VOLUME 5 Chapter 6: Abuse, Neglect, and Assault

D. The patient was physically abused. Although you should document every relevant​ detail, the most important element of this call to document carefully and accurately is the fact of physical​ abuse, which is a crime and will likely continue.

An elderly male refuses to be transported to the hospital after he was physically abused by his son following an argument. His injuries are​ minor, but the elderly man does not want to be transported because of the cost associated with it. What is most important thing to document about this​ call? A. The patient and son were in an argument. B. The​ patient's injuries were minor. C. The patient was concerned about the cost of transport. D. The patient was physically abused.

D. coining. With​ coining, a folk medical practice in the Hmong belief​ system, a utensil with a rounded edge​ (such as a coin or​ spoon) is used to rub the skin until bruising appears. This procedure leaves an oval ecchymotic area with an irregular border that may be mistaken for abuse.

A​ religious-based practice of rubbing a coin over the skin of an ill person that may make marks across the chest or back similar to those of abuse is​ called: A. flogging. B. pounding. C. leafing. D. coining.

D. Explain that showering and changing may destroy importance evidence. Any evidence of the attack on the​ female's body or included with her clothing becomes important for the prosecution.​ Therefore, the paramedic should take every possible​ measure, short of​ coercion, to convince the female not to shower or change clothing before going to the hospital.

During your assessment and management of a female rape​ victim, she states that she feels​ "dirty" and​ "violated" after the​ attack, and she refuses to go to the hospital until she showers and changes her clothes. What should you do in this​ situation? A. Have the police intervene so that you can make her go to the hospital without showering and changing. B. Allow her to​ shower, but you must bring her clothes with you to the hospital. C. Allow her to change her clothes but not shower. D. Explain that showering and changing may destroy importance evidence.

A. Rohypnol Rohypnol is a potent benzodiazepine that produces a sedative​ effect, amnesia, muscle​ relaxation, and slowing of the psychomotor response. It is widely prescribed outside the United States as a sleeping pill. It is​ colorless, odorless, and tasteless and can be dissolved in a drink without being detected. Rohypnol can be potentiated by the concomitant effects of alcohol.

Early one​ morning, you are assessing a patient who states that she was at a party last night drinking and brought a male home with her. She further states that she fell asleep on the​ couch, although she​ doesn't remember when that​ happened, the man was gone in the​ morning, and she thinks she was raped. If she is​ right, which of the following drugs is likely to have been used to facilitate the​ rape? A. Rohypnol B. Fentanyl C. Acetylcysteine D. Viagra

A. Neglect The two basic types of elder abuse are domestic and institutional. Domestic elder abuse takes place when an elder is being cared for in a​ home-based setting, usually by relatives. Institutional elder abuse occurs when an elder is being cared for by a person with a legal or contractual responsibility to provide​ care, such as paid​ caregivers, nursing home​ staff, or other professionals. Both types of abuse can be either acts of commission​ (acts of​ physical, sexual, or emotional​ violence) or acts of omission​ (neglect).

Of the various types of elder​ abuse, which involves acts of​ omission? A. Neglect B. Financial C. Physical D. Sexual

A. Nearly 3 million Nearly 3 million children suffer abuse each year and almost 5 children a day die as a result of child abuse.

On an annual​ basis, how many children are the victims of abuse in the United​ States? A. Nearly 3 million B. Less than 2 million C. More than 4 million D. Between​ 700,000 and 1.1 million

C. Amnesia The use of drugs to facilitate a sexual assault is occurring with increasing frequency. These medications generally render a person unresponsive or weaken the person to the point of being unable to resist an attacker. Some of these medications cause​ amnesia, thus eliminating or distorting the​ victim's recall of the assault.

Some drugs that are used to facilitate rape​ (known as date rape​ drugs) have which of the following effects on the​ victim? A. Increased mental awareness B. Heighted sexual intensity C. Amnesia D. Enhanced genital blood flow

B. Human trafficking Human trafficking is defined as the trade of​ humans, or the illegal movement of​ people, usually for forced labor or commercial sexual exploitation.

