In the ED

Emergency management of physical health should be performed as per the presenting complaint(s), with focus on resuscitation and stabilisation of the patient.

Safeguarding concerns should be raised to the most senior doctor in the department at the earliest possible moment, and the appropriate services contacted according to local protocols (details below).

Where indicated, emergency contraception should be offered in the ED. This decision should be guided by the sex of the victim and the perpetrator, as well as the nature of the offence. Remember that SARC attendance might be delayed or disrupted, and consider offering emergency contraception with this in mind.

Up to 72 hours after the assault offer Levonorgestrel 1.5mg as a stat dose (Levonelle). Ulipristal acetate (EllaOne) and copper intrauterine contraceptive device (Cu-IUD) are licensed for use as emergency contraception for up to 5 days, and where EC is indicated you should advise that Cu-IUD is the most effective form of emergency contraception. More detailed advice is available in this FSRH EC guidance.

Learning bite

For patients with a BMI > 26 or a weight > 70kg, there is evidence that levonorgestrel has reduced efficacy. In this group of patients, offer ulipristal acetate or a double dose (3g) of levonorgestrel.

Risk assess the victim for exposure to blood-borne viruses. This may differ from usual exposure policies, as the donor might not be known, or be unwilling to attend for testing.