Find information for police and legal counsel, medical providers, victim service workers, counsellors and social services.
Police and legal counsel
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What is a medical-forensic exam?
This is an examination done by a specially trained forensic nurse examiner and is offered to people within seven days of their violent experience. Victims have the choice of whether to have a forensic exam or not and how much of the exam they want. Medical care is always the priority. A forensic exam can include the details told to the nurse about the incident, a physical exam, documentation of findings, photographic images and possible collection of samples including clothing, body swabs, genital swabs, blood, urine and other samples. See the information below for details about forensic exam options.
There are three options for medical-forensic exam (read about these options in our frequently asked questions here).
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What will a medical-forensic exam tell you?
The forensic nurse examiner will not be able to confirm what may have happened to the victim. The forensic nurse examiner will write down anything they see, and collect anything that might be used as evidence in a police investigation. Any samples or clothing collected will be provided to a police officer following strict chain of custody protocols. No information can be shared directly with the police without the consent of the patient.
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How to get the victim help
Violence can result in health consequences. Please offer to take the person to the closest hospital for urgent and emergency medical care. If the person consents to a medical-forensic exam and it has been less than seven days since the incident, they can be transferred to the local Forensic Nursing Service for this care. Alternatively, the Embrace Clinic is available to offer rapid access to specialty medical care when a full forensic exam is declined, or it has been more than seven days since the incident. Embrace Clinic also offers a specialty Strangulation Clinic. Read about all of these services on the Getting help webpage.
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The role of the forensic nurse examiner (FNE)
FNEs are specially trained registered nurses who provide medical-forensic assessments and examinations for medically stable people who have experienced recent violence. These nurses are trained in injury identification and documentation, forensic photography, collection of biological specimens and chain of custody. They write medical-legal reports and can act as fact or expert witnesses in court. The FNE’s priority is always the medical needs of the person.
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The role of the Embrace and Strangulation Clinics
The Embrace Clinic is a specialist rapid access outpatient medical clinic that provides care to people who have experienced recent violence. They offer follow up medical care to people after they have had a medical-forensic exam, when they decline a medical-forensic exam or it has been more than seven days since their violent experience.
Embrace Clinic has nurse practitioners with a forensic backgrounds who can diagnose, treat, assess and manage the physical and emotional needs of survivors of recent violence. They can act as fact and expert witnesses in court.
Medical records are only released by the Embrace Clinic with a signed release of information form sent directly to the clinic.
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How to access the samples, documentation and photographic images from the forensic exam
If there is a signed release of information form specific to the medical-forensic exam, the Forensic Nursing Service will connect with the investigating officer to arrange for proper chain of custody handover of any forensic materials and documentation.
A request for medical records from the emergency department visit and/or Embrace Clinic will need to be made separately.
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How to get medical records (not forensic)
A release of information form will need to be signed and delivered to the health records department of the hospital in which care was provided for any medical records related to the emergency department and/or hospital visit. For Embrace Clinic records, a release of information form signed by the patient must be sent directly to the Embrace Clinic.
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Training and consultation
The Forensic Nursing Service and Embrace Clinic Teams can offer consultation and training on many aspects of interpersonal violence, including trauma informed practice, strangulation and head injuries, medical-forensic exams and more. Please contact us to inquire.
Medical providers
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What to do when a patient discloses recent violence
When a patient discloses recent violence, remember that medical care is always the priority.
Ask:
- Are you hurt, bleeding or injured?
Provide medical care and assessment. Do a physical examination as needed. - Was anything placed around your neck, like a hand or rope, and squeezed (strangled/choked)?
Provide medical assessment for head and neck injury, and depending on severity consider emergency department referral. - Were you hit on the head or face, or did you hit your head on anything that might cause a concussion?
Provide medical assessment and care for head injury. - Is there any chance you could be pregnant?
Test if unsure, assess for last menstrual period (LMP) and contraception. - Were any children witness, present or harmed during this incident?
