Violence: Impact for EMSDealing with Injury to Adults

Children,& Elderly

Susan Wood RN EMT-PIn Field EducatorContinuing Education

January 2013

GoalsGoalsGain an understanding for the role

of EMS in the lives of victims of abuse

Appreciate the impact EMS can have on interpersonal family

violence

Provide documentation pearls and avoid pitfalls

Child found unresponsive on the floor w/ condom in mouth

A father has been found guilty of killing his 15-week-old daughter while he was orally raping her.

In August 2011, baby was found in the bedroom of their mobile home bleeding from the nose, unconscious and not breathing.

Mother came home to find ex killed daughter, 7, & shot 9-yr-old son in head

Father murders two-week-old son because of gaming interruption

NFL linebacker kills his baby's mother, then himself as

coaches look on

I Am Adam Lanza's Mother': A Mom's Perspective On Mental Illness Conversation In America

WOODSTOCK, Il. (CBS) – In 2010, this 14mo old girl was left w/ a black eye & swollen head; she

was taken to the hospital due to injuries from child abuse. She suffered a head injury, &

spent nearly a week in the hospital; 2 adults were home w/ the girl at the time, yet no one

has been criminally charged. Two years later, no charges

had been filed, despite evidence of previous abuse.

IL DCFS case filed on the incident.

October 17, 2012

As an officer, Bell is mandated by law to report suspected child abuse. Prosecutors allege she failed to do so and filed a misdemeanor charge and filed a misdemeanor charge on July 17.

Remmers, a 54-year-old Corona resident, faces felony charges of kidnapping, false imprisonment, criminal threats, assault with a deadly weapon and inflicting corporal injury on a child in connection with the March 18 assault of the young boy. Two of Remmers’ followers face similar charges.

Prosecutors allege the group took the child to the desert, forced him to dig his own grave, then threw dirt on him. When they returned the boy to Corona, he was allegedly tortured with pliers and sprayed with mace before being forced to eat off the floor without using his hands, court documents and witnesses state.

BY LESLIE PARRILLA December 07, 2012; 06:29 PM

CRIMINAL ALLEGATIONS

Former members of a Corona church where the pastor is accused of child abuse say a police officer, firefighter

and other professionals failed to protect children from psychological and physical harm, even though

those professionals are trained to report child abuse.

What is the role of EMS?What is the role of EMS?Write one patient care interaction you have Write one patient care interaction you have encountered with any one of the following:encountered with any one of the following:

Child AbuseChild Abuse

Child NeglectChild Neglect

Elder Abuse Elder Abuse

HomelessnessHomelessness

Domestic ViolenceDomestic Violence

When faced with Child Abuse

PolicePoliceOLMCOLMCSystem PolicySystem PolicyDocumentationDocumentation

What resources are available to What resources are available to EMS when encountering a EMS when encountering a

suspected child abuse suspected child abuse situation?situation?

V-2 Suspected Child Abuse/Neglect

DefinitionsDefinitionsBase on The Abused & Neglected Base on The Abused & Neglected

Child Reporting Act (ANCRA)Child Reporting Act (ANCRA)

Mandated ReportersMandated Reporters

Medical personnel Medical personnel School personnel School personnel Law enforcement Law enforcement Child care personnel Child care personnel ClergyClergy

Things to ponder

Even if the call doesn’t start with suspicion of abuse, identification can be made in any setting

The law doesn’t require certainty; only reasonable cause

No assumption should be made that law enforcement or hospital personnel will file a report

ScenarioScenario

Local police request EMS for report of a Local police request EMS for report of a neighbor who states she heard yelling neighbor who states she heard yelling & children’s cries coming from a house, & children’s cries coming from a house, but she & her husband have never seen but she & her husband have never seen children since the couple moved in 5 children since the couple moved in 5 months ago.months ago.

