Patient physical and emotional status and the degree of required medical intervention: Refer or Treat?

Immediate Medical Intervention (Chapter 3, pg. 14)

If the following are present, conduct a full evaluation immediately:

• history of inappropriate sexual contact occurred within previous 72 hours or
• acute vaginal or rectal bleeding, vaginal or rectal pain and/or genital trauma.

Immediate intervention may also be indicated if the following are present:

• the child or parent/caretaker is emotionally distraught or
• emergency staff have reason to believe that the parent or caretaker will not keep a clinic appointment.

Urgent Medical Intervention (Chapter 3, pg. 14-15)

If the following are present, a referral to a specialist or clinic should be made and the child seen within 24 hours or as soon as possible:

• vaginal discharge and the possibility of a STD or
  
• possibility of pregnancy.

Immediate or urgent medical intervention should always include:

• a complete medical history;
• a complete physical exam, focusing on evidence of trauma, pregnancy, STDs and the collection of forensic evidence;
  
• an assessment of the child's psychological status;
  careful documentation of evidence of trauma in the medical record, including body diagrams and photographs.

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