Contact child protection as needed. - Are you currently safe from the person who hurt you?
Consult Social Work.
- Are you hurt, bleeding or injured?
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How to refer a patient for a medical-forensic exam
Visit our Getting help webpage for details.
Patients who are medically stable can be sent to their local Fraser Health emergency department where they will be medically assessed and, with consent, transferred to a site with forensic nurse examiners (Surrey Memorial Hospital and Abbotsford Regional Hospital). Please note that a medical-forensic exam will not be able to tell the patient what happened to them; refer to our Frequently asked questions for details about medical-forensic exams.
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Consultation for sexual assault, head injury, strangulation or other medical care after recent violence
Please contact the Embrace Clinic (open from Monday to Friday, 9:00 a.m. to 4:00 p.m.) for medical consultation and support. The Embrace Clinic accepts self referrals from patients, or from another provider or professional with the patient’s consent. Find referral forms and details here.
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Medical care after sexual assault
- Consider pregnancy prophylaxis – emergency contraceptive pill or IUD. The Embrace Clinic can insert emergency IUDs.
- Consider sexually transmitted infection (STI) prophylaxis for gonorrhea and chlamydia. Single dose regimes preferred to limit daily reminder. Can give to take at home with food to minimize nausea.
- Assess for HIV Risk, consult [BC Centre for Excellence in HIV/AIDS HIV PEP guidelines]. Only the highest risk cases qualify for HIV PEP.
- STI and HIV testing is of limited value within the first 10 days due to infection and testing window periods. Test based on current symptoms or as a baseline only. If offering baseline screening offer least invasive screening whenever possible: HIV, Syphilis, Hepatitis B and C, gonorrhea, chlamydia and trichomonas. [Embrace Clinic] can do this and or follow up with future screening.
- Ask about head injury, strangulation, current pregnancy risk, genital/anal injury, presence of minors. Contact child protection as needed (link to CFCSA Duty to report pamphlet)
- Further assessments may include mental health, suicide risk, substance use, sleep assessment, and managing emotions.
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Medical care after strangulation
- Assess head, neck, neurological function and vital signs.
- Risks: Anoxic brain injury, carotid artery dissection, thyroid injury, hyoid bone fracture (especially if lifted or dragged by neck) and laryngeal injury.
- Consider referral to the emergency department for urgent assessment and imaging referral to the Strangulation Clinic at the Embrace Clinic for non-emergency, rapid access assessment and care.
- Manage symptoms similar to concussion management and protocols, educate about red flags (stroke-like symptoms, breathing difficulties and increasing pain).
- Further assessments may include mental health, suicide risk, substance use, sleep assessment and managing emotions. Consider writing a note for time off school or work for appropriate brain injury recovery.
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Medical care after concussion from interpersonal violence
- Assess head, neck, neurological function and vital signs.
- Risks: Brain injury, neck injury and retinal detachment.
- Consider referral to the emergency department for urgent assessment and imaging (if needed), referral to the Embrace Clinic for rapid access non-emergency assessment and care.
- Provide concussion management and protocols, educate about red flags (stroke-like symptoms, breathing difficulties and increasing pain).
- Further assessments may include mental health, substance use, suicide risk, sleep assessment and managing emotions. Consider writing a note for time off school or work for appropriate brain injury recovery.
Victim service workers, counsellors and social services
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How to refer a patient for a medical-forensic exam
See the Getting help section of our website for more details.
Persons who have experienced violence should directed to their local Fraser Health Emergency Department where they will be medically assessed and, with consent, transferred to a site with Forensic Nurse Examiners (Surrey Memorial Hospital and Abbotsford Regional Hospital). Please note that a medical-forensic exam will not be able to tell the person what happened to them; refer to our FAQ section for details about medical-forensic exams.
Visit the Embrace Clinic and Strangulation Clinic pages for more information.