Management of OSCC Cases

Shageetha r
 What is OSCC?
• The One Stop Crisis Center (OSCC) service is an integrated and comprehensive
multiagency service center established in all Emergency and Trauma Departments
(ETD) of the Ministry Of Health for the management of survivors of domestic
violence, sexual assault, child abuse and neglect.
• The survivors are seen at the center where all agencies converge to manage them.
 OBJECTIVE
To provide multidisciplinary care of the survivors.

To identify and manage survivors of domestic violence, sexual

assault, child abuse and neglect.

To provide treatment and multilevel crisis intervention to

survivors.

To ensure the delivery of optimal care and evidence

management for the survivors.

To ensure appropriate management of medico legal evidence.

The OSCC shall work with the police to assist in evidence
management for medico legal purposes.
 Components of OSCC Service

• Rape and sexual assault

• Child abuse and neglect
• Sodomy
• Domestic violence
 Level 1:
Involves
initial
hospital
management
Level 2 : Involves
follow up
Level 3: Involves rehabilitation
programs with
various agencies & legal
proceedings
LAYOUT/COMPONENT
 Emergency and Trauma Department
Obstetrics and Gynecology Department
Pediatric Department
Surgical Department

MULTIDISCIPLINARY Forensic Department

TEAM
Psychiatric Department
Medical Social Services
Counseling Unit
Social Welfare Department
Royal Malaysian Police
Relevant Non-Governmental Organizations (NGOs)
 ED
• Responsible for the initial management
• Include : triage, history taking, general physical
examination, clinical stabilization, treatment of injuries,
and evidence collection other than that obtained from
vaginal examination.
• Evidence obtained in the Emergency and Trauma Department
shall be managed and handed to the Police Officer with
preservation of chain of evidence.
• Coordinate the management of OSCC cases
O&G

• Referrals to relevant team members.

• Primary team for the management of alleged rape and
female child sexual assault survivors
• history taking, clinical examination, sample evidence
collection, treatment and medico legal documentation.
• assess if there are female perpetrators implicated.
 • The Pediatric Department and/or SCAN team shall
manage suspected child abuse and neglect.
• Evaluate the impact of the child abuse and neglect
Paediatrics • determine child’s safety
• Assist with reports required for the child’s protection
to prevent further abuse or neglect
• Coordinate child and family rehabilitation after
discharge.
Surgical

• Management of sodomy survivors

• Assessment of alleged sodomy perpetrators
Forensic
•

• Consulted for fresh/acute cases that require evidence

management consultation
• The forensic specialist with clinical forensic subspecialty may
takeover the medico legal management
 Royal Malaysian Police
• All survivors with police report shall be accompanied by a Police
Officer to the hospital.
• The Police Officer shall be present at the OSCC to receive a new
police report or obtain statement from the survivor or parent/
guardian.
• Responsible for the receipt and preservation of chain of evidence.
• Protecting the survivor from harassment by the alleged perpetrator.

NGO
• Counseling and shelter placement.
• Provide relevant information about supportive organizations
 RAPE

A man is said to commit “rape” when he has sexual intercourse with a woman under the following:
circumtances :
• Against her will: This means that the women is capable of giving her consent but consciously rejects
sexual intercourse and is forced into it.
• Without her consent. Sexual intercourse may take place without the women’s consent because she is

incapable of giving her consent.

• With her consent when consent has been obtained by putting her in fear of death or hurt to her or
any other person, or obtained under misconceptions of the fact, and the man knows or has reason to
believe that the consent was given in consequence of such misconceptions.
• With her consent when the man knows that he is not her husband, and her consent is given because
she believes that he is another man to whom she is or believes herself to be lawfully married or to
whom she would consent.
• With her consent through deception.
• With her consent, when at the time of giving such consent, she is unable to understand the nature
and consequences of that to which she gives consent.
• With or without her consent, when she is under sixteen years of age (statutory rape).
 Penetration is sufficient to constitute the sexual intercourse necessary to the offence of rape.
Exception Sexual intercourse by a man with his own wife by a marriage which is valid under any written law
for the being in force, or is recognized in Malaysia as valid, is not rape.
u Explanation 2
u A woman:
a) living separately from her husband under a decree of judicial separation or a decree nisi not made
absolute; or
b) who has obtained an injunction restraining her husband from having sexual intercourse with her, shall be
deemed not to be his wife for the purposes of this section.
u Explanation 3
u A Muslim woman living separately from her husband during the period of iddah, which shall be
calculated in accordance with Hukum Syara, shall be deemed not to be his wife for the purposes of this
section.
Sexual assault - Under Section 354 of the Penal

