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Troubling Call, need to vent


anonymous

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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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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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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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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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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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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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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.

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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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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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