Question about Emergency Room services

I'll let others answer that question, since I'm not familiar with police procedure and the ER.

I just wanted to say, welcome to AW You didn't do anything wrong. AW has a great group of people with good info.

Go on over to the Newbie board and introduce yourself, also. It's a great way to get to know AW and for others to get to know you.

What does your story need?

For instance, dehydration can be a medical emergency or a minor problem. Why does the arm require surgery and not setting?

Police are lower on the food chain than medical emergencies. But a broken arm might require morphine. Dehydration can effect thought processes. So you have the ability of the patient to be coherent combined with how fast do the police need the information.

Lots of things can happen in the first two hours in the ER. Blood work, an IV for hydration, x-rays, maybe MRI or Cat Scan, notification of ortho surgeon, clothes removed and bagged for evidence, physical exam, pictures for evidence, maybe a police interview, maybe a rape exam. Primary goal, though, will be getting the patient stable, and figuring out what's wrong.

Best of luck,

Jim Clark-Dawe

Basenjichaos said:

Possible triggers!

I am new to this site and to forums in general, so please be patient if I've made any missteps.

I've got a female character that has been sexually assaulted, has a broken arm that will require surgery, is dehydrated, and her feet are a bit torn up from running on rough terrain. When she lands in an ER, what will happen and in what order, as the police try to talk to her and her friend to build their case? I assume the arm will take precedence, but will it be postponed so the police can question her? At what point will a SANE nurse step in?

Again, please let me know if I have made any etiquette errors. I thank you so much for your help and thoughts.

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I am going to give you a very basic textbook answer as to what should happen in an ER. That is not to say that every potential victim has been treated this way. Basically every hospital has its own rape victim protocol, but they all have these basic points

1. Patient arrives in triage, tells triage nurse that she has been raped. Depending on staffing situations that patient will be the first patient taken back to a room. The patient might have to wait a few minutes, as long as an hour potentially, but most of the time the triage nurse will try to get her into a room as soon as possible.

2. After being brought back her nurse will be assess her. Ideally this should be a SANE trained nurse, but EDs typically don't take SANE certifications when doing staffing, and since there's no requirement for a SANE nurse to be available 24-7, there are times when one isn't available. If there isn't one available in the hospital they will call someone in.

3. The nurse will conduct the initial assessment and determine if the patient has any injuries that need urgent attention. At this point they will try to make sure the patient is never alone. Ideally this is a social worker, patient advocate, rape crisis counselor, neuropysch or someone from an outside agency that specializes in offering care to rape victims.

I can't speak to what a sexual assault forensic examination is. I don't have the training.

Typically the hospital will offer emergency contraception, antibiotics and rapid HIV testing.

Also consider what you need from the police/criminal aspect. Many sexual attacks are unreported and, if you don't need the criminal investigation for your plot, you can simply leave them out.

Police will not question her if it interferes with critical medical treatment, though they would interview anyone with her for whatever information they can get. If she is able to talk to them, even briefly, they will want essential details. Who, what, where, when and, if she can tell them, how. Just like reporters, except the cops rarely care about why, that's the prosecutor's job.

Compound fractures will need surgery and can cause mobility issues, permanent or simply until she heals. She may need physical therapy while healing. Whatever your story needs, write the injury to fit.

Welcome, and good luck.

Jeff

Hi Basenjichaos -

SANE protocol for my wife's last round of training:

http://www.odh.ohio.gov/~/media/ODH/ASSETS/Files/hprr/sexual assult/adultprotocol2011.ashx

Good luck ~
Tux

What happens is going to be very dependent on the size of the town and the hospital, what time it is, and whether it's a normal working day.

I live in a suburban-to-rural area. The local hospital styles itself a "Regional Medical Center" and has limited services after 5PM and on weekends, including the ER, which doesn't even have an MD or X-ray tech after "normal working hours." They might page whoever is on call if something is serious enough, but normally they'll either give you an aspirin and send you home, admit you and stick an IV in and ignore you, or put you into an ambulance and send you to the nearest hospital with an actual functioning ER, almost thirty miles away.

Also, from personal experience in a few ERs, unless you're actually bleeding out in the lobby you'll spend at least half an hour proving you can pay and signing papers before they'll do more than acknowledge your existence in front of them. I don't know what happens to people who don't have their Blue Cross or Kaiser card with them.

Any kind of blood work, MRI, CAT, or other fancy diagnostic testing is likely to wait until morning; about half of the local hospitals send that stuff off to outside labs that run 9:5.

If your MC stumbles into Megalopolis City ER, where things operate like on TV, she'd be whisked in back, have an actual MD look at her, and probably have two specialists and a case worker within minutes of arrival.

Sorry, my experiences with emergency rooms have been generally ugly...


Back to your question:

I need her to be in the hospital for a couple of days, and some type of frustrating physical injury after she gets home.

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Concussion would be a good reason for a hospital to keep someone for a couple of days. Severe concussions are easy to diagnose, milder ones, not always. In conjunction with "affect" and behavior, the physician might choose to keep the patient under observation for a while.

Otherwise, depending on how difficult your MC's life has been immediately previous, it's not unlikely that she'd sleep for a full day or more. And depending on the hospital's workload, sometimes it takes a day or two to schedule various tests or get lab results back. If she doesn't have someone waiting to pick her up, it could be simpler to keep her an extra day rather than send her home and tell her to come back the next day.

Depending on her story, she might be transferred to a "rehab center" or rape crisis center, either a subsidiary of the hospital, public funded center, or even a privately funded outfit. If she'd admitted to any of those, her presence would be considered confidential and she'd probably be there at least a couple of days.