C.M.R. 16, 222, ch. 20, app 222-20-C
If questions arise during the collection of evidence from prepubertal children, please contact the Spurwink Child Abuse Program at 1-800-260-6160.
When a forensic examination is performed, it is vital that the medical examination and evidence collection procedures be integrated at all times in order to minimize trauma to the child.
If the alleged perpetrator is a pre-pubertal child, DHS should be notified.
If the assault or last sexual contact occurred within the 72 hours prior to the hospital visit or if the time frame cannot be determined, physical evidence from adolescents (15 years or older) can be collected utilizing the uniform standardized forensic examination kit, according to the instructions given for adults. However, physical evidence from prepubertal children should be collected using the following instructions:
NOTE: If it is determined that the last sexual contact took place more than 72 hours prior to the hospital visit, it is extremely unlikely that trace evidence will still be present on the child's body. This is most common in situations involving long-term abuse. Therefore, a careful evaluation of each case must be made to decide which, if any, evidence collection procedures should be implemented.
Regardless of when the last sexual contact might have occurred, valuable evidence can still be obtained through a medical examination and interview of the child. However, it is important that a child not be interviewed multiple times. The interview should be deferred to the most experienced interviewer. Emergency room personnel, including SAFE examiners, may not be the most appropriate persons to interview the child. Please consult with a forensic specialist to determine what evaluation is appropriate before examining and / or interviewing any child.
Do not force any steps of the examination and / or evidence collection process.
The collection of specimens for drug testing is not generally necessary for prepubertal children unless they provide a history consistent with drug ingestion, including drowsiness, altered consciousness, memory loss, impaired motor skills, or other symptoms consistent with drug ingestion. If the child is two years of age or younger and presents with these symptoms, head trauma should be considered.
PLEASE NOTE:
[TICK] Unless otherwise noted, do not moisten swabs prior to sample collection.
[TICK] All swabs should be air dried prior to packaging.
[TICK] Unless otherwise noted, place the evidence collection specimens back into the envelope or bag from which they came.
[TICK] All envelopes and bags should be sealed. Attach a tracking label to the outside of the envelope or and fill out all information requested.
Step 1. ORAL SWABS
NOTE: Oral swabs should only be collected if the case history indicates oral contact. Oral swabs may be difficult to obtain from very young children.
Carefully swab the buccal area and gum line using two swabs simultaneously, but collecting all four swabs. Be sure to collect the swabs from the upper and lower buccal areas and gum line, rotating the swabs during collection.
Place the swabs in the swab box. Mark the swab box "Oral".
Step 2. NASAL SWAB
NOTE: Do not collect nasal swab from children.
Step 3. FINGERNAIL CLIPPINGS/SWABBINGS LEFT HAND
NOTE: Do not collect fingernail clippings from young children unless the examination is performed under anesthesia.
Remove folded paper from envelope and place, unfolded, on a flat surface.
Hold patient's left hand over the paper and gently clip the entire nail, allowing the clippings to fall on the paper.
For swabbings, dampen a sterile swab from Step 17 and swab under the nails.
Place the dried swab in the folded paper.
Step 4. FINGERNAIL CLIPPINGS/SWABBINGS RIGHT HAND
NOTE: Do not collect fingernail clippings from young children unless the examination is performed under anesthesia.
Remove folded paper from envelope and place, unfolded, on a flat surface.
Hold patient's right hand over the paper and gently clip the entire nail, allowing the clippings to fall on the paper.
For swabbings, dampen a sterile swab from Step 17 and swab under the nails.
Place the dried swab in the folded paper.
Step 5. KNOWN DNA COLLECTION
Have the patient rinse his / her mouth with water prior to this evidence collection step.
Remove components from kit envelope.
Open the swab protector and slide the protector back to expose the swab head.
Using the swab, vigorously swab the inside of both sides of the patient's cheek for 5 to 10 seconds
Pull the swab head back into the protector and re-close the protector around the swab head.
Step 6. KNOWN HEAD HAIR SAMPLE
NOTE: It is recommended that the head hair standards not be taken from prepubertal children at the time of the initial examination.
Step 7. FOREIGN MATERIAL COLLECTION
NOTE: If patient changed clothing after the assault, inform officer in charge so the police may collect the clothing worn at the time of the assault. Do not cut through any existing holes, rips or stains in patient's clothing. Do not shake out patient's clothing. If secure facilities are available, air dry any wet or damp clothing. Otherwise, notify law enforcement personnel that clothing is wet or damp. If additional clothing bags are required, use only new paper (grocery type) bags.
