Synopsis
Deliver trauma-informed immediate care after sexual assault, treat injury and time-sensitive pregnancy or infection risk, preserve choice about forensic examination and reporting, and arrange safe follow-up.
- Believe the disclosure, thank the person for telling you, ask what they need now and avoid questions whose only purpose is investigating the allegation.
- Obtain explicit consent separately for history, examination, treatment, photographs, forensic samples, information sharing and police involvement; consent may be withdrawn.
- Treat life-threatening injury first, then address strangulation, head injury, genital or anal trauma, intoxication, pregnancy risk, HIV exposure and hepatitis B protection.
Key red flags
Strangulation can cause delayed airway, vascular and neurological complications even when external marks are absent.
Possible drug-facilitated assault creates short toxicology windows; obtain specialist forensic advice promptly while treating intoxication or overdose.
Pregnancy risk needs emergency-contraception assessment within method-specific time limits and must not wait for police contact.
A qualifying HIV exposure needs PEP assessment as soon as possible and no later than 72 hours under current UK guidance.
Children and young people require age-appropriate specialist examination, capacity or consent assessment and nation-specific safeguarding action.
The alleged perpetrator accompanying the patient, monitoring a phone or controlling transport may indicate immediate danger and an unsafe discharge plan.
Voice change, dysphagia, dyspnoea, neck pain, neurological symptoms or loss of consciousness after neck compression requires urgent assessment.
Unexpected amnesia, disproportionate intoxication or suspected covert administration needs prompt clinical care and specialist toxicology advice.
A potentially qualifying exposure should be assessed for PEP immediately because initiation is not recommended beyond 72 hours.
Perpetrator access, stalking, controlled communications or dependent children can make ordinary discharge arrangements dangerous.
Reasoning priorities
Identify airway, vascular, neurological, thoracoabdominal and genital injuries needing emergency treatment.
Normal external appearance does not exclude internal injury; symptoms and mechanism determine observation, imaging and referral.
Worked reasoning
An adult presents hours after an assault, has no major bleeding and is unsure about police involvement.
- Check immediate safety, ABCDE, strangulation, head and abdominal injury, intoxication, suicidality and whether anyone accompanying them is safe.
- Explain medical, SARC, forensic and reporting options separately and obtain consent for each chosen part without pressing for a decision.
- Address emergency contraception, HIV PEP within the current window, hepatitis B and site-specific testing while contacting the SARC for forensic advice.
- Agree safe transport and contact methods, result ownership, repeat pregnancy and infection testing, PEP follow-up and advocacy support.