assault or use of criminal force on a person with intent to

outrage modesty
Type of cases

Fresh /Acute Case

• < 72 hours from the incident

Cold Case

• > 72 hours from the incident

Level of Hospitals
-based on availability of services

Level A hospital (HKL & State hospitals)

• All hospitals with O&G Specialists, Pediatricians and Medical Social Worker if available.

Level B hospital (Other hospitals with O&G specialist)

• All cases in Level A & B hospitals must be seen by an O&G Specialist as soon as possible as the
experience and credibility of the doctors will be a focus in court. Doctors must be able to
describe highly technical matters in simple straight forward language. Handling of all cases
requires expertise in interpretation of vaginal injuries and collection of specimens to meet the
needs of the judicial system.

Level C hospital (Hospital without O&G specialist)

• All cases in Level C hospitals shall be seen by Medical Officer with months training post
housemanship in O&G or to discuss the case with the covering O&G Specialist. The Medical
Officer during their training in O&G Department must be credentialed and privileged to see
such cases. A total of 5 cases and 2 reports under supervision of the specialist are necessary
before they are privileged to see cases on their own.
Ways of presentation to ED

u Walk in : with or without police report

u Brought by parents / guardian / teacher / child protector.
u Pregnant
u Brought in semi-critical or critical condition
u Referred from Level C Hospitals or Health clinics
u Emergency and Trauma Department Call Centre / MECC
Triage

u The survivor should be escorted by well-trained staff whereby pre-counseling

can be given while awaiting further management.
u The registration process should be done by the health personnel
u If the patient is clinically stable, secondary triaging (taking of vital signs) can
be done in the vicinity of the OSCC room.
Prior to Examination
1. Police report
u If patient already lodge the police report, the police will escort patient and held Borang Pol59 for the request
of examination
u Age >18 : adviced for police report if not yet made
u Age < 16 : police report must be done urgently
u Child suspected (presented with genital pain / dysuria etc) : to lodge within 24 – 48 hours after examination
u Critically ill or mentally unstable : to be made by the attending Medical Office or Sp
2. Borang Pol59
u If the police report is not readily available, examination of the patient can be done with only the Borang Pol59
3. Consent
u Legal age for consent : 18 years old
u Age >18 :
u Stable : survivor consent
u Unstable : Specialist or Police
u Age < 18 : parents, legal guardians, Police Officer or Child Protector
Borang Pol59
Consent
History taking

u Primary team : OnG

u Doctors’ function is not to determine if rape has occurred.
u Rape is a legal term, not a medical term
u Use of standard terminology : General physical injury
Event Description :

u Record precisely, in the survivor’s

own words
u Include the name of the assailant,
and use statements, such as
“survivor states” or “survivor
reports”.
Survivor preparation

u Introduce yourself.
u Date and time of the examination and the name of staff present during the
interview and
u examination to be noted.
u Ensure that the trained support person of the same sex accompanies the
survivor throughout
u the examination.
u Explain to survivor
u Reassure the survivor
u Limit the number of people allowed in the room during the examination
u Preferably O&G, Surgical and Forensic Specialist not to be called to examine
the survivor at the same time
 Fresh case < 72 hours

u The earlier you see the patients the more findings will be obtained
u The Police Officer should be present at the time of examination to collect the
forensic specimens.
 Physical Examination Genital Examination Management

