Five main scenarios where sexual assault presents spontaneously or following routine enquiry

1. Patient is face to face in clinic:

Call 101 and ask to speak to a sexual offences liaison officer. If patient is attending a Sandyford/ Lanarkshire or Ayrshire & Arran Service there is also the option of the clinician contacting Archway 0141 211 8175 if seeking further advice.

If the patient opts to be referred for a forensic examination do not examine unnecessarily prior to a forensic exam (unless concerned about serious injury that needs emergency treatment).

Forensic samples looking for suspect DNA or samples for toxicology must be taken in a forensic setting to ensure they are admissible in court. Do not take evidential samples in sexual health services as they are not forensically secure.

2. Patient is on the phone having called for advice:

Advise to contact police directly on 101 or attend a police office.

Staff can offer to contact police on patient’s behalf by phoning 101 to initiate arrangements for police to make contact with patient.

See Gender Based Violence Poster taken from Turas when assessing and reducing risks whilst supporting disclosures.

Assess for other clinical risks including pregnancy, STI risks, onward safety and manage appropriately.

If patient resident in GC&C, A&A and Lanarkshire  then can access emotional support from the Archway Support Worker 0141 211 8175 with or without having had a forensic examination if within 7 days of the assault.

Explain within 7 days the options available for forensic capture of evidence are either

• Police involvement
• Self-referral to a sexual assault response coordination centre (SARC). Across Scotland patient’s have self-referral access where a forensic medical examination (FME) is carried out by a healthcare professional with the aim of collecting evidence that can be used to help identify the person who carried out the assault, if the patient decides to report to the police at a later date.

It may help to direct the patient to the Rape Crisis Scotland video guides to the criminal justice system

• the long video 

• the short overview

and NHS Inform for more information about the sexual assault self-referral service 

Advise patient to call NHS Scotland self-referral phone service on 0800 148 8888 if they decide on this option. Patients who are undecided should also be encouraged to contact the NHS Scotland self-referral phone service since this will provide an opportunity for the patient to speak in due course with a clinician working in the SARC.

Although SARCS retain evidence for 26 months there is no time limit on disclosing to police.  People, including those who did not attend a SARC, can opt to make a disclosure at any time by walking into any Police station or alternatively phoning 101 and asking to speak to a sexual offences trained officer.

Assess for safeguarding issues and any requirements to share information.

Assess and manage clinical risks and psychosocial wellbeing

• Offering examination of exposed sites if symptoms or injuries
• Hepatitis B vaccination
• HIV PEPSE assessment ( <72hrs)
• Emergency Contraception
• Emotional support needs and offer support referral

If resident D&G and Forth Valley refer to local support services which may include Rape Crisis  

If patient resident in GC&C, A&A and Lanarkshire 

• < 7 days offer “support only” referral to Archway 0141 211 8175
• > 7 days refer to local support services which may include Rape Crisis

• Child Protection / Vulnerable Adult concerns
• Risk of self-harm and coping strategies (+/- GP or mental health referral)
• Suicide risk assessment
• STI screening (starting 14 days after incident)
• Testing for HIV, syphilis, hepatitis B and C (after window period)
• Pregnancy testing
• Consider referral to “My Body Back” if cytology due and sexual violence more than 12 months previously

(Refer to Initial Consultation in a Sexual Health Setting for more detail)

Consider Options for Information sharing with the Police  “INTELLIGENCE ONLY” reporting following local protocols 

Advise to contact police directly on 101 or attend a police office.

The patient is beyond the opportunity for forensic capture.

Assess for safeguarding issues and any requirements to share information.

Assess and manage clinical risks and psychosocial wellbeing

• Offering examination of exposed sites if symptoms or injuries
• Hepatitis B vaccination
• HIV PEPSE assessment ( <72hrs)
• Emergency Contraception
• Emotional support needs and offer referral to local support services which may include Rape Crisis
• Child Protection / Vulnerable Adult concerns
• Risk of self-harm and coping strategies (+/- GP or mental health referral)
• Suicide risk assessment
• STI screening (starting 14 days after incident)
• Testing for HIV, syphilis, hepatitis B and C (after window period)
• Pregnancy testing
• Consider referral to “My Body Back” if cytology due and sexual violence more than 12 months previously

Refer to Initial Consultation in a Sexual Health Setting for more detail

Patients who have attended a SARC in Scotland will have a summary of their clinical management scanned into NaSH to support aftercare. In addition, there will be a clinical note outlining the follow up requirements in sexual health. This will minimise the details that are required to be sought directly from the patient to reduce re-traumatisation and inform staff to STI screen involved sites appropriately.

Irrespective of where in Scotland a patient attended a SARC generally follow up is in their health board of residence. Where relevant consent should be sought to allow the resident Health board to access details of attendance and follow up plan.

There may be exceptions where the patient has expressed a preference to be followed up in a health board in which they are not normally resident.

Patients who have attended a SARC outwith Scotland will not have details of the attendance documented in NaSH unless there has been direct communication from the SARC concerned with the sexual health service where follow up is likely to be taking place.

Follow up care may include STI and BBV and syphilis testing, completion of vaccinations, pregnancy testing or advice on ongoing contraception.

Occasionally, following liaison with a SARC, STI screening samples may be advised to be taken along with an appropriate chain of evidence form – see STI testing section within Initial Consultation in a Sexual Health Setting

Patient’s attending SARC in Lanarkshire, AA and GG&C who have consented to follow up with a support worker will have been already referred so no need to re refer. If unsure  check with Archway on 0141 211 8175.