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Troubling Call, need to vent

34 posts in this topic

Posted · Report post

Greetings all;

Contrary to the rules of this site, I have created this account for the sole purpose of creating this post and I do not intend to use this account again. Since the mods are previewing this post I will assume I am forgiven just this once if it appears in the forums.

The reason I am posting this anonymously is because I am a well known user on this forum and I've made no secrets of where I am from or who I am. Should this information be linked to me, a reader may also be able to identify who I am talking about. For the protection of my patient I am taking steps to avoid this possibility. This is not a scenario or a peer review, just a need to vent.

This afternoon I was dispatched to intercept a BLS unit with a 14 year old unconscious female with cold exposure. I assess the patient and she's not cold at all but her forearms are covered with old shallow cuts from self mutilation. GCS is 6 but she's maintaining her airway. She was last seen 2 hours prior in a normal state and was found unconscious by friends who carried her part way home then called her mother. Her vitals were fine, ECG was fine, and I only had enough time in transit to start an IV and give Narcan before we arrived at the hospital.

In the hospital her GCS came up to 8, it was determined that she had benzos, opiates, and THC on board, an NG tube was placed but nothing was aspirated. As the foley was being placed the nurse let out an exclamation...I can't see what I'm doing here, she's full of C-U-M!!!! (estimated 30cc) Immediately my concern shifts from a drug overdose to a drugging and rape. I express my concern to the doc who states. "you know this makes a bunch more work for me." I insisted, the doc does a quick exam an hour later and decides it's vaginal discharge.

Since our hospital isn't equipped to care for this kid we have to take her to a pediatric special care centre. The trip was uneventful and I transferred care to the peds specialist on call and told her my suspicions. I also made sure that mom was not aware of my suspicions and told the doctor such as well. Doc assured me she'd talk to mom and decide a plan.

This girl comes from an area with a very high teen pregnancy rate, and it's also violent. No doubt she'll be afraid to point any fingers. Unfortunately I suspect she is going to fall through the cracks and probably be a suicide statistic within 3 years.

After I got home I spoke to the nurse who gave me some further information. He was speaking to a friend who was in the location and actually saw this girl being carried by 4 boys who dropped her and ran as soon as they were spotted.

Sigh, I know it is up to the girl and her mother to decide if they are going to press any charges, but it breaks my heart to see this pretty young thing destroyed like this. I haven't decided if I should go to some police friends of mine with this information, even if I did, they likely couldn't do anything unless the girl or her mom complained.

I'll probably have a chat with one of them anyways...off the record.

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Posted · Report post

Hmmm....I got some opinions about this "call". I have seen my share sexual assault victims and have never heard of doctors having trouble with airway because of semen in the throat. I also don't know too many doctors who would take a look and be able to immediately recognize what they were looking at.

There are specific tests and procedures in place for a sexual assault victim. Making utterances about what a nurse or doctor is seeing is going to lead to legal trouble.

Sorry but I am not buying this story. Too many inconsistentcies to me.

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Posted · Report post

The semen was in her vaginal area I think. The nurse was having trouble placing a foley because of it. I'm not sure what is not to buy out of the story.

It sounds like a crappy situation where the EMS provider will lose regardless of what actions are taken. We have to report all possible rapes in my area to local deputies. That might be an option...or maybe CPS?

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Posted · Report post

The semen was in her vaginal area I think. The nurse was having trouble placing a foley because of it. I'm not sure what is not to buy out of the story.

It sounds like a crappy situation where the EMS provider will lose regardless of what actions are taken. We have to report all possible rapes in my area to local deputies. That might be an option...or maybe CPS?

I think I need to go back to bed, I completely missed that it was a folely. For some reason I thought the nurse was doing an airway. Wow, how did I get those mixed up?

Anyway, I still have reservations about this story. Maybe its because the author chose to post annoymous, maybe its the utterances made by the nurse, or maybe its just my skeptical nature.

I don't know any doctor who would complain about the work, especially when the victim is a child.

Sorry, just my opinion.

Anyway, my advice is simple: you didn't put the patient in the situation. Any help is better than no help.

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Posted (edited) · Report post

I also don't know too many doctors who would take a look and be able to immediately recognize what they were looking at.

I think its a pretty good assumption that clear, white fluid in a vagina could be semen.

Sorry but I am not buying this story. Too many inconsistentcies to me.

This is a story I've seen over and over in the city I work at, there is absolutely nothing inconsistent with this posters story. We as paramedics at least here, have an obligation to mention our concerns regarding sexual abuse of a minor. There's nothing odd about discussing it with a nurse or doctor.

Edited by Curiosity
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Posted · Report post

I think I need to go back to bed, I completely missed that it was a folely. For some reason I thought the nurse was doing an airway. Wow, how did I get those mixed up?

Anyway, I still have reservations about this story. Maybe its because the author chose to post annoymous, maybe its the utterances made by the nurse, or maybe its just my skeptical nature.

