Inform Authorities Immediately
When an adult or adolescent patient presents to the emergency room with multiple severe physical bruises from being beaten by a relative, you must immediately notify the appropriate authorities (police and/or adult/child protective services) as this represents domestic violence requiring mandatory reporting.
Immediate Action Sequence
1. Ensure Physical Safety First
- Assess and treat any life-threatening injuries before proceeding with other interventions 1, 2, 3
- Provide care in a calm, private environment that ensures the patient's immediate physical safety 1, 2
- Document all visible injuries with photographs and detailed descriptions using objective language without value judgments 1, 3
2. Mandatory Reporting Takes Priority
- Notify police and/or protective services immediately—this is legally mandated in cases of domestic violence and abuse 1, 2, 3
- This reporting requirement exists regardless of whether the patient initially consents to legal action 3
- Medical care should proceed even if the patient declines forensic evaluation or prosecution 1
3. Talk to the Patient (After Safety is Secured)
- Conduct a thorough interview in a private, secure setting that allows for confidentiality while maintaining safety 4
- Obtain a complete description of events before, during, and after the violent episode using the patient's own words 1, 4
- Assess immediate safety concerns: Does the patient have ongoing safety risks from the perpetrator or others? 3
- Screen immediately for suicidal ideation and self-harm behaviors, as domestic violence survivors are at elevated risk 2, 3
4. Comprehensive Documentation
- Record all findings meticulously, as medical records will likely be subpoenaed for legal proceedings 1, 3
- Use exact descriptions and avoid interpretive terms or value judgments about the patient's body language or expressions 5, 3
- Maintain an unbroken chain of evidence if forensic collection is indicated 5, 1
5. Provide Emotional Support and Education
- Offer age-appropriate reassurance that the violence was not the patient's fault 1, 2
- Provide information about domestic violence resources, shelters, and safety planning 6
- Arrange urgent mental health follow-up with professionals experienced in trauma 1, 2
Critical Pitfalls to Avoid
- Never delay reporting to authorities while attempting to "talk through" the situation first—reporting is mandatory and immediate 1, 2, 3
- Do not allow reassurance or education to substitute for mandatory reporting obligations 1, 3
- Avoid documenting subjective interpretations or assumptions about the patient's emotional state 5, 3
- Do not assume the absence of severe visible injury means the situation is not dangerous—psychological abuse often accompanies physical violence 7
Follow-Up Care
- Schedule follow-up within 1-2 weeks to assess healing and ensure mental health services have been initiated 1, 2
- Ensure ongoing psychological support, as both physical and psychological dimensions of domestic violence significantly impact well-being 7
- Provide clear referral mechanisms to domestic violence support services 6
The correct answer is C (Inform authority), though this must be accompanied by A (Talk to the patient) and elements of B and D as part of comprehensive care. However, informing authorities is the non-negotiable legal and ethical priority.