Crime Scene Investigation

An Internship Report submitted

in the partial fulfillment of the requirements of the
degree of
Bachelor Of Forensic Science

Submitted By:
Hamid Anees

Session 2021-2025

Department of Forensic Science

Faculty of Medicine & Allied Health Sciences

The Islamia University of Bahawalpur.

 Certification

It is certified that Hamid Anees has complete her/his six weeks

of crime scene Internship at crime scene unit of District Police
Office. During the duration of six weeks from 13/05/2024 to
23/06/2024. She/he regularly visited the crime scenes and
participated in evidence collection and Investigation. The
content of this report is Satisfactory and should be processed
for Evaluation; to be processed for award of degree.

Dean:
Faculty of Medicine and Allied Health Sciences
Prof. Dr. Saeed Ahmad

Mr. Sami Ullah Malik

Supervisor,

Mr. Qadeer-Ul-Hassan
In-charge,
Department of Forensic Science, IUB.
 Declaration

I,Hamid Anees hereby declare that the internship Report

submitted to the department of FS, is a record of an original
work done by me during the period from 13/05/2024 to
23/06/2024 under the supervision of Mr. Peer bakhsh, at CSU.

This report has not been submitted to any other institution or

university for the Award of any degree or diploma. The
information presented in this report is true to the best of my
knowledge and belief.

I understand that any form of plagiarism is an offence and I

have acknowledged all sources of information used in this
report.
 Dedication

I would like to dedicate my Achievement to my parents for

their unconditional love and endless prayers. No words can
describe the everlasting love of my parents to me. I owe a lot to
them; they encouraged and helped us at every steps of my life.
Their unwavering faith and confidence in my abilities always
motivated me.
And also dedicate this thesis to my respected Supervisor Mr.
Sami Ullah for his guidance, continuous support, and
motivation towards the task of learning.

Hamid Anees
 ACKNOWLEDGEMENT

I glorify with the depth of my heart to almighty ALLAH (‫)ﷻ‬,

Lord of the worlds. All praises to Prophet Hazrat
Muhammad (‫ )ﷺ‬who is the real embodiment of human
mortality. He showed humanity the actual supreme status that it
deserves.
I would like to express my deepest gratitude to my supervisor
Mr. Sami Ullah. Department of Forensic Science, Faculty of
Medicine and Allied Health Sciences, The Islamia University
of Bahawalpur, for his guidance and invaluable advice. His
constructive comments and suggestions throughout the
practical work report have contributed to the success of this
report. His timely and efficient contribution helped me shape
this report into its final form. I consider it my privilege to have
accomplished this report under his right guidance. His guidance
helped me all the time in writing this report. I could not have
imagined having a better supervisor and mentor for our BS
study. I have learned so much, and without you, this would not
have been possible. I am also grateful to Prof. Dr. Saeed
Ahmad, Faculty of Medicine and Allied Health Sciences. The
Islamia University of Bahawalpur, for providing great facilities
for conductance of such experienced internship.
 Introduction to
The Islamia University Of Bahawalpur

Foundation:
The roots of The Islamia university of Bahawalpur go back to
1925 when it was initially established, as Jamia Abbasia. This
institution was founded as a religious seminary by the Nawab
of Bahawalpur, Sadiq Mohammad khan V. the primary aim
was to provide Islamic Education and promote religious
scholarship in the region.

 In 1975, Jamia Abbasia was elevated to a full-fledged

university of Bahawalpur and renamed The Islamia
University of Bahawalpur.

Campuses:
The university is divided in to 3 sub campuses;

1. Abbasia Campus

2. Khawaja Fareed Campus:

3. Bghdad ul Jadeed Campus:
 Introduction to
Department of Forensic Science

The department of Forensic Science at Khawaja Fareed campus

IUB, is located on Railway road, BWP. The IUB established
this department of FS in 2021 under the faculty of Medicine
and Allied Health Sciences. This department offers BS (HONS)
program in Forensic Science. This department gets to upgraded
under the supervision of chairman Prof Naveed Akhtar, Dean
Dr. Saeed Ahmed, HOD, Qadeer ul Hassan and other faculty
members.

Visions:
 Inter-disciplinary education.

 Hands-on training and lab work.

 Focus on ethics and legal standards.

 Create internship programs with local labs.
 Provide career counseling resources.
List of Figures:
List of Abbreviations:
 Table of Page
Contents
No
Chapter No 1
Introduction to CSU
1.1 Abstract 13
1.2 Background and introduction 13 & 14
15
1.3 Aims & objectives 16
1.4 Equipment and Trainings 16 & 17

1.5 Importance 19

1.6 Role in criminal justice system 19 & 20

Chapter No 2
Crime Scene
Investigation
2.1 Abstract 20

2.2 Introduction 21

2.3 Protection of scene of crime 22

2.4 Tools and equipment 23

2.5 Methods for searching evidences 24 & 25

2.6 Types of Evidence at different crime scenes 25 & 26

2.7 Steps involved in Processing of Crime scene 26 & 27

2.8 Handling & Packaging of Evidence 28

Chapter no 3
Sexual Assault Of Women
3.1 Introduction 30
 3.2 Care of Sexual Assault survivor 31
3.3 Patient History and Physical Examination 32
3.4 Tips for taking History 32
3.5 Documentation and Collection 32 & 33

3.6 FIR 33 & 34

3.7 Medicolegal Examination 35
3.8 Victim Demographics Information 35
3.9 PFSA Sexual Assault case Submission Guidelines 37
3.10 PFSA DNA and Analysis Report 37 & 38
3.11 Judgement 39

Chapter No 4

Rape And Sexual

Violence
4.1 Abstract 40
4.2 Introduction 40 & 41
4.3 Statistics 41
4.4 Historical Pespective 42
4.5 Health Sequelae Of Sexual Assault 42 & 43
4.6 Trauma Informed Care As A Guiding Framework 43
4.7 Screening For Sexual Violence 43
4.8 Evaluation of Acute Presentation 46
4.9 Evidence Collection And Documentation 47
4.10 Diagnosis And Treatment 48
4.11 Delayed Presentations 51
4.12 Prevention 51
Summary &
References
Executive Summary
References 54 & 55

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 CH # 01
Introduction to CSU
Abstract
The CSU is a core part of the criminal investigation model and
is dispatched to the scene of the crime to thoroughly examine
collect through photography and secure any evidence within the
scene. Such division has the important accountability to deal
with physical evidence appropriately and this is central to
envisioning resolution of legal disputes and strengthening legal
cases. The personnel within the CSU are well trained in
different areas of forensic studies and are involved in serving of
different acclamation such as digital, DNA, blood stain pattern
analysis, fingerprint, etc., to support the evidence. They ensure

that the evidence collected during the interview and at the

crime scene is preserved a appropriate procedures and
technology is used up to the time when it will be called upon to
be produced in the court. This research outlines various aspects
of the CSU including its roles, qualifications of the workers, the
resources it has, and why it is so crucial in maintaining the
legal system with focus on what it proactively provides to the
criminal justice system, particularly the accurate evidence to
assist in the determination of guilty or innocence.