Mike: I suspect the reason you don't buy this story is because you have no experience in the healthcare scene. It is really a really poor attitude for fresh EMT-B to come into a thread like this where a practitioner is clearly reaching out for advice from fellow healthcare professionals, and get brushed off by an arrogant No0b, presenting yourself as "suspicious". What could the poster possibly gain from this thread other than a little compassion?? They are not asking for legal advise or money! Anyway; on to the OP. I suspect you also may be new(er) to EMS. This is a crappy lesson to learn, but it is a very real one. Sometimes horrible things happen to good people and children. Sometimes the healthcare system fails royally. You need to decide for yourself how far you are willing to go for this one patient. IF you decide to persue this, it could very well cost you your job... or possibly your cert, but most definatly, your reputation will change. If you decide to do nothing, you may not be able to live with yourself. I have no idea! What I do know is that you WILL run into very similar scenario's frequently and if you do not decide right now, how you are going to deal with these unfair instances, you WILL burn out rapidly. You must make peace with yourself.
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Posted (edited) · Report post

Thanks Mobes but I understand where Mike is coming from. I hadn't expected to post again but I'll address Mikes concerns. The nurse made the comment the crass way she did because she was so shocked that she reverted to her back ground. This nurse is from the same area as the patient and may even know the family. She was so shocked by what she witnessed that she couldn't even think of the right word for semen and knowing that the first word in her head was inappropriate she spelled it out. Fortunately there was no family in the room at the time.

Edited by anonymous
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Posted · Report post

I don't see how it could hurt you to make a call to CPS. You would have done your due diligence. At that age, I don't think there is any choice but for charges to be laid against the boys. If it was in fact rape.

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Posted · Report post

Man, It is a tough call no matter what you do. If it is rape, one of the hospitals should have sampled the discharge and should know what it is. Unless you have a specific directive to report to the police or law enforcement authorities I would leave the reporting to the higher level of care that I transferred to. I mean, you have strong suspicions but after all out "spidey sense" is not proof.

I learned that once the patient has been transferred and received then the burden is on the receiving higher level of care.

I feel for you and your patient. Best wishes to you.

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Posted · Report post

In BC if we suspect any type of abuse to a minor it is off to the Child welfare we go..........No if and or buts. We use to have to say our suspitions to the hospital staff but because of incidents of things not being reported it is now up to us.

Personally I would go and have that off the record chat and hopefully someone will look into it.

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Report your findings and go up your chain and perhaps even speak with your medical director for additional guidance. In addition, you need to chart this incident exquisitely in the event the case progresses. I find it strange that the doc did not treat this as a potential sexual battery. In my area we actually have specially trained providers known as sexual assault nurse examiners (SANE) who are immediately called upon in these kinds of cases.

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Here We are mandatory reporters in cases of suspected abuse , sexual assault and cases of neglect to children and the elderly. State statute is very clear on the requirements for us to file a report to the hospital receiving the patient AND the state hotline.

I would write up everything you can remember from the beginning of the call to the time you handed over care at the second receiving hospital.

DOCUMENT everything seen and heard.

Make copies and file one away at home in a sealed dated & timestamped envelope for safe keeping.

File one through your services normal chain and send one to the state or province CPS.

Be prepared to go to court to testify.

Good on you for coming here to vent and get other experienced providers opinions.

This is a call that has no good outcome for the young girl, don't let her down by doing nothing.

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Posted · Report post

Make the call to DCFS, I am sure you already have since we are mandated too. (At least where I am from)

After that drop it. You cannot get involved emotionally with this shit. I know some people don't want to hear me say it...I know I am not liked here, but you have to separate. Or else you will go crazy.

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Where I come from we are mandated reporters. There is no question.

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Gee, this is a tough one. Dealing with kids is hard enough, dealing with kids in a situation like this? I don't envy you. In our situation we don't have a duty to report something like this, more of a moral obligation, but geez....I dunno. It's not like the child was endangered by her mother, so going straight to child welfare might be a bit extreme. I think you're headed the right way, you passed the responsibility up the chain of command and the doc assured you there would be some followup. It's up to the mom and daughter to report if any crime occurred and all you've got is pretty circumstantial.

Follow up with your cop friend, he likely won't tell you any details, but he may be able to confirm if there is an investigation in progress and that might help.

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Posted · Report post

I would definitely file a report as a mandated reporter under state statute.

Let the powers that are above my pay grade figure out how to handle the case.

We do not have to witness an incident to make a report, we only need a reasonable suspicion of wrongdoing.

I would also be talking to a friendly LEO over a cup of coffee.

My job is to be the patients advocate, especially with a minor

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We're mandatory reporters of abuse or SUSPECTED abuse in minors and elders.

