence (Chain of Custody of
Evidence)
Items of evidence i.e. clothing, swabs, weapons etc., are referred to as
exhibits.
Each item of physical evidence to be produced in court as an exhibit,
must be identified by whom, where and when it was taken. This is
achieved by hearing the evidence of the person who took possession of
the item at the particular place and the date and place it was found.
Each witness may be required to give evidence as to what was done with
the item.
A garda assumes the role of Exhibits Officer and all items should be
handed over to the Exhibits Officer, who will prepare a chart showing all
movements of the exhibits.
A careful record of all exhibits should be maintained as follows:
• Description of the Item.
• Source or location of item.
• Date and time of transfer of the item.
• From whom.
• To whom.
1:6
Collection of Clothing from the Complainant
•
•
•
To avoid contamination, use gloves and other personal protection
equipment as required.
The garda who takes possession of the complainant’s clothing
should have no prior contact with the suspect.
Possession should be taken of the clothing the complainant was
wearing during the alleged rape/sexual assault.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
It is desirable that physical evidence passes through the custody of as few
persons as possible.
35
•
•
•
•
•
•
•
•
Consideration should also be given to taking possession of other
clothing worn by the complainant after the alleged rape/sexual assault.
The Garda should establish if these clothes have been washed since
the alleged rape/sexual assault.
It is advisable that each garment be placed in individual exhibit bags.
The exhibit bags should be sealed and labelled by the Garda. Seal the
bags by folding over the top and securing with staples or sellotape.
If envelopes are used for smaller exhibits, these should not be sealed
by licking.
If the clothing is dry or damp, pack in sealed paper bags. (Wet clothes
- see overleaf)
Sanitary protection should be packed in paper bags and labelled, if
wet, then it should be placed in a plastic bag.
Continuity of evidence (Page 85) should be maintained at all times.
KEY POINTS
Re: Colds / Allergy / Hay Fever
•
•
Masks should be worn.
Avoid sneezing directly onto the clothing.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Wet or Heavily Bloodstained Clothing
36
•
If the clothing is wet or heavily stained with wet blood then dry first
and pack in sealed paper bags, or –
•
Place in an open plastic bag and further pack in a sealed paper
bag.
•
Wet or heavily bloodstained clothing should be taken to the Forensic
Science Laboratory for drying at the earliest possible opportunity
1:7
Transfer and Storage of the Completed
Sexual Offences Examination Kit
This guideline covers the transfer and storage of the completed Sexual
Offences Examination Kit from the Examination Centre to the Forensic
Science Laboratory.
•
•
•
•
•
On completion of the Forensic Clinical Examination, the Sexual
Offences Examination Kit should be packed and sealed in the special
tamper evident bag, provided for this purpose in all Sexual Offences
Examination Kits.
The person who packs and seals the used Sexual Offences
Examination Kit should fill in the label on the bag.
The garda should keep a record of the Serial Number on the Sexual
Offences Examination Kit bag.
The Sexual Offences Examination Kit should be transported to the
Forensic Science Laboratory, as soon as possible, by a member of An
Garda Síochána, but in the interim the Kit should be kept in a cool
secure location.
Continuity of evidence should be maintained at all times. (Page 85).
.
Re: Transfer and Storage of the Sexual
Offences Examination Kit
Packed & sealed in the tamper evident bag from the Kit.
Person who packs & seals also labels the bag.
Garda keeps serial number record.
Transported to Forensic Science Laboratory – ASAP.
If delays in transporting, store in cool secure place.
Continuity of evidence maintained at all times. (Pages 35 and 85)
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
KEY POINTS
•
•
•
•
•
•
37
CTION
E
S
2
2:1
Role of the Clinical Forensic Examiner and the Forensic Clinical
Examination.
40
2:2
Reception of the Patient.
41
2:3
Consent.
44
2:4
History Taking.
45
2:5
Classifying Wounds and Injuries and Documentation of Wounds
and Injuries.
47
2:6
Photographic Evidence.
47
2:7
Female Patient: Genital Landmarks.
49
2:8
Male Patient: Genital Landmarks.
50
2:9
General Physical Examination.
51
2:10 Genital Examination.
53
2:11 Examination of the Alleged Perpetrator.
54
2:12 Forensic Sample Taking.
55
2:13 Possible Pregnancy Management.
58
2:14 Follow-up referrals.
59
2:15 Discharge.
60
Recent Rape/Sexual Assault National Guidelines on Referral and
Forensic Clinical Examination in Ireland
Clinical Forensic
Examiner Guidelines
39
2:1
Role of the Clinical Forensic Examiner and
the Forensic Clinical Examination
The Clinical Forensic Examiner, caring for the victim of sexual crime, has
many roles.
A caring, non-judgmental approach is of the utmost importance when
providing services for the victim of sexual crime. The examiner should
clearly convey that no one deserves to be raped and that they are not
responsible for the assault. The person should be reassured that he/she
made the best choices possible, under the circumstances. It is important
to remember, that the person may not recollect the entire incident, or may
be unable to tell some aspects of the incident.
All victims should be encouraged to report the assault to An Garda
Síochána. The person however, should be made aware that they can
themselves decide whether or not to disclose the information. (Flowcharts
pages: 11, 19.) It is, however, very important to remember that the
physical evidence can rarely be collected more than 72 hours after the
assault (Pages 58 and 80), whereas they can later decide not to pursue
the complaint.
40
The history taken should be sufficiently precise and accurate (Page 45) to
ensure an appropriate examination and collection of relevant forensic
evidence. The examiner must be able to detect and document all physical
injuries and for this reason, must be familiar with the normal appearance of
the genitalia and anus of adults (Pages 49-50). The examiner must pay
close attention to detail, to glean important forensic evidence, and must
record all specimens taken (Page 35). A complete report of the
examination is best prepared, as soon as is practicable, after the
examination, while the details of the examination remain fresh in the
examiner’s memory. The report should include an interpretation of the
findings and the examiner must be completely objective in this
interpretation.
Re: Clinical Forensic Examiner Role
•
•
KEY POINTS
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Examiners are responsible for documenting the pertinent aspects of the
history (Page 45) performing a careful physical examination, collecting the
required forensic material, treating physical injuries that have resulted from
the assault, providing care in terms of prophylaxis against pregnancy and
sexually transmitted infections and ensuring that there is appropriate
psychological support. Consent for all of the procedures undertaken
should be obtained after a thorough explanation. (Page 44)
•
•
•
•
•
•
•
Adopt a caring non-judgmental attitude
Consent should be obtained for all the procedures undertaken.
(Pages: 39, 44, 66)
Pertinent aspects of the history must be documented. (Page 45)
Collect all forensic evidence and record all specimens taken. (Pages: 35, 47, 85, 88)
Detect, treat and record any physical injuries.
Provide care and prophylaxis against:
o Pregnancy. (Page 58)
o Sexually Transmitted Infections. (Pages: 67-71, 75 )
Ensure that appropriate psychological support is given. (Pages: 57, 63)
A complete report of the examination should be prepared as soon as possible.
The report should include objective interpretation of the findings. (Page 45)
Evaluation of Patients with Serious Injury
Unfortunately, the examiner is sometimes asked to evaluate a victim
who has had serious injury. In this circumstance, life-threatening
conditions must be dealt with as a priority, and the forensic clinical
examination can then be performed after stabilisation of the patient. In
these situations it is important to document the extent and reason for
the delay.
KEY POINTS
•
•
•
Life-threatening conditions must be dealt with as a priority.
Forensic Clinical Examination performed after stabilisation of patient.
Document any delay and reason for the delay in performing Forensic Clinical
Examination.
Reception of the Patient
Coping as a victim depends greatly on experiences immediately following
the crime of rape/sexual assault. The psychological care received by the
victim will frame her/his recovery.
Most patients, attending the SATU, do so in an acute capacity and are
usually referred and accompanied by An Garda Síochána. If not
accompanied by An Garda Síochána, then consult the quick
reference/flowchart relevant to the situation e.g.
•
•
•
•
A Person Who Does Not Want to Report the Incident to An Garda
Síochána (Page 22)
Flowchart for Referral Pathways to a Clinical Forensic Examiner. (Page 23)
A – F Guide of Referral for a Forensic Clinical Examination. (Page 24)
A Guide to Help Preserve Forensic Evidence which may be Available.
(Page 25)
Sexual Assault Treatment Units (SATUs)
Information re:
Units in Ireland, appendix 6, page 105.
•
•
Equipment etc., appendix 7, page 107.
•
Prevention of contamination, and cleaning of equipment etc.,
appendix 9, page 113.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
2:2
Re: Patients with serious injury
41
Patient’s Behaviour/Feelings
The patient's behaviour may be different than what you expect. The
individual may laugh, giggle nervously, cry, be hysterical, dissociate,
have flat-effect, be withdrawn, angry, ashamed, embarrassed or guilty.
Her/his mood may suddenly change. Cultural influences may be
involved. The addition of alcohol and drugs may further confuse the
situation. The patient did not have training on how to be a victim.
On Arrival:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
•
42
•
•
•
•
•
•
•
Meet the patient.
Provide a safe and private setting, both for the reception of the
patient, and throughout the examination. (Page 107)
Greet her/him by name.
Introduce yourself by name and title, and very briefly outline your role.
Assess the patient’s medical needs: Medical stability is priority.
The forensic clinical examination is always secondary to medical
stability.
Be relaxed. Check your body language.
Offer the patient the opportunity to speak with a RCC support worker
or other psychological support. (Page 63)
Sit beside the patient, rather than stand over them.
Provide unhurried and confident actions with direct eye contact.
Do not judge behaviour or dress. (Table 1, page 43 Some Do’s and
Don’ts)
Do not try to minimise the individual’s trauma by using words such as
"well at least……."
Do not question the patient’s actions or decisions, this creates
disbelief and may re-victimise.
Affirm: "Whatever you did worked, because you survived, you are
here now."
Re-assure the patient regarding her/his safety and confidentiality
and any limits to confidentiality.
If the patient is alone, offer to contact a family member or friend, if
needed for support.
Give a brief explanation of procedures and their purpose, using clearly
understood language.
Explain, in a gentle and sensitive manner, that their permission will be
sought for the examination and that it will only proceed with their
consent, thus helping to restore their self-esteem and sense of
control. (Page 44 re: consent)
Encourage the patient to vent her/his feelings, concerns and
needs.
Validate the patient’s feelings, concerns with empathetic listening,
compassion and appropriate information.
Give reassurance that her/his response was normal. (Flower, 2002)
If the patient was not assaulted orally, offer them a cup of tea or a
cold drink.
The patient can have a family member, friend or support worker
present during the examination, if she/he so chooses.
Table 1: Some Do’s and Don’ts when receiving the patient.
Do
Don’ts
Greet the patient by name and give your
name.
Proceed if the patient is not medically
stable.
Make eye contact, check your body
language.
Proceed if the patient is not consenting.
Reassure the patient re: safety &
confidentiality.
Judge the patient’s dress or behaviour.
Listen, reassure and affirm the patient’s
actions.
Try to minimise the individual’s trauma.
Explain and offer to contact any
friends/family
Question the patient’s actions or decisions.
KEY POINTS
•
•
•
•
•
•
•
•
•
•
•
•
•
Laugh
Giggle nervously
Cry
Be hysterical
Dissociate
Appear ‘flat’
Be withdrawn
Feel angry
Ashamed
Embarrassed
Feel Guilty
Cultural influences may be involved.
Alcohol and drugs may be a factor.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Priority - Medical Stabilty
Re: Patient’s Behaviour/Feelings.
The person did not have training on how to
be a victim.
She/He may
43
2:3
CONSENT TO FORENSIC CLINICAL
EXAMINATION
The examiner should obtain consent for each step of the forensic clinical
examination: the patient under examination may refuse to participate in any
step of the examination or to halt the examination at any time.
Steps of the Forensic Clinical Examination Process are:
• History of the event.
• Comprehensive general health examination.
• Genital examination.
• Notification of An Garda Síochána of the event.
• Collection of forensic samples for An Garda Síochána (Including
blood).
• Photographs of injuries sustained. (Page 47)
• Administration of necessary treatment.
• Preparation of a medico-legal report based on the examination
findings.
• Presentation of the Forensic Clinical Examination details in a court of
law.
Special Considerations
It is very important to remember that there are special considerations, in
relation to consent, if the person is under the age of 16 years, or has
learning difficulties. In such a situation, it is appropriate to perform a
medical examination, if the patient clearly understands and agrees to the
process. Forensic evaluation requires the consent of parent or guardian
if the person is less than 17 years.
44
NB. Under 18 years of age Children First (1999) reporting procedure
should be followed, appendix 2, page 99. (Appendix 8: Sample consent
form, page 112)
KEY POINTS
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
If the person’s understanding of the procedures is felt to be impaired due
to alcohol or drugs, then the consent for, and the forensic clinical
examination itself, may need to be delayed, until informed consent can be
obtained.
Re: Consent
Consent obtained when:
•
Person fully informed;
•
Person aware they can withhold consent for any part.
Legal Considerations re:
•
Age;
•
Competency status;
•
Learning difficulties.
2:4
History Taking
The history from a patient who has suffered a rape/sexual assault will differ
from a routine medical evaluation in several ways. The purpose of the
history is to record the events that occurred and to guide the clinician
in collecting evidence and determining the injuries that may have occurred
as a result of the assault. Questions should be limited to relevant medical
history. The patient should be informed that it will be necessary to ask
some personal questions. It is important to remember that the medical
history is not an exhaustive account of the details of the crime.
•
•
Is to record events.
To guide the clinician re: determining injuries and collecting
evidence.
NB. The medical history is not an exhaustive account
General History
The general history should include the following information:
•
Past history of medical/surgical/psychiatric illness.
•
Medications.
•
Allergies.
•
History of sexually transmitted infections.
•
Contraceptive use.
•
Last consented sexual experience.
•
Tampon use.
•
Alcohol ingestion.
•
Illicit drug use.
•
Menstrual history and last menstrual period (LMP).
•
Obstetric history.
•
Possibility of current pregnancy.
The Forensic Interview
The forensic interview then addresses the details of the assault and the
patient must be informed that they may stop the questioning for a time, if
they wish and then continue, if and when ready.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
KEY POINTS
Re: Purpose of history
45
The Forensic Interview Part of the History Taking Should Cover:
•
Brief description of the incident.
•
Number and identity of the attacker(s), if known.
•
Date and time of the attack.
•
Location where assault took place.
•
Type of sexual acts that occurred e.g. kissing/ fondling/
contact with the vagina/ anus/ mouth/ breasts and other
locations on the body and for a male patient, contact with the
mouth / anus/ genitalia or other parts of the body.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Also noted is the following:
46
•
Consideration as to whether ejaculation took place.
•
Use of condom by the perpetrator.
•
Use of weapons or restraints by the perpetrator.
•
Use of objects to achieve penetration.
•
Actual or threatened violent behaviour used in the course of
the attack.
•
Any possible occurrence of bites by the perpetrator.
•
Any possible source of the assailant’s DNA e.g. ‘ belly button.’
•
After the assault, it is important to document whether the
patient has:
•
Changed clothes.
•
Bathed.
•
Passed urine or faeces.
•
Douched since the time of the assault.
If the oral cavity was involved, the patient should be asked if he or
she:
•
Has smoked.
•
Eaten or had anything to drink.
•
Brushed teeth or gargled since the assault.
IMPORTANT: All direct quotes made by the patient should be
denoted with quotation marks when these are recorded.
2:5
Classification and Documentation of
Wounds and Injuries
Any lesion on the surface of the body, the genital, anal and oral areas,
should be clearly documented with the proper medical terminology. The
presence of areas of tenderness should also be documented. For each
lesion, the location (reference to the nearest bony point can be helpful),
size, outline and colour should be recorded. Outline body maps are
included in the Sexual Offences Examination Kit and their use is very
helpful in documenting any injury noted.
The non-genital trauma may result from kicks, attempted strangulation,
bites, and restraints, including holding the upper arms and/or the inner
thighs and trauma on the back or front of the body from the surface
against which the patient was placed.
BRUISE
An injury to the body manifested as discoloration of
the skin, caused by an impact or blow. The skin
surface is intact.
NB. Bruising may not be noticeable until 1-2 days
after the incident.
LACERATION
An open wound where the skin has been torn rather
than cut.
ABRASION
The skin has been rubbed off by a force along the
body surface. The injury is to the outer layers of the
skin.
INCISION
A breach of the skin surface made by a sharp object
with the direction of the force along the skin.