Fig:1.1 Crime Scene Investigation Van

Background
The Crime Scene Unit (CSU) originated in the early days of
forensic science and a growing demand for specialized
investigative skills within law enforcement. Traditionally, law
enforcement personnel with limited scientific skill sets and
typically good powers of observation would be the ones to
conduct the investigation. As crimes started to get more
sophisticated and evidence-based, it became necessary for a
change in crime scene investigation techniques.
With the advent of these new forensic science technologies and
those who were proficient in using them including especially
specializations like fingerprint analysts, bloodstain pattern
analysis or ballistics — made a call for more specialized
training which was spurred on by two landmark cases at the
turn of the 20th century: Forefathers, such as Alphonse
Bertillon, who brought to the table anthropometry
(identification by body measurements), and Sir Francis Galton
with fingerprint classification established a structure for our
modern day scientific crime scene investigations. These
methods showed how proper care of a crime scene and
evidence collection helped solve cases.
With the advancement of forensic science, it became evident
that a more systematic and scientific method was needed for
collecting evidence. This eventually led to the creation of
specialized Crime Scene Units (CSU) within police
departments. Teams were required, but they needed to be ones
of specialists who had garnered an understanding beyond that
gained on a basic police training course and obtained additional
forensic skills which could withstand the scrutiny of legal cross
examination.
With the invention of DNA and other technologies by mid-20th
century, CSUs had become a fundamental apparatus in
contemporary law enforcement. From high resolution cameras
to custom forensic kits and digital forensics tools, the units are
a new age tech battleground! Training of CSU personnel
stretched past crime scene evidence gathering to include
forensic photography, preservation of trace analysis and the
emerging field digital forensics.
The CSU now serves as a vital piece of law enforcement, where
they take care to process and photograph crime scenes the right
way, ensuring no stone is left unturned while collecting
evidence for future scientific uses. In no small impact, their
work has been responsible for greater numbers of convictions
and fewer wrongful exonerations.
It has its origins in the history of forensic science and our
growing requirement to gain scientific evidence to solve crimes
and convict offenders. As forensic science has evolved, so too
have the series of advanced techniques available to
investigators today.

Introduction
The specialized group that negotiates post-crime scenes and
takes further charge in the collecting and preservation of
evidence from a crime scene is known as The Crime Scene
Unit (CSU). The more astonishing aspect of their job role
includes guarding the place, taking snaps of the scene,
collecting physical evidence and ensuring it remains free of
some other contamination for further use. In particular, this
team is made up of forensic experts, detectives and technicians
with varying proficiency in evidence-collection techniques.

The specialized group that negotiates post-crime scenes and

takes further charge in the collecting and preservation of
evidence from a crime scene is known as The Crime Scene
Unit (CSU). The more astonishing aspect of their job role
includes guarding the place, taking snaps of the scene,
collecting physical evidence and ensuring it remains free of
some other contamination for further use. In particular, this
team is made up of forensic experts, detectives and technicians
with varying proficiency in evidence-collection techniques.
In the past, crime scenes were handled by general police forces
but as science progressed forensic units such as CSU (Crime
Scene Units) were created. They are usually equipped with
state of the art evidence collection and forensic analysis tools
that form an integral part all modern law enforcement.
In addition to their work at the scene, members of CSU may
also be required to act as expert witnesses in court. They testify
about how evidence was recovered, the state of it and its
connection to a case. This is why it has become so important to
make use of reliable, statistical data as a method of
safeguarding the legal process and ensuring its fairness.
Crime scene units (CSUs) play an especially important role in
investigation of offenses through accurate collection and
analysis of physical evidence. These specialized units are
uniquely essential for the maintenance of the lack of contact
with contamination and protection, which is vital when solving
a case legally. Fundamental components of CSUs encompass:
Organization and People in Responding Unit
Crime Scene Unit
CSUs are normally made up of highly accomplished crime
scene investigators (CSI’s) that assist in law enforcement
investigations. When proper management structures are put in
place and specific functions assigned in the overall unit
productivity is enhanced.
Evidence Collection and Processing
A steady advancement in these fields of forensic science
especially in the field of DNA analysis together with the
emergence of new innovations in processing techniques has
revolutionized the way collection of evidence is conducted. In
as much as training and acquisition of specialized equipment
cannot be over emphasized for the efficient handling of the
various crime scenes, it is a revelation that the number of Crime
Scene Units across Britain and Ireland is on the decrease.
Quality Assurance and Standards
The above is achieved by the Forensic Science Regulator who
is expected to ensure that the forensic services provided have
complied with the set scientific quality standards, something
very important in enhancing the credibility of evidence that is
presented in court. Continued staff training and certification of
employees become essential for the maintenance of the high
standards. A continuous education and certification of
personnel is necessary for maintaining high standards.
Understanding The Nature Of Crime Scene Units (CSU) Crime
Scene Units (CSUs) are essential in criminal investigation ; but
factors such as the Improvements in technology, and the need
for training may obscure their working capability. The balance
of these factors is essential for the efficient running of the
crime scene and the maintenance of the admissibility of
evidence.

Aims and objectives

Aims and objectives of a crime scene unit as are inherent
therefore have the following overall approach: Crime scenes
are methodically and systematically searched and evaluated
with a view to identifying and securing physical evidence. This
procedure is crucial when attempting to connect offenders to
crimes and for understanding the events which took place.
Principal objectives encompass: 1. Ensuring the documentation
process of crime scene through photographs, sketch and notes
that contain a detailed information. 2. The process of collecting
and preserving physical evidence in order to reduce the chance
of contamination or destruction. 3. Participating with
policemen and/or other officers, and working together with
forensic experts to analyze evidence and construct hypotheses.
4. Presenting professional evidence in court for the purpose of
proving the genuineness of the obtained evidence. 5.
Continuously updating and training of procedures regarding the
enhancement in technologies and procedures within the field of
forensic science. This all embracing affair not only supports the
credibility of the investigation but ensures the community
develops trust in the criminal justice system as well.