The forced transport or trade of a person by such means as the threat or use of force or other forms of coercion is the definition of which of the​ following? A. Sexual assault B. Human trafficking C. Hate crimes D. Physical abuse

B. size of the elder population. The problem of elder abuse is expected to grow along with the size of the elderly​ population, which will increase dramatically within the next 20 to 30 years as baby boomers turn 65 and older. It is your responsibility to be aware of this situation and to remain alert to signs of elder abuse.

The problem of elder abuse is expected to grow alone with​ the: A. incidence of chronic illness in the elder population. B. size of the elder population. C. number of facilities devoted to serving the elder population. D. incidence of trauma in the elder population.

B. rape. Rape is usually defined as penile penetration of the genitalia or rectum​ (however slight) without the consent of the victim.

Unwanted sexual contact that includes penile penetration of the genitalia or rectum is​ called: A. sexual assault. B. rape. C. fornication. D. battery.

A. There is a history of physical violence in the home. One of the most consistent findings in the homes of abused children is a history of physical violence.​ Often, the abuser was also abused as a child.

What is one of the most consistent factors that can help to predict child​ abuse? A. There is a history of physical violence in the home. B. A child and parent are of different genders. C. The​ child's parents are separated. D. There are nonrelatives living in the home.

B. Racial bias Most hate crimes result from racial bias. This is followed by religious​ bias, sexual orientation​ bias, ethnicity and national origin​ bias, and disability bias.

What is the leading motivator of hate​ crimes? A. National origin bias B. Racial bias C. Sexual orientation bias D. Religious preference bias

B. Emotional abuse The paramedic may encounter many types of abuse. Emotional abuse occurs when the abuser consistently​ belittles, threatens, name​ calls, or even ignores his or her partner or someone under his or her care.

What type of abuse occurs when the abuser​ threatens, calls​ names, ignores, or swears at the abused person​ consistently? A. Sexual abuse B. Emotional abuse C. Physical abuse D. Financial abuse

B. sexual assault. Although the legal definitions vary from state to​ state, courts generally interpret sexual assault as unwanted sexual​ contact, whether it is​ genital, oral,​ rectal, or manual. Rape is usually defined as penile penetration of the genitalia or rectum​ (however slight) without the consent of the victim.

When a male is subjected to unwanted sexual contact of the genitals without anal​ penetration, by law this is​ termed: A. battery. B. sexual assault. C. rape. D. fornication.

D. show a willingness to hear what the patient has to say. Throughout the​ assessment, listen carefully to the patient. Indicate your attention by​ saying, "I hear what you are telling​ me." Often victims of abuse feel a sense of relief when someone else knows about the situation. This can be the first step toward seeking help.

When assessing a patient you suspect of being abused by her domestic​ partner, you​ must: A. indicate that you know what is going on and will take care of it. B. tell the patient to speak up about any abuse right now. C. question the patient until it is clear that abuse occurred and then end the interview. D. show a willingness to hear what the patient has to say.

D. All of the above Beyond the legal requirement to report​ sexual, elder, and child​ abuse, paramedics should also adhere to their ethical standards of protecting the public they serve by reporting situations that place others in danger that the individuals may not be able to control.

Which of the following do EMS providers have a legal and ethical obligation to​ report? A. Child abuse B. Elder abuse C. Sexual assault D. All of the above

A. Burns from the ankles down on both legs Burns tend to be in certain common​ locations: the soles of the​ feet, palms of the​ hands, back, or buttocks. They may or may not be found in conjunction with other injuries. When children accidentally get into water that is too​ hot, you can expect to see​ "splash" burns—marks created by spattering water as children try to escape. Intentional​ scalding, however, is characterized by the conspicuous lack of splash burns.

Which of the following injury patterns is most suggestive of abuse to a​ 14-month-old infant? A. Burns from the ankles down on both legs B. A burn to the fingers of one hand C. A splash burn D. A car seat burn

C. Dependence on drugs or alcohol Abusers usually exhibit overly aggressive personalities—an outgrowth of low​ self-esteem. They often feel insecure and​ jealous, flying into sudden and unpredictable rages. Use of alcohol or drugs increases the likelihood that the abuser will lose control and may not even clearly remember his or her actions. Abused partners often seek the numbing effect of alcohol​ and/or drugs.

