Sexual Assault Forensic Examination Training provides illuminating instruction at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs

Just as there is a night and day difference between performing a forensic exam versus a physical exam, there is also a definite distinction when using a blue light instead of a white light with a forensic camera kit. The end result of both can be illuminating.

The variation of exam formats and camera kit lighting were but two topics of interest conducted during Naval Hospital Bremerton’s Sexual Assault Forensic Examinations (SAFE) training session held August 19-21, 2014.

Illuminating a dummy for evidence… Lt. Cmdr. Eric C. Peterson, assigned to Branch Health Clinic Everett is assisted by NHB’s Hospitalman Peter Munoz in the command’s Simulation Lab as they practice forensic photography as part of Sexual Assault Forensic Examination Training
(Photo by Douglas H Stutz).

SAFE are part of the command’s response ability in conjunction with the Navy’s Sexual Assault Prevention and Response (SAPR) Program to prevent and eliminate sexual assault. Victim Care Protocols include safe (exam) room and victim advocate availability, exam test procedures, and especially a professional trained staff member to guide through the entire process. Those staff members just went through the three-day training needed to perform the necessary duties if called upon.

“The ability to perform a sexual assault forensic exam is a service we need to be able to provide to our beneficiaries, whether we are here stateside, floating on a carrier in the Mediterranean, or in the mountains of Afghanistan. The performance of a forensic exam is not the same as a physical exam. All examiners need to learn the principles behind proper evidence collection, forensic photography, and the how to interact with patients that have experienced that type of trauma,” said Lt. Cmdr. Lacy L Gee, Nurse Corps, Certified Nurse Operating Room, Sexual Assault Nurse Examiner and Main Operating Room division officer.

The U.S. military reported 5,061 sexual assault cases last year, compared to 3,374 cases among service members reported in 2012. A Defense Department survey, however, estimated 26,000 military men and women were sexually assaulted in 2012 compared to 19,000 the previous year.

“By training examiners and assistants while they are here stateside, we provide them the opportunity to carry this skill with them throughout the Navy, regardless of their assignment. For our SAFE team in Bremerton, we require additional class time in forensic theory and practice, above and beyond the BUMED requirement for training new examiners. We’ve established a multi-disciplinary forensic team that is committed to providing exceptional care to all our patients,” Gee said.

Naval Hospital Bremerton staff members utilize the command’s Simulation Lab to conduct mock forensic exams as part of the recently held Sexual Assault Forensic Examination (SAFE) Training (Photo by Douglas H Stutz).

NHB’s SAFE, as well as SAPR, are comprehensive programs staffed by trained personnel to reinforce a culture of prevention, response, and accountability for the safety, dignity, and well-being of Sailors and Marines. The Department of the Navy does not tolerate sexual assault.

“We hope we never have to use this type of training. If we do, we will be prepared to provide the necessary medical and emotional help to any victim. SAFE is important because we care for our own and can also provide follow-up services and consults if needed,” said Cmdr. Susan Toyama, NHB Sexual Assault Forensic Examiner Training Facilitator and Quality Management Department head.

The Navy’s Bureau of Medicine and Surgery (BUMED) directed the establishment of a multidisciplinary team – made up of doctors, nurses, hospital corpsmen – to be able to handle any such need at a military treatment facility like NHB, with staff trained and available to ensure timely and appropriate medical care is available to sexual assault victims as soon as possible.

“This is our second training evolution and it went really well. We now have added staff qualified to conduct a wide-ranging sexual assault forensic exam if needed. If anyone comes in that has been victimized by sexual assault, we will take immediate care of them and assist them. Taking care of patients is what we do and if we get a sexual assault victim, we will provide them support in a timely and prompt manner,” said Toyama.

Sifting for clues, under one fingernail at a time… Sexual Assault Forensic Examination (SAFE) Training at Naval Hospital Bremerton included demonstrating the importance of completing a thorough head to toe assessment of a victim to collect evidence (Photo by Douglas H Stutz).

There were a host of professionals from NHB’s Pastoral Care department, Naval Base Kitsap Fleet and Family Support Center, Navy Medicine forensic psychology, Naval Criminal Investigative Service, and Navy Judge Advocate General Corps sharing insight on various responsibilities in SAFE.

“This training being conducted is absolutely beneficial. It’s important to share that in my capacity as a victim legal counsel I don’t work for the prosecutor, defense or command. I work solely for the victim and form that attorney-client relationship directly with victim(s) of sexual assault,” explained Lt. Steven Meredith, Judge Advocate General Corps and Victims’ Legal Counsel assigned to Naval Base Kitsap Bangor, who covers all of the West Sound region/greater Kitsap Peninsula area.

“Any time there is any sexual assault case, the sooner I can meet with the victim the better,” Meredith continued. “I can help with their concerns, such as explaining the process so they can make informed decisions. I also can advocate for them in court; be with them doing an interview with NCIS; and if they are worried about collateral misconduct, such as underage drinking, their sharing is confidential and (falls under) restricted reporting.”

Staff members trained included seven providers, one physician assistant, one registered nurse, and approximately a dozen hospital corpsmen honing their skills for providing support as SAFE assistants.

NHB’s Simulation Lab provided an ideal setting to familiarize staff members with hands-on training in conducting an actual forensic exam, as well as using the forensic camera kit for capturing digital evidence.

“Say a victim has been hand-slapped across the face. Using the white light on the illumicam camera will show the handprint mark, but the blue light, the alternative light source, can show broken capillaries. The blue light enhances detection of needed evidence and other such markings and also toxicology samples like blood, urine and semen,” explained Gee.

Illuminating a dummy for evidence… Lt. Cmdr. Eric C. Peterson, assigned to Branch Health Clinic Everett is assisted by NHB’s Hospitalman Peter Munoz in the command’s Simulation Lab as they practice forensic photography as part of Sexual Assault Forensic Examination Training (Photo by Douglas H Stutz).

If a sexual assault victim arrives at NHB, there is a designated Isolation Room in the Emergency Department to conduct SAFE and respect their privacy. Although the ER is slated to transition to an Urgent Care Unit by Oct. 1, 2014, the Isolation Room will still be in place, with a backup space also available.

“The Isolation Room can be immediately used and is ideally suited for the need should it arise,” Toyama said, noting that NHB will provide compassionate, competent medical care that is victim-centered, gender-sensitive and takes into account the reporting preferences of the individual. On a regular basis, NHB also ensures that sexual assault education is provided to every Sailor. There is a informational photo board on the first floor displaying the command’s victim advocates, so staff as well as beneficiaries are aware of who they can turn to in case they have questions or need help. Additionally throughout the entire hospital, DoD Safe Helpline posters are affixed so everyone knows where to turn for increased professional help if needed.

NHB’s SAPR program and SAFE capability provide a balance of focused education, comprehensive response, compassionate advocacy, and just adjudication in order to promote professionalism, respect, and trust, while preserving Navy mission readiness.