STAB
The skin is pierced by the point of a sharp object. The
direction of force is thrusting into the body.
2:6
Photographic Evidence
Written documentation does not always describe or convey adequately the
visual depiction. The use of photographs may be felt to be a more
appropriate way of conveying the extent and impact of injuries and as a
way of supporting the documented findings. If the Clinical Forensic
Examiner, in consultation with the patient and the gardaí, feels that the use
of photographs will be of benefit to the case, then following informed
consent, photographs may be taken.
Consent to Photographic Evidence
Before photographic evidence is taken, the patient must have given written
consent (page 112), and must be fully aware that the photographs may be
shown in any subsequent court proceedings, this means the defence team
would have access to any photographs. This is of particular relevance for
photographs taken of the genital area.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Table 2: Useful descriptive terms when documenting injuries
47
Who Takes the Photographs?
The person with the most appropriate skill and expertise to take the
required photographs is a Garda Photographer. This also supports safe
practice with regard to continuity and storage of evidence. Where a Garda
Photographer is not available or not appropriate, the Clinical Forensic
Examiner/other should use a fresh roll of film to capture the images. The
roll of film should then be placed in a sealed plastic bag with the details,
signature of the Clinical Forensic Examiner/other and date and time
displayed on the outside of the bag. The sealed bag containing the roll of
film is then passed to the investigating officer.
The Future
Internationally, the area of photographic evidence is advancing on many
fronts including digital photography. The area of photographic evidence
from the Clinical Forensic Examiner perspective will continue to be
reviewed.
Re: Photographic Evidence
Take photographs if:
•
They would support and better convey the extent and impact
of any injuries.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
KEY POINTS
48
•
•
Taken following:
Consultation with patient and Gardai;
The patient’s consent (NB see page 49, paragraph 2)
Who Takes the Photographs?
•
If possible a Garda Photographer if available and appropriate;
•
If taken by others, then:
o
Use a fresh roll of film;
o
Film placed in a plastic bag;
o
Bag is sealed;
o
Display on outside of the sealed bag the following
details: signature of person who took the photographs,
date and time;
o
The sealed bag with the roll of film is given to the
investigating officer.
Table 3: Female patients genital landmarks (see Figure 2)
NAME
DESCRIPTION
LABIA MAJORA
fleshy outer lip of the vulva.
LABIA MINORA
smaller inner lip of the vulva.
CLITORIS
a small cylindrical body of tissue situated at the most
anterior pats of the labia minora
URETHRAL ORIFICE
opening into the urethra
HYMENAL OPENING
frilly, fleshy. fimbriated in the adult.
HYMENAL REMNANTS
after vaginal delivery.
FOURCHETTE
where the labia meet posteriorly.
INTROITUS/VESTIBULE
entrance to the vagina and is that point where the
labia touch when observing the genital area.
FOSSA NAVICULARIS
the depression between the fourchette and hymen.
Table 4: Descriptive terms for the vagina
ANTERIOR
POSTERIOR
RIGHT
LEFT
LOWER THIRD
MIDDLE THIRD
UPPER THIRD
FORNIX sulcus or valley of the vagina above and around the cervix referred to as
anterior / posterior, right / left.
Female Patients: Genital Landmarks
Figure 2: Female Patients: Genital Landmarks
Reproduced by kind permission from GW Medical Publishing, Inc. St. Louis.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
2:7
49
2:8
Male Patient: Genital Landmarks
In the examination of a male patient, it is important to carefully examine the
penis and scrotum for signs of trauma and to take the appropriate forensic
swabs (pages 56 and 78) using the Sexual Offences Examination Kit.
NB. It is important to note if the foreskin is present or if
circumcision has been performed.
Table 5: Male genital landmarks (see Figure 3)
SHAFT OF THE PENIS - Dorsal and Ventral
FORESKIN – A loose fold of skin that covers the glans of the penis.
GLANS OF THE PENIS – the red tip of the penis beyond the coronal sulcus
CORONAL SULCUS – the area where the foreskin is or was attached to the penis
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
SCROTUM
50
PERINEUM
ANUS
Figure 3: Male Patients: Genital Landmarks
Reproduced by kind permission from GW Medical Publishing, Inc. St. Louis.
2:9
General Physical Examination
Equipment
Before beginning the physical examination, the Clinical Forensic Examiner
must ensure that all equipment necessary for the examination and the
collection of forensic evidence is readily available (see key point, for full list
of equipment see appendix 4, page 103). A thorough physical
examination is then performed. The client’s height, weight and blood
pressure should be determined.
Re: Equipment
Sexual Offences Examination Kit.
Clean paper sheet.
Light source.
Disposable gloves.
Correct size speculum.
KY Jelly.
Height / Weight /BP apparatus.
If Required:
•
Mask/apron/sleeves. (Page 78)
•
Proctoscope.
Assessment of Non-Genital Physical Trauma
The assessment for evidence of non-genital physical trauma is very
important, as this occurs in 25% to 45% of victims (Giardino et al, 2003
p. 244). The patient should be sensitively asked to remove all clothing,
including underwear. The clothing may need to be kept for forensic
evidence. It is best to begin the examination with a non-threatening
approach, such as examining the head and neck. The examination may
then progress to the more distal parts of the body. It is essential to
visualise the whole body. It is important to search for lacerations, bruises,
abrasions, and evidence of bite marks, kicks, hand tie marks, tape marks
etc. or attempted strangulation. The forensic samples (page 56) may be
collected as the examination progresses.
In particular, the examiner should consider the possibility that the
perpetrator has deposited body fluids, including blood and saliva, as well
as semen. Where body fluids may have been deposited, the Clinical
Forensic Examiner should moisten a swab with the sterile water provided,
swab the area and then follow the moistened swab with a second dry
swab to mop up any remaining body fluids.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
KEY POINTS
•
•
•
•
•
•
•
51
Non-genital trauma occurs in 25% - 45% of victims.
KEY POINTS
Examine the whole body for evidence of:
•
Lacerations;
•
Bruises;
•
Abrasions;
•
Bite marks;
•
Kicks;
•
Hand tie marks;
•
Tape marks;
•
Attempted strangulation.
The perpetrator may have deposited Blood / Saliva / Semen
The Oral Cavity
The oral cavity should be examined carefully. Swabbing between the teeth
may yield semen, if the examination is performed shortly after ejaculation in
the mouth. It should be remembered that saliva may be the best source
of a forensic sample for detection of semen in the mouth. A moist swab
rubbed outside the lip margins may yield a sample of the perpetrator’s
cells deposited with saliva. (See page 56)
Swab for semen
•
Between the teeth;
•
And collect saliva.
Swab for perpetrator’s cells:
•
Inside the lip margins.
(Page 56)
Head and Pubic Hair Specimens
Suspicion that semen has been deposited in head hair or pubic hair
should be evaluated by swabbing, or cutting away the affected areas and
sending the swabs or cut hair as forensic specimens. The hair should be
combed with the special comb provided in the Sexual Offences
Examination Kit for the collection of fibres, debris and loose hair. Samples
of pubic hair and hair cut from the head should also be collected as a
comparative control sample.
KEY POINTS
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
KEY POINTS
52
Re: Oral Cavity
Re: Head & Pubic Hair may contain:
•
Semen;
•
Fibres;
•
Debris;
•
Loose hairs.
Pubic hair & hair cut from the head are collected as comparative
control samples.
Finger Nails
Foreign material, which may include skin cells from the perpetrator, may
collect under the fingernails. The cut nails provide the best sample for
forensic evaluation, but if this is inappropriate or unacceptable to the
patient, the material under the nail can be collected using the special swab
provided in the kit.
NB. Forensic swabs (taken depending on the history) are less likely
to give valuable evidence, if taken after wound cleaning or the
patient has washed, douched, brushed their teeth, rinsed their
mouth, drank / eaten, or defecated.
See: A Guide to Help Preserve Forensic Evidence which May be
Available (Page 25)
2:10 Genital Examination
The genital examination follows the general physical examination. Inform
the patient of the expected discomfort and of their right to stop the
examination at any time. The external and internal genitalia are carefully
examined using adequate lighting. The posterior fourchette, fossa
navicularis, labia minora and hymen (page 49) are particularly susceptible
to injury. Without magnification it is considered that up to 25% of victims
have evidence of genital trauma after a sexual assault (Biggs et al, 1998).
The majority of the genital injuries are minor, but trauma may be so
extensive as to require hospital admission for surgical repair.
A vaginal examination using a speculum should, if possible, be used to
assess for vaginal and cervical bleeding, lacerations and foreign bodies.
Any foreign body, such as a tampon, should be removed and retained for
forensic analysis. Swabs are taken as suggested in the Sexual Offences
Examination Kit (page 33) for forensic evaluation.
Anal Examination
Inspection of the anus for tears, bleeding or abrasions should also be
performed. It may be difficult for the patient to mention concern in regard
to anal penetration, and the use of the proctoscope for examination of the
lower anal canal in all victims is considered appropriate by some. The
recommended swabs (page 56) should then be taken from the anal/rectal
area.
Pelvic Examination
It is important to consider a pelvic bi-manual examination, in order to
exclude internal trauma e.g. torn broad ligament (Riggs et al, 2000), which
can occur without vaginal bleeding or vaginal discomfort being present in
the early hours after the incident. This is more commonly seen in
accompanying physical trauma.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Vaginal Examination
53
Blood Samples
The physical examination concludes by taking samples of blood for
determination of DNA, evaluation of the patient’s blood group,
determination of blood alcohol level and, if required, blood sample for
toxicology.
Without magnification it is considered that up to 25% of victims have
evidence of genital trauma.
Areas particularly susceptible to injury:
•
Posterior fourchette;
•
Fossa navicularis;
•
Labia minora;
•
Hymen.
KEY POINTS
Vaginal
•
•
•
•
Examination using a speculum if possible to assess:
Vaginal or cervical bleeding;
Haematoma;
Lacerations;
Foreign bodies e.g. Tampon.
Anal Examination for:
•
Lacerations;
•
Abrasions;
•
Bleeding.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Pelvic Examination to exclude:
•
Internal trauma.
54
2:11 Examination of the Alleged Perpetrator
An examination of the alleged perpetrator is sometimes required.
Generally this is following arrest and detention of the alleged perpetrator,
and in accordance with the requirements of the Criminal Justice Forensic
Evidence Act (1990).
(Appendix 1, page 93)
The Sexual Offences Examination Kit is designed for the examination of
either a victim or a perpetrator. This examination essentially takes the same
format as that of the alleged victim. In the examination of the perpetrator,
the examiner is looking for evidence of contact with the complainant,
evidence of injury that the complainant feels that they may have inflicted on
the alleged perpetrator and also evaluating the use of alcohol and drugs by
the person. Particular attention should be paid to pubic hair combings
and swabs of the coronal sulcus, the glans, shaft and base of the penis
(page 57), as these may yield the necessary evidence of intimate contact.
(See Figure 3, page 50)
Re: Alleged Perpetrator
•
•
Generally they are under arrest.
Sexual Offences Examination Kit used.
KEY POINTS
Look for evidence of:
•
Contact with the complainant;
•
Injury inflicted by the complainant.
Evaluate the use of:
•
Alcohol & drugs.
Particular attention paid to:
•
Pubic hair combings;
•
Swabs of the coronal sulcus, the glans, shaft and base of the
penis. (Page 57)
NB. If the same Clinical Forensic Examiner is to be used to take
samples from the complainant and the suspect, on the same day,
this should be done at separate locations and the examiner should
always wear a separate disposable scene of crime suit and gloves
for each.
2:12 Forensic Sample Taking
Prior to Commencing
•
The expiry date on the outside of the Sexual Offences Examination Kit
should be checked.
•
If there is an allegation of oral sex, the complainant should be given a
container and asked to spit into it, starting at the beginning of the
Forensic Clinical Examination and proceeding at intervals during the
course of the examination.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Before starting the forensic clinical examination and sample taking, the
following should be considered:
55
Table 6: Guidelines for the collection of forensic samples.
SALIVA
•
•
•
•
Detection of semen if oral penetration within 2 days.
Take 10 ml (if possible) of liquid saliva.
Pack in plastic bottle with its own evidence bag.
Do not re-seal in kit.
EXTERNAL LIPS
•
•
Detection of semen on outside of mouth.
Dampen swab with sterile water and rub lips and skin
around mouth.
Return swab immediately to tube.
•
MOUTH SWABS
•
•
Detection of semen if oral penetration within 1 day.
Take 2 sequential samples by rubbing swabs around
inside of mouth, under tongue and gum margins or over
dentures and dental fixtures.
SKIN SWABS
•
Detection of body fluids on skin e.g. semen;
saliva on kissed, licked, bitten area; blood stain that may
not be from the victim.
If stain is moist, recover on a dry swab.
If stain is dry, dampen swab with sterile distilled water.
Repeat with second dry swab.
Return swabs immediately to tubes.
•
•
•
•
UNUSED SWABS
•
Control sample.
Submit one unopened swab in every case where swabs
have been taken.
A.
Detection of semen. Cut or swab relevant area, if
applicable, place hair in plastic bag.
B.
Detection of fibres, foreign particles, foreign hairs - draw
comb with cotton wool through all the hair, place in plastic
bag.
C.
Control sample for microscopic hair comparison. Pull the
hair from the root or cut close to the base. A
representative sample of 10-20 hairs should be collected
and placed in plastic bag.
D.
A control sample of 10 – 20 hairs; which must be plucked
for DNA profiling (only if blood or buccal swabs are not
available).
PANTIES AND
SANITARY
PROTECTION
•
Semen may be detected on sanitary protection and
panties worn after incident, so take also.
Take panties worn at time of examination.
Leave pad attached to panties if present.
Take tampon if worn.
Panties in paper bag.
Tampon in plastic bag
VULVAL SWABS
•
•
•
•
(CONTROL SWAB)
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
HEAD HAIR
56
•
•
•
•
•
•
Detection of body fluids, if vaginal intercourse within 7 days or
If anal intercourse within 3 days, or
Ejaculation on to perineum.
First sample. Rub 2 sequential swabs over whole of
vulval area. Number the swabs in the order taken. (Moisten
swabs with distilled water if required).
Return swabs immediately to their tubes.
•
•
VAGINAL SWAB –
LOW (Continued)
•
•
VAGINAL SWAB –
HIGH
•
•
•
•
Detection of body fluids, if vaginal intercourse within 7
days or
If anal intercourse within 3 days.
Second sample. Take 2 sequential swabs, approx.
1 cm above hymen, using unlubricated speculum
(moisten with sterile distilled water if necessary).
Number the swabs in the order taken. As above.
Detection of body fluids, if vaginal intercourse within 7
days or
If anal intercourse within 3 days.
Third sample. Take 2 sequential swabs from the posterior
fornix via the speculum.
Number the swabs in the order taken. As above.
ENDOCERVICAL
SWAB
•
•
Take if vaginal intercourse more than 48 hours previously.
Final sample. Take 2 swabs via the speculum.
As above.
PUBIC HAIR
A.
Detection of semen, Cut or swab relevant area if
applicable, Place hair in plastic bag.
Detection of fibres, foreign particles, foreign hairs, draw
comb with cotton wool through the hair, place in plastic
bag.
Control sample for microscopic hair comparison. Pull or
cut a representative sample of 10 hairs and place in plastic
bag.
B.
C.
PENILE SWAB –
CORONAL
SULCUS / GLANS/
SHAFT
•
•
•
•
•
•
•
PERIANAL SWAB
•
•
•
RECTAL SWAB
•
•
•
FINGERNAILS
•
•
•
•
•
Detection of body fluids, if intercourse within 7 days.
Use swabs moistened with sterile water.
Take 2 sequential swabs from coronal sulcus.
2 sequential swabs from shaft and glans and
2 sequential swabs from base of penis including pubic hair
and scrotal sac.
Number the swabs in the order taken.
Return swabs immediately to tubes.
Detection of body fluids, if vaginal or anal intercourse
within 3 days.
Take 2 sequential swabs from the perianal area using
swabs moistened with sterile distilled water.
Number the swabs in the order taken. Pack as above.
Detection of body fluids if anal intercourse within 3 days.
Take swab from lower rectum after passing proctoscope
2-3 cm into the anal canal. The proctoscope may be
lubricated with KY jelly. NB. See appendix 9, point 4.
Pack as above.
Recovery of trace evidence (e.g. body fluid, possible fibres)
or connection with fingernail broken at scene (if the
circumstances suggest this as a possibility).
Preferably cut nails.
