• Sexual assault (SA) is a crime of power and control.
• 1/3 women and 1/6 men will experience a sexual assault in their lifetime.
• 96% of perpetrators are male.
• An approach to sexual assault applies principles of trauma-informed care: safety, trustworthiness, choice, collaboration, empowerment.
• How the patient is treated at the outset (i.e. with compassion, validation and giving them their choice in their care journey) will guide their subsequent course in how they handle the trauma of their assault.
• Medical treatment is different and separate from forensics. Patients should be able to get decent medical care at any ER/UCC/FD office in BC.
• Forensics are nice if we can have it, and only if the patient wants. Forensic care is mostly only offered at specialized sites within each Health Authority.  We generally have a bit of time to get forensics, but ideally sooner the better, especially if looking for toxicology.

Emotional and psychosocial care:

• Acknowledge difficulty and courage in seeking care.
• Respond with empathy, belief, and without judgment.“What happened is not your fault.”
• Offer to have support person to accompany patient, if available (patient friend, family, and/or through community organization (see Patient Community Resources section below).
• Identify existing sources of support and coping strategies.
• Consider offering referrals to:
  • Mental health services for post-assault counselling.
  • Social work.

• Safety plan in place.
• Options for post-assault counselling and social support offered.
  • See “Patient Community Resources” section below.
  • Social Work.
  • Mental Health Services.
• Follow up:
  • With family physician (if they have one).
  • Lab testing:
    • Pregnancy test in 1 month.
    • HIV and syphilis in 1 and 3 months.
  • Prescriptions for STI prophylaxis if started in ED.
    • For ex. HIV PEP for 28 days.
  • Completion of Hepatitis B vaccination (if first dose provided during visit).

• Requiring psychiatric stabilization.
• Currently Pregnant and/or at risk of miscarrying.
• Immunocompromised.
• Requires a Copper IUD insertion.
• severe trauma including genital or ABD trauma (eg. Perforated viscus), or strangulation with airway concerns or Loss of consciousness.

• Transfer to sexual assault service for medical and/or forensic examination within 7 days of the assault (call RACE line, see hospitals with sexual assault services)
• Severe trauma.

1. BCWH Sexual Assault Service: Serves Vancouver and Metro regions 24/7 at VGH/UBC.
2. List of hospitals/clinics with dedicated sexual assault service teams.
3. BCCDC STI treatment guidelines.

1. Women Against Violence Against Women (Rape Crisis Line, counselling services, 3^rd party reporting, hospital accompaniment in Lower Mainland).
2. VictimLink (information and referral services).
3. British Columbia Society for Male Survivors of Sexual Abuse (support services for male victims).
4. Health Initiative for Men (support and information for gay men).
5. Qmunity (counselling, information, referrals, peer support for LGBTQ people).

1. Learning Hub course on caring for survivors of sexual assault.

1. SACHA Sexual Assault Centre. SACHA: Statistics.

   
   

2. Subramanian S, Green JS. The General Approach and Management of the Patient Who Discloses a Sexual Assault. Mo Med [Internet]. 2015 [cited 2019 Dec 2];112(3):211.

   
   

3. BC Centre for Disease Control. Dispensing prophylactic medications post-sexual assault. 2018.

   
   

4. BC Centre for Disease Control. British Columbia Treatment Guidelines. 2014 [cited 2019 Dec 10].

   
   

5. Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, et al. Canadian Contraception Consensus (Part 1 of 4). J Obstet Gynaecol Canada [Internet]. 2015;37(10):936–8.