Which of the following is a common characteristic of an abusive relationship for both abusers and the​ abused? A. Good​ self-esteem in one of the individuals B. High socioeconomic status C. Dependence on drugs or alcohol D. A history of schizophrenia on the part of the abuser

C. A child has stopped attending school. A child who stops attending school is an indicator of human trafficking.

Which of the following is a common indicator of human​ trafficking? A. A child is assertive and independent. B. A child feels free to contradict a parent. C. A child has stopped attending school. D. A child is involved in activities with friends and family.

B. Fentanyl Drugs that have been associated with​ rape, which are also known as predator​ drugs, include​ Rohypnol, gamma-hydroxybutyrate​ (or GHB),​ ketamine, and MDMA. Fentanyl is a synthetic​ short-acting narcotic analgesic and not a predator drug.

Which of the following is not a common drug used for date rape purposes​ (also known as predator​ drugs)? A. Rohypnol B. Fentanyl C. Ketamine D. ​Gamma-hydroxybutyrate

C. Adults aged 18 to 45 All adults aged 18 to 45 are not a vulnerable population.​ Generally, any children or adults induced into commercial sex or forced to perform labor or services through​ force, fraud, or coercion are vulnerable to human trafficking.

Which of the following is not a commonly vulnerable population for human trafficking in the United​ States? A. Children under 18 years of age induced into commercial sex B. Children or adults forced to perform labor or services C. Adults aged 18 to 45 D. Adults over age 18 induced into commercial sex

A. Apprehension abuse The three types of child abuse most commonly encountered by the paramedic include physical​ abuse, emotional​ abuse, and sexual abuse. If the abuser were doing something that created a strong or sustaining apprehension in the​ patient, that would be a mechanism of emotional​ abuse, not a type of abuse.

Which of the following is not a type of child abuse the paramedic may​ encounter? A. Apprehension abuse B. Sexual abuse C. Physical abuse D. Emotional abuse

D. A​ 71-year-old male who is confined to bed and is living with his​ son, who was just divorced from his wife Characteristics of the abused patient include being confined to bed due to a chronic illness. For the​ abuser, significant marital discord or divorce may create enough stress that the added complication of caring for an aging parent may be too​ great, and violence may erupt.

Which of the following patients would be at the greatest risk for elder​ abuse? A. A​ 70-year-old female who lives in an elder care facility and remains active B. A​ 69-year-old male who has​ end-stage liver cancer and is in hospice care C. A​ 79-year-old female widow living alone D. A​ 71-year-old male who is confined to bed and is living with his​ son, who was just divorced from his wife

D. Failure to recognize abuse Failure to recognize the abuse is not typically the reason for not reporting it. Victims of partner abuse hesitate or fail to report the problem for a number of reasons. Fear is one of the biggest obstacles to taking action. Most battered partners fear​ reprisals, either to themselves or to their children. They also fear being humiliated for their powerlessness or inability to stop the​ violence, especially if the battered partner is a male. Many victims of abuse lack the knowledge or financial means to seek help.

Which of the following reasons typically does not influence the hesitation or failure of a female victim to report crimes of abuse committed against​ her? A. Fear of reprisal from the abuser B. Lack of financial resources C. Humiliation about the situation D. Failure to recognize abuse

A. Abuse can occur in​ same-sex couples. Partner abuse has been around as long as relationships. As​ such, abuse is also found among​ same-sex couples.

Which of the following statements about abuse is most​ correct? A. Abuse can occur in​ same-sex couples. B. Abuse is rare between married couples. C. The majority of victims of partner abuse are males. D. Abuse is always committed by males against females.

C. ​"I was at dinner last night with​ him, and​ that's the last thing I​ remember." Date rape drugs generally render a person unresponsive or weaken the person to the point of being unable to resist an attacker. Some of these medications cause​ amnesia, thus eliminating or distorting the​ victim's recall of the assault.

Which of the following statements by a female patient may indicate that she was slipped a date rape​ drug? A. ​"I think he put something in my drink last night because my heart was​ racing, and I felt really​ nervous." B. ​"I told him​ 'no' repeatedly, but he still forced himself on​ me." C. ​"I was at dinner last night with​ him, and​ that's the last thing I​ remember." D. ​"I think he was taking erectile dysfunction drugs when he used the bathroom in my​ home."