• Purpose : assess and • Identify and retrieve any • Wound : dressing, pain
treat physical injuries, stains, secretions, fibers, management
collect evidence hairs or particles that • EUA
• Never ask the survivor to could be relevant to the • Emergency
undress or uncover police investigation contraception
completely • Precise documentation • Levonorgestrel 1.5 mg
• The survivor should of all injuries orally
disrobe while standing • Detection of sexually • Copper IUCD within 5
on a brown paper to transmitted infection days of incidence
catch any falling debris, • If there has been vaginal • IM ATT
hair or fiber. penetration, gently • Multiple assailants
• Record the anatomical insert a speculum,
position, dimension and lubricated with water or • T Doxycycline 100 mg
shape of the wound normal saline BD x 2 weeks
• Look for presence of • T Metronidazole 200
• Examine most common mg TDS x 2 weeks
sites of extra genital foreign body in the
trauma : mouth, throat, vagina. • HIV Prophylaxis
wrists, arms, breasts and • IVDU
thighs • Bisexual/homosexual
• Use of pictogram • Practice of unsafe sex
• Referral to PSY
Sample sent
Chemistry Laboratory by the Police Officer:
• - Swabs from the cervical introitus for semen (DNA)*
• - Swabs from posterior fornix, high vaginal swab (HVS) for semen (DNA)*
• - Low vaginal swab (LVS) for semen (DNA)*
• - Blood for DNA
• - Blood for Alcohol
• - Blood for Drugs
• - Finger nails clippings : if the survivor scratched the assailant.
• - Any foreign material/ hair : for DNA.
• - Collection of clothing items for DNA to be dried and packed individually to prevent cross transfer.
Virology Laboratory by Police Officer:
• - Swabs from post fornix for microbiological examination.
• - Swabs from cervical introitus microbiological examination.
• - Blood for infective screening. (HIV, HBsAg, VDRL/TPHA)
Cold Case : > 72 hours

Physical Examination Genital Examination Management

• Note the size and color of • healing injuries to genitalia • UPT, USG – Referral for
any bruises and scars. and/or recent scars antenatal check up
• Rape complication : • Hymen and intraoitus injury • Wound management
deafness, fractures, • Vaginal examinationis not • IM ATT : incubation 3-21 days
abscesses, etc required if patient comfirm • Multiple assailants
• Sign of pregnancy pregnant • T Doxycycline 100 mg BD x
• survivor’s mental state 2 weeks
whether withdrawn, • T Metronidazole 200 mg
depressed, or suicidal. TDS x 2 weeks
• HIV Prophylaxis
• IVDU
• Bisexual/homosexual
• Practice of unsafe sex
• Referral to PSY
Pictogram
Chain of evidence

u All specimens :properly labeled, sealed and packaged.

u Collection of these specimens is to be documented, signed, witnessed and
dated.
u Each step of evidence collection should be documented by the attending
nurse, O&G Specialist/Medical Officer, Police Officer and laboratory staff who
collects and handles the specimens.
u Transport and delivery of DNA specimen as well as blood for DNA, drugs and
alcohol to the Chemistry Laboratory is the responsibility of the Police Officer
u Blood for infective screening VDRL/TPHA, HbsAg, HIV to be sent to the
hospital Virology Laboratory by the Police Officer. Swabs from post fornix and
endocervix for microbiological examination are to be sent to the hospital
Virology Laboratory.
Criteria for admission
1. Survivors requiring medical management for acute physical and emotional trauma.
2. Concern for personal safety of survivor. Admit if case is seen after office hours to be referred to
the Medical Social Worker/Social Welfare Department/NGOs for shelter and protection.
3. All suspected child sexual abuse after discussion with the SCAN team/Pediatrician/Adolescent
Pediatrician. All suspected intra-familial child sexual abuse or those involving young children below
12 years of age must be admitted for protection and more detailed history taking.
4. Survivors who are pregnant and present with complications due to pregnancy.
5. Survivors requiring acute management of vaginal trauma requiring examination under anesthesia
(EUA).
▪ All < 5 years child should have EUA to confirm findings. If the child is cooperative/ not distraught, examination
can be carried out in OSCC.
▪ If the older child is fretful and refuses to be examined the child needs to be admitted for EUA.
▪ In the presence of painful injuries e.g. vaginal wall tear.
▪ Risk of sexually transmitted disease and child does to allow adequate swab.
▪ If there is suspicion of a foreign body.
CHILD ABUSE AND NEGLECT
Definition

