According to Georgia law (O.C.G.A. §19-7-5), healthcare providers are required to report any abuse (obvious or suspected) to law enforcement. This law stipulates that EMS are mandatory reporters of child abuse. What is considered child abuse is not always cut and dry, however there are typical types of abuse that can be seen by the ambulance crew:

• Neglect may include inadequate health care, education, supervision, protection from hazards in the environment, and unmet basic needs such as clothing and food. Neglect is the most common form of child abuse.
• Physical abuse may include beating, shaking, burning, and biting. The threshold for defining corporal punishment as abuse is unclear. Rib fractures are found to be the most common finding associated with physical abuse.
• Psychological abuse includes verbal abuse, humiliation, and acts that scare or terrorize a child, which may result in future psychological illness of the child.
• Sexual abuse is defined as “the involvement of dependent, developmentally immature children and adolescents in sexual activities which they do not fully comprehend, to which they are unable to give consent, or that violate the social taboos of family roles.” Some cases of sexual abuse do not need to involve oral, anal, or vaginal penetration and may include exposure to sexually explicit materials, oral-genital contact, genital-to-genital contact, genital-to-anal contact, and genital fondling.

Assessment

Ambulances aren’t typically dispatched to cases of child abuse (that is more of a law enforcement matter). Ambulances are typically dispatched to a call where the patient or someone at location is sick or injured, and happen to come across a situation where a child may be abused. If the medics have some suspicion that a child is being abused, they should request law enforcement to the scene to investigate. Also, relay any suspicions to staff at the ER, as they are also mandatory reporters as well. Law enforcement or the hospital staff may request child protective services to the scene to investigate and may take the child into protective custody.

It is not the role of the ambulance crew to confront an abuser. The medics can help by keeping their eyes open. Listening for inconsistencies in explanations of injuries, measuring the caregiver’s behavior, and physical findings should move the index of suspicion toward abuse. The patient care report is a legal document that can be subpoenaed (requested for view by a judge). Ensure that any observations made by the ambulance crew are documented. Some medics worry that their lack of writing skills will not be helpful in a court of law, but these worries are unfounded. Attorney’s, judges, law enforcement have their own ways of documenting such issues, and when called to testify, the medic will be asked to explain in their own words what they wrote in the narrative of the patient care report.