D. The patient explains that she may not be transported to a hospital but must remain at the residence where you found her. Lack of freedom of movement is a sign of human trafficking.

Which patient should the paramedic consider might be a victim of human​ trafficking? A. The patient is dehydrated and in hypovolemic shock. B. The patient lives alone and shows many signs of neglect. C. The patient has sustained burns to her hands and forearms. D. The patient explains that she may not be transported to a hospital but must remain at the residence where you found her.

B. So that the victim can learn better strategies to help avoid or stop the abuse Many​ times, people who are victims of elder abuse feel alone and helpless. Through connections that are made with community services designed to help combat these​ issues, they can learn strategies to help deal with the situation and perhaps avoid any similar situations in the future.

Why is it important not only to provide proper care for a victim of elder​ abuse, but also to let the victim know about resources in the community for these types of​ situations? A. So that you can bill the ambulance call at a higher rate B. So that the victim can learn better strategies to help avoid or stop the abuse C. Because state regulations require it D. So that the hospital will not have to have a SANE nurse on staff

C. Because it is a crime As noted throughout this​ chapter, abuse and assault constitute crimes. Although the nature and extent to which an assault is considered a crime often depends on local​ laws, you have a responsibility to report suspected cases to the appropriate law enforcement officials. Because the assailants may be detained only a short​ time, you also have an obligation to find out about the victim and witness protection programs available in your area.

Why must a paramedic report any assault involving racism to the​ police? A. Because the paramedic must demonstrate opposition to racism B. Because racism is wrong C. Because it is a crime D. Because the paramedic must demonstrate professionalism

B. Because it is a crime Abuse and assault are crimes. Although the extent to which a situation of abuse or assault is prosecuted depends on local laws and​ investigations, the suspicion of abuse is considered to be mandatory reporting for all health care providers.

Why should any suspected instance of sexual abuse be reported to the​ police? A. Because it cannot be reported by the victim due to a conflict of interest B. Because it is a crime C. Because it can be determined only by law enforcement D. So that a restraining order can be automatically placed on the alleged abuser

B. Directly ask the patient if she is being abused In assessing the abused​ patient, direct questioning usually works best. Convey an awareness that the​ person's partner may have caused the harm or created conditions that led to the injury​ and/or the emotional trauma. Once the subject of abuse has been​ introduced, exhibit a willingness to discuss it. Any statements the patient makes should be carefully documented.

You are assessing a female patient who you believe is a victim of abuse. The suspected abuser is not​ home, and your partner just went out to the ambulance to get the stretcher. While you are alone with the​ patient, what should you do to help confirm or deny your​ suspicion? A. Find out what the patient may have done to spark the act of aggression. B. Directly ask the patient if she is being abused C. Ask the patient why she does not just leave the abuser. D. Ask the patient to call the alleged perpetrator so that you can talk with him.

A. Provide her with a list of local resources for victims of partner abuse It is important for paramedics to realize that they have obligations to patients that go beyond patient care. In this​ situation, although paramedical skills are not​ needed, the paramedic should still try to provide the patient with community resources that can help her manage this difficult​ situation, whether or not she decides to stay in this relationship.

You are assessing a female who was shoved down hard by her boyfriend during an argument. The police have the male in​ custody, and the female seems relatively unharmed. She has decided to not be transported to the hospital by ambulance. Before you​ leave, what should you​ consider? A. Provide her with a list of local resources for victims of partner abuse B. Have her placed in protective custody by the police so you can transport her C. Provide her with multiple ways to leave her boyfriend D. Give her your personal cell phone number in case she wishes to talk about the attack

A. The colors of the bruises Bruises in the different colors presented here demonstrates bruises of different ages in different stages of healing. This is a sign of likely abuse.

You are assessing a​ 7-year-old male patient with hypothermia and dehydration and discover bruises on the​ patient's arms and back that are​ red, blue,​ green, yellow, and brown. Which of these findings suggests this patient has been​ abused? A. The colors of the bruises B. The hypothermia C. The bruises being on the arms and back D. The dehydration

D. Neglect Abuse from neglect occurs when the abuser denies the abused person basic things the person needs in order to remain healthy and well​ (e.g., not providing adequate shelter from the​ elements, making one subject to the cold without a​ jacket, or denying the person​ food).