Collection and preservation of all sorts of evidence

Investigative work where the searcher looks for physical
evidence such as fingerprints, blood stains, textile fibres among
others. use of high profile forensic technologies like DNA
fingerprinting and fingerprint recognition. Preserving the non-
tarnishable nature of collected evidence by ensuring proper
documentation and handling.
Crime Scene Reconstruction
Participating logical synthesis and using the scientific
procedures in order to explain given evidence. Drawing
hypotheses to how the occurances chronologically unfolded
based on the gathered evidence. Applying actions which are
hypothetical in the setting of the laboratory in order to validate
various hypotheses.

Equipment
Accoutrements utilized by the crime scene investigation teams
is a critical success factor to the investigative undertakings and
the gathering of forensic proof. Basic equipment includes
mobile chemistry equipment, advance imaging technology and
special body bags which are developed to prevent deterioration
of forensic items. These enhancements substantially enhance
the usefulness and exhaustive nature of crime scene
assessments, which in turn helps to preserve desensitised
evidence. The following delineates the principal categories of
apparatus utilized in crime scene investigation units:

Portable Analytical Equipment

Ion Mobility Spectrometry

Used for real-time surveillance of narcotics and other
explosive commodities.
Mass Spectrometry
Enables both qualitative and quantitative evaluations of
chemical compound commodities
Gas Chromatography
Effectively analyzes fluctuating compounds existing at the
scene of the crime.

Imaging Systems

Three-Dimensional Terrestrial Laser Scanners

Foster complicated spatial reference knowledge relative to
matters of criminal incidents.
High-Resolution Electronic Imaging Systems
File fluorescent markers using high-definition Charge-Coupled
Device cameras

Specialized Body Bags

Crime-Scene Body Bags
Equipped with electronic data storage systems, fingerprint scan
technology and GPS for tracking objects/tangible/evidential
values.
 While these instruments greatly enhance the efficiency of
crime scenes investigations, there are challenges such as cost
and access barriers that may limit the broad adoption of these
instruments in different jurisdictions, therefore the need to
reinvent and propagate knowledge in forensic technologies.

Training
In recent years training of crime scene units has grown to
embrace better approaches of training the investigators.
Examples of recent developments are scenario-based training
aids, augmented reality applications, and mixed-reality systems
because they enhance both decision making and motor
competences. They respond to the dynamics in crime scene
investigation, as well as the need for blended learning
solutions. Key aspects include:

Scenario-Based Training
Explicitly incorporates knowledge acquisition methodology
that is used to replicate complicated crime scenes.
Utilizes senior Scene Examiners to provide example responses
that enrich its application of experience-based education.

Augmented Reality Integration

AR capability permits concurrent training of decision making
and psychomotor skills for the employee.
Enhances the accessibility /safety /availability and at the same
time, reduces the overall required spending in comparison to
conventional training centers.

Mixed-Reality Systems
Includes option to complete static and moving simulations of
actual crime scenes, which improves learning by experience.
The feedback given involves high satisfaction by the users and
high efficiency in enhancing the skills.

Importance
Crime scene units’ significance is derived from the focal
responsibility of a systematic evaluation of all criminal
incidences. The desired characteristics are needed for CSUs to
effectively collect, archive, and examine physical evidence,
without which, successful prosecutions cannot be obtained.
Their operation is based on legal procedural laws including the
Locard Exchange Principle to make sure that all evidential
trace is recorded and handled in a way that it does not corrupt
the incident. However, there has been tremendous development
on the side of forensic technology; this requires CSU personnel
to undergo further training in how to use the new technology.
Key aspects of CSUs include:

Collected and preserved as evidence

Looking for forensic clues in the form of fingerprints, blood
stains and /or fibre.
Application of different methods of evidence collection
including use of vacuum sweepers and lifting.

Documentation and Analysis

Photographic record, drawings, and paperwork.
The incorporation of techniques of the forensic laboratory to
map out a crime scene.

Training and Equipment

Periodic training of personnel on existing and emerging new
technologies on the forensic field.
Necessity of having befitting apparatus to manage different
types of crime scenes.

As effective agents in the criminal investigations, issues like

evidence tampering and the aspect of training of CSUs show
that they have their operations complicated. Preserving the
crime scene is one of the greatest concerns of the justice system
as a whole.

Role in criminal justice system

The crime scene unit seems to be an essential component of the
criminal justice structure because it implements the crime and
then passes it on for investigation. Their fundamental duties
encompass:

1. Preserving the Crime Scene:

Securing the area

This includes the preservation of the crime scene in order not

to compromise the credibility of collected evidence and in
order to minimize the loss of evidence.

Identifying and marking evidence

They carefully define and categorize the likely exhibits in
order to comprehensively detail and properly recover them.

2. Collecting Evidence

Gathering physical evidence

The unit professionally gathers several types of identification
such as fingerprints, samples of human DNA, thin fibers, and
tools used at the scene of a crime.

Packaging and preserving evidence

This must be done in order to make certain that evidence
accrued during an investigation, or from the scene of the
incident, is not compromised.

3. Documenting the Scene

Taking photographs
They take general photographs of the crime scene to make sure
that such photographs are taken from different views.
Creating sketches
It describes that they draw out accurate sketches of the scene
mapping how the evidence and other important elements fit.
Taking detailed notes
They do record details, observations, measurement alongside
other important factors associated with the crime scene.

4. Analyzing the Evidence

Identifying potential suspects

The unit may use the evidence to build the possibility of who
the suspect may be or may not be depending on other
parameters such as age, sex, or occupation.
Linking evidence to the crime
They try to make link between the suspect, the victim and the
scene of the crime based on information gathered.