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I've seen the term "mandatory reporter" many times here, does that mean the same thing to everyone? Who are you obligated to report to? It seems that part of the OP was asking if he should speak to the police. Being a mandatory reporter is awesome, but unless the OP knows much more about it than I do, that statement alone doesn't really help much.

Also, if this child comes from one of the American war zones that we call 'inner cities', then being to galant can put this girl in more danger than she is now. It's important that when we start to skirt the system, which I'm a fan of and do regularly, that you consider the unforseen consequences and don't cause additional pain, which I've also done more often that I'd like to admit. Sometimes are best efforts outside of the system spiral out of control due to our ignorance of 'the big picture' and our good turns ugly, and often passes beyond our control to mitigate that ugliness once it does.

Awesome post. I'm not clear why you would choose to not continue your discussion. This topic is so important, and too often ignored...

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I consider myself very fortunate to not have to deal with these calls very often in the region I work in. I feel for you; it seems like it's weighing down on you pretty hard.

I think you've done the right thing so far by opening up to peers (even if just anonymously). You'll get lots of opinions, lots of advice, and lots of Monday Morning quarterbacks, but I have a feeling you're going to get the most benefit from simply typing the whole thing out and organizing your thoughts.

In the end you've just got to do what will help you get to sleep at night. Follow your gut, and good luck.

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Here, it's the reliability of the receiving hospital to take care of such issues. Pediatrics usually are very sensible to this matter and know what to do (and how to do it). Preclinical providers are supposed to report their suspicions to hospital staff/receiving doctor.

Anonymous, if that's not the case for your system or you're unsure with that, I'd suggest to report to your superiors. Most likely they already have dealt with such situations and either can point you to appropriate ressources or take action themselves. At least they should know the quality management process flowchart for these cases or now feel the urge to create one.

Would I step up to help this one poor girl at any costs (her life security, mine, my job...) with my limited power, other than trying to get the ones involved that should be in charge? Most likely: no. Choose well. But don't do nothing. Those are your nightmares.

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In Maine : Mandated reporter statute covers us as Healthcare providers ,firefighters, law enforcement officers , teachers & school administrators : It means we have to report our suspicions to the receiving hospital ER Doctor personally and file a report over the phone to either the child protective services office for children or the Elder services office of DHS. The system does work and I have made use of it in the past.

Both have a 24/7 hotline and will have a caseworker in touch with you within an hour to get a full report and followup.

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I'm with Dwayne... Everyone is tossing out mandatory reporting.... the OP did this. She/he reported their suspicions to the ER doc and it sounds like s/he was going to talk to some LEO friends.

Any call like this, I believe should involve a CISM debrief afterwards. Calls involving violence to children should be included under their protocol for a CISM meeting after the call. You should not have to process the events alone. There are resources available through most departments in the US, and possible Canada but I have no clue, to help the OP handle their feelings after calls like this.

To the OP and anyone else who has experienced a call like this, reach out to CISM, to a friend, religious leader, anyone you feel comfortable talking to.

To the OP: Sounds like you did all you could to help this child, unfortunately, a lot of the time things like this fall through the cracks. Not all rapes cause physical damage to the vaginal area that would be evident to a doctor without the training to recognize such an issue. Someone previously mentioned SANE nurses and their value in a case like this a incredible. They can speak with the victim, and often times the victim is more likely to speak to them rather than the MD on the case. Does your area have access to SANE nurses? I am really sorry that you had to experience this call, but I do hope that you reach out and continue to process the events that happened.

Best of luck to you.

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Interesting. Everywhere I've worked mandatory reporting has meant to law enforcement, CPS or social services. It has not stopped simply with telling the ER doc. Verifying the process could be as simple as referencing local protocols. Failing that a call to the state/province/regional EMS office to ask about the process should prove helpful. Of course, this is all assuming you don't want to talk to your boss at work about it.

Be wary of this process. Failure to follow established reporting guidelines or laws can come back to bite you in the arse and leave you in a heap of legal trouble. Figure out your reporting responsibilities and get the reporting done correctly.

Be careful with mandatory CISM debriefings. If one is inclined to need to talk something like this out then a professional counselor or therapist, one who has been educated and trained to provide counseling/therapy/psychological services, is probably a better bet. Never mind the potential damage that can be created by forcing someone to attend one of these type of meetings.

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I've always found that being told to attend gives someone the opportunity to talk...I have never seen someone forced to talk, just strongly urged to attend and have the opportunity to talk... CISM can also refer those who need further assistance to professional therapists and counselors. In my experience, it is meant to be a first step to help get the ball rolling if needed.

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Then offer the referrals to involved crew members without the dangerously undertrained, or altogether untrained, "CISM counselors".

These things can do more harm than good. Professionally trained and educated counselors, psychologists or therapists, preferably ones with experience dealing with EMS or first responders, are much better than people who took a couple of weekend classes to be "CISM counselors". Mandating attendance breeds resentment which is not something you want on top whatever issue may be at hand.

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