CYAF 493/893 Guest Speaker: Sue Gabriel

Keith McGuffey (Uploader) Author

03/31/2016 Added

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Sue Gabriel's presentation to CYAF 493/893

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[00:00:00.459]Good morning.
[00:00:02.112]Hi. So we have another guest speaker with us here today
[00:00:06.699]to continue our conversation in terms of
[00:00:09.045]intimate partner violence.
[00:00:10.805]We have Doctor Sue Gabriel from Nebraska Wesleyan University
[00:00:14.443]who is also a Sexual Assault Nurse Examiner.
[00:00:18.080]And so she will be talking with you today
[00:00:20.405]a little bit about her role as a SANE
[00:00:23.445]and what she does in her work with victims
[00:00:26.304]in terms of working in hospitals
[00:00:27.531]and some of her experience, etc,
[00:00:29.525]and what the process looks like for
[00:00:31.349]an individual who is assaulted
[00:00:32.768]and who needs medical care.
[00:00:35.711]Are there any questions, comments or concerns
[00:00:38.069]before we get started?
[00:00:42.325]Okay, well if you haven't already done so, again,
[00:00:44.128]please put your laptops and other electronics away
[00:00:46.431]and let's give Doctor Gabriel our full attention.
[00:00:49.643]Thank you.
[00:00:51.051]Well thanks for inviting me,
[00:00:53.151]I always like the opportunity to come and speak with you.
[00:00:57.163]I teach nursing students at (mumbles)
[00:01:01.151]and this is one of my topics I am taking, I'm asked,
[00:01:05.525]to speak on for my nursing students.
[00:01:09.525]So a little bit before we get started just to tell you
[00:01:15.125]what is involved in training for a sexual assault nurse.
[00:01:20.864]We have to go through 40 hours of classroom and then
[00:01:25.707]about another 200 hours of preceptorship with a trained,
[00:01:31.691]experienced sexual assault examiner.
[00:01:35.947]So, it's kind of a journey and then we can be regular
[00:01:44.768]SANE nurses.
[00:01:46.005]Or, after practicing for a few years, then we can sit
[00:01:49.664]for our certification.
[00:01:51.605]Which, the the A in my SANE designates that I'm a certified
[00:01:56.085]sexual assault nurse examiner for adults and adolescents.
[00:02:00.843]They also have a certification for pediatrics.
[00:02:04.064]So, that doesn't negate the fact that we do, you know,
[00:02:08.768]even SANE trained nurses are certified nurses will also
[00:02:14.869]do children.
[00:02:16.032]So we do have training in that.
[00:02:18.592]I'm also a board certified forensic nurse,
[00:02:21.855]which means it kind of gives me a little bit bigger circle
[00:02:26.795]out of sexual assault only.
[00:02:33.066]So, and I have a masters in forensic science.
[00:02:39.019]So you've probably seen the definition of, I'm assuming,
[00:02:42.464]since you talked about sexual assault, seen the definition,
[00:02:46.048]that it's not about sex, it's about power and control.
[00:02:54.389]And there was an update to that definition in 2012 by
[00:02:58.837]the US Attorney General who brought some more information
[00:03:04.917]into the definition.
[00:03:06.496]And the reason he did that was that every state has a
[00:03:09.301]different definition of sexual assault and so this will,
[00:03:13.344]this orange portion will go into every states definition
[00:03:23.936]of sexual assault.
[00:03:25.323]So you can see it's pretty specific about penetration,
[00:03:29.280]no matter how slight, of the mouth, the vagina, the anus
[00:03:34.976]with a sex organ or an object, which includes fingers.
[00:03:47.851]And have you talked about Nebraska?
[00:03:52.821]Like I said, everything goes through that.
[00:03:58.059]But, the reason I put this up is because a lot of people
[00:04:03.904]don't understand what rape really, and that's a common
[00:04:07.243]question that we get from victims.
[00:04:09.323]What exactly is rape or what is sexual assault?
[00:04:14.197]And the biggest part that Nebraska law has that many other
[00:04:19.285]states don't have is that it talks about a person who is
[00:04:25.280]mentally or physically incapable of appraising the danger
[00:04:29.717]of the situation or resisting.
[00:04:32.565]So that includes the mentally challenged,
[00:04:37.099]the physically challenged, or anybody who's under the
[00:04:40.245]influence of anything.
[00:04:42.816]They don't have their faculties to give appropriate consent.
[00:04:50.859]There's a couple new laws that were passed in 2006
[00:04:56.608]which no longer is there a statue of limitation
[00:05:00.853]for sexual assaults.
[00:05:02.091]So, if someone was assaulted when they were 19 and now
[00:05:06.538]they're 45 and they want to prosecute the case,
[00:05:09.013]they still can do that.
[00:05:11.157]As long as they're alive.
[00:05:14.411]And then in September of 2012, Nebraska made it legal for
[00:05:23.733]18 year olds, they lowered the age by one year.
[00:05:26.837]So anyone who is 18 years old can come in and have an
[00:05:32.821]exam done without parental consent.
[00:05:36.405]So those two are important laws.
[00:05:39.744]Sexual assault occurs about, or one sexual assault occurs
[00:05:45.739]about every 1.3 minutes nationally.
[00:05:49.461]Those are the national standards for sexual assault.
[00:05:54.325]So that just gives you some idea.
[00:05:58.123]300,000 women, 90,000 men have been,
[00:06:04.266]have given reports as being raped in the last year.
[00:06:10.208]That was a report that was done in '06, a big research.
[00:06:15.691]Women are more likely to have rape occur,
[00:06:21.045]almost three times that of men.
[00:06:27.925]Children, by the time boys and girls are 18 years old,
[00:06:32.608]one in four girls will have been sexually assaulted,
[00:06:35.573]and one in six boys will have been sexually assaulted.
[00:06:40.480]85 to 90% of them know who their offender was.
[00:06:46.709]And only about 15% of kids will disclose that.
[00:06:56.373]A little bit about same gender sexual assault.
[00:07:00.384]Perpetrators, or the one that commits the crime and the
[00:07:05.003]victims can be of any sexual orientation or any gender.
[00:07:14.037]And right now we're seeing statistics that are almost equal
[00:07:19.264]that of heterosexual offenders.
[00:07:26.069]And sometimes sexual assaults will occur with coercion.
[00:07:31.189]And what's that mean?
[00:07:34.901]Someone is coerced.
[00:07:41.653]Did you hear that term?
[00:07:44.448](mumbling)
[00:07:51.115]Or threatens you verbally or with a weapon, okay?
[00:07:56.043]"If you don't do this, this is what's gonna happen."
[00:07:59.083]So the victim, it makes the victim feel threatened.
[00:08:05.995]So some of the myths of sexual assault is that the big
[00:08:09.259]one we hear is that it only happens to females.
[00:08:13.066]And you can see by this statistic, that's not true.
[00:08:17.536]The other one is that sexual assault is committed
[00:08:21.333]by strangers.
[00:08:23.189]And that's not true.
[00:08:24.331]Very seldom in the 15 years, almost, that I've done this
[00:08:30.389]has a stranger been involved.
[00:08:35.755]It's someone that the victim knows.
[00:08:40.395]Another myth is that friends, acquaintances, or relatives
[00:08:43.605]never commit sexual assault.
[00:08:46.261]And those are the biggest group of offenders.
[00:08:53.045]No one will believe you if you disclose what happened,
[00:08:56.533]especially if there's no (mumbling).