You are called by the police to a particular street address. When you​ arrive, you are directed to a police​ cruiser, where a​ 7- or​ 8-year-old boy is sitting in the back​ seat, covered with a wool blanket placed by the officer. The officer reports that the patient was found sitting outside in the cold with no winter​ coat, locked out of his house. As you evaluate this​ boy, you find that he is unusually thin for his age and dirty. Which type of abuse best categorizes this​ patient? A. Sexual B. Physical C. Psychological D. Neglect

A. She is likely a victim of a date rape drug. Date rape drugs are powerful agents that cause​ drowsiness, unresponsiveness, or other​ mood-altering effects. The purpose is so that the abuser can rape the other person without the victim fighting back​ and, in some​ instances, not even remembering having had sex or who they had sex with.

You are called to a party at a fraternity house where an​ 18-year-old girl was found in an upstairs bedroom passed out. When you walk​ in, you find the girl to be responsive to painful​ stimuli, she has dilated pupils and slow​ breathing, and she is naked from the waist down. No one at the party seems to know who she is. What may have happened to the​ patient? A. She is likely a victim of a date rape drug. B. She most likely got drunk at the party and went upstairs to​ "sleep it​ off." C. She is likely either a diabetic or epileptic. D. She was probably abusing meth and suffered a stroke.

D. Emotional Emotional abuse occurs when the abuser verbally accosts the abused with​ derogatory, hurtful, or inflammatory statements.

You are called to help an elderly patient back into bed who has fallen out. While you are doing​ so, the​ man's daughter with whom he lives returns home from work. She is instantly angry and starts calling him​ dumb, stupid,​ useless, and a pain. What is the best description of this type of​ abuse? A. Physical B. Sexual C. Neglectful D. Emotional

C. The patient is being neglected. What you have witnessed are signs of acts of omission. The​ patient's malnutrition,​ dirtiness, and ulcerations all point to a lack of needed​ care, not to acts of commission that would signal active abuse.

You are called to the home of an elderly patient who is reliant on his daughter for ongoing care. His daughter is also on​ scene, having just arrived home from work. During your assessment of the​ patient, you find him to appear malnourished and​ dirty, and he has multiple areas on his body where ulcerations are forming. Despite your desire to transport​ him, the daughter keeps​ stating, "Just leave him​ alone, he's fine.​ I'll make an appointment sometime​ soon, so just leave​ now." What should you conclude about this​ patient? A. The patient is experiencing the normal problems of aging. B. The patient is being emotionally abused. C. The patient is being neglected. D. The patient is being physically abused.

D. Institutional elder abuse The two basic types of elder abuse are domestic and institutional. Domestic elder abuse takes place when an elderly person is being cared for in a​ home-based setting, usually by relatives. Institutional elder abuse occurs when an elderly person is being cared for by a person with a legal or contractual responsibility to provide​ care, such as paid​ caregivers, nursing home​ staff, or other professionals.

You are called to treat an elderly patient who​ "fell while​ walking," according to the extended care facility staff where you picked him up. During your​ assessment, you find multiple injuries to different locations of his​ body, the patient looks malnourished and​ dirty, and you read in his medical records that he has a debilitating brain injury that rendered him unable to ambulate. What type of abuse may this​ be? A. Heath​ care-based abuse B. Domestic elder abuse C. Service elder abuse D. Institutional elder abuse

D. Concern over a​ parent's absence After many years of​ abuse, children often adopt a very flat​ affect, meaning that they really​ don't show many emotions.​ However, they may have sudden outbursts of poor behavior or have an excessive fear of EMS assessing them because the injury patterns of abuse may be found. Concern for an absent​ parent, though, is not as common.