u CHILD – all those aged below 18 years

u CHILD ABUSE or NEGLECT Constitutes all forms of physical abuse and/or
emotional ill-treatment, sexual abuse, neglect or negligent treatment or
commercial or other exploitation, resulting in actual or potential harm, to the
child’s health, survival, development or dignity in the context of a
relationship of responsibility, trust or power. - WHO Violence Injury and
Prevention Team, 1999
 SCAN TEAM
This is a multidisciplinary team of hospital staff, comprising….
a) Paediatricians
b) Gynaecologist
c) Surgical
d) Mental health professionals-Psychiatrist/caunsellor/Ustazah
e) Accident & Emergency (A&E) staff
f) Forensic pathologist
g) Nurses
h) Medical social worker (work together with designated welfare officers from Jabatan Kebajikan
Masyarakat -JKM)
i) Police officers

Evaluate and manage child abuse cases.

Classification
Level A

Level
B

Level C
Level A –HKL and state hospital
Member
u Paediatrician Role
Medical social worker (Paediatric department)
u
• Provide consultation or
u JKM officer support to other
u Police officer professionals who are not
u Specialist e.g. Paediatric department, Emergency
specialized in SCAN cases
department, O&G, Psychiatry and Forensic • Identify gaps in services
department. and to participate in long
u Paediatric/OSCC nurse term planning for child
u Counselor or Psychologist protection services
• Accept referrals from
Level B & C hospital
Level B - Hospital with specialist
Member Role
u Paediatrician
u Specialist/MO from O&G, Emergency
• Provision of such care as in
Department, Psychiatry ,Forensic Level A hospital although this
Department may involve the referral of
u Medical social worker cases to Level A hospital with
u JKM officer specialized services` for
u Police officer complex cases
u Nurse
Level C -Hospital without specialist
Member
u FMS/Hospital Director
u Senior nurses/Medical assistant
u JKM/Police officer
Role

u Expected to consult or refer all scan cases to hospital with specialist

Role of Various Members

Doctors

Nurses Medical Social

Worker

JKM Officer Police

Doctor

• To examine and evaluate for scan

• To treat physical injuries and mental health problems
• To work with the welfare officer and police officer to
protect the child
• To meet the needs of the criminal justice and child
protection system by careful documentation of injuries,
collection of evidence and interpretation of findings
• To provide reports and opinions of medical examination,
including that of psychiatric assessment of emotional
trauma that can be used as evidence in care or criminal
proceedings
• To represent the hospital in JKM Child Protection Teams
Doctor Role under Child Act 2001

