The week of Little 500 is known as a “reproducible mass disaster” at the IU Health Bloomington Hospital Emergency Department.
The department calls in its entire staff to tackle the large influx of patients that fill its waiting room during the latter part of the week, Emergency Department Director Dr. Drew Watters said.
A room is reserved specifically for drunk students. The students often have to wait six to eight hours before treatment because they are too drunk to speak coherently to nurses.
“There’s only so many beds in the ER,” Watters said. “There’s just no place to put them.”
Alcohol and sexual assault
High amounts of alcohol consumption often occur hand-in-hand with higher numbers of sexual assault, Watters said. A large portion of the sexual assault cases the hospital receives involve IU students.
They often don’t know how much they’re drinking or where they’re drinking, said Brandy Summers, sexual assault nurse examiner.
They lose control, and this puts students at much higher risk of sexual assault.
Regardless of the location or circumstances, nurses urge patients to come to the hospital as soon as possible after the sexual assault.
Going to the hospital if you have been sexually assaulted
If a patient arrives within 96 hours of a sexual assault, they can receive a sexual assault forensic examination, often called a “rape kit.”
Without forensic evidence, it is more difficult for prosecutors to press criminal charges following a sexual assault. Time is of the essence, Watters said.
A victim who receives a forensic examination is not required to report the sexual assault to the police. Forensic exams not given to the police are stored for a year under a specific case number. If the DNA is collected and stored, a victim can later decide to report the case.
“You’d rather collect it and not regret it,” Watters said. “Reporting is a huge step in the process to regaining independence.”
Sunday evenings or Monday mornings are the most common times that sexual assault victims visit the hospital, Summers said. These times fit within the 96-hour requirement, but the sooner victims come in, the more evidence they might have for their cases.
She urges sexual assault victims not to shower after an assault and, when possible, not to change clothes. She realizes this a difficult and counter-intuitive request for victims who have just experienced the trauma of a sexual assault. But each time a victim showers, more and more DNA gets washed away.
What happens at the hospital
The nurse takes the patient to a specific room — room 19. It’s where the hospital keeps all items necessary for sexual assault forensic examinations.
He or she tells the patient she is sorry this happened, that it is not the patient’s fault and that the recovery process starts now. The patient is in control.
The nurse then asks the patient to tell them what happened. Where did it take place — in a bed, a car, the floor of an apartment? Were you physically coerced — were you restrained, shoved, abducted, choked? What were you wearing at the time, and what types of sexual acts did the perpetrator commit?
“When we ask you, ‘Did they bite you?’ we’re not saying, ‘Did you bite back?’” Summers said. “We’re looking for where we can find DNA.”
Summers realizes that when a victim describes sexual assault, it’s like he or she is being assaulted all over again.
Watters said he tries not to push patients to tell him what happened.
“I don’t care what happened sexually,” Watters said. “I will assume everything was done. My perspective is on the wellness of the body.”
The patient is then asked whether or not they would like to report the sexual assault to the police. If a patient decides not to, Summers said she aims to find out why.
Sometimes, it’s because they knew the perpetrator well. Other times it’s because they don’t trust the legal system.
Every patient copes with the stress of a sexual assault differently.
“Some just want to get it over with, some are hysterical, some are laughing,” Summers said. “The patient who is laughing and giggling is treated the same as the person who is crying hysterically.”
The patient is offered the chance to work with Bloomington-based Middle Way House, a domestic violence program and rape crisis center, to receive support and legal advocacy.
Next, the nurse will begin the sexual assault forensic examination process, if the patient decides to proceed with it. She takes a blood sample from the patient and then begins collecting external DNA.
“We start least invasive to most invasive,” Summer said.
If it’s been less than six hours since oral contact, the nurse flosses the patient’s teeth and collects swabs from the mouth. She takes finger nail scrapings, in case the patient was able to scratch the perpetrator.
The patient is asked to comb his or her own hair to look for hairs that don’t belong.
The patient is then asked to remove all clothing except undergarments, if they’re willing. The nurse asks to keep the patient’s underwear as evidence, providing a replacement pair.
She looks for any visible injuries, and she uses a special black light to search for bodily fluids on the skin. She then performs the genital exam, gathering DNA from the patient.
The next steps
After all evidence is documented, the nurse offers the patient medication for STD prevention. If it’s been within about three days, the nurse offers emergency contraception, also known as Plan B.
She then helps prepare the patient for recovery. If the patient is a student, the nurse helps arrange for a follow-up with the Sexual Assault Crisis Service through IU Health Center’s Counseling and Psychological Services.
“If they call while they’re here, they’re more likely to go to SACS,” Summers said.
The IU Health Center also offers two trained nurses who can perform sexual assault forensic examinations, but they are only available during business hours.
Most importantly, Summers urges students to be careful and responsible. She tells students never to leave friends by themselves at parties.
“We’ve had some people say, ‘She was fine, so we just left her at the party,’” Summers said. “They’re leaving her in unknown territory.”
She encourages students to seek blunt consent before having sex.
Physical cues are not enough — both individuals must give verbal confirmation.
But if a sexual assault does happen, Watters said the best thing a patient can do is respond as quickly as possible.
“If something happens, it is not the end,” Watters said. “It is just the beginning.”