[00:08:59.691]And we'll talk a little bit later when I talk more in depth
[00:09:03.157]about the exam, that's one thing I always tell my patients
[00:09:07.061]is, 90-95% of the time we will not see any injuries
[00:09:12.501]and that does not negate that something happened.
[00:09:16.181]Because there's more to the pieces of the pie than
[00:09:19.904]just injuries and sexual assault.
[00:09:22.784]That's what we'll talk about in a little bit.
[00:09:25.440]No one will believe you if you disclose and nothing
[00:09:29.429]will be done, that's not true.
[00:09:34.975]At least in this state.
[00:09:38.976]Other states, I can't speak for.
[00:09:42.987]And then some information on college students.
[00:09:46.069]There's a lot of perceived fears associated with sexual
[00:09:50.378]assaults (mumbling) men and women.
[00:09:54.571]And the reason that is is that a lot of times college
[00:09:59.253]students don't really understand what encompasses that
[00:10:03.178]sexual assault, that definition.
[00:10:06.155]And they don't understand the risks, the things that put
[00:10:10.592]them at risk for sexual assault.
[00:10:13.013]What's the biggest risk on college campuses?
[00:10:17.472]Alcohol, drinking.
[00:10:20.192]I would say 99.9% of victims that come in have been
[00:10:25.920]under the influence of alcohol and could not make
[00:10:31.520]good decisions at that time.
[00:10:33.568](mumbling)
[00:10:35.765]Because of the use of alcohol.
[00:10:41.003]Okay, a lot of college students have, still,
[00:10:45.568]that stigma or myth that they believe that they're only
[00:10:49.791]going to be raped by strangers, which puts them even
[00:10:54.123]more at risk.
[00:10:55.989]They may have someone they feel have a good friendship
[00:10:59.051]with and they feel comfortable with, they feel protected
[00:11:02.624]when they go out to a bar, to a restaurant, to an activity.
[00:11:09.963]And they say, "I'm going with so and so and I know that
[00:11:13.035]"I'm safe if I go with them."
[00:11:15.797]When sometimes, I would say a big percentage of the
[00:11:19.840]times it's those friends that, put in the right situation,
[00:11:25.835]turn out to be the offender.
[00:11:27.840]And so the person lets their guard down and doesn't
[00:11:31.061]look at the big picture so it makes them more vulnerable.
[00:11:39.221]So here's just some information on college campus stats,
[00:11:44.864]and this is nationally.
[00:11:46.773]In a five year college career, one in four to five women
[00:11:50.144]will experience a sexual assault and one in seven to 10
[00:11:53.205]men will experience.
[00:11:56.011]So if we had a campus of 10,000,
[00:12:02.347]we should be seeing about 350 assaults reported
[00:12:07.392]on the college campus of 10,000 in an academic year.
[00:12:12.320]Do we see that many?
[00:12:14.261]No, we don't.
[00:12:18.783]We do not.
[00:12:19.985]And that's one reason why they lowered the age on
[00:12:22.620]the law for 18 year olds to report without parental
[00:12:27.142]consent.
[00:12:28.284]95% of sexual assault attacks on college campuses go
[00:12:32.326]unreported, only five percent are reported.
[00:12:36.092]Why is that?
[00:12:43.353]Anyone take a guess?
[00:12:46.553](mumbling)
[00:13:00.548]"Why did my friend do this to me?
[00:13:02.404]"Surely it isn't sexual assault, I know they didn't
[00:13:04.932]"mean it. "
[00:13:06.628]We hear that a lot.
[00:13:10.948]What else?
[00:13:16.334]I think that a lot of people could be ashamed or
[00:13:18.980]embarrassed of what happened.
[00:13:20.185]Like, they don't want to admit that they were out drinking
[00:13:22.318]and they went home with someone, or whatever the situation
[00:13:24.558]may be.
[00:13:27.161]And that's another thing that I always tell the patients
[00:13:29.828]is, "I don't care what you were doing,
[00:13:32.772]"I don't care what you were using, drinking, wearing,
[00:13:37.390]"I'm here to make sure you're medically okay."
[00:13:40.409]And you can just see the shoulders relax.
[00:13:45.294]And did you have something else to say?
[00:13:48.421]I was going to say probably blame themselves.
[00:13:50.304]Yes, there is a lot of self blame.
[00:13:53.333]If onlys.
[00:13:54.507]"If only I wouldn't have gone with that person,
[00:13:56.907]"if only I wouldn't have gone to the bar alone,
[00:13:58.944]"if only I would've worn this, if only one drink."
[00:14:02.731]I mean there's a lot, a lot of self blame.
[00:14:05.440]But bottom line, what I tell my patients is,
[00:14:09.835]"Did you give permission for this?"
[00:14:12.181]"Did you wear a sign around your neck that said,
[00:14:14.773]"'go ahead, you can sexually assault me, I give my
[00:14:17.675]"'permission."
[00:14:19.573]And every one of them say, "No."
[00:14:22.240]I say, "Then it's against the law.
[00:14:25.397](mumbling)
[00:14:39.925]And another reason is they're afraid if their parents
[00:14:42.069]find out, what's going to happen?
[00:14:45.824]If they're from out of state, out of town?
[00:14:48.216]Parents are going to jerk them out of school (mumbling).
[00:14:52.717]Or they don't want to get MIP, all those things.
[00:14:57.784]So, but I can tell you working with law enforcement
[00:15:00.749]for as long as I have over the years they're more concerned
[00:15:03.146]with sexual assault than (mumbling).
[00:15:13.344]So, sexual assault is truly one of the silent epidemics
[00:15:15.403]on college campuses.
[00:15:18.357]We see a real peak in the age group of that 18 to 24,
[00:15:25.803]which are college students, and then it dips down,
[00:15:30.123]and then it peaks again at about 40.
[00:15:34.539]Why would that occur?
[00:15:46.773](mumbling)
[00:16:07.445]Exactly, exactly very good.
[00:16:10.464]By 40 a lot of people have gone through divorces and in
[00:16:13.696]that mid-life crisis time, as they refer to it,
[00:16:17.600]and then they have to start dating all over again.
[00:16:22.197]And they don't know what the rules are anymore 'cause it's
[00:16:25.003]probably been 20 or 30 years since they dated.
[00:16:28.160]And what else is big now?
[00:16:32.480]What do you see advertised?
[00:16:36.971]Online dating.
[00:16:38.741]And people get into situations with online dating,
[00:16:42.059]not using a vetted source and make it into an online
[00:16:49.717]dating chat room or one that isn't really sanctioned
[00:16:53.739]by anybody.
[00:16:55.360]And we're starting to see over the last couple years
[00:16:58.442]a lot of sexual assaults occurring because they met
[00:17:01.760]somebody online.
[00:17:04.160]And in that meeting them face to face and it's not
[00:17:09.461]what they thought, or who they thought.
[00:17:13.013]So we're seeing a lot of that.
[00:17:18.421]Then, like I said, 95% go unreported on college campuses.
[00:17:22.485]90% of them knowing who their perpetrator was,
[00:17:27.759]or who assaulted them.
[00:17:29.995]About 42% of college women will tell nobody.
[00:17:35.435](mumbling)
[00:17:41.099]In Nebraska, how many of you are from Nebraska?
[00:17:45.589]Majority?
[00:17:47.104]Okay.
