What is the proper procedure for collecting a Sexual Assault Response Team (SART) kit?

Proper Procedure for Collecting a Sexual Assault Response Team (SART) Kit

The collection of a SART kit must be performed by a trained healthcare professional such as a physician who specializes in child abuse or a nurse with sexual assault care training to ensure an unbroken chain of evidence and accurate documentation of findings. 1

Initial Preparation

• Obtain informed consent from the patient before examination and evidence collection
• Ensure privacy and create a supportive, non-judgmental environment
• Explain the procedure to the patient, including what samples will be collected and why
• Document the patient's history using direct quotes when possible, avoiding value judgments or interpretations of body language 1
• Use printed labels or barcodes rather than handwritten ones to avoid sample mix-up and protect confidentiality 1

Timing of Evidence Collection

• Forensic evidence should be collected as soon as possible after the assault
• With DNA-amplification techniques, forensic examination is useful for at least 4 days after assault and possibly longer 1
• Between 4-7 days, contact local authorities to determine if evidence collection is still useful
• After 1 week, examination and treatment can occur without forensic collection 1

Required Personnel and Documentation

• The examination must be performed by a trained professional who can maintain chain of custody 1
• Document all findings meticulously, using exact descriptions and avoiding interpretative terms like "hymen not intact" 1
• Photograph injuries when possible with patient consent
• Label all specimens clearly with appropriate identifiers while protecting confidentiality 1

Specimen Collection Procedure

Physical Evidence Collection

1. Collect clothing and bedding that may contain evidence
2. Perform visual inspection of genital, perianal, and oral areas for injuries, warts, and ulcerative lesions 1
3. Document injuries using colposcopic procedures when available to detect and document genital trauma, including microtrauma 1

Biological Sample Collection

1. Genital Samples:

   • For females: Collect vaginal specimens for STI testing and DNA evidence
   • For males: Collect urethral specimens when discharge is present 1

2. Extragenital Samples:

   • Collect specimens from the pharynx and anus in both males and females 1
   • Collect specimens from any sites of penetration or attempted penetration 1

3. Blood Samples:

   • Collect baseline serum samples for STI testing (HIV, hepatitis B, syphilis)
   • Preserve serum samples for subsequent analysis if follow-up tests are positive 1

4. Toxicology Samples:

   • Collect separate toxicology samples when substance use is suspected
   • Collect first urine produced after assault if drug-facilitated sexual assault is suspected
   • Document chain of custody for toxicology specimens 1

Special Considerations

• For children, the decision to evaluate for STIs must be made individually based on risk factors 1
• For adolescents, be aware they are more likely to have used alcohol/drugs and less likely to incur nonanogenital injury during assault 1
• Male victims may be less likely to seek help due to concerns about privacy and stigma 2

Post-Collection Procedures

• Ensure all samples are properly sealed and labeled
• Maintain chain of custody documentation
• Store specimens according to proper protocols (refrigeration or freezing as appropriate)
• Arrange follow-up testing at 2 weeks and 12 weeks after assault 1

Common Pitfalls to Avoid

• Failing to maintain proper chain of custody, which can compromise legal proceedings
• Using value judgments or interpretations in documentation
• Not collecting toxicology samples when substance use is suspected
• Inadequate labeling of specimens
• Failing to provide appropriate prophylactic treatment for STIs at initial visit

By following these guidelines meticulously, healthcare providers can ensure proper collection of evidence while minimizing additional trauma to the sexual assault victim and preserving the integrity of potential legal proceedings.