5. Expert Testimony
Testifying in court
Specialist officers engaged in the crime scene unit can provide
critical insights to elucidate the significance of the evidence
and its implications.
Supporting the prosecution
Their evidence plays an instrumental role in aiding the
prosecution, thereby facilitating the court's ability to convict the
offender. Consequently, it can be asserted that criminal
investigation is fundamentally reliant on the crime scene unit.
They employ a comprehensive methodology in addressing
cases by ensuring the meticulous collection, preservation, and
analysis of vital evidence that contributes to substantiating a
case and advocating for justice.
 CH # 02
Crime Scene Investigation

Abstract
Criminal forensic investigation is a very sensitive stage of
investigation. We know it as the convergence of science, logic
and law.
Criminal investigations at the scene are time-consuming and
methodical, requiring thorough documentation, photography, or
demography, depending on the circumstances and location of
the evidence.. The gathering of any physical clue that would
shed light on the incident is challenging, as it's impossible to
completely eliminate the obscurity surrounding it. However,
the process aims to clarify what occurred, offering insights into
how and who was involved, also possibly that scene is not in
original condition, in fact, there’s no ‘normal’ pattern in the
occurrence of this phenomenon,roofs and there are no
conventional methodology used in investigative cases. Each
CSI unit or section involved in the separation of lab work and
field time has its own purpose,asu, headquarters owned CSI
unit, CSI temporarily at a new site. work and lab work in a
different way. A1l crime scene investigators must always
remember that they are not forensic scientists. Many detectors
perform field investigation as a result I need to provide them
the evidence and also get the witness statement in an advanced
forensic exams and report. These investigations also present
specific strategies as well as recommendation to the agency
workers to fix incident scene precautions to prevent
inadmissible evidence, spoiled and eradicable evidence.
 Fig:2.1 Crime Scene Investigation

Introduction
Identification and retrieval of tangible evidence mark the start
of the inquiry at the spot. Following the examination and
development of the physical evidence and papers that have
been found, along with the testimonies of the witnesses, the
complete findings are then presented to the court. All staff,
including first responders and information users at the end,
should be sufficiently knowledgeable about the forensic
process, including identification, recovery, collection,
preservation, transportation, and appropriate documentation to
uphold the chain of custody. Since the crime scene is the site of
the initial encounter, the process of investigating it aims to
document it as well as identify and gather all tangible evidence
that may be useful in solving the case.
The exact spot or location where the incident occurred is
known as the scene of crime or place of incidence. When police
officers arrive at a crime site, they usually start their
investigation there first. First responding officers are the
members of the police force who arrive at the crime scene first
(FRO). The crime scene and its evidence are appropriately
guarded by the first responding officer (FRO).
The ability of the first responding officer to correctly identify,
isolate, and secure the evidence (s) is critical to the success of
the overall investigation. By creating a limited perimeter, the
crime scene can be made secure. This can be accomplished by
use crime scene tape, rope, or barriers.
One or more locations of events may be involved in an
incident's investigation. At another place, there might be
multiple secondary or tertiary crime scenes in addition to the
primary crime scene. The scene of a crime is any area (indoor,
outdoor, car, etc.) where an incident has happened or where
evidence of that crime has been found and linked to a specific
incidence.
In essence, a incident site is the location (s) where the crime
has committed or where possible clues of the offence has been
found.
A crime scene is more than just the spot where the crime was
committed. A crime scene is the location or locations where
relevant evidence relating to a specific incident may be found
or recovered.
All of these crime scenes should be thoroughly examined
throughout an investigation to discover the real story behind the
incident. Even the most difficult crime scenes can be
successfully investigated through high good or advance
practice if a good crime scene detector applies methodical
along with logical technique. Every crime scene is different.
The scientific method of investigating a crime scene entails
measuring, photographing, and documenting the scene,
gathering and packaging tangible evidence, and then
reconstructing the scene.
When investigating a crime scene, the evidence's chain of
custody must be meticulously adhered to.
The initial responding officer, who is usually a police officer, is
crucial to the success of the whole crime scene investigation
procedure. Maintaining the integrity of the crime scene and the
evidence is the police officer's first duty.
The early documentation of the crime scene and all of the
evidence found within is another duty of the police officer.
Since first res ponders are typically not forensic specialists,
having proper training on managing evidence at the SOC is
essential to carrying out these tasks efficiently. In cases when
there is a possibility that the evidence will be lost, corrupted, or
destroyed, the first responding officer must carry out certain
basic recovery procedures prior to the reaching of the incident
site detectors.
 Fig:2.2 Introduction Of CSI

Protection Of Scene Of Crime

That is why the primary goal for gathering along with securing
of clues is the protection of the site of incident. The incident
location needs to be secured heavily up to the point when all
photographic and video recording, as well as gathering of clues
is completed from the crime location to ensure that the
collected evidence is not contaminated. The chance of
prosecuting the case may be affected by the state of the
physical evidence when it was collected as well as the position
of evidence. Criminal scene safeguarding gets going with the
landing of the first res ponder on the scene of the crime
(regularly a police officer). Concerning the accessibility
arrangement, entry or exit points must be analyzed. The
individual who initially arrive at the site should take charge of
the the incident site as well as subsequently quantify for the
security that has been provided at the scene.. Information from
any change or disturbance should be derived from individuals
that were within the scene prior to the first res ponder or police
officer’s arrival in order to determine the state of incident site
and location of evidence. Vandalizing is frowned upon and
people allowed or observed to come in or go out of the scene
should record their activities.
 Fig:2.3 Protection of crime scene with cordon

Tools And Equipment

Common hand tools essential for the examination of a crime
scene are provided in a collective format and include
comprehensive crime scene kits and crime scene-specific
apparatus such as face shields, protective ocular wear, safety
kits, digital imaging devices, and forensic illumination sources.
Additionally, five ancillary products are included: crime scene
lighting apparatus, photographic documentation kits, adhesive
identification markers, evidence designation markers, and gas
reference number 50 masks. Other essential tools and
equipment include portable chemical detection apparatus,
explosive and narcotic detection kits, gunshot residue sampling
equipment, fingerprint collection kits, semen analysis kits,
blood detection apparatus, and impression evidence tools such
as tire and footprint examination kits and tool mark analysis
kits. Specialized equipment like arson investigation apparatus,
digital evidence collection toolkits, laptops, and fingerprint
recovery kits are also provided.
 Fig:2.4 Crime scene tool kit

Methods For Searching Evidence

Investigative Techniques Employed by Detectives in the
Examination of Crime Scenes The collection and identification
of physical evidence constitute the fundamental elements of
crime scene analysis. From this perspective, it is imperative to
identify the appropriate methodologies for conducting searches
as required. Such considerations ensure that my crime scenes
unmistakably align with the defined category of crime scenes.
Numerous search protocols may be implemented for
investigation in accordance with the established framework
regarding the crime scene. A selection of these methodologies
is delineated as follows: -

1. Strip Method
2. Spiral Method
3. Quadrant
4. Grid Method
5. Pie or Wheel method
6. Point to point search
7. Aerial search technique
8. Forensic search with technology
9. Canine seach
10. Phtographic search
 Fig:2.5 Crime scene search pattern

Types of Evidence At different Crime Scenes

Impressions evidence:
This category encompasses biometric markers such as
thumbprints,shoe prints,implement marks, among others. 
DNA evidence:
This type includes various organic materials or bodily fluids
Microscopic clues:
This encompasses a range of materials, including gunshot
residues and substances associated with arson, such as
accelerants, paint, glass, and fibers, among others. 
Firearms:
This category comprises weaponry, gunpowder patterns,
bullets, casings, shot, scattered remains, scattershot, and
cartridges, among others.
 Electronics evidence:
This includes devices such as computers, laptops, CCTV
systems, cameras, CDs/DVDs, mobile phones, and wires,
among others. 

