A study to determine perceived and actual knowledge of Cape Town emergency medical care providers with regard to child abuse

Abstract

Aim: The aim of this study is to determine the level of perceived and actual knowledge of Cape Town emergency care personnel when dealing with children who acutely disclose incidents of sexual abuse. Method: Operational EMS personnel and emergency medicine registrars in emergency centres located in the Cape Town metropolitan area were asked to complete a quantitative questionnaire with an optional qualitative portion. Informed consent was obtained and the participants' anonymity was guaranteed. A total of 120 voluntary participants - made up of 30 doctors, 30 Advanced Life Support personnel, 30 Intermediate Life Support personnel and 30 Basic Life Support personnel - took part in the study. Findings: This study reveals that EMS personnel and emergency medicine registrars believe that they are inadequately trained and equipped to deal with situations in which a child discloses abuse. They remain capable of treating physical injuries but feel inadequate, frustrated and helpless when confronted by incidents of child abuse. The current EMS syllabus (with particular reference to its teaching and application in the Western Cape metropolitan area) is limited in the coverage of this subject. The syllabus only addresses types of abuse and how to treat the physical injuries relating to abuse, leaving many gaps in the knowledge of medical personnel. With specific reference to sexual abuse, there is a paucity of information in the syllabus relating to how children who disclose their experiences of abuse should be managed. The current training syllabus does not include any information that could lead to an understanding of disclosure, the manner in which it evolves, why children are not always forthcoming with disclosure and more importantly, what to say to children when they disclose abuse. Conclusion: When EMS personnel are called to a scene of child abuse they are uniquely first person the child encounters directly after the abuse is frequently an EMS member. This person is afforded a unique opportunity to observe the behaviour of the victim as well as that of the child's caregivers. They are also able to corroborate the mechanism of injury and verify aspects of the story as given to them by the caregivers, thus being more easily able to identify situations of suspected child abuse. More comprehensive training is required to enable EMS members to effectively and confidently deal with cases involving suspected or confirmed child abuse as well as disclosures of abuse by the patient.