[00:17:48.469]In Nebraska, about one in every eight adult women
[00:17:53.365]or about over 84,000 women in Nebraska has been a victim
[00:17:58.101]of forceful rape some time in their life.
[00:18:03.147]And those are the stats that are out from 2014.
[00:18:08.331]I just picked some of the bigger communities in the
[00:18:12.555]state of Nebraska, which lists the number of sexual assaults
[00:18:18.411]the true investigated and confirmed sexual assaults.
[00:18:26.133]Which brings me to another state that I want to clarify.
[00:18:30.411]A lot of times it was one of those myths people say that
[00:18:35.275]nobody will believe you.
[00:18:36.917]And it's not anybody's decision to say whether this is
[00:18:42.794]a real sexual assault or it's not.
[00:18:47.392]It is for the court of law and the evidence.
[00:18:50.709]And so that's why we encourage people to come in
[00:18:53.909]and have the evidence collected.
[00:18:56.330]Because it's not one thing that will say yes or no
[00:19:00.384]that this is a real sexual assault.
[00:19:02.901]It's not anybody's job but the evidence and the story
[00:19:08.608]of what happened that helps, the real story.
[00:19:13.227]And so when people say, "How many false reports do you get?"
[00:19:17.024]I really don't know that there are any false reports
[00:19:21.888]that I've ever heard.
[00:19:25.675]So it has to be investigated, the evidence has to be
[00:19:28.523]looked at, and all the pieces have to be put into the puzzle
[00:19:34.986]and then a jury of peers, when you go to court,
[00:19:40.800]are going to decide from the evidence and the story,
[00:19:44.725]the evidence that's gathered, whether they're going to
[00:19:48.939]convict someone.
[00:19:50.859]That's another part of sexual assault nurses jobs is
[00:19:57.163]we're considered expert witnesses in a court of law
[00:20:00.447]so we have to testify in court.
[00:20:05.803]So this is just a map of the United States.
[00:20:08.394]And the orange tells you per 100,000 people,
[00:20:15.797]your little guide on the right tells you how may per
[00:20:19.648]100,000.
[00:20:21.181]And so the really dark reds, like Alaska,
[00:20:24.445]that's the worst state in the United States for
[00:20:28.840]sexual assault.
[00:20:32.424]They have the most.
[00:20:33.554]Then South Dakota for some reason.
[00:20:36.168]But you will see Nebraska's in the orange, the darker orange
[00:20:41.074]so it says 21 to 40 per 100,000.
[00:20:50.354]And this just kind of gives you an idea by demographic,
[00:20:53.341]or race, the percentage of some of the different races
[00:20:59.698]and the percentage of sexual assaults.
[00:21:03.378]Now, bare in mind that these are the reported ones.
[00:21:08.360]Or the tip of the ice berg, probably,
[00:21:11.826]because all sexual assaults aren't reported.
[00:21:15.922]Why aren't they reported?
[00:21:18.504]Besides some of what's been talked about?
[00:21:32.648]They don't want to go through the court process,
[00:21:34.667]they don't want any retaliation, they don't want parents
[00:21:38.987]to know, don't want anybody to know.
[00:21:46.752]Now this was a huge study and it's a 2000 study,
[00:21:50.623]so it's old.
[00:21:52.341]But they have never replicated it, that I can find.
[00:21:57.642]But it shows you by years and age the types of sexual
[00:22:02.421]assault that will occur in those age groups.
[00:22:06.635]So with our younger kids, and I've seen as young as
[00:22:16.277]a couple months old, that has been sexually assaulted.
[00:22:22.955]As old as 99.
[00:22:25.205]So nobody is without the possibility of becoming a victim
[00:22:31.797]of sexual assault.
[00:22:33.301]We've had older people in long term care facilities
[00:22:38.026]that have been assaulted by their care givers.
[00:22:43.381]We've had babies go home from the newborn nursery
[00:22:47.328]and been assault within weeks or a month of being
[00:22:53.792]as a newborn.
[00:22:58.112]How do you guys normally find if the range is like
[00:23:01.600]in the really really young or if a person is really
[00:23:04.096]really old how do you know if they've been assaulted
[00:23:06.080]or not?
[00:23:09.099]Usually with the little babies somebody will bring
[00:23:11.861]them to their doctor because they had blood in their diaper.
[00:23:16.170]Is that what you mean?
[00:23:18.208]Or there may, their external genitalia will be swollen
[00:23:24.768]or red and so, with those you have to be careful not to
[00:23:31.285]right away jump to the conclusion that this is
[00:23:35.328]sexual assault.
[00:23:37.930]Because diaper rash, you know, yeast infections can all
[00:23:42.741]mimic that appearance and that's a great question.
[00:23:48.267]So there has to be some investigation done.
[00:23:51.616]Unless there is obvious injuries and the baby's not
[00:23:55.797]mobile, not crawling, not where they fall on something.
[00:24:01.877]So then it becomes more suspicious of something like
[00:24:06.070]that happening.
[00:24:07.509]With older people, they may, especially people who are
[00:24:14.048]suffering from dementia and the offender thinks that
[00:24:18.283]they're safe in doing something like that because they
[00:24:21.248]aren't going to remember have happened to them.
[00:24:25.600]Then, kind of the same thing.
[00:24:27.829]When you're really young and when you're really old
[00:24:30.954]your skin is very pliable, or fragile.
[00:24:35.531]And so the least little bump or rub on an older persons
[00:24:43.552]skin will leave bruises or tear because it's so fragile,
[00:24:51.253]just like babies.
[00:24:53.109]And so a lot of elderly people will say, I'm going to use
[00:25:02.337]male names because oftentimes it is a male, so sorry.
[00:25:05.589]They'll say, "Joe played that game with me and it hurt."
[00:25:13.493]And they might find blood on the sheets or injuries
[00:25:17.291]to that frail skin, tissue.
[00:25:21.319]And so they bring them for an exam.
[00:25:23.783]Then we'll talk to them what we can find out in
[00:25:26.202]the exam.
[00:25:29.647]But this is just kind of the different, different age groups
[00:25:35.887]have different types of sexual injuries, or assaults.
[00:25:43.204]And then when you get into that 12 to 17 on down,
[00:25:47.482]then it becomes a forceful rape.
[00:25:54.884]Military, anybody in the military?
[00:25:58.783]The guard?
[00:26:00.779]I also worked with the military in doing education
[00:26:05.579]for them on sexual assault.
[00:26:08.000]But this is where you really see
[00:26:15.360]some increase in statistics, even though they've really
[00:26:20.981]done quite a bit of education and have advocates
[00:26:23.253]in the military for victims of sexual assault.
[00:26:29.269]So, men as well as women can be involved in this.
[00:26:35.392]Probably has the most impact of being seen in the military.
[00:26:41.547]This is 2015 statistics, 10,600 men and 9,600 women
[00:26:47.872]reported sexual assaults in the military.
[00:26:53.173]These are the percentages for the army, navy
[00:26:54.944]marines.
[00:27:00.565]That's a lot of people.
[00:27:05.173]Talk a little bit about the SART team.
[00:27:07.674]And SART stands for Sexual Assault Response Team.
[00:27:12.427]And I sit on the Lancaster County Sexual Assault
[00:27:15.051]Response Team.
[00:27:16.747]So on that team is the legal system.
[00:27:20.715]So the prosecutors, we have representation on the team
[00:27:25.152]from all branches of law enforcement.