Documentary Evidence:
This consists of materials such as suicide notes, letters, printed
documents, writings, notes, registers, files, bills, forms,
property documents, and photographs, among others.
 Chemical Evidence:
 This category includes various chemical substances,
combustible materials, explosive compounds, and related items.
 Digital evidence:
This encompasses technological devices, messages from
technological gadgets, voice communications, random calls,
abduction-related calls, and images, among others.
 Tool:
This includes cutting implements such as knives and axes;
excavation tools like spades; probing instruments such as rods;
impact tools like hammers; and twisting tools such as crowbars,
among others.
 Miscellaneous:
This category includes items such as buttons, bricks, cigarette
butts, ash, soil, and other related materials.

Steps Involved In The Processing Of Crime

Scene

1. Define the scene parameters and consider.

possible safety and health risks
The first thing that the investigators do is find the main point
of contention, the primary scene area. This can be a room
where belonging pillaged, a space where a violence happened,
or the room where an individual was discovered. Laying out
from that point, police set up an area that is big enough to
presumably encompass all, if not the majority, of the physical
evidence that may be there. It becomes easier for the
investigators to contain the size of the scene at a later time than
it is to find that crucial evidence outside the scene has been
compromised by other people or accidentally destroyed by
journalists or audience. Besides, entry/exit opportunities for the
perpetrator are also described. During the initial approach to the
scene there is added emphasis on safety. People might find
themselves facing weapons, bio and chemical threats, and even
purposefully constructed traps on the way. If medical, fire or
coroners will be on scene, they will need some information
concerning evidentiary issues too.
2. Implementation of Security Plan
Following Locard’s Exchange Principle that advances that
anyone coming into contact with a crime scene left something
of himself behind and took something from the scene this
research posits that the scene must be secured as soon as
possible. Furthermore, in an effort to control admission, the
place could be enclosed by a yellow crime scene tape, traffic
cones or other acceptable means. Further, a specific lobby is
normally set and there are people who are supposed to deal
with telephone calls among other tasks, and this area has to
provide place for the identification of all the workers on the site
at the time when the barriers are installed. In addition, the
additional consultation zones and the storage of the materials
could be arranged depending on the current circumstances.
3. Scheme of Investigative Actions, Dissemination
of Information, and Oversight As it is typical for
numerous procedure activities before the beginning of
investigation and evidence collection, hypothesis about specific
nature of given crime must be stated. Therefore, the kinds of
evidence expected are, to a large extent, dependent on the sort
of crime that has occurred and is thus revealed as such to all
stakeholders of an investigation. They may include, for
instance, processes of collecting information from potential
witnesses or any other relevant persons. From this intelligence,
the crime scene investigation team will determine how best it
will tackle the task of crime scene investigation keeping in
mind factors such as weather, time of day and other factors that
can influence this massive exercise. Further, sometimes there
may be a need for more logistical forensic services.
4. Perform a subjective assessment
A scout on the scene is then performed in order to determine
the most important evidence to collect. In this walkthrough, the
lead investigator will note possible sources of evidence,
document a brief description and photo of the scene and the
proffered evidence. These conditions include whether lights
were on or off, and this is recorded to help in investigation;
position of shades and door; position of the movable furniture;
smells, if any; temperature, etc. For this purpose, crime scene
specialists sometimes make a walk-thru in front of the main
area of interest while sweeping that area for evidence.
5. Record and investigate at a crime scene
When a plan is set, the crime scene team carefully reconstructs
the scene and gathers all the relevant piece of evidence. This
requires legible records through pictures or videotaping using
cameras or, in case, a three-dimensional scanner. For some
conditions too, sketches and diagrams are also drawn. While
conducting the evidence collection process, the crime scene
investigator should adhere to the right practice in terms of
handling, packing as well as preservation of the discovered
evidence especially in case where it involves biological
samples. Observations may be washed away by rain, affected
by sun, wind, or other natural conditions, body’s fluids may
degrade by these effects, or inspector can simply fail to notice
blood stains if ALS is not used at the scene
6. A second walk through/second survey
As a measure to check if the scene was searched properly, a
second look at the scene is made.
7. Record and preserve evidence
Being definite about the fact that all evidence has been taken
into consideration, an inventory log is made. The descriptions
entered in the log should correspond with the photo of the
evidence taken on the scene and the description in the crime
scene report. For example, if a gun is collected, the signature on
the firearm in the log of evidence must match the number
shown on the photo taken at the scene or during the collection
process. This paper trail set the chain of custody of the
evidence that will be followed in the life cycle of the case.