If the nails are too short or cutting is unacceptable,
moisten swab with sterile water and thoroughly swab the
area underneath each fingernail of one hand.
Use a second swab for the fingernails of other hand.
Place in evidence bag.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
VAGINAL SWAB –
LOW
57
BLOOD Sample 1
•
•
•
For DNA analysis:
Take 5ml of venous blood.
Place venous blood into EDTA container.
BLOOD Sample 2
•
•
•
For blood grouping:
Take 5 ml of venous blood.
Place venous blood in plain container (no preservative).
BLOOD Sample 3
•
•
•
•
Detection of alcohol and drugs of abuse.
Only taken if within 24 hours of incident.
Take 10 ml of venous blood.
Place venous blood in fluoride oxalate bottles.
URINE
•
•
•
Detection of alcohol and drugs of abuse.
Only taken if within 72 hours of incident.
Ask subject to urinate into the wide universal container.
Pack fluoride oxalate bottles and urine sample in
toxicology pack.
BUCCAL SWAB
•
•
•
•
•
DNA reference sample.
Take only when blood sample is NOT available.
Firmly rub a swab 10 times against the inside of one cheek.
Repeat procedure with second swab on other cheek.
Return immediately to swab tubes.
Appendix 9: Copy of Sexual Offences Examination Kit instructions. (Page 113)
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
2:13 Possible Pregnancy Management
58
Emergency contraceptive measures should be discussed with all women
who attend for evaluation following an allegation of sexual crime. In the
USA, the rape related pregnancy rate has been estimated at 5% per rapes
among those of reproductive age (Holmes et al, 1996) if emergency
contraception is not used.
The most suitable method of emergency contraception will depend on the
patient characteristics, the time that has elapsed since the assault and the
timing of any unprotected consented intercourse. The sooner that
emergency contraception is started the greater the efficacy. A single dose
of Levonorgestrel 1.5 mg, (two 750 microgram tablets) given orally as soon
as possible within 72 hours. This is an effective and well-tolerated
regimen, although the woman should be advised that no contraceptive
method is 100% reliable. There is some evidence to suggest that it is of
value up to 5 days (120 hours) after unprotected intercourse. The patient
should be advised to take contraceptive precautions until the start of their
next menstrual period.
Insertion of a copper containing intrauterine contraceptive device is a
highly effective method of preventing pregnancy, and could be considered
for women presenting after 72 hours but within 5 days (120 hours) after
the time of expected ovulation (Table: 7, p. 59).
Table 7: Time Frames for Postcoital Contraception
METHOD
TIME FRAME
Single dose of Levonorgestrel 1.5 mg (two
750 microgram tablets) orally.
•
•
As soon as possible within 72 hours.
Some evidence is of value up to 5
days (120hrs) after unprotected
intercourse.
A copper-containing intrauterine device.
•
After 72 hours but within 5 days
(120 hrs) after the time of expected
ovulation.
2:14 Follow-up Referral
Sexual Assault Treatment Units need to have a system in place whereby
patients have access to a broad range of services/ expertise which is
immediately available, should the need arise e.g. Emergency Departments,
Gynaecology Services (Table: 8, below).
Some of these needs are identified at the time of the Forensic Clinical
Examination, whereas others may become apparent during the follow-up
examinations or from a positive result in STI screening. The examiner will
use professional judgement and in consultation with the patient or
guardian, make the decision regarding appropriate referrals for support
and care.
•
•
•
Services / expertise from other services e.g. Emergency
Department, Gynaecology.
Follow up appointment or referral for Sexually Transmitted
Infection review. (Page 71)
Psychological support services if patient has not seen a
support worker. (Page 65)
•
For a patient under the age of 18, Children First (1999) referral
procedures should be followed. (Appendix 2, page 99).
•
GP and/or other Primary Health Care Professionals (page 88)
For:
o
Additional support.
o
Wound care / completion of TT/ Hepatitis B course etc.
o
Prevention / treatment of short and long-term health
problems
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Table 8: Possible Follow-up Referrals
59
2:15 Discharge
On the completion of care in the Sexual Assault Treatment Unit, the patient
should be discharged to a safe environment, ideally accompanied by a
family member, guardian, friend or support person.
Discharge Information Given to the Patient:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Instruction on the care of any injuries.
Medication instructions, if applicable.
Follow-up appointments with place, dates and times.
Referral letter, if applicable.
Letter for G.P., if desired. (Page 88)
Letter for work, college, school, if required.
Information leaflet issued by Sexual Assault Treatment Unit,
stating support line number and details of services provided.
Phone number and printed information leaflet (if Support
Worker has not spoken with the patient) from the RCC, which
offers psychological support for the patient and her/his family.
(Page 65)
Name with contact number of accompanying Garda.
Relevant information leaflets from The Health Promotion Unit,
HSE and independent agencies which deal with issues such as:
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
•
•
•
•
60
Domestic Violence;
Interpersonal Violence;
Drug and Alcohol programmes;
Safety / Prevention programmes.
CTION
E
S
3
3:1
Role Of Psychological Services.
62
3:2
Setting up Links with the SATU/Clinical Forensic Examiner.
63
3:3
Making a Referral for Immediate Psychological Support.
63
3:4
Role of a support worker.
64
3:5
Role of a support worker in a SATU or with a Clinical Forensic
Examiner.
65
When a Victim/Survivor Leaves the SATU/Clinical Forensic
Examiner.
65
If a Victim/Survivor Chooses not to have a Forensic Clinical
Examination.
66
Future Contact with the Victim/Survivor.
66
3:6
3:7
3:8
Recent Rape/Sexual Assault National Guidelines on Referral and
Forensic Clinical Examination in Ireland
PSYCHOLOGICAL
SUPPORT
GUIDELINES
61
3:1
Role of Psychological Services
"The essential element of rape is the physical, psychological, and
moral violation of the person. Violation is, in fact, a synonym for rape.
The purpose of the rapist is to terrorise, dominate, and humiliate his
victim, to render her utterly helpless. Thus rape, by its nature, is
intentionally designed to produce psychological trauma." (Herman,
2001, pp. 57-58). Women learn in rape that they are not only violated
but dishonoured. (ibid, p. 66). All this applies whether a
victim/survivor is female or male.
When psychologically, morally and physically traumatised by rape/sexual
assault a victim/survivor has a variety of needs – varying from immediate
physical and emotional safety to overcoming shame, arriving at a fair
assessment of her/his conduct, rebuilding trust, and recreating a positive
sense of self (ibid). Psychological support encompasses a variety of
activities that go some way towards meeting these needs from a number
of different sources including friends, family, medical and nursing staff, rape
crisis personnel, work colleagues and religious personnel.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Health care staff can provide crucial psychological support in terms of
treating a victim/survivor respectfully, providing information in a way that
they can understand, and allowing her or him to make their own choices.
In order for a Clinical Forensic Examiner’s report and testimony to be
credible, the Forensic Clinical Examination needs to be conducted in an
objective manner.
62
An individual victim/survivor may need and want to have someone else
with them while deciding whether to undergo a Forensic Clinical
Examination, file a report with the Gardaí and choose whether or who in
their life she or he wants to tell about the rape/sexual assault. She or he
may also want to have someone with them while undergoing a Forensic
Clinical Examination. A support worker from a RCC is able to provide
psychological support at the time and aid the victim/survivor in making
choices about any other sources of psychological support that the person
chooses to access in the long-term. Sometimes, victims/survivors choose
to use rape crisis personnel for support because they are not sure what
their friends or family will think or how they will react. Ideally, a support
worker is available to come to the SATU at any time, 24 hours a day, when
a victim/survivor arrives at the unit and chooses to speak with a support
worker. Whether a victim/survivor chooses to speak with a support worker
at the time or not, written information including myths surrounding rape,
the psychological effects of rape and sources of psychological support
should be given to all victims/survivors. The provision of excellent
psychological support will depend to a large extent on on-going contact
and co-operation between the SATU and the local RCC. This will ensure
up-to-date knowledge of any changes in the availability of local services.
(Appendix 10: History and role of Rape Crisis Network Ireland (RCNI)
page 116).
3:2
Setting up Links with the SATU/Clinical
Forensic Examiner
When a SATU is established, three steps need to be taken in order to
subsequently provide a victim/survivor with appropriate psychological
support. These steps are:
•
The nomination of one staff person in the RCC to liaise with
the SATU/Clinical Forensic Examiner;
•
The establishment of a reciprocal referral mechanism between
the SATU/Clinical Forensic Examiner and the RCC;
•
Information leaflets provided by the RCC should be available in
the SATU.
It is helpful if the nominated liaison person is one who is generally available
during day-time hours, as this will facilitate contact. This ongoing
communication is useful so that both the RCC and the SATU/Clinical
Forensic Examiner are aware of available services and can sort out any
potential difficulties. It is the responsibility of the RCC liaison person to
inform the SATU/Clinical Forensic Examiner of any service delivery changes
or developments. The nominated liaison person, as well as SATU
personnel needs to be aware of the availability of any other community
services that are potentially useful for victims/survivors, such as women’s
support services and refuges. Some of this information will be available in
the information leaflets.
•
Designated liaison person in the RCC.
Establishment of reciprocal referral mechanisms between
RCCs and SATUs/Clinical Forensic Examiners.
Information leaflets made available in the SATUs.
Making a Referral For Immediate
Psychological Support
Best practice is that a support worker from the RCC is immediately
available to speak with a victim/survivor if she/he so chooses. Mechanisms
should be in place to ensure this happens. In rural areas, the required
driving time for a support worker to reach the SATU may be problematic.
Telephone options while the support worker is en route should be
explored.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
KEY POINTS
3:3
•
•
63
KEY POINTS
3:4
Re: Referral of Victim Survivor to RCC
support worker
•
•
•
Victim/survivor always has a choice whether or not she/he
speaks to a support worker.
Best practice is that a support worker is available immediately
to speak with the victim/survivor.
If there are difficulties due to distance, then the option of
telephone contact with the support worker should be explored.
Role of a support worker
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Official personnel, with whom victims/survivors come in contact, are
focused on objective tasks. The Gardaí gather information and collect
evidence to facilitate their investigation. Health care personnel assess
medical needs, offer treatment, offer support and collect evidence.
Someone subjected to sexual violence must make many, often
overwhelming, decisions. support workers can offer a tangible and
personal connection to immediate support and long-term sources of
advocacy, support and counselling. When support workers support
victims/survivors, Clinical Forensic Examiners can more easily maintain an
objective stance.
64
A support worker is Present in a SATU or with a Clinical Forensic
Examiner In Order to:
•
Provide emotional support and crisis advocacy.
•
Ensure that the victim/survivor gets as much information as
she/he needs in a way that they can understand.
•
Support the victim/survivor in whatever decisions she/he
makes – including decisions about reporting to the Gardaí and
undergoing a Forensic Clinical Examination, and
•
Ensure the victim/survivor’s decisions are respected.
A support worker is NOT Present in a SATU or with a Clinical
Forensic Examiner to:
•
Strengthen a potential prosecution, or
•
Pressure the victim/survivor into making any particular
decision.
3:5
Role of a support worker in a SATU or with a
Clinical Forensic Examiner
3:6
When a Victim/Survivor Leaves the
SATU/Clinical Forensic Examiner
Whatever decisions a victim/survivor makes prior to leaving the
SATU/Clinical Forensic Examiner, she or he needs to have information and
the option and ability to access any further support. If a support worker
has been involved, the support worker will provide the following
information, as well as ensuring that the victim/survivor has a safe place to
go to. If a support worker has not been involved, the following information
should still be provided. Any information needs to be provided in a
language with which the victim/survivor is comfortable. If the
victim/survivor has literacy difficulties or sight impairment, the information
should be provided on audio-tape or in some other format that is useful.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Services Offered in the SATU or with a Clinical Forensic Examiner
Include:
•
Accompaniment through each component of the process that
the victim/survivor chooses – including making a statement to
An Garda Síochána and a forensic clinical examination.
•
Crisis intervention and emotional support.
•
Advocating for victims/survivors self-articulated needs to be
identified and their choices respected.
•
Advocating for the elimination of any communication barriers
the victim/survivor may face.
•
Supporting victims/survivors in voicing their concerns and
complaints to legal and medical personnel.
•
Providing information about sexual violence and its after
effects.
•
Aiding victims/survivors in identifying individuals who could
support them in their healing process.
•
Helping families and friends to cope with their own reactions
to the rape/sexual assault, providing information and
increasing their understanding of the type of support
victims/survivors may need.
•
Assisting victims/survivors in planning for their own safety and
well-being, and
•
Linking victims/survivors to more long-term counselling,
support and advocacy service options.
See Section 3:4 for the overall role of a support worker.
65
Information that should be Available to the Victim/Survivor Prior to
Leaving the SATU/Clinical Forensic Examiner:
•
Facts about sexual violence and the after-effects.
•
Myths about sexual violence.
•
RCC contact information for the centre closest to the
victim/survivor – including any appointment times that the
victim/survivor may have made with the centre.
•
Contact information for other local agencies that may be
useful for the victim/survivor. (Appendix 11: Professional
Groups and agencies contact details, page 117).
•
The name, telephone number and times available of a contact
person in the SATU.
3:7
If a Victim/Survivor chooses not to have a
Medical Examination
In addition to the information previously outlined, if a victim/survivor
chooses not to have a Forensic Clinical Examination, she or he needs the
following information:
•
•
•
In female victim/survivor possible pregnancy / postcoital
contraception. (page 58)
Relevance of sexually transmitted infection review in two
weeks time (after the incident). (page 71)
Availability and benefits of using GP and other Primary Health
Care Professionals for additional support. (page 87)
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
(See Flowchart page 22)
66
3:8
Future Contact with Victim/Survivor
Best Practice in Relation to Contacting Victims/Survivors
To date, client-led best practice has been that victims/survivors are
given the option of contacting services and that RCCs do not make
pro-active contact with victims/survivors. In other words, if a
victim/survivor leaves a SATU and has not chosen to make an
appointment with the local RCC, that centre will not contact her or
him. A recent Home Office study in England (#285) (Lovett et al,
2004) indicates that at least some victims/survivors may want to have
more pro-active contact made with them. Making another telephone
call may just be too overwhelming. Best practice needs to be
continually reviewed in this area over the next few years.
CTION
E
S
SEXUALLY
TRANSMITTED
INFECTION
FOLLOW-UP
GUIDELINES
4:1
Epidemiology and demography.
68
4:2
Screening at Forensic Clinical Examination.
68
4:3
High-risk indicators.
70
4:4
Sexually Transmitted Infection Follow-up.
71
Recent Rape/Sexual Assault National Guidelines on Referral and
Forensic Clinical Examination in Ireland
4
67
4:1
Epidemiology And Demography
Rates of STI’s following sexual assault vary depending on the population
studied, known risk factors for STIs and the sensitivity of the test used for
identifying the STI. Furthermore, it is difficult to determine the incidence of
STIs following sexual assault, as infection may pre-date the sexual assault.
The most frequently identified infections are Gonorrhoea, Chlamydia and
Trichomoniasis.
A review of epidemiological aspects of STIs in adult victims of sexual
assault (Reynolds et al, 2000) found the following reported prevalence
rates:
•
•
•
•
•
N. gonorrhoeae 0.0 to 26.3%;
C. trachomatis 3.9 to 17%;
T. pallidum 0.0 to 5.6%;
T. vaginalis 0.0 to 19.0%; and
HPV 0.6 to 2.3%.
A review of 90 female victims of sexual assault found that 85% of those
identified with an STI had been sexually active within 3 months of the
assault, and the authors suggest that prior history of sexual activity is the
most important factor in determining risk for an STI (Lacey, 1990). Of 138
STI screens performed at the SATU, Rotunda Hospital in 2003, 53 (30%)
were positive, with Chlamydia Trachomatis being the organism identified
in 15.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
It is important to acknowledge that the identification of an STI in a victim of
sexual assault rarely assumes evidential significance and may, in fact, have
a negative impact on the victim’s case (Ledrey, 1993). Nonetheless,
appropriate screening and follow-up protocols for STIs are integral to the
provision of a sexual assault service.
68
4:2
Screening and Treatment at Forensic
Clinical Examination
The identification of a sexually transmitted infection, after an assault, is
usually more important for the psychological and medical management of
the patient, than for legal purposes, as the infection may pre-date the
assault. However, international guidelines recommend initial screening for
STI for victims of sexual assault ((Association for Genitourinary Medicine
and the Medical Society for the Study of Venereal Diseases, 2001,
Workowski, 2002), as high default rates are commonly reported (45% of
those offered follow-up screening in 2002 at the SATU Rotunda Hospital
defaulted). For appropriate tests of STI screening see Tables 9,10 page 71.