[00:27:27.147]So, university police, sheriffs department, state patrol,
[00:27:32.533]LPD are all on there, advocates.
[00:27:37.355]And an advocate is someone who goes through
[00:27:39.775]training to support victims and help them walk through
[00:27:45.248]the legal system, help them get restraining orders,
[00:27:49.792]those kids of things.
[00:27:51.295]So we have advocates on the team from both the
[00:27:54.592]adults spectrum and from the child advocacy spectrum.
[00:27:59.531]We have sexual assault nurses, and sometimes they're
[00:28:04.032]called forensic nurse examiners, FNE's,
[00:28:08.267]from the hospitals here in town.
[00:28:11.307]We have someone from the crime lab and air and army
[00:28:15.509]guard and some universities and colleges sit on the
[00:28:18.912]SART team.
[00:28:20.491]And we do that, we have that team available and we
[00:28:24.512]discuss a lot of protocols so that every one of us knows
[00:28:28.928]what everybody's job is as part of that team
[00:28:32.811]of helping victims of sexual assault.
[00:28:37.909]The nurses practice by national standards.
[00:28:42.795]And so, the American Nurses Association and the
[00:28:47.392]Forensic Nursing Organization have set standards
[00:28:53.621]and protocols by which we follow the rules of doing
[00:28:59.701]a sexual assault exam.
[00:29:03.381]So in the national average for time, that's one thing
[00:29:06.149]that I tell patients when they come in for an exam is
[00:29:10.848]how long it's gonna take.
[00:29:13.269]And so the national average of time for an exam
[00:29:17.930]is three to four hours.
[00:29:19.690]And that's not the actual hands on exam with the patient,
[00:29:23.541]but that includes a lot of teaching, a lot of,
[00:29:29.088]we have to find out what happened so we can take
[00:29:32.010]a statement from the patient as to what happened.
[00:29:35.904]And then we look them over from head to toe,
[00:29:39.723]we collect evidence, we have to package and bag
[00:29:42.890]all of that, document everything.
[00:29:45.941]It's a very tedious job, not like what you see on TV.
[00:29:50.987]We don't wear stilettos and have plunging necklines
[00:29:56.704]and you get the DNA results back in five minutes.
[00:30:00.341]That's kind of a TV image.
[00:30:05.685]It's a very tedious job, it's not, probably, people's most
[00:30:15.829]sought after jobs.
[00:30:17.877]It just is, it takes time and it takes sensitivity
[00:30:23.360]and working with the patients.
[00:30:26.453]So, if we do just a regular exam and there's no injuries
[00:30:33.952]to document, there was just, I say just,
[00:30:39.680]but there was only vaginal penetration,
[00:30:44.021]then you're probably looking at three to four hours.
[00:30:47.360]Now, if there was oral penetration, vaginal penetration,
[00:30:52.416]anal penetration, then that's 60 minutes for each orifice
[00:30:57.675]that was penetrated because we have to examine
[00:31:00.875]all of that.
[00:31:03.915]And if there's visible injuries like bruises, cuts,
[00:31:07.840]burns sometimes, that would take longer to document.
[00:31:14.923]So the purpose of, then, an exam is we start with a clean
[00:31:20.640]medical assessment after we've explained everything
[00:31:24.981]because our number one goal is to make sure that the
[00:31:28.459]patient is medically sound.
[00:31:30.997]Sometimes they may come in with a fractured arm, say,
[00:31:34.144]or a laceration that needs stitches,
[00:31:37.600]those things take priority from the evidence.
[00:31:41.066]And we do look and finish gathering that evidence once
[00:31:44.939]their medical needs are taken care of.
[00:31:49.205]We have to have a documentation of what happened.
[00:31:52.693]So we ask the patient to start from the time that they
[00:31:57.312]encountered the person to after the assault occurred
[00:32:02.208]and we write down in quotes what happened.
[00:32:06.997]Exactly what the patient tells us.
[00:32:09.088]So a lot of times it's hard for nurses to write four
[00:32:13.813]letter words or slang words in there.
[00:32:17.568]Nursing documentation because we're told we can only
[00:32:20.309]document what we see objectively and professionally.
[00:32:25.771]And so to say in quotes what the patient tells you,
[00:32:30.752]it's sometimes the F word, sometimes a derogatory
[00:32:34.112]statement, but we put it in quotes so that they know
[00:32:38.731]when that goes to court that that's exactly what the
[00:32:42.069]patient stated.
[00:32:47.072]So we don't clean language up, we don't clean words up,
[00:32:50.795]we write it just like we were told.
[00:32:53.899]And sometimes that becomes difficult for the nurses.
[00:33:01.323]We treat their injuries, we treat them for possible
[00:33:06.731]sexually transmitted diseases, that's part of the standard
[00:33:10.528]protocol and emergency pregnancy prevention,
[00:33:14.848]CRISIS intervention, and then evidence collection.
[00:33:19.093]So those are all the things that take place.
[00:33:24.608]Like I said earlier, about 99% of the time we don't
[00:33:27.999]see any injuries whatsoever and then the patient
[00:33:31.317]immediately thinks, "Nobody's gonna believe me."
[00:33:35.093]But if we do our job and collect what we can,
[00:33:39.690]get the story that the patient tells us,
[00:33:45.056]then we can hopefully collect evidence.
[00:33:48.459]So, some of the questions that we will ask the patient,
[00:33:51.936]whether he's a female or male is were you licked or
[00:33:57.237]kissed or bitten anywhere?
[00:34:01.013]"Well yeah, I think somewhere on my neck."
[00:34:03.712]So we'll swab that neck for DNA.
[00:34:10.357]So hopefully that we can get some type of evidence.
[00:34:14.443]The thing that you will find with sexual assault crimes
[00:34:18.347]is that oftentimes as you're learning, it's intertwined,
[00:34:22.709]a lot of these family violence things are intertwined
[00:34:28.203]with each other.
[00:34:29.269]Where if you see one, you see others.
[00:34:31.840]So, for instance, with your domestic violence,
[00:34:34.624]a lot of times sexual assault will go along with that.
[00:34:37.365]And with your domestic violence patients,
[00:34:39.947]you see it in a progression.
[00:34:41.749]It starts out as verbal abuse, then it goes to physical
[00:34:46.304]abuse, then it goes to sexual abuse.
[00:34:49.728]So depending where on that spectrum the domestic
[00:34:53.429]violence is you can see sexual abuse with that,
[00:35:00.160]sexual assault.
[00:35:02.229]One other myth that people will believe is that because
[00:35:06.368]he's my husband or she's my wife,
[00:35:08.821]it can't be sexual assault.
[00:35:11.243]Well I'm here to tell you, yes it can.
[00:35:14.421]If your husband says, "I want to have sex."
[00:35:18.165]And you say, "No, I really don't."
[00:35:20.480]And he pins you to the bed, or she pins you to the bed,
[00:35:25.141]pins her husband to the bed, that can be termed as
[00:35:28.427]a sexual assault because nobody gave consent for it.
[00:35:33.664]So sexual assault does occur within married couples.
[00:35:44.575]So, as a specially trained examiner for this,
[00:35:50.869]we have to know what is potential evidence and what
[00:35:55.371]is real evidence when we collect evidence.
[00:35:58.709]So what would be an example of real evidence?
[00:36:04.469](mumbling)
[00:36:06.571]Saliva, blood you see, stuff we can see.
[00:36:09.557]So potential evidence would be what?
