On-Shift Toolkit

• Treat urgent injuries before anything else

• Move to a private room immediately

• Create a calm, consistent environment: comfortable temperature, same staff when possible

• Introduce everyone in the room and explain why they are there

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"I'm so sorry this happened. You are safe here. I'll explain before I do anything — and you are in charge."

Assault removes a person's autonomy—  restore it in every way possible​

• Remind the patient they are in complete control of the exam-- can say no at any time

• Allow patient to control pace

• Let the patient move their own gown and drape where possible — not the clinician

• Allow clothing to remain on parts of the body not being examined

• Offer self-insertion of the speculum or specimen swabs

"Would you prefer to sit or lie down?"  "May I take your blood pressure?"

Consent is not just a single signature. Reaffirm consent before each step.

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Withdrawal of consent may be nonverbal. 

Watch actively for:

• "Wait," "stop," "ouch" — these explicitly rescind consent; stop immediately

• Going silent, tensing, pulling away, recoiling, or moving away from you

• Closing their legs during a genital exam

• Changing the subject, tears, visible distress, or dissociation mid-exam

When you observe any of these: STOP. Check in.​

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"Do you want to take a break?"  |  "You are in charge — we can stop here."

• Avoid any language that implies doubt or judgment

• Acknowledge the trauma of the event

• Center their resilience and strength, not only their injury

• Simple statements can carry enormous weight:​​

  • "This shouldn’t have happened to you."

  • "Thank you for trusting me with this information."

  • "You did the right thing by coming in."

  • "It took a lot of courage to come to the ER."

• Patients may laugh, cry, seem calm, dissociate, or express anger — none of this reflects credibility

• Memory may be fragmented or non-linear — this is neurobiology, not deception

• Do not assume gender, pronouns, orientation, or relationship to assailant

• Patients from marginalized communities may justifiably fear medical and legal systems — these fears are founded

• Immigration status, race, disability, LGBTQ+ identity, and prior system involvement all affect how patients present and what they need

• Adapt your approach to meet the patient

Be transparent, predictable and patient-led.

• Explain what you are about to do before every step — narrate throughout;

• Stay within the patient's eyesight at all times (ex. raise head of exam table during pelvic exam)

• Avoid sudden movements; speak clearly, slowly, and calmly

• Allow the patient to control the pace

• Allow clothing to be shifted rather than removed when possible

• Offer self-insertion of the speculum or specimen swabs whenever possible

• Offer a mirror or allow the patient to place their hand over the clinician's to guide the exam

• Offer a support person (friend, family, or advocate)

• Minimize repetitive interviews — balance trainee education against re-traumatization through multiple examinations

• "Bed" >> "Exam Table"

• "Rape Kit" >> "Evidence Collection Kit"

• "Feel/Touch" >> "Examine/Evaluate"

• "Why did you...?" >> "Tell me more about"

• "You need to..." >> "One option is...." / "Would you like to..."

• "Try to relax" >> "Take all the time you need. We can pause or stop at any point."

• ​"I need to examine you now" >> "The next step would be a physical examination. Would it be okay to proceed? You can say no to any part of this.”

• "Your [body part]" >> "The [body part]"

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• We ONLY report sexual assault to police if it involves a weapon or a minor (under 13 years old), or if the patient expressly requests it. 

• Do not immediately contact law enforcement when a patient presents and do not mention it until after the exam.

• Many patients — undocumented individuals, people of color, LGBTQ+ patients, those with prior system involvement — have well-founded fears of law enforcement. Respect this without question or challenge.

• Never express surprise or disapproval if a patient declines to report

• The hospital is required to store evidence for up to 20 years, so patients can decide to report later.

• After the exam, offer once, calmly:

     "Reporting is entirely your choice. Evidence can be preserved so that option remains open."

• Secondary trauma is real. Burnout is real.

• Women are more likely to sexually assaulted, and also more likely to perform (or be delegated to perform) sexual assault exams as clinicians

• Watch for Signs: intrusive thoughts, numbness, compassion fatigue, avoidance of certain cases

• Seek peer debriefing and supervision regularly

• Use available mental health and EAP resources