In certain circumstances, where the perceived risk for acquiring an STI is
high and/or the likelihood for default from follow-up is high, it may be
appropriate to administer prophylactic antimicrobials at the time of initial
assessment.
Antibiotic prophylaxis
The efficacy of antibiotics in preventing bacterial STI’s following sexual
assault has not been proven. Antibiotic choices should ensure cover
against C. trachomatis and N. gonorrhoeae. The sensitivities of these
organisms to antibiotics, particularly N. gonorrhoeae, may change and
recommendations must reflect the likely sensitivities in the population. At
present, appropriate prophylaxis against C. trachomatis and N.
gonorrhoeae is Azithromycin 1g stat po + ceftriaxone 250mg IM stat.
Antibiotic prophylaxis
British guidelines recommend that all victims of sexual assault be offered
vaccination against Hepatitis B (Association for Genitourinary Medicine and
the Medical Society for the Study of Venereal Diseases, 2001). The role of
Hepatitis B immunoglobulin is uncertain in these circumstances, but may
be considered, where the perceived risk for Hepatitis B acquisition is high.
In those who have previously been vaccinated, or in whom natural
immunity is likely, urgent Anti-Hepatitis B full markers (specimen sent to the
Virus Reference Laboratory) can be checked to assess the need for
vaccination or immunoglobulin.
Post-exposure prophylaxis (PEP) against HIV following sexual exposure is
controversial and no definitive data is available to support
recommendations. Studies are underway to ascertain the role of
antiretroviral therapy following sexual exposure or potential sexual
exposure to HIV. Where the assailant is known to be HIV positive, or at
high risk for being HIV positive, PEP may be deemed appropriate. Other
factors in the history may support the use of HIV PEP (see high-risk
indicators). The decision to proceed with HIV PEP must be made in
conjunction with the victim, in the knowledge that its effectiveness remains
unproven.
For those attending the SATU at the Rotunda Hospital, the decision to
administer HIV PEP is made by the Department of Infectious Diseases at
the Mater Hospital. Victims should be given a referral letter to attend the
Mater Hospital, ideally within 72 hours, to determine the role of HIV PEP.
NB. Confidentiality
Samples and information relating to sexually transmitted infections and
cervical cytology will be dealt with by health care professionals and
personnel outside of the forensic area. It is important that any person
who comes in contact with information regarding an attendance at a
SATU is aware of the confidentiality of that information and if there is a
need to respond in terms of treatment and follow-up, that this will be
through the SATU examining doctor. If, for any reason, this is not
possible, contact with the patient will be in a sensitive and appropriate
manner.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
HIV post-exposure prophylaxis
69
4:3
High-Risk Indicators
In determining the risk for acquisition of an STI, (including HIV and
Hepatitis B) following sexual assault, many factors must be considered:
assailant factors: victim factors and specifics of the assault.
Assailant Factors
Assailant known to be suffering from an STI/ HIV or Hepatitis B or deemed
to be high risk (i.e. coming from a country of high HIV or Hepatitis B
prevalence or history of injecting drug use).
Victim Factors
The risk of acquisition of HIV following sexual assault is increased if the
victim is suffering from an STI at the time, where HIV and other STI’s
operate in epidemiological synergy (Centre for Disease Control and
Prevention, 1997).
Assault Factors
The risk of acquiring any STI is increased where unprotected penetration
has occurred. For HIV the risk is increased where significant genital trauma
with breach of mucosal surfaces has occurred and the risk is greater for
anal penetration versus vaginal penetration.
Unknown Assailant
70
Re: High Risk Indicators
KEY POINTS
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Where the assailant is unknown to the victim, the perceived risk, on the
part of the victim for acquisition of an STI may be greater.
•
•
•
•
Assailant Factors: Assailant with known STI or from a high risk
area.
Victim Factors: Patient with an STI at increased risk of HIV.
Assault Factors: Unprotected penetration. Significant genital
trauma, anal penetration.
Unknown Assailant: The perceived risk to the victim may be
greater
4:4
Sexually Transmitted Infection (STI) Follow-Up
Table 9: Appropriate STI Screening Tests at time of initial examination or
2 weeks after the incident.
N. gonorrhoeae
Culture for N. gonorrhoeae from sites of penetration or attempted penetration.
N. gonorrhoeae is a fastidious organism and specific culture media are required.
C. trachomatis
Tests for C. trachomatis from sites of penetration or attempted penetration. In the
UK courts culture for C. trachomatis is the accepted test but has largely been
replaced in practice by nucleic acid amplification tests (NAATS). LCT is available
in Rotunda.
T. vaginalis, candida, bacterial vaginosis
Vaginal slides or cultures taken for T. vaginalis, candida, bacterial vaginosis.
Cervical Cytology
This is a high risk group for cervical abnormalities. Cytology should be taken
according to the British Colposcopy Guidelines.
Syphilis, Hepatitis A
Serology for Syphilis, Hepatitis A.
Table 10: Screening for HIV and Hepatitis B and C
Serology for HIV, and Hepatitis B and C – Baseline Screening and repeat
screening at least 3 months after the incident (to reflect the window period for
sero-conversion for these viruses).
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
HIV and Hepatitis B and C
71
CTION
E
S
5
5:1
History and Role of the Forensic Science Laboratory.
73
5:2
Key Objectives of the Forensic Science Laboratory.
75
5:3
Cases of Alleged Sexual Assault.
75
5:4
Risk of Contamination.
77
5:5
Prevention of Contamination.
77
5:6
Instructions and Information re: the Sexual Offences
Examination Kit.
78
5:7
Analysing Samples for the Presence of Semen.
79
5:8
Time Frames for Detecting Semen.
80
5:9
Specimens for Toxicology.
82
5:10
Early Evidence Kits.
83
5:11
Trace Evidence.
83
5:12
Damage to Clothing.
86
Recent Rape/Sexual Assault National Guidelines on Referral and
Forensic Clinical Examination in Ireland
FORENSIC SCIENCE
LABORATORY
GUIDELINES
73
5:1
History and Role of the Forensic Science
Laboratory
Mission Statement
The mission Statement of the Forensic Science Laboratory is to assist in
the investigation of crime and to serve the administration of Justice, in an
effective manner, by a highly trained and dedicated staff, providing
scientific analysis and objective expert evidence to international standards.
History
The Irish Forensic Science Laboratory was established in 1975. The
Laboratory offers a full service, from crime scene to courtroom and is part
of the criminal justice sector.
The Forensic Science Laboratory is divided into four sections; Biology,
DNA, Chemistry and Drugs. The workload of the Forensic Science
Laboratory has steadily increased throughout the years as An Garda
Síochána and the courts realised the value of forensic scientific evidence.
In 2005 the staff numbers, including administrative staff, were in excess of
60.
The bulk of the work carried out in the Forensic Science Laboratory,
consists of the examination of samples submitted by An Garda Síochána.
In specific instances, staff from the Forensic Science Laboratory are invited
to attend scenes of crime, where they assist in interpretation, advise on the
taking of samples and on the potential of evidence.
Each year, the laboratory receives more than four hundred cases of alleged
sexual assault.
74
The initiation of a DNA service in 1994 was a quantum leap in the Forensic
Science Laboratory’s ability to compare biological samples. DNA profiling
is the technique used to identify areas of high variability in the DNA of
individuals. DNA is present in all body tissues, but those most commonly
encountered in criminal cases for forensic analysis are stains, or deposits
such as blood, semen, vaginal fluid, saliva and vomit. The DNA from crime
stains is compared with the control DNA from suspects and victims. This
control DNA is extracted from blood samples, or in the absence of blood,
from hair roots (plucked) or a buccal (mouth) swab. Cases of alleged
rape/sexual assault are usually dealt with in the Biology section, where
samples are selected for DNA analysis when relevant.
KEY POINTS
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
DNA Service
Re: DNA Service
•
•
DNA from crime stains is compared with the control DNA from
suspects and victims.
Control DNA is extracted from blood, hair roots or buccal
(mouth) swabs.
5:2
Key Objectives of the Forensic Science
Laboratory
The objective of the Forensic Science Laboratory is to have the best
possible samples collected from the complainant, in a way that minimises
the risk of contamination and to elicit the information that aids in the
interpretation of the results obtained. The Forensic Science Laboratory is
very dependent on the selection and quality of the samples received.
Therefore the Laboratory sees education as a very important part of their
role. Training is provided by the Laboratory to An Garda Síochána on
collection of samples at crime scenes. In recent years, the Forensic
Science Laboratory has worked closely with the Sexual Assault Treatment
Unit (SATU) in the Rotunda Hospital and has provided speakers for various
SATU conferences. This increased communication has been very
beneficial and the Forensic Science Laboratory welcomes any vehicle,
which allows them to further improve the quality of the samples they
receive. The Forensic Science Laboratory views the development of
National Guidelines as a vehicle for the achievement of all of the outlined
key objectives.
•
•
•
•
•
5:3
To have the correct specimens collected in a way that best suits
forensic analysis.
To ensure that all the potential evidence is collected.
To ensure that the samples are taken and stored in such a way
that there is no risk of contamination from the surrounding area.
To have the samples preserved in such a way that they reach the
Forensic Science Laboratory in the best possible condition.
To provide the Forensic Science Laboratory with the information
needed to interpret the results obtained.
Cases of Alleged Sexual Assault (see
page 55 re: taking samples)
In most sexual assault cases, the Forensic Science Laboratory receives
Sexual Offences Examination Kits, taken from the complainant and also
from the suspect. The Forensic Science Laboratory also receives the
clothes worn by the person at the time of the assault and where
appropriate, the clothes worn by the suspect. In some cases, samples
taken from the scene are also analysed.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
KEY POINTS
Re: Key requirements for the Forensic
Science Laboratory in cases of alleged
sexual assault:
75
Sexual Offences Examination Kit
The Sexual Offences Examination Kit is designed for use in the Forensic
Clinical Examination of either the complainant or suspect. It includes a
form to be completed by the Clinical Forensic Examiner, which elicits
information necessary for the scientific interpretation of results. It also
itemises the samples to be taken. These may depend on the crime and
the subject being examined, but include swabs used to collect samples
from the vagina, anus, mouth and also blood samples, hair samples, nail
scrapings and other samples considered relevant by the Clinical Forensic
Examiner.
Supply of Sexual Offences Examination Kits
Sexual Offences Examination Kits are supplied by the Forensic Science
Laboratory to the Rotunda Hospital, SATU and to the children’s hospitals
in Dublin, namely Temple Street Hospital, Crumlin Hospital and the
Children’s Unit in Tallaght Hospital. The Forensic Science Laboratory also
supply the SATUs in Cork, Letterkenny and Waterford and the General
Hospital in Tralee. The aim is to have a Sexual Offences Examination Kit
readily available when a Forensic Clinical Examination is requested. For this
reason in the rest of the country, they are supplied to An Garda Síochána,
who bring one to the Clinical Forensic Examiner at the time of the
examination.
76
KEY POINTS
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
The Sexual Offences Examination Kits have a finite lifetime and it is more
desirable that they are stored in an area where there is going to be a
constant throughput.
Clothing
Taken where appropriate
•
From complainant
•
From suspect.
Sexual Offences Kit:
•
Designed for use for both complainant and suspect.
Specimens may include
•
Swabs from the vagina, anus, mouth.
•
Blood samples.
•
Hair samples
5:4
Risk of Contamination
Risk of Contamination
The objective of the Forensic Clinical Examination from a Forensic Scientist
point of view is to collect the best possible samples from the complainant,
in a way that minimises the risk of contamination and to elicit the
information from them that aids in the interpretation of the results obtained.
The Sexual Offences Examination Kit is designed so that it can be used by
Clinical Forensic Examiners who have a lot of experience in the collection
of evidence from complainants of rape/sexual assault; but also by those
that have very little. With increased sensitivity in DNA techniques, it has
become very important that practitioners take samples in such a way that
there is no risk of contamination.
Contamination is most likely to be from epithelial cells from hands, saliva
and dandruff. Hair is also a potential DNA source. Contamination
between different cases is also a concern.
5:5
Prevention of Contamination
The following are adaptations of guidelines for the prevention of
contamination followed by the Staff of the Forensic Science Laboratory.
These should also be considered during the Forensic Clinical Examination
of the complainant in cases of alleged rape/sexual assault.
•
The examination couch should be cleaned with bleach or a
recommended cleaning agent before and after examinations.
•
Fresh paper roll should be used under complainants.
•
Chairs on which the complainant may have sat before or after the
Forensic Clinical Examination should also be cleaned with bleach or a
recommended cleaning agent.
•
If handling wet or damp items, the practitioner should wear
disposable aprons, gloves and sleeves over conventional coats.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
KEY POINTS
Risk of Contamination from Practitioners:
Most likely from epithelial cells e.g.
•
Hands.
•
Saliva.
•
Dandruff.
•
Hair.
•
Possible contamination between cases examined in the same
SATU.
77
•
•
•
Gloves must be worn when handling exhibits.
If disposable sleeves are not worn, ensure that the gloves reach the
cuffs and that the wrists are not exposed.
If coats have shrunk or the wristbands have become loose, the coats
should be replaced.
Re: Prevention of Contamination
KEY POINTS
Clean
•
•
•
with Bleach or recommended cleaning agent
Examination couch.
Chairs on which complainant sat before or after exam.
Fresh paper roll for the couch after each case.
Handling Damp items:
•
Disposable aprons.
•
Sleeves over coats.
Gloves
•
Handling relevant exhibits.
•
Gloves should reach the cuffs – wrists not exposed.
•
Masks must be worn if:
(i)
(ii)
•
•
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
5:6
78
You have a cold/hay fever/allergy etc.;
The items under examination are being discussed.
When not masked, do not talk over exposed clothing or open
swabs etc.
A log or record should be kept of cases examined on each
examination couch.
Instructions & Information Re: The Sexual
Offences Examination Kit
The Clinical Forensic Examiner is advised to read carefully the guidelines
contained in the Sexual Offences Examination Kit prior to starting the
Forensic Clinical Examination. The following is a summary of the
information/guidelines, which are included in every Sexual Offences
Examination Kit.
Complainant needs to Urinate
If the complainant needs to urinate, a sample is collected in case it is
required for toxicology (page 34).
Allegation of Oral Sex
If there is an allegation of oral sex, the complainant should be given the
relevant container from the Sexual Offences Examination Kit and asked to
spit into it, starting at the beginning of the Forensic Clinical Examination
and proceeding, at intervals, during the course of the examination.
Use of Lubricants during the Forensic Clinical Examination
Lubricants, such as KY Jelly, or the sterile water provided, may be used as
a lubricant during the Forensic Clinical Examination. The use of lubricant
should be noted on the Sexual Offences Examination Kit form.
NB * In the past it was felt that lubricants could interfere with DNA
profiling, Recent research has suggested that lubricants do not interfere
with the current techniques in DNA profiling.
Using a Speculum or Proctoscope
When using a speculum or proctoscope, take the sample ahead of the
implement and avoid contact with the sides of the implement on the way
in and out, to prevent contamination.
Examination of Male Complainants and Suspects
The requirements of the Forensic Clinical Examination are the same as for
female complainants, except that penile swabs are taken instead of vaginal
swabs.
Prior to Completing the Case
The Clinical Forensic Examiner is requested to:
•
Fill in all relevant information.
•
Ensure the form is signed and dated.
5:7
Analysing the Sexual Offences Kit for the
Presence or Absence of Semen
The Forensic Science Laboratory analyses the swabs and sometimes the
saliva sample for the presence of semen. The presence of semen
confirms that sexual activity has taken place. Obviously, this evidence
alone does not indicate whether or not a rape/sexual assault has taken
place. Also the absence of semen on the swabs does not mean that
penetration did not occur.
In the majority of alleged Sexual Offences, the accused agrees that sexual
activity occurred and the issue is whether the complainant consented. In
most of these cases DNA profiling is not required.
When the suspect denies that intercourse took place, or when the
complainant has had a previous sexual partner, DNA profiling will be
carried out on seminal staining on the swabs or on the clothes. In cases
of "stranger rape", where the victim does not know the assailant, DNA
profiling will always be carried out on any seminal staining recovered and
this profile is kept on file for future reference. (Figure ?, page ?).
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
(Appendix 6: Copy of the information contained in every Sexual Offences
Examination Kit, page 105).