u A medical officer before whom a child is presented under subsection 20(1) or

(4)—
u (a) shall conduct or cause to be conducted an examination of the child; (b)
may, in examining the child and if so authorized by a Protector or police
officer, administer or cause to be administered such procedures and tests as
may be necessary to diagnose the child’s condition; and (c) may provide or
cause to be provided such treatment as he considers necessary as a result of
the diagnosis.
u If the medical officer who examines a child under section 21 is of the opinion
that the hospitalization of the child is necessary for the purposes of medical
care or treatment, a Protector or police officer may authorize the child to be
hospitalized.
u If a child is hospitalized under section 22, the Director General shall have the
like control over, and responsibility for the maintenance of, that child as a
person in charge of a place of safety would have had if the child had been
placed in that place of safety.
u (1) If, in the opinion of a medical officer, the child referred to in section 21
requires treatment for a minor illness, injury or condition, a Protector or
police officer may authorize such treatment.
u (2) If, in the opinion of a medical officer, the child referred to in section 21 is
suffering from a serious illness, injury or condition or requires surgery or
psychiatric treatment, a Protector or police officer— (a) shall immediately
notify or take reasonable steps to notify and consult the parent or guardian of
the child or any person having authority to consent to such treatment; and (b)
may, with the written consent of the parent or guardian or such person,
authorize such medical or surgical or psychiatric treatment as may be
considered necessary by a medical officer.
u If a medical officer has certified in writing that there is immediate risk to
the health of a child, a Protector may authorize, without obtaining the
consent referred to in subsection (2), such medical or surgical or psychiatric
treatment as may be considered necessary by the medical officer but only
under any of the following circumstances:
u (a) that the parent or guardian of the child or any person having authority to
consent to such treatment has unreasonably refused to give, or abstained
from giving, consent to such treatment;
u (b) that the parent or guardian or the person referred to in paragraph (a) is
not available or cannot be found within a reasonable time; or 36 Laws of
Malaysia Act 611
u (c) the Protector believes on reasonable grounds that the parent or guardian
or the person referred to in paragraph (a) has ill-treated, neglected,
abandoned or exposed, or sexually abused, the child.
Steps to be taken after medical
examination or treatment
u 1) A child who is taken into custody under section 18 and is medically
examined or treated under section 21 shall be brought before a Court For
Children within twenty-four hours—
u (a) of the completion of such examination or treatment; or
u (b) if the child is hospitalized, of his discharge from the hospital.
u (2) If it is not possible to bring the child before a Court For Children within
the time specified in subsection (1), the child shall be brought before a
Magistrate who may direct that the child be placed in—
u (a) a place of safety; or
u (b) the care of a fit and proper person, until such time as the child can be brought
before a Court For Children.
u (3) A child who is taken into custody under subsection 20(4);
u shall be returned to the person from whose care the child was taken— (aa) upon
the completion of such examination or treatment; or (bb) if the child is
hospitalized, upon his discharge from the hospital.
Nurse

• To foster awareness among nursing staff, particularly in emergency and paediatric

department of the signs of child abuse
• To maintain close communication with social worker/police and doctor in handling
the cases
• To ensure close observation and documentation of the child’s behaviour with staff,
parents and visitors
• To coordinate SCAN meeting (secretariat)
Medical Social Worker

• To do social assessment and conduct home visit if

necessary
• To assist doctors in reporting and coordinating with JKM
• To maintain data on child abuse and neglect cases
handled by hospitals

Police

• Provide immediate protection to child and non-abuser

parent or family member
• Investigation of offences and assisting prosecution of the
offender
 Child Protector

u “Protector” means— (a) the Director General; (b) the Deputy Director
General; (c) a Divisional Director of Social Welfare, Department of Social
Welfare; (d) the State Director of Social Welfare of each of the States; (e) any
Social Welfare Officer appointed under section 8;
u E.g JKM
u Role:
u Investigation and social assessment of whether child is in need of further care
and protection
u Ensure protection of child and placement of child in a safe environment
u Assist in rehabilitation of child and family
u Provide financial assistance, schooling and other social support
u To provide data to National Registry on SCAN cases
Hospital Departments

Paediatric Department

Emergency O&G
Department

Psychiatric Forensic
Department Services
Management - Flow Chart

Brought by parents/ Brought by police/

teacher/ public to NGO/GP
the hospital Referral to the hospital

Triage at Accident & Emergency

Crtitical/Semi Critical Non- critical

At emergency department
Call relevant specialist OSCC/Ward
Give acute care
Proper documentation & Review by SCAN team
collection of evidence as Examination/
required Treatment
JKM/Police report made
Case conference
Discharge according to case conference decision
Inform child protector and police about the
discharge
Follow-up appointment