Handling And Packaging Of Evidence

Once all photography and conservation work at the scene of the
crime is completed, and after meticulous search for physical
evidence at the scene, the evidence can be collected and
preserved. It is recommended that one person be responsible for
collecting and handling the evidence as this would make it
easier to ensure that the evidence was collected; packaged;
labeled; sealed and stored in a proper manner. Nothing will be
missed, lost or contaminated if one person is solely responsible
for this crucial process in the investigation. I can’t say that
there is a definite procedure about collection of the evidence,
yet, some type of evidence due to their characteristic, should in
some way, be given some priority in order. Fixed, non-volatile
or otherwise erasable evidence should be collected first. Certain
pieces of evidence because of their position within that scene
may be shifted or re-positioned to accommodate other pieces.
Documentation must realize as soon as items are moved and
new evidence is found. The accumulation of physical evidence
cannot be generalized.
Based on the type of PT physical evidence, certain or as
primary receptacles are suitable to hold and preserve trace
physical evidence. Bigger papers can be folded over bigger
objects to secure traces in place for moderation. These folds
are then inserted into outer covers like envelops, packets, cans,
paper bags and shear net bags. The outer containers must
always be properly closed with a security shrink wrap or other
tampering proof material. The outer containers have to bear
information on the contents, the collectible’s owner and
collection date, time and place. The sealing tape or evidence
tape should fully overlay the top of the outer container and it
should be annotated with a repository code, collector’s initial
and collection date and time. At a crime scene, the packaging
containers, sealants, and markers should be of many different
types.
The majority of items of evidence are categorized as being
sound and can be recovered, archived, and conserved in the
above stated ways. Flammable or perishable products should be
stored in sealed, non-disposable containers. Organic Wet,
moist, or living biological evidence can be temporarily
packaged in non airtight containers. It should then be a- lowed
to air dry in a controlled environment and should be repackaged
with the original containers in new non- airtight containers.
Every product should be divided individually concerning the
other so that they don’t mix up with each other. The containers
should be appropriate sealed and labeled at point of collection
to avoid contamination by intermingling of samples during
transfer to other areas. Events, suspects, and other cases may
utilize control standards or alibi standards or those control
samples. The crime scene investigator should always be
conscious of the types of evidential materials gathered and
whether or not controls should be collected and when. For fire
investigation, trace evidence, blood and body fluid stain
examination and questioned documents, control is paramount.
This is because forensic analytical techniques are getting better.
Since the use of samples, the amount of these samples needed
for testing has been decreased while information on probable
sources of the evidence has increased. Due to these improving
techniques and sensitivities the proper collection and packaging
of such physical evidence is very crucial. Sophisticated
laboratory procedures cannot be employed whenever samples
are misplaced or decomposed because of mishandling
performance done at crime scenes.
 CH # 03
Sexual Assault Of Woman

Introduction
Sexual violence encompasses various forms such as intimate
partner violence, human trafficking, forced prostitution,
bondage, exploitation, neglect, infanticide, and sexual assault.
It is a global issue that impacts nearly one third of women
throughout their lives.As compared to the constitutional
meaning of sexual violence which is understood to be inserting
a genital organ against the will of the victim, sexual violence is
defined as insertion of the female reproductive tract, the oral
cavity, or the anal region. Most of the time, the prevalence of
sexual abuse is unreported, and the variables in the calculated
incidence over time vary greatly depending on how the data is
gathered. For example, women seeking medical intervention
have a smaller percentage twelve to twenty percent) than those
from community surveys twenty to thirty percent). Fifty to
eighty percent of sexual offenses are thought to be committed
by the victim's acquaintances. Fewer than 25 percent of
survivors choose to report sexual assault incidents to law
enforcement.An act of hostility committed by the powerful
against the weak is known as sexual violence.While women
and men can both be When women are sexually abused, they
are most danger.Particularly at risk are certain demographics,
such as teenagers; survivors of sexual or physical maltreatment
during childhood; individuals who are disabled; those who have
substance abuse issues issues with abuse; sex workers; people
who are homeless or impoverished; and people residing in jails,
establishments, or military installations dispute.

Fig:3.1 Age ratio of Sexual Assault Fig:3.2 Sexual

Assault ratio of women
Care of the Sexual Assault Survivor
Three aspects about immediate care of victim after
experiencing sexual assault should be addressed: legal,
medical, and psycho social. Police authorities, Healthcare
providers, and Therapeutic care providers coordinate care.
Reassuring the caring of victim along with not at fault for the
attack is crucial.Most females who have engaged in sexual
assault response will arrive at Hospital Intensive care
department. If a victim shows up at the General physician’s
clinic, the doctor must ascertain whether they are capable of
evaluating the patient suitably and, if required, talk to her about
a referral. The choice to refer should be determined by (1) the
accessibility of a different location for evaluation, (2) the time
allotted to finish the assessment (Approximately half an hour to
an hour for the consultation, Plus extra time to arrange social,
legal, and mental health services), (3) the doctor’s experience
in providing care for victims of sexual violence, as well as (4)
the capacity for gather along with maintain suitable proof (such
as items from a "rape kit" on hand). A family doctor's office
offers the advantages of a less daunting environment and a
long-standing relationship with the doctor, which may be
comforting for the survivor. In the event that the victim must
chooses to report about the violence, contacting with the police
is necessary.

“Sexual Violence Kit” and Their Objectives

Item Role
Large sheet of For the victim to stand on while removing clothing for gather
paper any trace sample that may be dislodged.
Kraft evidence Employed for gathering and tagging trace,prevents biological
bags traces deterioration, unlike plastic bags.
Sterile applicators Collects trace from the rectum, Intimate area, as well as
pharynx.
Hair collection Collects trace from genital area
tool
Absorbent paper Used with the aim of collect trace from the hair collection tool.
sheets
Compact Transports blood collection tubes with red and purple tops,
cardboard boxes along with other evidence samples.
Patient discharge Provides information on Accessible neighborhood support
instructions services,Subsequent consultations or visits and relevant contact
 numbers.
Contents Provides purpose, check-off form, and formats for
instructions documenting physical examination and history, ensuring all
relevant evidence is gathered.

Patient History and Physical Examination

The healthcare provider taking the victim’s history should

document it in the victim’s remarks, while maintaining a kind,
nonjudgmental demeanor. The history could seem disjointed
and asynchronous, much like any trauma. A woman may fear
criticism or blame from others because she believes she was
somehow responsible for the incident. Obtaining the victim's
permission at every point of the examination gives her back
control and is frequently mandated by law. A film outlining the
evaluation processes or the inclusion of a victim advocate may
be helpful, if it is accessible.

An assessment for abnormalities is the first step in the physical

examination. In around half of recorded cases, illnesses are
reported., with non-genital injuries being more common than
genital ones. As part of the medical record, Many organizations
make use of a body image to document the size, location, and
specifics of physical damage, like bites, cuts as well as scrapes.
Alternatively, With permission from the victim, body images
may be used.The majority of body injuries are barely noticeable
but any severe trauma needs to be treated right once and takes
precedence over more forensic examination. If there is no
major trauma, the physical examination and evidence collection
can proceed simultaneously.