79
Semen Present
NO
YES
Absence
does not
mean
penetration
did not occur
Confirms
Sexual
Activity took
place
Both parties agreeing sexual
intercourse took place –
and issue is one of consent
then usually DNA Profiling is
not necessary.
YES
Previous
Sexual
Partner
within last
7 days
YES
Suspect
denies
Sexual
Intercourse
took place
YES
Stranger
Rape DNA
Profile & kept
on file for
future
reference
DNA
PROFILING
Figure 4: Indicating when DNA profiling may be carried out.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
5:8
80
Time Frames for Detecting Semen
The persistence of semen varies between individuals and is influenced by
the activity of the individual after the alleged offence (Davies and Wilson,
1974). In the experience of the Forensic Science Laboratory, semen may
be detected on vaginal swabs taken up to approximately four days after
intercourse. In the majority of cases however, it will not be detected on
swabs taken more than forty eight hours after intercourse (Forensic
Science Laboratory data 2005). There are reports in the literature of traces
of seminal staining being recovered up to a week afterwards, so this is the
outer limit after which the Forensic Science Laboratory will not analyse kits
(Allard, 1997).
Semen will persist for much shorter periods in the rectum and in the mouth
(Keating and Allard, 1994). Generally, in the laboratory, semen is not found
on anal swabs taken twenty four hours after the alleged incident, but
swabs are analysed up to forty eight hours afterwards. On oral swabs
semen is rarely found if these are taken more than six hours after the
alleged incident. However, oral swabs taken up to twenty four hours
afterwards are examined, if oral sex is alleged. Liquid saliva, taken up to
forty eight hours afterwards, is examined.
Semen will persist in dead bodies for a much longer period of time and in
the Forensic Science Laboratory, it has been recovered on vaginal swabs
taken six weeks after death. Once the swabs are taken from the person,
the semen, if present, will persist indefinitely on dry swabs. Dried seminal
staining on clothes will persist until the clothes are washed, this can be
useful in cases which are not reported within a few days. (See table 11,
page 81)
Table 11: Contamination of Evidence
Site
Time Frame – Presence of Semen
Mouth & Rectum
Semen present for only a very short period of time. Mouth
6-9 hours. Rectum – 24 hours.
Vaginal swabs 48 hours
after sexual intercourse
Majority of cases semen will not be found after this time
Vaginal swabs 4 days
after sexual intercourse
Semen may be detected in a small number of cases
Vaginal swabs 1 week
after sexual intercourse
Literature reports traces of semen found –
Outer time limit for taking swabs.
Dead body
Semen can persist for a much longer period of time – 6
weeks.
Dried seminal staining
on clothes
Semen persists until clothes are washed.
Swabs (dry)
Semen lasts indefinitely if swabs are dry.
Other Specimens
Role of the Forensic Clinical Examiner as an Investigator.
While the samples to be taken are listed and instructions on how they are
to be taken are set out clearly in the Sexual Offences Examination Kit, it
cannot cover every eventuality. The Laboratory views the Forensic Clinical
Examiner as having an investigative role in the procedure of evidence
collection, just as the gardaí do in collecting evidence at the scene of a
crime. It is important that they have as complete an account from the
complainant as possible, in order to guide them in the direction of potential
forensic evidence. Any opportunity that the alleged assailant had to
deposit DNA on the victim, or vice versa, should be considered and areas
of contact should be swabbed (see pages 35 and 55). Stains, which are
at odds with the account of what happened, should also be swabbed for
further examination in the Forensic Science Laboratory.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
As well as analysing the Sexual Offences Examination Kit for the presence
of semen, it may be necessary to carry out other analyses in cases of
alleged rape/sexual assault. The clothes of the complainant will be tested
for seminal staining depending on the circumstances of the case. The
clothing will also be checked for damage (see section on damage) and
blood staining. In some cases, the Forensic Scientist will look for hairs
(see section on hair) and fibres (see section on fibres), which may have
transferred between the two parties. If necessary, samples of urine and
blood will be sent for toxicology (page 82). Depending on the
circumstances of the case, items from the scene will also be analysed for
the presence of blood and semen or fibres.
81
5:9
Specimens for Toxicology
To have an effect, a drug has to be present in an individual’s blood. A
blood sample will, therefore, identify what drug is affecting an individual’s
behaviour at the time of sampling. Detection times for drugs in blood can
be comparatively short. A delay of even two to three hours between the
report of an incident and the collection of a blood sample can be
significant.
Blood samples can, however, be particularly useful when examining an
individual’s recent drinking history, as it is possible to ‘back calculate’ to
earlier blood alcohol concentrations. When found in combination with
drugs, an accurate determination of a person’s blood alcohol
concentration, at the time of an incident, can be particularly useful in
explaining events. Blood samples, however, have to be collected by
medical staff, and this can introduce delays to sample collection,
potentially losing valuable information.
Drugs and their metabolites are eliminated from the body through a variety
of routes, including urine. Urine tends to concentrate drugs to a level that
can be relatively easily detected and measured, thus extending the
detection times.
Urine samples reflect what has been through the body rather than what is
now affecting an individual’s behaviour. Urine can, therefore, be particularly
useful if the alleged event happened more than a few hours earlier. It is
not possible, however, to carry out an alcohol back calculation from a
urine sample. In addition, the extended detection time of drugs in urine
can include drug use prior to an incident.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Urine samples can be collected by non-medical staff and should be
collected, as soon as possible, after the incident is reported.
82
The most important factor in cases of suspected drug facilitated sexual
assault is speed of response. The sooner the samples are collected, the
more likely that a useful forensic toxicological examination can be carried
out. If there is any doubt as to whether or not a particular sample should
be taken, it should be collected and submitted to the laboratory for
evaluation, to establish what analysis is appropriate.
Drugs can be divided into three general categories with rapid, intermediate
and extended elimination times from the body (certain drug groups include
drugs of each category). These elimination categories are indicative only,
as some individuals have significantly different metabolisms, derived from
their genetics. There is no one sample that can answer all potential
toxicological questions. The combination of the amount of drug ingested
and its metabolic characteristics determine the detection time of a drug in
a particular sample.
Table12: Persistence of different drugs in blood / urine
ALCOHOL
SHORT DETECTION TIME DRUGS
Alcohol, GHB, Solvents, LSD
MEDIUM DETECTION TIME DRUGS
Tricyclic antidepressants, Cocaine,
Amphetamine, Ecstasy, Opiates, Low dose
benzodiazepines (e.g. Rohypnol, flunitrazepam)
EXTENDED DETECTION TIME DRUGS
Methadone
Some benzodiazepines (e.g. diazepam)
Some barbiturates (e.g. phenobarbitone)
Blood
Urine
20hrs
24hrs
4-12hrs
18hrs
12-24hrs
48-96hrs
50hrs
120hrs
Sending Specimens for Toxicology Screening
•
•
•
The expiry date on blood bottles should be checked before use.
Fill in the separate toxicology form.
Pack the form, blood sample and urine sample in the separate tamper
evident bag provided.
5:10 Early Evidence Kits
Sometimes, it may not be possible for the victim of an alleged rape/sexual
assault to see a Clinical Forensic Examiner immediately after reporting the
crime. Some complainants have to travel long distances in order to be
examined at the nearest SATU, or a Clinical Forensic Examiner may not be
available until the morning, if the incident occurs late at night. With every
hour that passes physical evidence may be lost or deteriorate. Because of
this, an Early Evidence Kit is available to be used by An Garda Síochána in
cases of rape/ sexual assault. For details relating to the use of the Early
Evidence Kit see under An Garda Síochána guidelines. (Page 33)
5:11 Trace Evidence
Trace evidence includes any kind of physical evidence, which might help
link a suspect to a victim or to a scene. When the Forensic Scientist looks
for the transfer of materials such as paint, glass, soil, hair and fibres, they
are looking for trace evidence.
If a suspect is denying any contact with a complainant, the Forensic
Scientist can look for evidence of fibre transfer, between the suspect and
the complainant’s clothes.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
In 2004 the Forensic Science Laboratory introduced an Early Evidence Kit.
83
Transfer of Fabric Traces on Contact
Textile fabrics are composed of mainly woven or knitted yarns and fibres.
Tiny fragments of the fibres are broken off the surface of the fabric and
may transfer to a second surface on contact. These fibres are generally
invisible to the naked eye and have the potential to provide evidence of
contact. The size of the fibres and the ability to transfer means that great
care must be taken at all times to avoid contamination.
Work in the Forensic Science Laboratory involves searching for transferred
foreign fibres and comparing these to suspect sources e.g. fibres from the
suspect’s jumper, on the clothing of the complainant and visa versa.
Although fabrics are generally mass-produced the finding of large numbers
of transferred fibres, especially if these involve more than one type, is a
strong indicator of recent contact (Cook and Wilson, 1986).
Example
If it is suspected that John Smith attacked Mary Jones, the finding of 20
fibres matching her jumper and 15 fibres matching her trousers on John
Smith’s clothes certainly supports the allegation of contact. If, in addition,
fibres matching John Smith’s jacket were found on Mary Jones clothing,
this would very strongly support the suggestion that they were in contact.
This is so, notwithstanding the fact that all the garments are mass
produced.
Difficult Fabrics
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Some fabrics are not suitable as a source of fibres for various reasons.
These include a non-shedding surface, pale colours or extreme
commonness, as in the case of denim. The retention of transferred fibres is
also affected by the surface of the garment and regardless of the surface
type; fibres will be rapidly lost with wearing.
84
Hair
Hair is continuously shed from the body throughout life. The main types of
hair encountered in Forensic Clinical Examinations are head and pubic hair.
Samples submitted to the laboratory on which hair may be found include:
balaclavas, clothing and bedclothes. Hairs are then compared in the
laboratory with possible sources. (Mann, 1990) Control samples of hair
from complainant and from suspects are essential for comparative work.
(See page 37 and 55 on how to collect control hair samples).
Because hair is continuously growing, control samples taken more than
approximately twelve weeks after the incident will generally not be of use.
Microscopic comparison of hairs alone is considered to be weak evidence.
If the hair has a root, and it is important to have it analysed, DNA profiling
will be attempted on it
If there is an allegation that the hair was pulled out, a microscopic
examination of the root can indicate if the hair was removed forcibly or fell
out naturally.
Contamination of Trace Evidence
In Forensic Science terms, contamination is any transfer or deposition of
material, which occurs after a crime, possibly via a third party not involved
with the crime. It may also occur because of a common place of contact
e.g. complainant and suspect carried sequentially in the same patrol car,
or clothing from the complainant and the suspect being exposed in the
same room. The danger of contamination exists with all forms of trace
evidence, i.e. paint, glass, fibres, hair, soil, and body fluids. Contamination
is probably the greatest problem that exists in the area of trace evidence.
(See tables 13 &14). The possibility of accidental contamination exists from
the first moment of contact between the gardaí and the scene, suspect or
complainant.
Table 13: Contamination of Evidence
Contamination can be due to:
Primary transfer of evidence from direct contact between items.
Secondary transfer of evidence caused, for example, by the same person
handling items from different aspects of a case, or by packing items from different
persons or scenes in the same room.
•
The same car should not be used to convey the suspect and complainant,
for example the complainant to the hospital and the suspect to the Garda
station.
•
If the suspect denies contact with the complainant or vice versa, any Garda
who has had contact with the suspect should not have contact with the
complainant.
•
Within the Garda Station the suspect and the complainant should not be
interviewed in the same room, or sit on the same seat.
•
Clothing and other samples from the complainant and suspect should be
taken, packed and sealed by different Gardaí in different rooms. The bags
should be sealed using sellotape.
•
Sealed bags should be labelled immediately to eliminate any need for
reopening.
•
The history of the handling and packing must be available to the Forensic
Scientist.
•
If the same Clinical Forensic Examiner takes samples from the complainant
and the suspect, this should be done at separate locations and the
examiner should ideally wear different disposable scene of crime suits and
gloves for each.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Table 14: Precautions to avoid contamination of evidence.
85
5:12 Damage to Clothing
In cases of alleged sexual assault, damage to clothing is sometimes
encountered. Its examination may provide valuable information about the
possible implement that caused the damage, or the manner in which it
was caused. Damage analysis may corroborate or refute a particular
crime scenario. This can be especially important in cases of alleged sexual
assault where the only issue is whether the complainant consented. In
some cases, simulation experiments are used, in an attempt to reproduce
the damage to a garment. The use of simulation experiments makes it vital
that detailed descriptions of how the damage was allegedly caused are
available to the scientist.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Damage to clothing can be separated into a number of different types:
•
Damage Due to Normal Wear and Tear. This is to be distinguished
from other forms of damage, which may be related to a crime. It may
include unravelling of hems and seams, snags (especially in nylon
stockings/tights), pilling and the thinning of fabric prior to hole
formation.)
•
Rip. A severance caused by breaking or unravelling of the sewing
thread usually at a seam.
•
Tear. A severance caused by the pulling apart of a material, leaving
ragged or irregular edges.
•
Cut. A severance with neat edges caused by a sharp edged
instrument. Types of cuts include stab cuts, slash cuts and scissor
cuts.
•
Puncture. Penetration through material by an implement producing
an irregular hole.
•
Abrasive damage. Caused by the material rubbing against another
surface (Taupin et al., 1999).
86
CTION
E
S
GENERAL
PRACTITIONERS
(GPs)/ GP
CO-OPERATIVES
GUIDELINES
6:1
6:2
Care Of A Patient Who Presents Giving A History Of Rape/
Sexual Assault.
88
Contact with a General Practitioner following Evaluation
in a SATU.
88
Recent Rape/Sexual Assault National Guidelines on Referral and
Forensic Clinical Examination in Ireland
6
87
6:1
Care of A Patient Who Presents Giving a
History of Rape/Sexual Assault
Information from these guidelines regarding the care of the patient giving a
history of rape /sexual assault, which is relevant to the General Practitioner,
is available on the ICGP website. (www.icgp.ie) This includes the referral
pathways for forensic clinical examination to a SATU and information if the
patient is not reporting the incident to An Garda Síochána. The website
assists the GP in the immediate and follow-up care, if the patient wishes to
have care only with the GP.
NB. Confidentiality
Samples and information relating to sexually transmitted infections and
cervical cytology will be dealt with by health professionals and personnel
outside of the forensic area. It is important that any person who comes in
contact with information regarding an attendance at a SATU is aware of
the confidentiality of that information and if there is a need to respond in
terms of treatment and follow-up, that this will be through the SATU
examining doctor. If, for any reason, this is not possible, contact with the
patient will be in a sensitive and appropriate manner.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
6:2
88
Contact with a General Practitioner
following evaluation in a SATU
Following an incident, which has required attendance at a Sexual Assault
Treatment Unit, it is best practice to suggest to the patient that the General
Practitioner (GP) is provided with a short report regarding the incident. As
the primary care giver for the patient, this would enable the General
Practitioner to ensure that the appropriate follow-up services have been
offered to her/him, including evaluation with regard to sexually transmitted
infections and counselling with regard to the incident.
It can happen that long-term sequelae from the incident present as
seemingly unrelated symptomatology and the General Practitioner’s
knowledge of the incident can ensure a more holistic approach, if this
situation arises.
In this context, it is appropriate to ask the patient for permission to send a
report to the General Practitioner, even in circumstances where the referral
to the Unit has not involved the primary care doctor. In circumstances
where the patient feels that it is not appropriate, at least at that time, for
this contact to be made, the patient should be given a letter simply
outlining that a sensitive incident requiring her/his attendance at a Sexual
Assault Treatment Unit has occurred, which the patient can give to the
General Practitioner some time in the future, if she/he feels that this is an
appropriate step.
RE: Referral to GP
The GP is the primary care giver. There may be long-term sequelae from
the incident, the patient may present to GP with seemingly unrelated
symptomatology. The GP having knowledge of the incident can ensure a
more holistic approach.
Flowchart 5:
YES
NO
Confidential Report
sent to the Patient’s GP
Letter Outlining visit to
SATU given to the
patient which, she/he
can use in the future if
she/he so wishes
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
PATIENT CONSENTS FOR REPORT TO BE SENT TO HER/HIS GP
89
Appendix 1
The Law in Relation to Sexual crime in Ireland.
93
Appendix 2
Children First: National Guidelines for the Protection &
Welfare of Children, Standard Reporting Procedure.
99
Appendix 3
Sexual Assault Statistics in Ireland.
100
Appendix 4
Continuous Professional Development.
103
Appendix 5
Monitoring & Evaluation.
