Armed Forces Center for Child Protection Child Abuse in the ER Roles and Goals

Armed Forces Center for Child Protection

Child Abuse in the ERChild Abuse in the ERRoles and Goals


The SetupThe Setup

The ER Physician or Nurse becomes suspicious of abuse

The ER cannot or does not want to deal with it

The Pediatric Resident is called


Are You Alone?Are You Alone?

Resources Family advocacy Children’s protective services Law enforcement

Consultants Pediatric attending AFCCP


ResourcesResources

Who should you call? Who should come in?

Case match with the goals of the resource


Pediatric Roles and Pediatric Roles and GoalsGoals

Primum non nocere Always hard when abuse is the concern

Treat the injury Return the child to the best home

environment available

Return the child to the best home environment available Determine if there is abuse Identify who or where the abuser is Arrange for the child to be elsewhere


Family Advocacy Roles Family Advocacy Roles and Goalsand Goals

Treat military abused and abuser Substantiate / Unsubstantiate abuse Identify abuser and abused Provide treatment Inform command

(no power without the support of the command)


CPS Roles and GoalsCPS Roles and Goals

Protect children from maltreatment Substantiate / Unsubstantiate abuse Identify abuser and abused Identify ongoing risks to the child Separate high risk children from their abuser Take action to decrease risk over time Re-unify separated families


Law Enforcement Law Enforcement Roles and GoalsRoles and Goals

Maintain public order Detain fleeing families with abused children Controlling disorderly people

Investigate possible crimes for possible prosecution Process rape kits Investigate crime scenes Interviews witnesses / suspects


Back to our heroBack to our heroIn the ERIn the ER

What can you do by yourself? History Physical examination Labs and Radiographs Treat the patient Admit to the hospital


HistoryHistory

Interview each verbal person separately Record the first explanation Press for high level of detail Identify the source of all information Point out inconsistency Record changes and additions


Physical ExaminationPhysical Examination

Complete Not problem oriented Hidden skin surfaces (ears, scalp, palms,

soles, buttocks, genitals) Oral cavity (frenulae, lips, alveolar ridges) Palpate the skeleton Look at the eye grounds Examine genitals (supine and knee chest) Neurological / Abdominal injuries


LaboratoriesLaboratories

? Bleeding involved -- PT, PTT, INR, CBC, Family history vs. Von Willebrand’s panel

Recent or significant trauma -- AST, ALT, Amylase, Urinalysis


RadiographsRadiographs

Under age 2 -- Skeletal survey Altered consciousness plus

unexpected trauma in an infant -- CT scan


TreatmentTreatment

Needs no elaboration


The Admission The Admission DecisionDecision

Medical indication to admit Provide a safe environment while

question of abuse and abuser is evaluated

Allows monitored contact with a possibly innocent family


When Do You Need When Do You Need Help?Help?

Abuse in the home Parents uncooperative with

hospitalization Hospital bed unavailable Urgent exam beyond your ability Rape kit


ReportingReporting

UCMJ mandated report to family advocacy

MD, VA, DC law mandated report to appropriate agency Abuse in home -- CPS In the county where the child lives Out of home rape or assault -- Police In the jurisdiction where the crime occurred


Follow UpFollow Up

Document encounter well Probable legal follow up Possible court testimony

Research the medical basis of the abuse question Member of the case evaluation team Advocate for the child within the system

Documents

Armed Forces Center for Child Protection Child Abuse in the ER Roles and Goals