[00:36:17.835]Okay, could be swelling.
[00:36:19.488]Or if we asked the patient, "Were you bitten, licked?"
[00:36:22.315]"Yes, somewhere here."
[00:36:24.629]Or on the breasts or the legs, but there's nothing
[00:36:29.035]to see so we'll swab that general area.
[00:36:31.733]So that could be potential evidence.
[00:36:34.918]Our physical findings, we look at the medical forensic
[00:36:38.374]history.
[00:36:39.621]So the story that they tell us we have to document
[00:36:42.235]and we have to use proper evidence collection so that
[00:36:45.937]it can be used in a court of law.
[00:36:48.442]So that means once we open this kit,
[00:36:50.897]and all the kits come sealed, so one we open this kit
[00:36:54.555]it doesn't leave our side, it goes where we go.
[00:36:57.574]We can't have anybody stay and watch the evidence
[00:37:00.453]for us, we can't leave it alone unattended.
[00:37:03.974]Because in courts they will say,
[00:37:06.140]"Can you guarantee that no one has tampered,"
[00:37:08.773]'cause it's your signature, "That no one has tampered
[00:37:11.653]"with this this kit?"
[00:37:14.326]And I will say, "Yes, it stayed at my side the whole time
[00:37:19.446]"until it was sealed and I handed it to the officer."
[00:37:22.784]So that's called chain of custody.
[00:37:24.885]So we have to maintain that.
[00:37:31.051]So we have to collect it, preserve it in a way that
[00:37:34.123]it can be used by the crime lab.
[00:37:37.440]We hear a lot about drug facilitated rape.
[00:37:42.997]And you hear the words GHB and a lot of those drugs,
[00:37:48.469]but the largest drug for drug facilitated rape is alcohol.
[00:37:58.187]Okay, so our documentation we kind of talked about.
[00:38:03.477]The best evidence we can collect is usually within
[00:38:06.805]72 hours.
[00:38:08.267]But sometimes it will go up to 120 hours,
[00:38:11.723]which is five days.
[00:38:13.548]But, usually, by then the patient has showered,
[00:38:17.301]all of those things so the evidence is washed away.
[00:38:25.547]We never use the word alleged.
[00:38:27.915]Because if I said to you, "Tell me about your alleged
[00:38:32.458]"sexual assault."
[00:38:34.592]What would that say to you?
[00:38:39.979](mumbling)
[00:38:42.411]I don't believe what you're gonna tell me.
[00:38:44.384]So we never use that word, "alleged".
[00:38:47.147]Tell us what happened.
[00:38:49.589]Tell us the story from start to finish what happened.
[00:38:51.783]And we document all of that.
[00:39:00.252]So, some of the physical things that we look for,
[00:39:03.062]we ask our patients about pain and we look for
[00:39:05.952]any bruising, we document the size of the bruise,
[00:39:08.833]the color, the shape, the location, pattern injuries,
[00:39:13.217]if they were hit with something.
[00:39:15.541]Sometimes we've had patients who were held hostage
[00:39:19.745]by their abuser, attacker, perpetrator for several
[00:39:26.357]hours to several days and during that time they've been
[00:39:29.185]burned with cigarettes, beaten with ball bats,
[00:39:35.446]different things used to insert, penetrate them.
[00:39:39.958]Beer bottles, all kinds of things we've seen.
[00:39:45.003]So we look for those bruises, abrasions, lacerations,
[00:39:50.582]swelling, redness in places where they tell us in the story.
[00:39:56.320]And then we have to stop and think,
[00:39:58.305]"Does the story match the injuries that we're seeing?"
[00:40:01.557]Because that's a question you get asked in court.
[00:40:04.118]Are these injuries consistent with sexual assault?
[00:40:12.363]So when someone comes to the hospital,
[00:40:15.029]how many of you have been in the emergency department
[00:40:17.408]somewhere in your life?
[00:40:19.212]You go up to the desk and what do they ask you?
[00:40:24.491]Why are you here, how can we help you?
[00:40:26.741]And so, you have to say, "I think I've been sexually
[00:40:32.822]"assaulted."
[00:40:34.337]That's not an easy thing to say.
[00:40:36.716]And so at the hospitals here in Lincoln and in Omaha,
[00:40:40.373]they have special rooms within the emergency department,
[00:40:43.542]they ask you a few questions, make sure you're medically
[00:40:46.795]okay then they show you back to that room and then they
[00:40:50.123]call the on call SANE nurse, law enforcement if they
[00:40:54.241]haven't already been called, and then they ask you if
[00:40:57.217]you want an advocate.
[00:41:00.960]And we are mandatory reporters as nurses,
[00:41:03.852]so we have to report to law enforcement.
[00:41:09.951]So, we explained the time involved to get the permits,
[00:41:15.532]the law enforcement issues us a case number that we
[00:41:18.347]have to write on all of our papers.
[00:41:21.014](mumbling) Law enforcement agents will come either
[00:41:24.512]before or after your exam and ask you for a statement.
[00:41:29.312]Then you tell us a story so we know where to look
[00:41:32.704]for evidence, extra evidence on your body.
[00:41:35.648]And, like I said, that head-to-toe medical assessment.
[00:41:39.211]And our role is not to be judgmental in any way.
[00:41:42.805]We have to maintain objectivity and after, like I said,
[00:41:46.987]I've told patients, "I don't care what you were wearing,
[00:41:49.632]"what you were doing, what you were using,
[00:41:52.064]"I'm here to just make sure you're medically okay."
[00:41:55.531](mumbles)
[00:41:58.667]And they can begin to talk freely.
[00:42:04.011]We use a black light to go over their body,
[00:42:07.041]and that usually, any protein substance will fluores.
[00:42:12.341]Semen, blood, saliva, also laundry detergent.
[00:42:17.196]So anything that fluoresces, we collect.
[00:42:20.876]We don't know if it's semen, we don't know if it's
[00:42:22.699]laundry detergent, that's the labs job, okay?
[00:42:27.318]In our kit here we have, and I'll pass this around,
[00:42:30.080]you can look at what's inside, we have 14 envelopes
[00:42:34.037]of different things that we collect.
[00:42:37.707]And I always explain to the patient that each of those
[00:42:42.369]envelopes, and I will tell them, 'cause this is informed
[00:42:45.793]consent, "You have the option of saying yes or no
[00:42:50.294]"to any of these envelopes after I explain it.
[00:42:54.368]"But please realize that this is our only time we have
[00:42:58.528]"to collect evidence because once you leave and you take
[00:43:02.453]"a shower and you change your clothes, it's gone."
[00:43:06.016]Okay.
[00:43:07.776]So they have the right to decline any or all parts
[00:43:11.275]of the exam.
[00:43:17.557]And that's kind of the paperwork involved,
[00:43:23.201]and we have to make triplicates of everything because
[00:43:25.963]a copy goes to law enforcement, a copy stays at the
[00:43:28.683]hospital, and a copy goes into the kit for the crime lab.
[00:43:35.445]We have to take clothing, all your clothing,
[00:43:39.670]and sometimes patients will say, "But I just spent $150
[00:43:43.573]"on these jeans, this is the first time I've worn them."
[00:43:46.677]And so we try and work with them because we don't
[00:43:50.102]have any say so of, number one, when they'll get
[00:43:53.846]their clothes returned or in what condition.
[00:43:57.184]Because at the crime lab they may cut spots
[00:43:59.637]out of the clothing.