104
Appendix 6
Sexual Assault Treatment Units in Ireland.
105
Appendix 7
Commissioning a Sexual Assault Treatment Unit.
107
Appendix 8
Consent Form: Sample
112
Appendix 9
Sexual Offences Examination Kit:
Copy of Kit Instructions.
113
Appendix 10
History & Role of Rape Crisis Network Ireland (RCNI). 116
Appendix 11
Support Groups and Agencies contact details.
117
Appendix 12
Possible Input for Report.
121
Appendix 13
Critical Readers.
123
Appendix 14
Acknowledgements.
125
Rape/Sexual Assault: National Guidelines for Referral and Examination
in Ireland
Appendix List
91
92
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Appendix 1
The Law in Relation to Sexual Offences in
Ireland
Introduction
The criminal law provides for a wide range of sexual offences and for severe penalties
on conviction for these offences. Legislation enacted in 1991 created new offences
and updated legislation, which up to that time merely consisted of rape and indecent
assault. The law also protects children and young persons and provides anonymity
to victims in sexual offence cases. The most recent legislation enacted in this
jurisdiction places requirements on certain convicted sex offenders to notify An Garda
Síochána of their place of residence. This section briefly outlines the relevant
legislation in sexual offences.
Rape
Table 15: Criminal Law (Rape) Act, 1981.
S 2.(1).
A man committed rape if:
(a) he has sexual intercourse with a woman who at the
time of the intercourse does not consent to it, and
(b) at that time he knows that she does not consent to
the intercourse or he is reckless as to whether she
does or does not consent to it.
Penalty
Imprisonment for life.
Court Venue
Central Criminal Court
Criminal Law (Rape) Amendment Act 1990
Table 16: Criminal Law (Rape) Amendment Act, 1990.
Act
Criminal Law (Rape) Amendment Act, 1990
S.5.
Any rule of law by virtue of which a husband cannot be guilty of
the rape of his wife is hereby abolished.
Penalty
Imprisonment for life.
Court Venue
Central Criminal Court
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Criminal Law (Rape) Act, 1981
Act
93
Rape Under Section 4
Table 17: Rape Under Section 4.
Rape under Section 4
Act
S.4.
Rape under section 4 means a sexual assault that includes:–
(a) penetration (however slight) of the anus or mouth by
the penis or
(b) penetration (however slight) of the vagina by any
object held or manipulated by another person.
Penalty
Imprisonment for life
Court Venue
Central Criminal Court.
Aggravated Sexual Assault
Table 18: Aggravated Sexual Assault
Criminal Law (Rape) Amendment Act 1990
Act
S.3.
Aggravated sexual assault means a sexual assault that involves
serious violence or the threat of serious violence or is such as to
cause injury, humiliation or degradation of a grave nature to the
person assaulted.
Penalty
Imprisonment for life
Court Venue
Central Criminal Court.
Sexual Assault
Table 19: Sexual Assault
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Act
94
Criminal Law (Rape) Amendment Act 1990
S.2.
The offence of indecent assault upon any male person and the
offence of indecent assault upon any female person shall be
known as sexual assault.
Penalty
Where complainant is a child – imprisonment not exceeding 14
years – any other case period not exceeding 10 years.
Court Venue
District/Circuit Criminal Court
Criminal Law (Amendment) Act 1935
Table 20: Criminal Law (Amendment) Act 1935
Criminal Law Amendment Act 1935
Act
S.14.
It shall not be a defence to a charge of indecent assault upon a
person under the age of 15 years to prove that such a person
consented to the act alleged to constitute such indecent
assault.
Persons under 15 years cannot consent to a sexual assault.
No statutory definition for sexual assault, but it has been defined
as an assault accompanied with circumstances of indecency.
Incest
Table 21: Incest
Act
S.1.
Any male person who has carnal knowledge of a female person,
who is to his knowledge his grand-daughter, daughter, sister or
mother.
S.2.
Any female of or above the age of 17 years who with consent
permits her grandfather, father, brother or son to have carnal
knowledge of her (knowing him to be her grandfather, brother or
son as the case may be).
Penalty
Incest by a male with a female over 15 years of age
– Life imprisonment.
Incest by a male with a female under 15 years of age
– Life imprisonment.
Incest by female over 17 years
– 7 years imprisonment.
Court Venue
Central / Circuit Criminal Court.
Unlawful Carnal Knowledge of Girl under 15 Years
Table 22: Unlawful Carnal Knowledge of Girl under 15 Years
Act
Criminal Law Amendment Act 1935 (as amended by Section 13
Criminal Law Act 1997)
S.1.
Any person who unlawfully and carnally knows any girl under
the age of 15 years shall be guilty of an offence.
Penalty
Life imprisonment
Court Venue
Central Criminal Court.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Punishment of Incest Act 1908 as amended by the Criminal Law
Amendment Act 1935, The Criminal Justice Act 1993, The
Criminal Law (Incest Proceedings) Act 1995
95
Unlawful Carnal Knowledge of Girl Under 17 Years
Table 23: Unlawful Carnal Knowledge of Girl Under 17 Years
Act
Unlawful Carnal Knowledge of Girl Under 17 Years
S.3.
Any person who unlawfully and carnally knows any girl who is
over the age of fifteen years and under the age of 17 years shall
be guilty of an offence.
Penalty
1st conviction – 5 years imprisonment, 10 years for any
subsequent convictions.
No prosecution for an offence under Section 2 shall be
commenced more than twelve months after the date on which
such offence is alleged to have been committed.
Court Venue
Central Criminal Court.
NB.
Consent is immaterial – The age of consent to sexual intercourse by a female is 17
years.
Buggery with Persons under Fifteen Years
Table 24: Buggery with Persons under Fifteen Years
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Act
96
Criminal Law (Sexual Offence) Act 1993
S.3.
A person who commits or attempts to commit an act of
buggery with a person under the age of 17 years (other than a
person to whom he is married or to whom he believes with
reasonable cause he is married) shall be guilty of an offence.
Penalty
(a)
(b)
(c)
(d)
Court Venue
Persons under 15 years – imprisonment for life.
Attempt with person under 15:–
1st conviction – imprisonment not exceeding 5 years
2nd or subsequent conviction – imprisonment not
exceeding 10 years.
Person over 15 years and under 17 years: –
1st conviction – imprisonment not exceeding 5 years
2nd or subsequent conviction imprisonment not
exceeding 10 years.
Attempt with person over 15 years and under the age of
17 years:–
1st conviction – imprisonment not exceeding 2 years
2nd or subsequent conviction imprisonment not
exceeding 5 years.
Central Criminal Court.
Sexual Intercourse or Buggery with Mentally/Impaired Persons
Table 25: Sexual Intercourse or Buggery with Mentally Impaired Persons
Act
Criminal Law (Sexual Offences) Act 1993
S.5.
A person who
(a)
Has or attempts to have sexual intercourse or
(b)
Commits or attempts to commit an act of buggery with a
person who is mentally impaired (other than a person to
whom he is married or to whom he believes with
reasonable cause he is married) shall be guilty of an
offence.
Penalty
Imprisonment not exceeding 10 years.
Attempt :–
1st conviction – imprisonment not exceeding 3 years
2nd or subsequent conviction imprisonment not exceeding 5
years.
Court Venue
Central Criminal Court.
NB.
Definition "Mentally impaired"
"Mentally impaired" suffering from a disorder of the mind, whether through mental handicap
or mental illness, which is of such a nature and degree as to render a person incapable of
having an independent life or of guarding against serious exploitation.
Anonymity
Act
S.7.
S.8.
NB.
Section 7: Criminal Law (Rape) Act, 1981 as amended by
Section 17 of the 1990 Act
After a person is charged with a sexual assault offence, no
matter likely to lead members of the public to identify a person
as the complainant in relation to that charge shall be published
in a written publication available to the public or be broadcast
except as authorised by a direction given in pursuance of this
section.
In certain circumstances, on application to the court, the Judge
may direct that section 7 shall not apply.
In a case where the complainant wishes to waiver his or her
anonymity the direction of the Court is required.
After a person is charged with a rape offence, no matter likely to
lead members of the public to identify him as the person against
whom the charge is made shall be published in a written
publication available to the public or be broadcast except:(a)
As authorised by a direction of the Court in certain
circumstances, or after he has been convicted of the
offence.
This section provides for the anonymity of a person accused of a rape offence but
this protection is lifted if the accused is found guilty
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Table 26: Anonymity
97
Restriction of Public Access – In Camera Rule
Table 27: Restriction of Public Access – In Camera Rule
Act
S.6.
Criminal Law (Rape) Act 1981 as substituted by Section 11 of the
Criminal Law (Rape) (Amendment) Act 1990
In any proceeding for a rape offence or the offence of aggravated
sexual assault or attempted aggravated sexual assault or of aiding
and abetting counselling or procuring the offence of aggravated
sexual assault or attempted aggravated sexual assault or of
incitement to the offence of aggravated sexual assault or conspiracy
to commit any of the foregoing offences, the Judge, the Justice or the
court as the case may be, shall exclude from the court during the
hearing all persons except officers of the Court, persons directly
concerned in the proceedings, bone fide representatives of the press
and such other persons if any as the Judge, the Justice or the Court
as the case may be, may in his or its discretion permit to remain.
This provides for the exclusion of the public from proceedings in a
rape case but allows bone fide representatives of the press and
others with the courts permission to remain. This section also
provides that the verdict and sentence must be announced in public.
There is no specific legislation restricting public access to trials of
sexual assault
Criminal Justice Act 1990 (Forensic Evidence)
Table 28: Criminal Justice Act 1990 (Forensic Evidence)
Act
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
S.2.(1)
98
NB.
NB.
Criminal Justice Act 1990 (Forensic Evidence)
Power to take bodily samples –
Subject to the provisions of subsections (4) to (8) of this section
where a person is in custody under the provisions of section 30
of the Offences against the State Act, 1939, or section 4 of the
Criminal Justice Act, 1984, a member of the Garda Síochána
may take, or cause to be taken, from that person for the
purpose of forensic testing all or any of the following samples,
namely:–
(a)
A sample of –
(i) Blood.
(ii) Pubic hair.
(iii) Urine.
(iv) Saliva.
(v) Hair other than pubic hair.
(vi) Nail
(vii) Any material found under a nail.
(b)
A swab from any part of the body other than a body
orifice or a genital region.
(c)
A swab from a body orifice or genital region.
(d)
A dental impression.
(e)
A footprint or similar impression of any part of the
person’s body other than a part of his hand or mouth.
Certain authorisation and consents are required in the taking of samples as outlined
in Section 2 of this Act
At the time of going to press the Law reform Commision have issued a report
containing details of a draft Criminal Justice (DNA Database) Bill 2005 which will
amend the Criminal Justice Act 1990 (Forensic evidence). (LRC78-2005).
Appendix 2
Children First: National Guidelines for the
Protection and Welfare of Children-Standard
Reporting Procedure
Table 29: Children First: National Guidelines for the Protection and Welfare of
Children, Standard Reporting Procedure
CHILDREN FIRST–
National Guidelines for the Protection and Welfare of Children (1999) 1.1.1.
These National Guidelines are intended to assist people in identifying and reporting child
abuse. They aim, in particular to clarify and promote mutual understanding among
statutory and voluntary organisations about the contributions of different disciplines and
professions to child protection. They emphasise that the needs of children and families
must be at the centre of childcare and child protection activity and that a partnership
approach must inform the delivery of services. They also highlight the importance of
consistency between policies and procedures across health boards and other statutory
and voluntary organisations. They emphasise in particular that the welfare of children is of
paramount importance.
(i)
A report should be made to the *health board in person, by phone or in writing.
Each health board area has a social worker on duty for a certain number of
hours each day. The duty social worker is available to meet with, or talk on the
telephone, to persons wishing to report child protection concerns.
(ii)
It is generally most helpful if persons wishing to report child abuse concerns make
personal contact with the duty social worker. This will facilitate the social worker in
gathering as much information as possible about the child and his or her
parents/carers.
(iii)
In the event of an emergency, or the non-availability of *health board staff, the report
should be made to An Garda Síochána. This may be done at any Garda Station.
* The Health Service Executive (HSE) in 2005 replaced the former Health Boards.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Standard Reporting Procedure 4.4.1
If child abuse is suspected or alleged, the following steps should be taken by members of
the public or professionals who come in contact with the children.
99
Appendix 3
Sexual Assault Statistics in Ireland
The SAVI Report:
Sexual Abuse and Violence in Ireland (McGee et al, 2002)
In order to identify the prevalence of Sexual Violence in Ireland, the SAVI
researchers interviewed 3,118 adults (>17 years) in 2002. The data found
that:
•
•
•
•
20.4% of all adult women reported experiencing contact sexual
assault as adults (one in five of all women).
6.1% of all adult women reported contact abuse which involved
penetrative sex.
One in ten men reported experiencing contact sexual abuse as
adults.
One in ten of these cases (0.9%of all adult men) involved penetrative
sex.
SAVI also found 10% of women and 6% of men, who had experienced
abuse at some point, reported the crimes perpetrated against them to An
Garda Síochána.
RAPE CRISIS NETWORK IRELAND (RCNI) STATISTICS FOR 2004
(RCNI, 2004)
•
Calls to telephone helplines (estimates) 45,000
•
Face to face counselling, support and advocacy services for 2,289
victim/survivors.
•
Face to face counselling, support and advocacy services for 158
supporters of victims/survivors.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
These numbers include all the RCCs in the Republic of Ireland that are
members of the RCNI.
100
•
•
•
•
•
•
•
•
•
89% of the victims/survivors were female, 11% male.
44% of the victims/survivors were between 18 and 29 years of age.
86% were settled/Irish, 7% refugees or asylum seekers, 1% Irish Travellers.
4.5% had a disability.
34% were victims/survivors of rape.
5% were victims/survivors of sexual assault.
2% were victims/survivors of drug assisted rape or sexual assault.
0.4% were victims/survivors of ritual abuse.
54% were adult victims/survivors of child sexual abuse.
The above percentages include all centres except Dublin.
Dublin Rape Crisis Centre Statistics: 2004 (DRCC, 2004)
Crisis Line
Counselling calls
11,863
(# with silent, hang-up, hoax and obscene calls are subtracted)
Table 30: Breakdown of type of calls.
•
•
•
•
First time callers
Repeat calls
Information calls
Unknown/details undisclosed
3,468
3,375
3,541
560
Table 31: Types of Assault/Abuse
•
•
•
•
•
•
Adult Rape
Child Sexual Abuse
Adult Sexual Assault
Sexual Harassment
Drug Facilitated Rape
Ritual Abuse
53%
37%
7%
0.8%
1.4%
0.3%
Table 32: Gender Breakdown
•
•
Female
Male
88%
12%
Sexual Assault Treatment Unit accompaniment – 205
Number of Clients Receiving Counselling – 610
Table 33: Gender Breakdown of Clients Receiving Counselling.
•
•
Female
Male
88%
12%
Table 34: Breakdown of Types of Assault/Abuse Clients are being
Counselled for.
•
•
•
•
•
•
Adult Rape
Child Sexual Abuse
Adult Sexual Assault
Sexual Harassment
Drug Facilitated Rape
Ritual Abuse
49%
38%
9%
0.6%
2.5%
0.6%
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Court Accompaniment – 3 cases
101
In 2003, there were 2,070 sexual offences reported to An Garda
Síochána.
Table 35: Breakdown of An Garda Síochána 2003 Statistics.§
•
•
•
•
•
•
•
•
•
Sexual Assault
1,449
Sexual Offence involving mentally impaired person
23
Gross Indecency
38
Buggery
78
Unlawful carnal knowledge
95
Rape under Section 4
55
Aggravated Sexual Assault
11
Rape of a female
315
Incest
6
Rotunda Hospital, Sexual Assault Treatment Unit, Statistics 2004
(HSE, 2004)
•
In 2004, there were 272 attendances to the SATU.
•
These were made by 255 females and 17 males.
•
Of 267 attendances following a recent incident, 221 were seen
within 72 hours.
•
The Garda were involved in 96% of these very recent cases.
•
The assailant was a stranger in 49 cases.
•
The unit saw 77 clients to evaluate the possibility of a sexual crime
because of memory loss.
•
There were abnormal results in 27% of the 147 tests for sexually
transmitted diseases performed by the unit.
The Forensic Science Laboratory Statistics: 2002
In 2004, the Forensic Science Laboratory received 476 cases of alleged
rape and sexual assault.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
§ 2004 statistics not available at time of going to print.