Review at follow up and plan rehabilitation

Critical/Semi-Critical

u Attended immediately in acute zone of A&E

u Police report done urgently for all cases of sexual abuse (<72 hours) and
physical abuse where the child’s life is at risk
u The MO has to lodge a police report if parents not available or unwilling. In
cold cases(>72 hours) report can be lodged in 24 to 48hours
Non-Critical

u Patient directed to OSCC ward

u Paediatric team on call informed
u Assess need for admission or discharge
MO in ED

u Treat life threatening condition

u Examine and stabilize patient
u Take care not to tamper with forensic evidence
u Examine child together with relevant department e.g. paediatrics or O&G
u All examination findings documented in case notes
u Relevant forensic specimens collected, labeled and directly given to the
police officer
u Photos may be taken by police officer prior to cleaning wounds
Referral…

u Medical illness (convulsion, fracture, vaginal discharge)

u Behavioural problems
u Psychological problems
u Alleged abuse or assault
u Found abandoned
Admission

u Require medical treatment

u Safety is a concern
u All cases of child sexual abuse
u Presentation after office hours for adequate assessment by SCAN Team.
Consent

u Parent or guardian
u Police officer with written order (Borang P59)
u Order by Child Protector

JKM notification
• Doctors are mandated by law to report to JKM (Borang 9)
BORANG 9
BORANG 4
Police report

When should report be made (by MO):

u For all sexual abuse cases
u For severe or chronic physical abuse
u In children with severe neglect
u Urgently in life threatening situations or at immediate high risk
u When there is risk of future substantial harm or other child under the care of
alleged perpetrator

u Penalty to doctor if not make police report?

Follow up

u All abused children need follow up

u To ensure the potential of the child is optimized
u FMS and community nurses are involved in follow up
u All cases are informed to JKM officer prior to discharge from the ward.
SODOMY
Definition

u Sodomy -sexual intercourse between 2 persons by introduction of penis into

the anus of another person.
u S377A - “any person who has sexual connection with another person by
introduction of penis into the anus or mouth of another person is said to
commit carnal intercourse against the order of nature”.
u S377 (c) when the above act committed without the consent or against the
will of another person, or by putting the other person in fear of death or hurt
to the person or any other person.
u S377 (CA) the above offences is committed by introduction any objects into
the vagina / anus of the other person without the other person’s consent.
Type of cases

u Fresh = Acute = < 120 hours

u Cold = Non Acute = >120 hours
Triaging System

u Critically / semi-critically : EDRZ /EDYZ >> respective department concerned.

u Stable victims >> directed to the OSCC.
u Acute cases should be seen within 90 minutes upon arrival at the OSCC.
u If > 120 hours since the assault :
u complete physical examination should still be conducted
u to examine for injuries to the body and the genitalia
u to offer treatment
u provide information for support resources.
 Clinical Medicolegal/Forensic Examinations
- 2 basic but very important requirements

1. Borang Polis 59 “ Permintaan untuk pemeriksaan bagi orang yang

terlibat dalam kes polis”.
2. Consent from the patient
If > 18 years old. If the patient refused, don’t proceed.
If < 18 yrs - from parents or guardian or protector or police officer. S20
and S21 Child Act 2001.
Consent before examination
u Informed consent for :
- physical examination
- Samples from body
- private parts examination
- samples from private parts
- photograph of injuries
- photograph of genital injuries
- use as evidence in court
Anorectal Examination

u For all acute cases external anal swab should be collected.

u 1 First, swab the area around the anus for DNA. Then another swab on the
perianal region. Third swab from any area of the perianal region is for
microbiological examination.
u 2. The sphincter is dilated using an appropriate size, preferably lubricated
proctoscope. While examining, 3 internal swabs shall be taken (2 swabs for
DNA and 1 swab for microbiology test).
Adult Sexual Assault Survivor

Evidentiary examination
• Clothing/trace evidence
• Nail scrapping, scalp hir, pubic hair

ED Survivor Physical • Reference blood for DNA

• Reference blood for STI
Triage interview Examination • Cotton swab : skin, injury site,
body orifice