EMS is led to a bedroom where they find 3 whimpering EMS is led to a bedroom where they find 3 whimpering children all less than 7yo. All are clothed in children all less than 7yo. All are clothed in underwear only, & are huddled together in a bed. It underwear only, & are huddled together in a bed. It is filthy; odor of urine & feces is strong. They are is filthy; odor of urine & feces is strong. They are very thin & do not answer when spoken to. Each very thin & do not answer when spoken to. Each has bruising on their upper arms & torso w/ has bruising on their upper arms & torso w/ abrasion type markings around their wrists. As abrasion type markings around their wrists. As EMS approaches, they cower.EMS approaches, they cower.

Using resources available, Using resources available, what should be done?what should be done?

How would this How would this situation be defined?situation be defined?

What is the duty of What is the duty of EMS?EMS?

What procedure should What procedure should be followed?be followed?

Is Is temporary temporary protective protective custody custody necessary?necessary?

EMS must confirm the followingEMS must confirm the following

Reason to believe Reason to believe continued custody continued custody presents immediate presents immediate dangerdanger

Responsible adult Responsible adult unable/refuses removal of unable/refuses removal of childrenchildren

No time to apply for court No time to apply for court orderorder

1-800-25-ABUSE1-800-25-ABUSE

This number is available 24 hours a day, 7 days a week

Calls should be made as soon as possible after caring for the medical needs of the patient

Caller should be prepared to leave a callback number

Hotline worker will determine is information meets legal requirements to initiate investigation

Hotline Information Needed

Names, birthdates/approx. ages for all subjects

Addresses for all victims including current location

Information about siblingsSpecifics about the abusive incident or

circumstances contributing to risk of harmDo not delay call to obtain this informationWritten confirmation within 48 hrs (CANTS)

Written confirmation is neededWritten confirmation is needed

Children at Greatest RiskChildren at Greatest Risk

3 years of age or younger3 years of age or youngerSeparated from their parents at birthSeparated from their parents at birthChildren adoptedChildren adoptedLiving in a foster homeLiving in a foster homeStepchildrenStepchildrenChronic medical problemsChronic medical problemsBehavioral or mental problemsBehavioral or mental problems

The ugly truth of child maltreatment is that it The ugly truth of child maltreatment is that it happens regardless of ethnicity, culture, happens regardless of ethnicity, culture, religion, or financial or social status.religion, or financial or social status.

How does EMS identify accidental from non-accidental trauma?

Location, location, location

What specific ASSESSMENT

findings are helpful in making a

determination?

Cases of abuse can involve life-Cases of abuse can involve life-threatening conditionsthreatening conditions

Expedited response is often indicatedExpedited response is often indicated

Difficult SituationsDifficult Situations

What should be done?What should be done?

Cases are horrifying & emotionally challenging

NEVERNEVER confront a caregiver w/ suspicions

Primary role is to treat & transport

Confrontation only creates ↑ danger

EMS information may be the VITAL VITAL PIECE FROM THE SCENE PIECE FROM THE SCENE

NECESSARYNECESSARY to the investigation

EMS holds a key position in not only assessing EMS holds a key position in not only assessing the child, but also the environment. There are the child, but also the environment. There are

key questions & observations to note.key questions & observations to note.

Support personnelSupport personnel should have an awareness should have an awareness of surroundings, including observation of of surroundings, including observation of other children in the home & hx provided in other children in the home & hx provided in order to accurately document (usually) after order to accurately document (usually) after the fact.the fact.

Some things to be mindful of…

1. What are the living conditions of the child? Do 1. What are the living conditions of the child? Do they appear to be in an unsafe or unsanitary they appear to be in an unsafe or unsanitary environment?environment?

2. How does the family relate to the child in the 2. How does the family relate to the child in the current situation?current situation?

3. How does the caregiver interact with the EMS 3. How does the caregiver interact with the EMS professionals? professionals?

4. Are the injuries consistent with the mechanism of 4. Are the injuries consistent with the mechanism of injury?injury?

5. Does the story being told change over time? 5. Does the story being told change over time?