102
Appendix 4
Continuous Professional Development
Continuous professional development and training forms part of the remit
of all agencies/disciplines that form part of the Integrated Inter-Agency
response to rape/sexual assault. One of the central tenets of integration
is the ability of disciplines/agencies to learn with and from one another.
For this reason as well as individual discipline/agency education at local,
regional and national level integrated education should be fostered.
National Conference
The commencement of a biannual national conference for all
disciplines/agencies will further promote this agenda. The national
conference will also allow a platform for each agencies/discipline to share
with colleagues from other agencies/disciplines relevant new
developments in best practice.
An Garda
Síochána
SATU
Rape Crisis/
Psychological
Services
STI Clinics
Forensic
Science Lab
GPs
Inter-Agency/Discipline Continuous Professional Team & Individual Development A
Consultative/Collaborative Process
Figure 5: Inter-Agency/Discipline Continuous Professional Team and
Individual Development.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
BIANNUAL NATIONAL CONFERENCE
103
Appendix 5
Monitoring & Evaluation
From a National Perspective, Regional & Local Perspective
Ongoing monitoring, evaluation and audit should form an integral part of
all agencies /disciplines involved in providing an Integrated Inter-Agency
response and the disciplines/agencies that provide follow-up to
rape/sexual assault. Possible areas for audit using a structure, process
and outcome approach (Lazenbatt, 2002). (See table 36)
Table 36: Structure, Process and Outcome Audit.
Structure
Resources:
•
•
•
•
Staff – knowledge &
skills
Buildings - physical
space, refurbishment,
overheads etc.
Equipment
Documentation e.g.
standardised policies,
protocols, guidelines
etc.
Process
Outcome
Processes:
•
•
•
Actions & decisions
Communication lines.
Education and Ongoing
Professional
Development
•
•
•
•
Quality of response
from victim/survivor’s
perspective.
Response times to
attend when
rape/sexual assault
occurs.
The appropriateness of
the response from a
staff, environment
viewpoint.
Quality of forensic
evidence submitted.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Evaluation should take place both from an individual agency/disciplines standpoint and from
the collective response stance of an Integrated Inter-Agency response using clinical audit
methodologies.
104
Appendix 6
Sexual Assault Treatment Units (SATUs) in
Ireland
The
•
•
•
•
•
•
services provided for the person are:
Medical Examination;
Forensic Clinical Examination;
Crisis Support;
Emergency Contraception;
Screening for Sexually Transmitted Infection;
Telephone Support Line.
The
•
•
•
•
SATU also provides:
A range of training programmes for doctors;
Input into training of other disciplines;
Liaison with others working with victims of sexual crime;
National information centre.
CARE Unit, Letterkenny General Hospital, Letterkenny,
Co. Donegal.
Tel: The Emergency Department, Letterkenny General Hospital
(074) 9123595
The CARE Unit was opened in 1998 under the remit of Nursing
Management within the Emergency Department of Letterkenny General
Hospital. The CARE Unit provides a local co-ordinated response to
victims of sexual crime.
The
•
•
•
•
•
services provided for the person are:
Medical / Forensic Clinical Examination and Nursing support;
Emergency Contraception;
Referral for Sexually Transmitted Infection screening;
Opportunity to meet a RCC support worker;
Relevant information regarding available psychological support, etc.
The
•
•
•
CARE Unit Team also provides:
Study days for staff new to the CARE Unit Team;
Input into a range of training programmes;
Links with other relevant disciplines/agencies.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Dublin SATU, Rotunda Hospital, Dublin 1
Tel: 01 8730700
The SATU of the Rotunda Hospital, Dublin opened in 1984 and was the
first such service in Europe. The SATU provides an on-call service for
adult victims of sexual crime.
105
South Infirmary/ Victoria Hospital, Cork, SATU.
Tel: 021 / 4926100, Ext. 26297
Website: www.sivh.ie
The SATU of the South Infirmary / Victoria Hospital opened in October
2001.
It is a unit for acute sexual assault i.e. It sees clients both male and
female up to and within seven days of an incident occurring. Children
under the age of 14 years are not seen in the unit. It provides an on-call
24-hour service, 365 days of the year.
The
•
•
•
•
•
•
services provided for the client are:
Medical Examination;
Forensic Clinical Examination;
Crisis Support;
Emergency Contraception;
Screening for Sexually Transmitted Infections;
Telephone Support Line.
The unit may refer clients to Accident and Emergency departments,
Infectious Disease clinics, Obstetrics and Gynaecology specialists, where
appropriate.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Waterford Regional Hospital, Waterford, SATU.
SATU Waterford Regional Hospital Telephone: 051 842157
Community Child Centre, Waterford Regional Hospital 051 842646.
The SATU Waterford Regional Hospital was opened in September 2004.
The service provides a coordinated service for both male and female
victims of rape and sexual assault. The service operates 24 hours a day
/365 days a year. Normally clients who are less than 18 years will be
seen at the Community Child Centre at Waterford Regional Hospital 9am
– 5pm Monday to Friday, however out of hours clients from the age of 14
years can be seen at the SATU.
106
The
•
•
•
•
•
•
•
services provided for the client include:
Crisis support;
Forensic screening;
Emergency contraception;
Hepatitis B and Tetanus prophylaxis;
Opportunity to meet a Rape Crisis Support Worker;
Appointment for screening for Sexually Transmitted Infections;
Telephone Support Line.
Appendix 7
Commissioning a Sexual Assault Treatment
Unit
The cost analysis should consider the following human resource
expenditures:
•
Clinical Forensic Examiner – on call rates for 24-hour cover 365 days
a year;
•
Nurse – on call rates for 24-hour cover 365 days a year;
•
Clinical Forensic Examiner and Nurse remuneration per individual
case;
•
Staff replacement factors due to court attendance, etc.;
•
Recruitment, training, supervision and call-out costs for Support
Workers.
•
Administration and Secretarial support;
•
Domestic services;
•
Budget for continuing education for staff;
•
Clinical supervision or other support frameworks for staff.
Physical Space
Costing will vary depending on the individual circumstances of
prospective units, e.g. whether a building is available or will have to be
built/ rented/refurbished.
The ideal desirable physical space would contain:
•
Private waiting area/room;
•
Separate interview room;
•
Examination room with a wash hand-basin preferably with elbow
mixer taps;
•
Office area;
•
Kitchen/kitchenette area;
•
Toilet & shower facilities;
•
Staff toilet;
•
Telephone lines.
storage space required for:
•
Supplies;
•
Replacement clothing;
•
Filing cabinets for files if they are to be stored on site.
The cost analysis for individual units should reflect the following:
•
Building / rental cost;
•
Refurbishment in a supportive, non-clinical, gender-neutral and child
friendly manner;
•
Annual electrical / heating / maintenance costs;
•
Anticipated service demand:
This will influence the setting up cost and should be factored into
subsequent yearly budget allowance.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
The ideal desirable physical space should be:
•
Safe;
•
Private;
•
Accessible for disabled persons;
•
Child friendly.
107
Table 37: Furniture, Equipment and Supplies for a Sexual Assault
Treatment Unit.
Area & Description
Reception / Waiting Area
Comfortable Supportive Chairs (washable vinyl covering).
Sofa
Coffee Table
Lamps
Small tables for lamps and magazines
Pictures
Rugs
Children’s Toys/ Storage Box/ Books
Manually operated heater
Music system
Electric Kettle
Tea Pot / sugar/milk jug/ tray
Delph
Rape/Sexual Assault: National Guidelines for Referral and Examination in
Ireland
Cutlery
108
Small Fridge
Toilet & Shower Area
Door lock (that can be opened from outside in emergency)
Individual toiletry packs
Towels
Dressing Gowns
Non slip mats
Hairdryer
Linen Basket
Chair (washable covering)
Number
(No. depending on
service demand)
Furniture, Equipment and Supplies
Examination Room – Equipment
Essential – Examination Couch (standard)
Long dressing type trolley
Good light source which can be angle adjustable neck (gooseneck)
Movable light source with magnifying mirror
Screen
Desk
Chairs (surface that can be cleaned to prevent contamination, page 77)
Desk Lamp
Leaflet/Information holder
Small filing cabinet
Wall clock with second-hand
Manually operated heater
Small drug cabinet and drug fridge
Adjustable height stool/chair with wheels
Camera automatic focus 35mm
Filing Cabinets with locks
Freezer with lock (for future storage of used kits – for continuity of evidence)
Mobile phones and land lines as required
Small photocopier
Desirable – Electric examination couch gynaecology type with stirrups
May be desirable in the future – Colposcope or Medscope
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Computer with Internet Access and Printer
109
Furniture, Equipment and Supplies, continued
Examination Room – Equipment
Clinical Supplies
Airways (oropharangeal)
Bag-Valve-Mask (Ambubag)
Blankets or duvet with covers
Culture swabs
Dressing pack for small scratches
Disposable rulers (odontology) for wound sizing
Disposable proctoscopes
Disposable Masks
Disposable plastic aprons
Disposable long sleeves
Dressings (various small sizes)
Gloves varying sizes (non sterile powder free)
Gloves varying sizes (sterile – surgical powder free)
Gauze – sterile packs
Height ruler
Leardal mask
Linen – sheets for examination couch & or paper rolls for exam couch
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Pillow cases
110
Pregnancy test kits and urine containers
Scales for weight
Scissors – small sterile disposable
Nail Clippers – sterile
Sharps Containers
Speculums – disposable (small & medium)
Sphygmomanometer
Stethoscope
Stationery
Suction – hand held or electrical
Syringes
Tissues
Furniture, Equipment and Supplies Continued
Thermometer tympanic
Thermometer covers
IV Giving Set
Venflons
Haemocel/ Jelofusion
Oxygen cylinder small
Pharmacy Supplies
Analgesia – Paracetamol / Ponstan
Postcoital Contraception (individual packs)
Zythromax
Canesten cream/ pessaries
Cleansing fluid for wounds
Sachets of KY Jelly
Replacement Clothing
Tracksuits – small / medium / large
Tee shirts – small / medium / large
Pants / socks
Shoes – different sizes
Nightdresses / gowns
Domestic Supplies
Paper towel holders
Soap dispensers for 4 sink areas
Liquid Soap
Paper Towels for sink areas
Waste disposal bin
Bags – clinical waste
– household waste
– linen
Cleansing solutions containing bleach (see page 77)
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Same as above for males
111
Appendix 8
Sample Consent Form
I,
of ____________________________________
Consent to and authorise
and the staff of
(Clinical Forensic Examiner)
to obtain a history, to perform a physical
examination and administer treatment on
E
PL
M
SA
I further authorise the aforementioned Clinical Forensic Examiner and / or Staff of this
Hospital to take all samples deemed necessary by the Forensic Clinical Examiner and
/ or Staff of this Hospital, including blood samples for forensic examination, to notify
Gardaí of this occurrence and to turn over to the Gardaí all forensic samples and
information deemed by the Gardaí to be necessary for the investigation of this
occurrence.
I understand that
may be required to produce
(Clinical Forensic Examiner)
a report based on the examination and that details of the examination may be
required to be revealed in court.
I have been advised that I may strike out any of the above before I sign, and that I
may halt the examination at any time I wish.
I understand that the information recorded on this form and any photographs taken
may be later required by the court.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Did the Garda accompany the patient to the Hospital
112
YES
NO
Patient and/or Parent/Guardian Signature
Garda’s Name
Badge No.
Garda Station
Tel. No.
Witness Signature
Date
Time
Appendix 9
Sexual Offences Examination Kit:
Copy of Kit Instructions.
Please Read Carefully Before Starting the Examination
Prior to examination:
If the complainant needs to urinate, collect a sample in case it is required for
toxicology. Do not give the complainant a drink if there is an allegation of oral sex.
Please check expiry date on outside of kit.
2.
If there is an allegation of oral sex, the complainant should be given a
container and asked to spit into it, starting at the beginning of the examination
and proceeding at intervals during the course of the examination.
3.
If
•
•
•
4.
If possible, lubricants such as KY Jelly should not be used during the
examination, as these can interfere with subsequent DNA profiling of the
recovered biological material. The sterile water provided can be used as a
lubricant. *NB this will be changed in future forms as recent research has
suggested that lubricants do not interfere with the current techniques in DNA
profiling.
5.
When using a speculum or proctoscope take the sample ahead of the
implement and avoid contact with the sides of the implement on the way in and
out to prevent contamination.
6.
Examination of male complainants and suspects: The requirements of the
examination are the same as for female complainants, except that penile swabs
are taken instead of vaginal swabs.
7.
Please fill in all relevant information and make sure to sign and date the form.
E
PL
M
SA
1.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
toxicology is required:
Check expiry date on blood bottles before use.
Fill in the separate toxicology form.
Pack the form, blood sample and urine sample in the separate tamper proof
bag provided.
113
General Information
Name of Subject
Age
M
Sex
F
Is the subject the complainant or suspect?
Complainant
Suspect
Date & time of incident:
Date:
/
/
Time:
:
AM / PM
Date and time of examination
Date:
/
/
Time:
:
AM / PM
Previous Sexual Activity:
Yes
Was the subject sexually active within previous 7 days?
No
If yes, specify sexual activity:
Date
/
Time
/
:
E
PL
M
SA
Date and time of previous
sexual activity:
Contraception in previous sexual activity:
Condom
Spermicide
AM / PM
Partner vasectomised
Other contraceptive (specify)
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Specific Information Relating to the Alleged Offence
114
Penile / oral penetration (male to female)
No
Unsure
Yes
Penile / oral penetration (male to male)
No
Unsure
Yes
•
Penis in mouth of complainant
No
Unsure
Yes
•
Penis in mouth of suspect
No
Unsure
Yes
Penile / vaginal penetration
No
Unsure
Yes
Penile / Anal penetration
No
Unsure
Yes
Digital penetration
No
Unsure
Yes
(Specify Site)
Object penetration
(specify object)
No
Unsure
Yes
No
Unsure
Yes
No
Unsure
Yes
(Specify Site)
Ejaculation onto skin/hair/clothes
(Specify Site)
Kissed / licked / bitten (circle relevant action)
Condom
No
Unsure
Yes
Lubricant
No
Unsure
Yes
Spermicide
No
Unsure
Yes
Menstrual bleeding
No
Unsure
Yes
Bleeding due to genital / anal injury
No
Unsure
Yes
(Specify Site)
Tampon/pad in place during incident
No
Unsure
Yes
(Circle Relevant Protection)
Tampon/pad worn after incident
No
Unsure
Yes
(Circle Relevant Protection)
Bleeding from any other
part of body at time of incident
No
Unsure
Yes
(Specify Site)
E
PL
M
SA
Check if subject had a bleeding injury at time of assault, which may not be
apparent, now e.g. nose bleed.
No
Showered / washed / bathed / douched
Unsure
Yes
(Circle Relevant Protection)
(Frequency)
Anal intercourse:
defecated since offence
No
Oral intercourse:
mouth cleansed since offence
Subject suffering from infectious
disease
Unsure
Drink
Mouth Wash
Unsure
Yes
Yes
No
Toothbrush
(Specify Disease)
Any Additional Information:
Signature of Medical Examiner:
Contact telephone No.
Kit Sealed:
Yes
No
Opened By:
Date:
/
/
Contents present as listed on form:
Exceptions to list:
Yes
No
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Name of Medical Examiner (Block Capitals):
115
Appendix 10
History and Role of Rape Crisis Network
Ireland (RCNI)
The RCNI was set up in 1985. The six rape crisis centres (RCCs) in existence at the
time came together to exchange information, pool expertise and unite in common
goals of societal change. The RCNI first received funding, from the Department of
Health and Children, in 1999 and now includes sixteen member centres. The RCNI
supports member RCCs, develops and provides training for staff and volunteers,
undertakes research and collects data relating to the causes, nature and extent of
sexual violence in Ireland. The RCNI’s vision is a society in which rape and all other
forms of sexual violence no longer exist.
Individual RCCs offer support, advocacy, information and counselling to
victims/survivors of any form of sexual violence or abuse, as well as information and
education to the public in general. Due to the experiences of and skills gained from
more than two decades of supporting victims/survivors, some of that in existing
SATUs and other forensic medical examination settings, RCCs are uniquely placed
to offer advocacy, support and information to victims/survivors in SATUs.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Table 38: Costs Associated with Providing Psychological Support
116
Recruiting of volunteers/paid staff
Recruiting expenses include advertising, the
interview process and the selection process.