Collection of Collection of foreign Anorectal

clothing material Examination
DOMESTIC VIOLENCE
Definition - Domestic Violence
(Domestic Violence (amendment) Act 2012) is the commission of one or more of the following acts:
u Willfully or knowingly placing or attempting to place the victim in fear of physical injury;
u Causing physical injury to the victim by such act which is known or ought to have been known would result in
physical injury;
u Compelling the victim by force or threat to engage in any conduct or act, sexual or otherwise from which the
victim has right to abstain;
u Confining or detaining the victim against the victim’s will;
u Causing mischief or destruction or damage to property with intent to cause or knowing that it is likely to cause
distress or annoyance to the victim;
u Causing psychological abuse which includes emotional injury to the victim;
u Causing the victims to suffer delusions by using any intoxicating substance or any other substance without the
victim’s consent or if the consent is given, the consent was unlawfull obtained; or
u In the case where the victim is a child, causing the victim to suffer delusions by using any intoxicating substance or
any other substance; and
u By a person whether by himself or a third party, against:
u his or her spouse
u his or her former spouse
u a child
u an incapacitated adult
u any other member of the family
Definition - Spouse
• Husband, wife
• ex-husband or ex-wife
• “de facto spouse”
• a person who has gone through a form of ceremony which is recognised as a mar
riage ceremony.
• According to the religion or custom of the parties concerned, not-withstanding t
hat such ceremony is not registered or not capable of being registered under a
ny written law relating to the solemnization and registration of marriage (Dom
estic Violence Act of 1994).
• Heterosexual cohabitant partners where unmarried heterosexual couples live toget
her in a relationship that resembles a marriage.
Defination-incapacitated adult

u Means a person who is wholly or partially incapacitated or infirm, by reason of

permanent or temporarily physical or mental disability or ill health or old age
Interim Protection Order, IPO (Domestic
Violence Act of 1994):
u Issued by the court
uProhibiting the ‘assailant’ to have another
opportunity!!!
u A police report must be lodged first.
Protection Order, PO (Domestic Violence Act of
1994):
u Issued by court
uRestraining the person
against whom the order
is made from inflicting
domestic violence.
The Emergency Protection Order (EPO)

u The Emergency Protection Order (EPO) is issued by the social welfare

department (JKM), can be obtained immediately — in most cases, within two
hours after you apply for it at JKM.
u The EPO may contain one or more of the following orders:
u prohibiting the perpetrator from using domestic violence against the survivor
u prohibiting the perpetrator from inciting any other person to commit
domestic violence against the survivor; or
u prohibiting the perpetrator from entering the survivor’s safe place, shelter,
place of residence, shared residence or alternative residence.
u The EPO is valid for seven days. You don’t need to make a police report in
order to obtain an EPO. You can apply for an EPO before obtaining an Interim
Protection Order (IPO) or Protection Order (PO).
Sample / Evidentiary Collection
Labelling and sealing the sample
Form and envelope to be given to police
officer
Personnel Protection before Evidence Collection and
Handling

u The Doctor, SN, MA’s and any

assistants must wear :-
Head Covers
Gloves
Masks
Disposable Aprons
u These PPE’s must be changed in
between examination of other
patients
a) Microscopic examination
- to determine type of hairs (head or pubic hairs)
b) DNA Analysis (if hair roots are present)
– to determine its origin

About 12 hair strands is enough

Nail scrapping
Examine and document the clothings
Torn from the front neck to the lower chest

Smear of mud on the lower front end

Clothing Evidence
u Collection of clothes that may potentially contained evidence eg
blood, seminal stains, hairs, fibers, dirt, paint contracted at the scene
or from the assailant
u If the patient has not changed cloth after the incident. Some patients
may changed clothes but not the undergarments.
u During undressing, the Doctor should examine the clothing at least for
any blood, seminal stains or dirt.
u Each piece of clothing collected should be placed in a separate paper
bag (Not plastic bag) to avoid cross contamination
Physical Evidence swabbing
Forensic specimens
Chain of Custody of Evidence

u Name of the attending doctor collecting the evidence.

u Name of the person handling the evidence.
u Name of the person receiving the evidence.
u Date and time of transfer of the evidence must be clear.
u All evidences and specimens collected must be sealed and labeled.
u There should be a proper documentation of the transfer of the evidence or
specimen.
REFERENCE
One stop crisis centre : policy and guidelines for hospital, ministry of health Malaysia