UNFOLD AND PLACE A CLEAN HOSPITAL BED SHEET ON FLOOR.
Remove paper sheet from "Foreign Material Collection" bag, unfold and place over bed sheet.
Instruct patient to stand in the center of paper sheet and carefully remove each item of clothing.
Collect each item as removed and place each in a separate clothing bag, as labeled.
Refold paper sheet on which patient stood in such a manner as to retain any debris present, then return it to the "Foreign Material Collection" bag.
Step 8. DEBRIS COLLECTION
NOTE: Do not package debris from different areas in the same envelope. Use Step 16 for additional packaging material or use facility materials and make a druggist fold.
Remove the folded sheet of paper from the "Debris Collection" envelope.
Unfold the paper and place on a flat surface.
Collect any debris present on the patient (dirt, hair, leaves, fibers, etc.) and place in the center of the paper.
Fold the paper so as to retain the debris.
Identify the location from which the samples were removed on the anatomical drawings on the envelope.
Step 9. DRIED SECRETIONS
Using two moistened swabs, wipe the genital perineal area.
Using two moistened swabs, wipe the sulcus area
Mark on each swab box the location the swabs were taken from.
Place each set of swabs in the appropriate box.
Step 10. PUBIC COMBING
NOTE: Instead of collecting pubic hair combings from perpubertal children, carefully examine the thighs and external genitalia for any loose hairs or fibers. If any are found, collect according to the instructions given in Step 8 of these instructions.
Step 11. KNOWN PUBIC HAIR SAMPLE
NOTE: It is recommended that the pubic hair standards (if present) not be taken from prepubertal children at the time of the initial examination.
Step 12. GENITAL/PENILE SWABBINGS
Moisten swabs provided with a minimal amount of distilled water.
Holding the swabs together, briskly swab the external genitalia making sure to rotate the swabs during the collection procedure.
Place the swabs in the box and mark "Genital / Penile".
Step 13. ANAL SWABS
NOTE: All four swabs should be used for the collection of anal specimens; however, the swabs should be used one at a time. Swabs may be moistened with a minimal amount of distilled water for the comfort of the patient.
Carefully swab the anus using one swab at a time.
Place the swabs in the swab box and check "Anal".
Step 14. VAGINAL SWABS
NOTE: For prepubertal females, young adolescent females, and for the adolescent who is too traumatized or anxious to have a pelvic examination, evidence specimens can be obtained by gently swabbing the thigh and genitalia area (including the sulcus, fossa navicularis, posterior fourchette for girls and the testicles, scrotum, and perineum for boys) using four swabs slightly moistened with distilled or sterile water (refer to Step 12 of these instructions). Unless there is evidence of penetrating trauma in the prepubertal female, it is not necessary to collect vaginal swabs. (If there has been penetrating trauma, vaginal swabs can be obtained during the repair of the trauma). Attempts to collect vaginal swabs on the prepubertal female can result in hymenal trauma that may mimic abuse.
If the swabs are collected under anesthesia, all four swabs can be obtained simultaneously. If it is determined that the simultaneous use of four swabs for the collection of the vaginal specimens may cause unnecessary discomfort or additional trauma to the patient, the swabs should be used one at a time.
Collect four vaginal swabs from the vaginal vault. The swabs should be collected one at a time unless the collection is being done under anesthesia.
Place the swabs in the swab box and mark "Vaginal."
Step 15. CERVICAL SWABS
NOTE: Do not collect cervical swabs from prepubertal children.
Step 16. MISCELLANEOUS EVIDENCE COLLECTION
NOTE: This step is provided for the collection of evidence not previously covered.
Collect item of evidence and allow to air-dry if necessary.
Place in paper bag labeled "Miscellaneous."
Step 17. ADDITIONAL SWABS
NOTE: This step is provided for the collection of evidence not previously covered elsewhere.
If necessary, moisten the swabs provided with a minimal amount of distilled water. Holding the swabs provided, thoroughly swab the area making sure to rotate the swabs during the collection procedure. Check "Other" on the outside of the swab box and identify the sample on the line provided. Place the swabs in the swab box and write the area of the patient's body from which the sample was obtained. Place the swab box in the "Additional Swabs" envelope.
Step 18 and 19. URINE SPECIMEN and BLOOD ALCOHOL/TOXICOLOGY SPECIMEN
NOTE: Generally this specimen will not need to be collected, however, if the patient presents with drowsiness, memory loss, impaired motor skills, etc. or there is a suspicion of a drug used to facilitate rape, follow the instructions provided in the adult instructions.
C.M.R. 16, 222, ch. 20, app 222-20-C