Initial training of volunteers/paid
staff
All Support Workers require training in
sexual violence and its after-effects, healing
processes in general, the counselling
process, rape crisis centre policies, support
agencies, Forensic Clinical Examinations, the
criminal justice process.
Supervision of volunteers/paid staff
Along with supervision on all of the more
pragmatic issues, support workers require
clinical supervision in the same way that
counsellors do.
Ongoing training of volunteers/paid
staff
All support workers require ongoing training
in order to improve their skills and keep upto-date.
Telephone
All support workers need to be contactable
by telephone. It may make sense for
support workers to share a mobile
telephone.
Call-Out
Payment for call-out of support worker.
Per diem expenses
Out-of-pocket expenses for support workers
including mileage, meals, child care, elder
care.
Appendix 11
Support Organisations’ Contact Details
All organisations are listed by the county in which they have their main office.
•
All RCCs support women and men. Please see Section 3.3 for setting up a link
with the closest RCC.
•
All Women Refuge & Support Services Network members support women only
unless otherwise indicated.
•
Other organisations are listed with a description.
Table 39: All organisations by county in which main office is located.
CARLOW
Carlow & South Leinster RCC
Helpline – 1800 727737
Business – 05991 33344
Carlow Women’s Aid
Helpline – 1800 444944
Business – 059 9130990
CLARE
Clare Haven Services
Helpline – 065 682 2435
Business – 065 684 2646
CORK
Sexual Violence Ireland
Helpline – 1800 496496
Business – 021 4505736
OSS Cork (also supports men)
Telephone– 1800 497497
Cuanlee Refuge
Telephone – 021 421757
Mná Feasa
Helpline – 021 421757
Business - 021 4212955
DONEGAL
Donegal Rape Crisis & Sexual Abuse Centre
Helpline – 1800 448844
Business – 074 28211
Donegal Women’s Domestic Violence Service
Helpline – 074 912 6267
Business – 074 9129725
Inishowen Women’s Outreach
Telephone – 077 9373232
DUBLIN
Dublin RCC
Helpline – 1800 778888
Business – 01 661 4911
Aiobhneas Women’s Refuge
Helpline – 01 867 0701
Business – 01 867 0705
Dublin 12 Domestic Violence Service
Telephone – 01 4563126
Rathmines Women’s Refuge
Telephone – 01 4961002
Saoirse Women’s Group
Telephone – 01 4522533
Women’s Aid
Helpline – 1800 341900
Business – 01 867 4721
Text for Deaf Women – 087 9597980
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
West Cork Violence against Women Project
Helpline – 1800 203146
Business – 027 53847
117
DUBLIN
One in Four (counselling & advocacy for
male & female survivors of sexual violence)
Telephone – 01 662 4070
GALWAY
Galway RCC
Helpline – 1850 355355/ 091 589495
Business – 091 583149
COPE – Waterside House Women’s Refuge
Telephone – 091 565985
MASC – Male Abuse Survivor’s Centre
Helpline – 091 530094
Business – 091 534594
KERRY
Kerry Rape & Sexual Abuse Centre
Helpline – 1800 633333
Telephone – 066 7123122
Adapt Kerry Ltd
Telephone/Helpline – 066 7129100
KILDARE
Teach Tearmainn
Helpline – 045 438461
Business - 045 449524
KILKENNY
Kilkenny Rape Crisis & Counselling Centre
Helpline – 1800 478478
Business – 056 7751555
AMBER – Kilkenny Women’s Refuge
Helpline – 1850 424244
Business – 056 7771404
LAOIS
Laois Housing Association
Telephone - 0502 21089
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
LIMERICK
Limerick RCC
Helpline – 1800 311511
Business – 061 311511
118
Adapt House
Telephone – 1800 200200504
Southill Domestic Abuse Project
Telephone – 061 313025
LONGFORD
Longford Women’s Link
Telephone – 043 41511
LOUTH
Rape Crisis & Sexual Abuse Centre
NorthEast
Helpline – 1800 212122
Business – 042 9339491
Women’s Aid Dundalk
Helpline – 042 9333244
Business – 042 9333245
Drogheda Women’s Refuge
Helpline - 041 9844550
Business – 041 9844998
MAYO
Mayo RCC
Helpline – 1800 234900
Business – 094 9025657
Mayo Women’s Support Service
Telephone 094 9027519
MEATH
Meath Women’s Refuge & Support Service
Telephone – 046 9022393
MONAGHAN
Tearmann Domestic Violence Services
Helpline – 047 72311
Business – 047 72749
OFFALY
Tullamore Sexual Abuse & Rape Crisis
Counselling Service
Helpline – 1800 323232
Business – 0506 22500
Offaly Women in Crisis
Helpline – 0506 51886
Business - 0506 51796
ROSCOMMON
Family Life Centre – also supports men
Telephone – 071 9663000
SLIGO
Sligo RCC
Helpline – 1800330033
Business – 07191 71188
TIPPERARY
Tipperary RCC
Helpline – 1800340340
Business – 052 27676
WAVES
Telephone – 07191 41515
Ascend Women’s Support Service
Helpline - 0505 23999
Business – 0505 23379
WATERFORD
Waterford Rape & Sexual Abuse Centre
Helpline – 1800 296296
Business – 051 873362
WESTMEATH
Esker House Refuge
Telephone – 090 6474122
WEXFORD
Wexford Rape & Sexual Abuse Support
Service
Helpline – 1800 330033
Business – 053 22722
WICKLOW
Bray Women’s Refuge
Telephone – 01 286 6163
NORTHERN IRELAND
Rape Crisis & Sexual Abuse Centre
Northern Ireland
Helpline – 04890 249696
Business – 04890 329001
Oasis House Refuge
Helpline – 1890 264364
Business – 051 370367
Mullingar Women in Crisis
Helpline – 1850 214814
Business – 044 33868
Wexford Women’s Refuge
Helpline – 1800 220444
Business – 053 21786
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Cuan Saor Women’s Refuge & Support
Service
Helpline – 1800 567567
Business – 052 27557
119
Table 40: Contact List of RCCs throughout Ireland
Athlone
RCC
2 Fairview,
Garden Vale,
Athlone,
Co. Westmeath
Cork
Sexual
Violence
Ireland
5 Camden Place
Cork
Helpline: 1800 306 600
Helpline: 1800 496496
Business: 0902 73815
Business: 021 4505736
Donegal
Rape Crisis &
Sexual Abuse
Centre
13 St. Eunans
Close,
Convent Rd,
Letterkenny,
Co. Donegal
Dublin
RCC
70 Lower
Leeson Street,
Dublin 2
(24 hours)
North East
Rape Crisis &
Sexual Abuse
Centre
PO Box 72,
Dundalk,
Co. Louth
Tel: 01 6614911
Helpline; 1800 212122
Helpline: 1800-778888
Business: 042 9339491
Helpline: 1800-448844
Phone: 074-28211
Galway
RCC
7 Claddagh
Quay
Galway
Carlow &
South Leinster
RCC
72 Tullow Street
Carlow
Helpline: 1850 355355/
Helpline: 1800 727737
091 589495
Business: 05991 33344
Business: 091 583149
Kilkenny
Rape Crisis &
Counselling
Centre
1 Golf View
Terrace
Off Grangers
Road
Kilkenny
Limerick
RCC
Rocheville
House,
Punch’s Cross,
Limerick
Mayo
RCC
Newtown,
Castlebar, Co.
Mayo
Helpline: 1800 311511
Business: 094 9025657
Helpline: 1800 234900
Business: 061 311511
Helpline: 1800 478478
Business: 056 7751555
Sligo
RCC
42 Castle Street
Sligo
Helpline: 1800 750780
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Business: 07191 71188
120
Helpline:1800 633333
Tullamore
Sexual Abuse &
Rape Crisis
Counselling
Service
4 Harbour View,
Store Street,
Tullamore,
Co Offaly
Business: 066 7123122
Helpline: 1800 323232
Kerry
Rape & Sexual
Abuse Centre
5 Greenview
Terrace
Princes Quay,
Tralee
Co. Kerry
Tipperary
RCC
20 Mary Street
Clonmel,
Co Tipperary
Helpline: 1800 340340
Business: 052 27676
Business: 0506 22500/01
Wexford
Rape & Sexual
Abuse Support
Service
Clifford St,
Wexford
Helpline: 1800 330033
Business: 053 22722
Northern
Ireland
Rape Crisis &
Sexual Abuse
Centre
29 Donegal
Street,
Belfast BT1 2FG
Helpline: 04890 249696
Business: 04890
329001/2
Waterford
Rape & Sexual
Abuse Centre
2A Waterside,
Waterford
Helpline:1800 296296
(24 hour)
Business: 051 873362
Appendix 12
POSSIBLE INPUTS FOR REPORT
One of the following range of phrases could be chosen as appropriate
for interpretation of the findings for the medical report:
PRECLUDES
DOES NOT PRECLUDE
CONSISTENT WITH
SUGGESTS
STRONGLY SUGGESTS
DESCRIPTIVE TERMS
BRUISE: an injury to the body manifested as a discolouration of the
skin, caused by an impact or blow.
LACERATION: a full thickness open wound where the skin has been
torn rather than cut.
ABRASION: damage by a force along the body surface which has not
penetrated the full thickness of the skin.
INCISION: a breach of the skin surface made by a sharp object with the
direction of force along the skin.
STAB: the skin is pierced by the point of a sharp object - the direction of
force is thrusting into the body.
Some centres of international reputation advise caution when interpreting
genital injury. They suggest that it not be assumed that such injury is
conclusive medical evidence of sexual crime.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
CAUTION
121
OUTLINE MEDICAL REPORT
A report on the Medical Examination of A…... B…… of 123 Main St. with
a date of birth of 01/01/70 and therefore, 30 years of age at the time of
the examination. The examination was performed on 01/04/00 at 03.00
hours at The General Hospital by Dr. C……D…… assisted by Nurse
E……F…… in the presence of Garda G……H……(Reg. No. 456) of The
Police Station.
This examination was required because A ……B…… alleged that at
31/03/00 at 23.OO hours .........
On examination of the head and neck ……
On examination of the upper limbs ……
On examination of the lower limbs ……
On examination of the chest and abdomen ……
E
PL
M
SA
On examination of the back and buttocks ……
On examination of the genital and anal areas ……
The following clothing and samples were given to the Garda for forensic
evaluation ……
IN CONCLUSION:
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
A……B…… was a 30-year-old lady who looked her age. She was tearful
and distressed recounting the alleged events. The findings on general
examination were consistent with the alleged events. There were no
signs of recent trauma on genital examination, but the absence of genital
trauma does not preclude the possibility of unconsented sexual
intercourse.
122
Appendix 13
Critical Readers
An Garda Síochána: Commissioner Noel Conroy, Garda Headquarters,
Phoenix Park, Dublin.
Ms. Noleen O’Donnell, Information Officer, Health Promotion Department,
Health Service Executive, North Western Area.
Mr. Chris Fitzgerald, Principal Officer, Health Promotion Department,
Department of Health & Children, Hawkins St. Dublin 2.
Ms. Paula Mullin, Assistant Principal Oficer, Health Promotion
Department, Department of Health & Children, Hawkins House, Dublin 2
Dr. Gouri Columb, Sexual Assault Treatment Unit, Rotunda Hospital,
Parnell Sq. Dublin
Ms Kate Mulkerrins, RCNI Legal Co-ordinator, The Halls, Quay St.
Galway
Sergeant Bobby Mullally, Letterkenny Garda Station, Letterkenny,
Co. Donegal
Mr. Paul McGinn, Barrister, Four Courts, Dublin
Ms Sandra Delamere, Advanced Nurse Practitioner Sexual Health,
GUIDE Clinic, Hospital 5, St. James Hospital, Dublin.
Ms Alna Robb, Director, Nursing Practice Development Unit, Wishaw
Hospital, Wishaw, Scotland.
Dr. Maureen Smyth, DNA Section, Forensic Science Laboratory, Garda HQ
Phoenix Park, Dublin 8.
Ms Lorraine Harrison, Clinical Nurse Manager 2, Sexual Assault
Treatment Unit, Waterford Regional Hospital, Waterford.
Mr Doncha O’Sullivan, Principal Officer, Department of Justice, Equality &
Law Reform, Old Faculty Building, Shelbourne , Ballsbridge, Dublin 4.
Dr. Mary McKay, Consultant Paediatrician, Children’s University Hospital,
Temple St., Dublin 1.
Det. Sgt. Thomas G. Deegan, Domestic Violence Sexual Assault Unit,
National Bureau of Criminal Investigation, Harcourt Square, Dublin 2.
Detective Garda Niamh Guckian, Domestic Violence Sexual Assault Unit,
National Bureau of Criminal Investigation, Harcourt Square, Dublin 2
Dr. Louise McKenna, Deputy Director, Forensic Scientist, Forensic
Science Laboratory, Garda HQ, Phoenix Park, Dublin 8.
Ms Annette Kennedy, Director of Professional Development, Irish Nurses
Organisation, The Whitworth Building, North Burn, Dublin 7
Dr. Gráinne Courtney, Associate Specialist in Genitourinary Medicine,
Guide Clinic, St. James Hospital, James St, Dublin 8
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Ms Ingrid Wallace, Limerick RCC, Rocheville House, Punches Cross, Limerick,
Co. Limerick.
123
Garda Ann Byrne, In-Service Training, Harcourt Square, Dublin 2.
Ms. Finola Tobin, CNM 2, Sexual Assault Treatment Unit, South Infirmary
/ Victoria Hospital, Cork.
Ms. Georgina Farren, National Council for Nursing and Midwifery, Unit 67, Manor Business Park, Manor Street, Dublin 7.
Dr. Sheila Willis, Director, Forensic Science Laboratory Garda HQ,
Phoenix Park, Dublin 8.
Dr. Geraldine O’Neill, Forensic Science Laboratory, Garda HQ, Phoenix
Park, Dublin 8.
Dr. Seán McDermott, Biology Department, Forensic Science Laboratory.
Detective Inspector Michael O’Sullivan, Domestic Violence Sexual
Assault Unit, National Bureau of Criminal Investigation, Harcourt Square,
Dublin 2.
Dr. Angela Gilligan, GP, High Road, Letterkenny, County Donegal.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
Ms. Alessandra Fantini, Policy Officer, The Women’s Health Council,
Abbey Court, Irish Life Centre, Abbey Street Lower, Dublin 1.
124
Appendix 14
Acknowledgements
The contribution and support of a number of individuals and groups must
be acknowledged in the compilation of these guidelines.
An Garda Síochána
Chief Superintendent Blake, Legal Section, Crime Policy and Administration,
Chief Superintendent Noel White, National Bureau of Criminal Investigation.
Forensic Science Laboratory
Dr. Sheila Willis, Director of the Forensic Science Laboratory,
Dr. Maureen Smyth Head of the DNA Department, Forensic Science
Laboratory,
Dr. Louise McKenna, Deputy Director, Forensic Science Laboratory
Dr. Sean McDermott, Head of the Biology Department, Forensic Science
Laboratory.
Nursing Letterkenny/Donegal
Letterkenny General Hospital, namely Staff of the CARE Unit, the Nursing
Practice Development Unit and Nursing and General Hospital
Management. The Staff of the Centre for Nursing and Midwifery
Education, Donegal. Ms. Noleen O’Donnell, Health Promotion Unit, HSE,
NW. and Mr. Jim Browne, the Nursing and Midwifery Planning and
Development Unit, HSE, NW. The National Council for the Professional
Development of Nursing and Midwifery. Ms. Annnette Kennedy, the Irish
Nurses Organisation.
The National Council for the Professional Development of Nursing
and Midwifery
Staff and volunteers from member centres in Ireland
INO
Ms. Annette Kennedy, the Irish Nurses Organisation.
Rape Crisis Network Ireland
Staff and volunteers from member centres in Ireland
Rotunda Hospital
Dr. Michael Geary, Master of the Rotunda Hospital, Dr. Gouri Columb for
her valuable input; Rita O’Connor & Eileen Tunney for administrative
support.
Thanks to
Royal College of Obstetrics and Gynaecology Press, UK for use of Figure 2;
GW Medical Publishing Inc., St. Louis for the use of Figure 3.
The formation and work of the Guidelines Steering Group was truly
integrated, inter-agency teamwork. Everyone participated with a sense of
commitment and passion, in a mutually respectful fashion in the
compilation of this document.
Rape/Sexual Assault: National Guidelines for Referral and
Examination in Ireland
DOHC
Ms. Paula Mullin Assistant Principal Officer, DOHC,
Mr. Joe Doyle, DOHC.
125
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