Tips For Taking History

Advice for Women Who Have Experienced Sexual Assault:
When taking the patient’s history, use her exact words. Employ
the terms “sexual assault by history” or “alleged sexual
assault,” and avoid using the term “rape,” as it is a legal term
rather than a medical one. Note the patient’s age and any
identifying details about the attacker, as well as the time, date,
and place of the assault. Document specific facts surrounding
the incident, such as information on any sexual contact, contact
with internal fluids, along with the victim’s actions following
the violence (for example,washing or shower, dressing, or
douching). Record any use of restraints, such as alcohol, drugs,
or firearms. Additionally, take note of the patient’s gynecologic
history, particularly the timing of her most recent consensual
sexual interaction.

Documentation and Collection

The documentation of evidence in the chain of custody, often
referred to as the chain of evidence, is crucial. This includes
noting what evidence is collected (for example, sperm samples,
torn garments), by whom, when, and how it is transported.
Accurate records of each person who physically handles the
evidence are necessary, as the chain of trace material is
essential in court cases. Most intensive care rooms have a
sexual violence kit along with procedures in place, although the
presence of doctor also crucial. Traces must be gathered from
the victim’s clothing; under the nail by swabbing; hair from the
scalp and pubic area; hair samples; blood samples; and vaginal,
rectal, and oropharyngeal swabs. when the patient is
discharged, they should be given information on available local
support services and recommended follow-up actions. Given
the legal significance of evidence gathering in sexual assault
cases, it is essential to handle this process carefully,doctors
must advised not to assemble a sexual violence kit themselves
unless absolutely necessary.
Under the influence sexual violence must considered if the
victim reports feeling as though “something sexual happened”
or experiencing partial or complete amnesia. The presence of
alcohol or drugs may be used by the offender as a means of
blame, shifting responsibility onto the victim for the assault.
Alcohol is mostly linked with sexual violence and mostly with
illicit, prescription, or Prescription-free medicines.
Common drugs used in these cases include gamma-
hydroxybutyrate (GHB) and many others.

Reference
(Luce, Schrager et al. 2010)

Luce, H., et al. (2010). "Sexual assault of women." American

family physician 81(4): 489-495.

FIR

RYK-SKP-005275 Police Form No 24-5(1)

Making preliminary report and other offense cognizable to the
police under Section 154 of the Compiled Penal Code

No 266/22 Police Station Sadar Khanpur District Rahim Yar

Khan E-Tag No Saddar Khanpur-4/21/2022-1633

Date and Time of Incidence 7 months before

Date\Time Of Report 21-04-2022\10:45 AM

Name and Address Sugran Bibi D\O M subhan
of Informant Basti Kalheri Mouza Kabil Laar Tehsil
Khanpur District Rahim Yar Khan
Occupation House keeper
CNIC No 31301-8075275-9
Phone No 03026559750
Location and After Basti Kalheri Mouza Qabil Laar
Distance From at a distance of 8 Km next to South Lot
Police Station And no 23
Direction
Signature Abdul Hameed
Belt No 494B
Telephone No 03067793121

Proceedings Related investigation If there is any delay in filing

the information, it should be submitted in writing and the
reason for filing the case should be stated.

FIR
Thanks to Mr. SHO of the police station in Mr. Sadar Khanpur.
According to Mr. Highness, Sayla Basti Kahiri Mauza Qabil
Laar is a virgin, a well-to-do inhabitant, and a housekeeper.
About seven months ago, Sayla was going to pull weeds in the
crop field close to her house when Miss Shafiq Ahmad, the son
of Bashir Ahmad of Kahiri village, Kahiri town, appeared from
behind and violently seized her, removing her shalwar.
Witnesses, Saeed Ahmed, son of Noor Muhammad, Qoum
Kahiri, Basti Kahiri, Mouza Qabil, Laar 313012808997, and
Jameel Ahmed, son of Noor Ahmed, Qoum Kahiri, Settlement
Kahiri, Mouza Qabil, Laar 3130145124313, accused Shafiq
Ahmed after she attempted to resist and raised a commotion.
Shafiq Ahmed, the accused, escaped to the field after Sayla
tried to apprehend him upon seeing the witnesses. Out of
embarrassment, her parents, the witnesses, and she remained
silent and did not take action. Sayla and her father went to get
tested on April 19, 2022, and the results showed she was
approximately six months and twenty days pregnant. A
photocopy of the test results is included.
The accused is hereby submitted with a written request to take
action against Muhammad Shafiq for compelling her to commit
adultery. Reported by Muhammad Subhan, daughter of
Sughran Bibi, born in Kahiri Village, Kahiri Mauza Qabil Laar
Tehsil Khanpur. Thumb mark of the applicant, Bibi Action
Police Sughran. At this moment, Sughran Bibi has filed a
written application against Shafiq Ahmed at the police station,
and the transcription of that application has also been received.
Accordingly, it has been determined that the written application
contains the crime under Section 376 T.P. The plaintiff
received the original written application for extradition together
with a copy of the FIR and the final proceedings.

Medico legal Examination

Emergency No 4527

MLC No. 22 AS 2022.

Name of The THA Khanpur.
Institution/Department
Name of The Doctor. Dr Amna Sultan

Victim Demographics Information

Sughran Bibi, daughter of Muhammad Subhan, is a 25-year-old

woman from the Kalheri caste, residing in Basti Kalheri,
Mouza Qabil Laar. Her CNIC number is 31301-8075275-9, and
she can be reached at telephone number 0302659750. She
arrived for examination at 3:00 PM on April 24, 2022,
accompanied by the police, following a court order dated April
21, 2022. During the examination, two distinguishing physical
features were noted: a black mole on her nose and another on
her upper lip. The medical examination was conducted by Dr.
Amna Sultan, MBBS, FCPS, who serves as a Medical Officer
at THQ Hospital Khan Pur. Dr. Amna Sultan has signed this
report to confirm the examination details.

Examination Of Clothes

No blood stain found at the clothes,although clothes were

examined because semen might be present which was a great
evidence. Cuts, tearing,broken button and zippers might be
considered at the crime scene. There were no stains of non
biological evidence

Examination of Body

Victim was average age and well oriented at the time of

incident, cooperative and with average height and weight. No
tears,laceration,bruises,abrasions or swelling.
Old torn of hymen were found and there were no stains of
blood and seminal.

