Notes – Abuse and Maltreatment

Abuse and Maltreatment

Patient Safety Considerations

  1. If no medical emergency exists, the next priority is safe patient disposition/removal from the potentially abusive situation
  2. Do not confront suspected perpetrators of abuse/maltreatment. This can create an unsafe situation for EMS and for the patient

Notes/Educational Pearls

Key Considerations

  1. All states have specific mandatory reporting laws that dictate which specific crimes such as suspected abuse or maltreatment must be reported and to whom they must be reported. It is important to be familiar with the specific laws in Missouri including specifically who must make disclosures, what the thresholds are for disclosures, and to whom the disclosures must be made.
  2. Clues to abuse or maltreatment can vary depending on the age group of the patient and on the nature of the abuse. Remember that not all abuse or maltreatment involves physical harm. It is important to realize that the job of EMS is to document their concerns, assess the patient for potentially serious injuries, make sure that their concerns are disclosed to the appropriate legal authorities, and work towards getting the patient into a safe situation. EMS personnel should not take it upon themselves to investigate, interview, or intervene above and beyond those concepts and should leave further intervention to the appropriate law enforcement personnel.
  3. It is very important to have a high index of suspicion for abuse in children presenting with a Brief Resolved Unexplained Event (BRUE). Of the very serious causes of BRUE, child abuse has been found in as many as 11% of cases. One retrospective review noted that a call to 911 for BRUE was associated with an almost 5 times greater odds of abusive head trauma being diagnosed as the cause of the BRUE, clearly emphasizing the high index of suspicion EMS providers must have when responding to these calls.
  4. Abuse and maltreatment can happen to patients of all ages
  5. Patients may be unwilling or unable to disclose abuse or maltreatment so the responsibility falls on EMS personnel to assess the situation, document appropriately, and take appropriate action to secure a safe place for the patient.
  6. Document findings by describing what you see and not ascribing possible causes (e.g. “0.5-inch round burn to back” as opposed to “burn consistent with cigarette burn”).
  7. Providers should be knowledgeable about mandatory reporting statutes in their area, especially regarding adults (domestic violence, elder abuse).

Pertinent Assessment Findings

As noted above

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914187 – General-Neglect or Abuse Suspected

Key Documentation Elements

  • Meticulous documentation of any statements by the patient and any physical findings on the patient or the surroundings are critical in abuse or maltreatment cases

Performance Measures

  • No recommendations

References

  1. Blue Campaign. DHS.gov. https://www.dhs.gov/blue-campaign. Updated April 5, 2016. Accessed August 21, 2017.
  2. Child Abuse and Neglect: Definitions. CDC.gov. http://www.cdc.gov/violenceprevention/childmaltreatment/definitions.html. Accessed August 13, 2017