[00:44:02.358]But each piece of clothing has to be collected in an
[00:44:07.861]individual sack.
[00:44:10.645]It has to be evidence taped, signed, sealed, delivered.
[00:44:15.307]What's in the sack?
[00:44:17.163]So if you want to wear any Nebraska jersey brand t-shirt
[00:44:21.324]with "go big red" on the front, then that's how
[00:44:25.226]we have to describe it on the outside of the bag.
[00:44:28.225]And if it had a hole under the left arm, that's specific,
[00:44:31.318]so they know when you're asked in court,
[00:44:34.197]"Is this the t-shirt that you collected?"
[00:44:38.678](mumbling)
[00:44:41.397]And they can see what's inside the bag.
[00:44:44.043]So there's the black light.
[00:44:46.187]So when we go over someone's body with the black light,
[00:44:51.285]this is what it would look like if the protein substance
[00:44:54.005]would floures.
[00:44:57.866]This was on a mannequin, not a person.
[00:45:02.089]We practice by Locard's Principle,
[00:45:04.628]which is when two things come in contact,
[00:45:06.688]there's an exchange.
[00:45:07.925]So all of you here are going to experience Locard's
[00:45:10.944]Principle because the chairs you are sitting in,
[00:45:14.987]someone else sat in those.
[00:45:17.130]So you're going to take skin cells from people that
[00:45:19.787]previously sat in those chairs.
[00:45:22.144]This will make you really want to sit in these
[00:45:24.129]chairs again, or at the movie theater.
[00:45:27.125]Usually in the movie theater.
[00:45:30.869]So when you leave today, you will take evidence from
[00:45:34.977]somebody that sat in these chairs before and you will
[00:45:39.003]leave part of your evidence on the chairs when you leave.
[00:45:44.885]That's something to think about.
[00:45:48.715]Okay, and we talked about that, 72 hours or 120.
[00:45:53.270]And the different injuries that we may see on the body,
[00:45:59.168]externally.
[00:46:00.896]I've got some pictures of those.
[00:46:02.709]And this is either male or female.
[00:46:04.609]I've done exams on males, females, prisoners,
[00:46:09.153]transgender people, same sex orientation people,
[00:46:15.115]and we do them all the same.
[00:46:21.216]We also look in the mouth for any chipped teeth because
[00:46:24.907]if you were under the influence of something,
[00:46:26.987]you may have fallen, chipped your teeth, been hit
[00:46:31.307]in the mouth.
[00:46:33.109]We also have patients turn their upper lip,
[00:46:37.100]pull their lower lip down so we can see if there's
[00:46:39.947]any lacerations in their mouth.
[00:46:45.525]This is called a colposcope.
[00:46:47.648]It's like a pair of binoculars that goes to the computer
[00:46:53.845]screen.
[00:46:54.645]We used to use this at both east and west campus,
[00:47:00.150]and now we've switched to a digital forensic camera
[00:47:06.498]to photograph.
[00:47:07.573]And this is, again, the patients option.
[00:47:09.952]If there's no injuries that we see, we usually don't
[00:47:12.597]take photographs, but if we do see injuries,
[00:47:15.477]we have to ask the patient permission if they would
[00:47:20.374]let us take a picture of that.
[00:47:22.496]And some patients will say, "I don't want any photographs
[00:47:24.661]"taken," and some will say yes, that'll help.
[00:47:28.166]So it's entirely up to the patient.
[00:47:30.769]We use an (mumbling) forensic
[00:47:36.826]ruler to measure the injuries.
[00:47:39.531]So you can see here in this picture.
[00:47:43.275]Here a lot of patients with domestic violence and sexual
[00:47:46.518]assault will have bruising on their neck from manual
[00:47:49.462]strangulation.
[00:47:51.296]And a lot of times you can see finger prints on the neck.
[00:47:58.315]Bite marks, over here with the ruler.
[00:48:01.685]Grab marks down here.
[00:48:06.561]So we document and measure all of those
[00:48:11.072]if we see them.
[00:48:12.232]And, like I said earlier, not all evidence is obvious.
[00:48:15.687]So part of the evidence collection is asking them
[00:48:22.193]to tell that story.
[00:48:23.324]So we need to know where on your body,
[00:48:25.330]if you were licked or bit or kissed.
[00:48:30.844]So we document all of our findings,
[00:48:33.697]maintain that chain of custody, we seal up the kit
[00:48:37.900]and the bags and we call law enforcement.
[00:48:40.213]They come and pick it up, they take it down to the
[00:48:42.273]evidence room and it eventually makes it's way over to
[00:48:47.477]the crime lab.
[00:48:51.776]And right now we have a four to six month back log of
[00:49:00.566]looking at kits.
[00:49:02.314]And you've probably seen this in the news where many
[00:49:05.355]facilities have years and years and years of SA kits in
[00:49:09.782]storage that they've never looked at.
[00:49:12.715]And that's not true here in Nebraska.
[00:49:20.032]So after the exam we do a lot of teaching,
[00:49:23.200]thank the patient for coming in,
[00:49:25.024]that they did the right thing, answer any of their questions
[00:49:29.056]we give them dismissal instructions.
[00:49:30.998]Dismissal instructions, we'd like to have them follow up
[00:49:35.136]with their primary care provider in about two weeks
[00:49:38.303]and six weeks.
[00:49:39.957]Because usually it takes two weeks for symptoms of
[00:49:46.283]sexually transmitted diseases to occur,
[00:49:49.611]unless they have had one previously before the assault
[00:49:53.867]took place.
[00:49:55.030]And six weeks from the time of the assault if they want
[00:49:59.670]for HIV testing.
[00:50:03.072]'Cause it takes about that long for that to show up
[00:50:08.768]on blood work.
[00:50:10.550]We encourage them to seek counseling at the advocacy
[00:50:18.913]program, it's free, they have support groups.
[00:50:22.474]Call them any time, night or day, 24/7 on their hotline
[00:50:26.572]and talk to somebody.
[00:50:28.533]Like I said, there's a lot of self blame.
[00:50:30.869]And I always tell patients, I really encourage them to
[00:50:35.274]utilize the counseling because at some point in time
[00:50:38.709]in their life it will come back to bite them in the rear.
[00:50:42.017]With relationships, future relationships, school,
[00:50:47.019]all those things.
[00:50:48.811]It has kind of a ripple effect on the victim.
[00:50:56.534]We talked about that.
[00:51:00.779]And that.
[00:51:02.230]These are the antibiotics that we offer.
[00:51:05.461]We offer one for gonorrhea, chlamydia, bacterial vaginosis,
[00:51:10.966]testing in six weeks for hep B, HIV, and then we always
[00:51:18.965]ask if they've had their hep B vaccines and tetanus.
[00:51:25.589]And then we offer the emergency pregnancy prevention.
[00:51:30.240]And again, the patient, some patients don't want any of it.
[00:51:33.441](mumbling)
[00:51:37.333]They can also go to the health department,
[00:51:41.302]the STI clinic for treatment.
[00:51:47.659]So, real quick, some of the barriers.
[00:51:49.408]We've talked about the self blame, the alcohol,
[00:51:53.290]being afraid of the consequences, not understanding the
[00:52:00.074]real definition of sexual assault and thinking that the
[00:52:04.214]crime of sexual assault is always committed by a stranger,
[00:52:09.835]not their friends.
[00:52:12.523]Guys especially don't like to report.