You are caring for a​ 13-year-old girl who you believe is a victim of physical abuse. If this is​ true, which of the following characteristics of the abused child would most likely not be​ present? A. Sudden behavior changes B. Fear of letting EMS perform a physical assessment C. Absence of emotions D. Concern over a​ parent's absence

C. Her daughter Too​ often, the person abusing the patient is not only someone the person​ knows, it is a family member. Some people do not have the​ time, energy, coping​ skills, or support system to deal with​ long-term care of a patient​ (even if​ it's a​ relative), and abuse may start to emerge.

You are caring for a​ 79-year-old female patient who is noncommunicative and dependent on care by her daughter after suffering a debilitating stroke four years ago. During your​ assessment, you find bruises all over her body in various stages of healing. If this patient is being physically​ abused, who would most likely be the​ perpetrator? A. The medical supply delivery team B. Her home care physician C. Her daughter D. The housemaid

C. ​"Were you sexually assaulted by​ him?" In assessing the abused​ patient, direct questioning usually works best. Convey an awareness that the​ person's partner may have caused the harm or created conditions that led to the injury​ and/or the emotional trauma. Once the subject of abuse has been​ introduced, exhibit a willingness to discuss it. Any statements the patient makes should be carefully documented.

You are gathering a past medical history of a patient who you​ suspect, on the basis of physical findings and clues you have noticed on​ scene, was sexually assaulted by her​ boyfriend, who fled the scene. During this​ process, which of the following questions should you​ ask? A. ​"I promise not to tell the hospital​ this, but did someone touch you​ inappropriately?" B. ​"Is there something important that​ you're not telling​ me?" C. ​"Were you sexually assaulted by​ him?" D. ​"Is there a secret about what happened today that I need to​ know?"

B. Leave the scene and call for police. Although this is an emotionally charged​ situation, the paramedic should leave the scene and call for police support. At no time does the paramedic have a duty to act when faced with a potentially dangerous situation. It will do no good to anyone if you become injured by the man in any ensuing struggle.

You are on scene where a patient says that she was sexually assaulted by her new boyfriend. The boyfriend left the scene before your​ arrival, but he returned while you were still there. He starts to yell at you and​ screams, "Over my dead body you will take her out of​ here! Now leave​ immediately!" What should you do​ next? A. You and your partner should restrain the man physically while the woman goes to the ambulance. B. Leave the scene and call for police. C. Try to calm the man down while your partner sneaks the woman out of the back of the house. D. Pick up the patient and rush out of the house.

D.. Leave the scene and call for police

You are on scene where a patient says that she was sexually assaulted by her new boyfriend. The boyfriend left the scene before your​ arrival, but he returned while you were still there. He starts to yell at you and​ screams, "Over my dead body you will take her out of​ here! Now leave​ immediately!" What should you do​ next? A. You and your partner should restrain the man physically while the woman goes to the ambulance. B. Try to calm the man down while your partner sneaks the woman out of the back of the house. C. Encourage the patient to immediately leave the house with you. D.. Leave the scene and call for police

B. disrupted the chain of evidence. In the case of​ rape, any evidence that you collect must remain in your custody until you can give it directly to a law enforcement official to preserve the chain of evidence. Failure to do so can result in evidence destruction and the inability to admit the evidence into a court of law.

You are preparing to transport a young female patient who was​ assaulted, raped, and left unresponsive in her​ apartment, where she lives alone. You are preparing to transport the patient when the family shows up. They tell you that they will bring with them to the hospital the clothing that you had to remove during your assessment. By not keeping that clothing in your​ custody, you​ have: A. implicated unaffiliated people in the crime. B. disrupted the chain of evidence. C. failed to incorporate Standard Precautions. D. interfered with local EMS protocols.

C. Alert law enforcement immediately. If you believe you have identified someone who is or may presently be in a human trafficking​ situation, alert law enforcement immediately. It may be unsafe to attempt to rescue a human trafficking victim yourself. You have no way to know how the trafficker may react and retaliate against the victim and you.

You are treating a patient who you suspect is a victim of a forced marriage as a result of human trafficking. The​ patient's spouse is hovering​ nearby, and you feel that his presence is influencing the​ patient's responses to your questions. What should you​ do? A. Ask the patient to leave the scene with you. B. Tell the spouse to leave the room. C. Alert law enforcement immediately. D. Ask the spouse about the circumstances of his marriage to the patient.