Synopsis
Provide immediate trauma-informed medical care, preserve choice and consent, recognise occult injury and safeguarding risk, and coordinate timely SARC, forensic, pregnancy and infection interventions.
- Believe and validate the disclosure without asking the person to prove it; use their words, avoid blame and ask only what is needed for immediate clinical decisions.
- Consent is separate for history, examination, photography, samples, forensic evidence, treatment and information sharing; the person can pause or withdraw from any part.
- A sexual assault referral centre can provide medical, forensic and advocacy care whether or not the person reports to police, and many services accept self-referral.
- Stabilise injury, strangulation, intoxication and mental-health crisis first; forensic value never justifies delaying lifesaving or urgent clinical treatment.
- Contact the SARC promptly because forensic sampling windows depend on assault type, site, timing and local capability; washing or changing clothes does not remove the right to assessment.
- Offer pregnancy testing and emergency contraception: a copper IUD is most effective, ulipristal acetate 30 mg is used up to 120 hours and levonorgestrel 1.5 mg is licensed up to 72 hours after exposure.
- Assess HIV PEP immediately and start when indicated as soon as possible, ideally within 24 hours and no later than 72 hours, for a 28-day course under BASHH guidance.
- Assess hepatitis B vaccination and immunoglobulin need, baseline STI and blood-borne-virus testing, and follow-up windows without making empirical antibiotics automatic for every survivor.
- Offer an independent sexual violence adviser, psychological support, safety planning and a named follow-up route while preserving control over police involvement wherever law permits.
Key red flags
Voice change, dysphagia, dyspnoea, neck swelling, petechiae, neurological deficit or loss of consciousness after strangulation needs urgent emergency assessment despite few external marks.
Haemodynamic change, uncontrolled bleeding, severe abdominal pain, peritonism, head injury, suspected internal injury or inability to pass urine requires acute hospital care.
Intoxication, reduced consciousness, overdose, acute psychosis or suicidal intent requires immediate safety and capacity assessment before non-urgent examination.
Ongoing access by the alleged perpetrator, threats, coercive control, trafficking, child sexual abuse or an adult-at-risk concern activates safeguarding procedures.
A substantial possible HIV exposure approaching 72 hours or pregnancy risk within the emergency-contraception window needs same-day specialist action.
Investigation priorities
Identify airway, vascular, neurological, abdominal, genital and musculoskeletal harm that needs urgent treatment.
Management branches
A person discloses recent or historical sexual assault in any healthcare setting.
- Move to privacy, assess immediate danger, ABCDE, strangulation, injury, intoxication, suicide risk, capacity and safeguarding needs.
- Treat life-threatening problems first, documenting objective findings and spontaneous words without repeated investigative questioning.
- Contact emergency specialists and the regional SARC early, agreeing a safe advocate, interpreter and communication method with the person.