[00:52:15.264]"I'm the guy, I should've been able to defend myself.
[00:52:19.180]"Who will believe me?"
[00:52:21.163]So we don't have a lot in the literature,
[00:52:23.627]don't have a lot of accurate reports on the LGBT and the
[00:52:30.240]male populations because they tend to be
[00:52:38.144]not real good reporters because of the stigma that
[00:52:43.232]goes along with male or the LGBT population.
[00:52:52.161]So this is a good example.
[00:52:55.222]When this young man reported, he was told,
[00:52:57.120]"Men can't be raped."
[00:53:01.259]Some ignorant person said that to him because
[00:53:04.129]males can be raped.
[00:53:06.144]And they can be raped by females.
[00:53:09.365]A female can be an offender as well as a man,
[00:53:12.352]but most of the time males, from the statistics that
[00:53:15.734]we have are the offenders.
[00:53:20.907]Some facts that they've uncovered is that about 71%
[00:53:25.014]of sexual assaults are planned in advance.
[00:53:29.141]About 80% of women will resist the assault.
[00:53:36.085]48, almost 49% don't consider what happened to them as rape.
[00:53:41.611]And that's, again, because they didn't mean it,
[00:53:45.696]"This was my friend."
[00:53:57.557]So the impacts on victims, 40% of rape survivors develop
[00:54:02.624]sexually transmitted infections.
[00:54:05.344]80% suffer physical and psychological problems over time.
[00:54:09.749]13 times more likely to commit suicide,
[00:54:14.464]and 25 to 50 will have been (mumbling)
[00:54:17.109]as a result of the rape.
[00:54:19.584]And a lot of times that's depression.
[00:54:26.080]Impacts are education, they drop out of classes
[00:54:31.403]'cause they can't concentrate.
[00:54:33.643]So if you think you resolved it, make sure you call
[00:54:38.262]law enforcement and give a statement to them.
[00:54:42.155]Contact either the advocacy programs,
[00:54:45.909]depending on the age of the victim.
[00:54:49.056]How would you know, or why would you have suspicion
[00:54:52.608]that you may have been assaulted?
[00:54:55.254]What would you notice about yourself?
[00:55:15.968]Clothes are on backwards, inside out, missing,
[00:55:20.139]those are statements that have been
[00:55:26.636]told to us when people come in for an exam.
[00:55:32.022]"I didn't put my clothes on like this, I'm dressed odd,"
[00:55:36.715]or, "I'm missing pieces of my clothing."
[00:55:40.235]So counseling is, like I said, free at Voices of Hope
[00:55:43.616]here in Lincoln.
[00:55:44.917]We have the child advocacy, but it is a traumatic experience
[00:55:49.121]for people and it's really important that you follow up.
[00:55:52.383]A lot of people think that they're going to put it in
[00:55:54.677]a little box in their mind and shove it out of the way,
[00:55:57.983]but it will come back to visit you in ways that are
[00:56:03.925]not pleasant.
[00:56:05.889]And most of all, remember, it's not your fault.
[00:56:09.845]That you did not give consent.
[00:56:12.693]So I have a short little video here.
[00:56:20.555]We're dancing, having fun, I mean, I thought (mumbling).
[00:56:25.419]I liked him, but I was a little drunk and I wasn't
[00:56:27.915]ready to do it anyway.
[00:56:29.696]Whenever I talked to my friends (mumbling)
[00:56:33.153]playing hard to get.
[00:56:34.859]They like a guy that can take charge and be assertive
[00:56:38.101]and go for it.
[00:56:39.937]Stop.
[00:56:40.672]I told him, "Hey, get off me!"
[00:56:42.773]Some guys just don't get it.
[00:56:44.576]Don't touch me with out asking first.
[00:56:57.270](mumbling)
[00:57:00.650]I went to a party last night with these girls and I was
[00:57:02.443]thinking, "Nice, I want a piece of that."
[00:57:05.461]Excuse me?
[00:57:08.363]Learn how to talk, seriously.
[00:57:09.889](mumbling)
[00:57:13.184]Dude, are you hearing yourself right now?
[00:57:15.210]What makes you think you can talk to women like that?
[00:57:17.163]When I'm at a party, I'm there with my friends to
[00:57:19.008]relax and have fun.
[00:57:20.608]Don't talk to me like a piece of meat or objectify me
[00:57:23.189]by whistling like I'm a dog or something.
[00:57:25.771]Treat us like women, be a man.
[00:57:39.307]I just wanted to go out with my friends and have
[00:57:41.068]a good time, but I tried to catch my breath and Matt
[00:57:44.085]was all over me.
[00:57:45.825]Acting really stupid and kind of forward.
[00:57:49.131]I had a lot to drink that night so I wasn't thinking
[00:57:51.628]too clearly.
[00:57:52.907](mumbling)
[00:57:55.925]It works every time.
[00:57:57.793]I saw Matt acting crazy and I knew I had to step in.
[00:58:09.941]Thank God Taylor was there 'cause he really gave me
[00:58:12.245]a way out.
[00:58:30.155]So, big thing is, if you see potential for sexual assault
[00:58:34.080]don't be a passive bystander, do something about it.
[00:58:37.866]And remember, consent is the difference between
[00:58:40.406](mumbling)
[00:58:47.403]Rape and consensual sex.
[00:58:53.484]Okay, any quick questions?
[00:58:55.563]Are there any questions on your mind?
[00:58:58.379]Yes?
[00:58:59.861]So, like, if there wasn't a guy like Tyler to be there
[00:59:02.772]to step in, what would the girl do in that situation
[00:59:05.632]would she keep doing this or get up?
[00:59:09.195]Well it depends on what she would be capable of.
[00:59:15.114]But if she isn't capable of giving consent,
[00:59:17.759]then that would be considered, or progressed to that,
[00:59:20.672]it would be considered sexual assault.
[00:59:26.318](mumbling)
[00:59:37.750]There are places we could still get evidence.
[00:59:40.609]We do not only an external exam, but an internal on gals,
[00:59:45.867]not on guys, be a little tough.
[00:59:48.833]But we could do an internal exam and get swabs,
[00:59:54.796]vaginal swabs.
[00:59:56.502]And then under fingernails we get.
[01:00:02.188]And if nothing more, then documenting your story
[01:00:04.609]and making sure you're okay.
[01:00:08.544]Good question.
[01:00:10.369]Yes?
[01:00:11.713]What would you recommend us doing if we're out
[01:00:14.550]at the bar or something and we someone, like,
[01:00:19.573]making out or doing something with some who is
[01:00:21.205]intoxicated and you don't think the other person is
[01:00:23.797]intoxicated?
[01:00:25.046]I've seen it happen before, I was at a bar and this guy
[01:00:27.649]was all up on this girl and she was kind of out of it
[01:00:30.113]and I didn't know what to do.
[01:00:32.374]Like she didn't really know what was going on?
[01:00:38.592]You could be an active bystander, if you knew the girl,
[01:00:42.539]and say, "Can you come here with me?
[01:00:45.217]"I need some help in the bathroom."
[01:00:47.756]And redirect that situation and then see if you can
[01:00:51.916]get her to a safe place or take her home or,
[01:00:56.758]sometimes you can call law enforcement and say,
[01:01:01.057]"I don't like what I'm seeing, could you help me out?"
[01:01:04.204]And tell them what's going on.
[01:01:06.156]And they usually come in and try to do something.
[01:01:10.379]Kind of redirect things and keep that.
