Management of Domestic Violence in the Emergency Setting
When a female patient presents with multiple injuries caused by domestic violence, the optimal action is to inform the authorities, document the injuries thoroughly, and provide comprehensive medical and psychological care.
Initial Assessment and Medical Management
- Prioritize immediate assessment of the patient's injuries and provide appropriate medical care for any acute trauma, as the treatment of physical injuries may be the priority depending on their severity 1
- Perform a thorough physical examination to document all injuries, both genital and non-genital, which may be important for both medical care and potential legal proceedings 1
- Implement multimodal pain management strategies to address acute pain from injuries 2
- Consider imaging studies as appropriate to assess the extent of injuries, particularly if there are signs of significant trauma 1
Mandatory Reporting Requirements
- In most jurisdictions, healthcare providers are legally required to report cases of domestic violence to law enforcement or child protective services, even if the patient does not want it reported 1
- Documentation should be detailed and include descriptions of all injuries, using imaging systems (photos or video) when available to record findings for potential forensic evidence 1
- Write a comprehensive medical report that can be used by authorities, including the nature and extent of injuries, patient's account of how they occurred, and your professional assessment 3
Safety Assessment and Planning
- Directly ask the patient whether they have safety concerns related to the perpetrator, whether they have been threatened, and whether they are afraid of anyone 1
- Assess for immediate danger by inquiring if the perpetrator or their associates have a history of violence and access to weapons 1
- Recognize that victims of domestic violence are at high risk for repeated and potentially fatal injuries - 30% to 50% of female homicides are committed by a present or former partner 3
Psychological Support and Resources
- Provide trauma-informed care that acknowledges the psychological impact of domestic violence 1
- Offer crisis intervention and ongoing support, particularly important for victims of interpersonal violence who are at risk of repeat injuries and psychosocial trauma 1
- Connect the patient with local resources such as domestic violence shelters, counseling services, and legal advocacy 4
Follow-Up Care
- Arrange follow-up care within 1-2 weeks to reassess injuries, evaluate mental health functioning, and determine the need for additional psychological counseling 1
- Refer to appropriate specialists for ongoing physical and psychological care 1
- Consider referral to trauma specialists as part of a multidisciplinary approach to address all contributors to symptoms 1
Common Pitfalls to Avoid
- Failing to recognize domestic violence as the cause of injuries - up to 35% of all emergency room visits by women are the result of domestic violence, but it is often overlooked by treating physicians 3
- Treating only the physical injuries without addressing the underlying cause of violence 5
- Discharging the patient without a safety plan or resources to prevent future incidents 5
- Not documenting injuries thoroughly enough for potential legal proceedings 1
Healthcare providers play a critical role in breaking the cycle of domestic violence by identifying victims, providing appropriate care, connecting them with resources, and fulfilling legal reporting obligations. Timely identification and intervention by healthcare professionals can save lives 3.