[01:01:14.838]That's a great question.
[01:01:19.883](mumbling)
[01:01:26.902]That's a good question and I've been asked that before
[01:01:29.750]and I guess what I will say is, when people ask me how
[01:01:33.910]I can do this job I tell them, as weird as it sounds
[01:01:38.828]I really enjoy it 'cause I like helping people and it's
[01:01:42.101]just my little sliver of the pie, big picture,
[01:01:46.764]of helping victims of sexual assault.
[01:01:53.141]Because I think being specially trained they get
[01:01:56.630]personalized care.
[01:01:59.350]Rather than if it were just a nurse coming in and,
[01:02:04.971]like emergency room nurse.
[01:02:06.636]Not that they're bad nurses, but they don't have the
[01:02:09.121]training.
[01:02:10.838]Because it does take a lot of sensitivity to ask some of
[01:02:15.116]the questions that are on the papers in the kit and ask
[01:02:19.276]some real direct personal questions.
[01:02:22.017]And I always preface that in my explanation of what's
[01:02:24.843]gonna go on with the kit is that I have to ask some
[01:02:27.414]really personal questions and I just want you to be
[01:02:31.221]aware of it.
[01:02:32.693]I'm not asking out of curiosity, but it's part of the
[01:02:38.357]evidence collection.
[01:02:42.134]Does that answer your question?
[01:02:43.861]Also, when you get home do you do something special
[01:02:46.742]for yourself to help you forget?
[01:02:49.142]I like to do regular things like garden.
[01:02:53.344]Do normal things like that, but it gives me satisfaction
[01:02:57.484]knowing that I've helped somebody.
[01:02:59.499]So I guess that's kind of the bottom line of it.
[01:03:04.779]I don't like testifying, but that's part of the job.
[01:03:11.829](mumbling)
[01:03:26.785]And that's why they have us do it.
[01:03:29.708]Because we are very sensitive to that and that's why
[01:03:32.929]we tell them if they don't want it done,
[01:03:35.948]they don't have to have it done.
[01:03:41.387]But that's, if something's gonna be done about it--
[01:03:46.636](mumbling)
[01:03:59.275]None of that sounds pleasant at all.
[01:04:01.782]No, it's not, but we try and with the advocates there,
[01:04:06.998]they try and, you know, support the victim,
[01:04:11.563]pick up conversation with them as we're doing
[01:04:16.524]what we need to do.
[01:04:17.781]But if, bottom line, it comes down to whether they want
[01:04:20.641]it done and then we have to do a good job and explain
[01:04:24.246]why we're doing something, what the purpose of it is.
[01:04:28.982]Because most people have to understand the purpose
[01:04:31.862]of what I'm asking you to do and they can stop and
[01:04:36.725]take a breath and regroup, you know.
[01:04:40.107]I always tell them that if you need a time out,
[01:04:43.340]let me know, I'll stop.
[01:04:45.206]But most people really want to know that they're okay
[01:04:53.419]and that they're being taken care of.
[01:04:54.827]So we really focus on the medical, just like after a
[01:05:00.044]traumatic event, whether if you're in a car accident
[01:05:02.869]or whatever.
[01:05:04.129](mumbling)
[01:05:07.062]Not very often.
[01:05:08.406]Parts of the exam, they may.
[01:05:10.668]But very seldom do we have somebody say,
[01:05:14.390]"I'm not staying here this long, I'm leaving."
[01:05:19.530]That's part of the advocates.
[01:05:21.505]You know, when the advocate is there with them, you know,
[01:05:23.585]when I'm working with a client (mumbling)
[01:05:30.283]there is hesitation and sometimes there is a feeling that
[01:05:32.192]you're being victimized, but that's also part of the
[01:05:34.112]reason the exam takes so long because you need those
[01:05:36.565]breaks or you need those opportunities to talk to them
[01:05:39.169]and let them calm down,
[01:05:41.131]but also help them understand the situation that
[01:05:43.894]they're in.
[01:05:44.908]And so, for example, Dr. Gabriel talked about the fact
[01:05:47.008]that you keep the kits.
[01:05:48.652]Because it may be that the individual doesn't want to talk
[01:05:50.954]with you at that time, or they're not interested in
[01:05:54.048]going forward (mumbling) law enforcement.
[01:05:56.812]But, by collecting the evidence, you give them the
[01:05:59.253]opportunity to later say, "Well maybe I've changed my mind
[01:06:02.636]"and this is something that I'd like to pursue."
[01:06:04.812]So some of the it is just an advocate being there to hold
[01:06:09.420]that person's hand and give them that support.
[01:06:11.680]So those feelings that you're talking about right there
[01:06:13.451]are validated, but they can see all sides of what they're
[01:06:17.504]saying and doing and how it could potentially be
[01:06:20.300]beneficial.
[01:06:23.637]So it's understandable what you're saying,
[01:06:27.585]but that's why there are so many people and so many
[01:06:29.548]advocates in place to help them during those times.
[01:06:32.022]You call law enforcement, you call an advocate,
[01:06:34.006]you have a SANE so that you don't have a random
[01:06:37.046]emergency room doctor prodding you for three minutes
[01:06:40.161]and you have no support.
[01:06:42.241]And the other thing I didn't say is that we practice
[01:06:44.364]pretty independently.
[01:06:46.348]So after our exam is done, 'cause we practice by the
[01:06:49.792]standards and protocols, so when our exam is done we
[01:06:54.837]visit with the emergency room physician and the
[01:06:57.921]emergency room nurse who is assigned to that
[01:07:00.961]particular patient, in front of the patient.
[01:07:06.404]And I discuss my findings with the physician and I
[01:07:09.483]always tell the patient that the physician isn't going to
[01:07:12.139]redo everything that I've done, but they may listen
[01:07:15.980]to your chest, they may ask you one or two questions,
[01:07:19.167]and that's it.
[01:07:20.800]So, we practice pretty independently and since we've
[01:07:27.041]been specially trained and the emergency room physician
[01:07:29.761]has not, so they depend on what our findings are.
[01:07:37.461]Do you ever get re-training or go back?
[01:07:40.086]We have to renew our certifications every three years,
[01:07:42.870]and that requires 45 hours of education as a part of that
[01:07:48.950]and they specify what type of education.
[01:07:52.246](mumbling)
[01:08:00.588]Good question, I forgot to tell you that.
[01:08:02.529]The kit that's going around, law enforcement pays for
[01:08:07.372]and the sexual assault victim should not be charged for
[01:08:12.993]any part of the exam.
[01:08:15.189]And part of that is once you give your statement to the
[01:08:19.446]officer the officer says, "I want you to go in and have
[01:08:24.076]"the exam done."
[01:08:25.228]Now, if the officer says that, then the exam shouldn't
[01:08:28.513]be charged to the patient.
[01:08:30.892]But anyone can come in and if they don't want law
[01:08:34.389]enforcement contacted then that cost may be theirs.
[01:08:40.417]But if law enforcement is contacted (mumbling)
[01:08:50.656]Then they shouldn't be charged.
[01:08:54.805]Good question.
[01:08:56.609]Any others?
[01:09:00.288]You've been a great group and thank you for letting me
[01:09:02.273]come and visit and I wish you well in your travel
[01:09:07.211]to graduation.
[01:09:10.432]Thank you.
[01:09:11.137](applause)

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CYAF 493/893 Guest Speaker: Sue Gabriel

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