Evidence collected

Vaginal swabs both internal or external swabs and nail swabs

Result

Ultrasound of abdominal pelvic cavity showing (single alive

intrauterine pregnancy of about 22 weeks and 6 days.
Punjab Forensic Science Agency Sexual
Assault Case Submission Guideline For
Serology And DNA Analysis

FIR 266/22 Under 376

21 4/n Section
Police Saddar District Rahim Yar
Station Khanpur Khan
Road 592/21 MLC# 22 As 2022
Certificate 25 4/9 Date Of 21-04-22
Date Of 7 month Medical
Incident before Examination
Name Abdul Hameed Belt # An
ID Card # 31302- Cell # 0306-
6814988-9 7793121
Submitted By

Subject : Victim is pregnant,incident 7 month before

For the case to proceed, certain conditions must be met. First, if

the Medico-Legal Certificate (MLC) examination occurs within
5-7 days following a sexual assault or within 3 days of a
sodomy incident, cervix or anal swabs should be collected and
submitted within these time frames. This is necessary because
sperm cells have limited survival within the body. In instances
where DNA and serology testing are essential, evidence or
samples should be submitted with a letter from the Regional
Police Officer (RPO) providing justification. Additionally, the
victim's clothing will be accepted as evidence only if it was
worn at the time of the incident, bears possible stains from
semen, and has not been washed.
Dated
26-04-2022

Punjab Forensic Science Agency DNA And

Analysis Report

Agency Case No. PFSA2022-499547- Attention to DPO, Rahim

DNA- 079792 Yar Khan

Analysis Request Paternity testing through FIR No. 266/22 (21-04-

Forensic DNA analysis 2022)

Submitting Police Station Sadar Complainant's Sugharan Bibi

Agency Khanpur, Rahim Yar Name
Khan

Mother's Name Sughran Bibi Reference August 18, 2022

Samples
Submission Date

Father's Name.. Shafiq Ahmad

Questioned Child New Born Baby
Item No. Description of evidence as
provided by submitting agency

MI. Buccal swab standards of Sugharan

Bibi.

S1. Buccal swab standards of Shafiq

Ahmad.

CI. Buccal swab standards of new born

baby.

Methodology

Extraction: DNA extraction was performed by Organic

method.
Amplification: Identifiler™ Plus kit using Applied Biosystems
Veriti™ thermal cycler.
Genotyping: Genotyping of amplified products was performed
on Applied Biosystems genetic analyzer 3500 system.

Results and Conclusion

Based on the DNA analysis, Shafiq Ahmad (item No. S1)

cannot be excluded as being the biological father of new born
baby (item No. CI) because they share alleles at all the genetic
markers tested Assuming 50% prior chance, the probability of
paternity is 99.9999992% and combined paternity mdex (CPI)
is 140,531,592.

NIST Caucasian population database of unrelated individuals

was used for frequency calculations.

Disposition of Evidence

Portion of the pertinent item(s), if available, will be stored at

appropriate temperature in the laboratory.

Note: The result(s) in this report relates only to the item(s)

tested.
Date
Issued : 30-09-2022
Judgement
THE STATE VS SHAFIQ AHMAD

PS SADDAR KHANPUR

13.12.2023 Present:

Accused Shafiq Ahmad on bail

Mr. Muhammad Asim khan Advocate, learned defense counsel

Mian Anwar ul Huda Advocate, learned counsel for

complainant

Mr. Farooq ur Rahman Goraya, learned DOPP for the STATE

The accused Shafiq Ahmad S/O Bashir Ahmad, Caste Kahiri

resident of Mouza Kabil Laar Tehsil Khanpur District Rahim
Yar Khan, present in the court, has been convicted U/S 376 and
sentenced for the period of ten years rigorous imprisonment
along with fine of Rs. 50,000, and compensation of Rs.5-Iacs In
terms of section 545-8 Cr.P.C, the whole fine and
compensation recovered from the convict Shafiq Ahmad shall
be paid to the victim Sughran Bibi for medical anguish and
Psychological damage caused by the offence of rape committed
by the convict.

In case of default of payment of fine and compensation, he will

further undergo simple imprisonment for six months
concurrently. Convict Shafiq Ahmad is also extended benefit of
section 382-B Cr.P.C. The convict Shafiq Ahmad has been
given copy of the judgment free of cost. The convict Shafiq
Ahmad is on bail, he be taken in to custody and sent to jail to
serve out the sentence awarded to him along with warrant of
sentence in the name of Superintendent District Jail, Rahim Yar
Khan

Case property be dealt with in accordance with the after expiry

of period of appeal or revision, if any.File be consigned to the
record room after its due completion.

Announced: 13.12.2023.
 (Zahid Hussain Bakhtiar), Add l: Sessions Judge/ Special
Judge G.B Violence, Court, Khanpur

CH # 04
Rape And Sexual Violence

Abstract
Over 40% of women will experience sexual violence at some
point in their lives, making it a serious public health and human
rights issue. Although both men and women can experience
sexual assault, women are more vulnerable. Adolescents,
LGBTQ+ people, and active-duty military personnel are among
the populations that are disproportionately impacted. Sexually
transmitted infections, the possibility of unwanted pregnancies,
mental health conditions like PTSD, and long-term health
problems like persistent pelvic discomfort are all linked to the
health consequences of rape or sexual assault.

Family doctors are essential sources of assistance for survivors

throughout the acute phase after an assault and during the
healing process. Trauma-informed and survivor-centered
practices ought to guide care. The U.S. Preventive Services
Task Force advises universal screening for intimate partner
violence in women of reproductive age, notwithstanding
recommendations from other groups for routine screening for a
history of sexual violence among women. This can be
facilitated by tools such as the Two-Question Screening Tool.

Treatment of physical injuries, preventative antibiotics for

STDs, adequate vaccinations, and sensitive psychological care
are all part of the initial care. When using evidence collection
kits, states and local governments have required providers to
adhere to certain protocols; many hospitals have created
standardized policies and offer certified staff members like the
Sexual Assault Forensic Examiner (SAFE) or Sexual Assault
Nurse Examiner (SANE).

A multimodal approach is required to avoid sexual violence,

focusing on community dynamics, interpersonal interactions,
individual conduct, and larger societal effects.

Introduction

The United Nations describes violence against women as "any

act of gender-based violence that leads to, or has the potential
to lead to, physical, sexual, or mental harm or suffering for
women." This includes threats, coercion, or arbitrary denial of
freedom, whether the act is in public or in private.

Intimate partner violence means any violent behavior by a

current or former partner, which could include physical
aggression, sexual coercion, psychological or controlling
actions that result in physical, sexual, or emotional harm.

Sexual violence is any sexual act, attempt to commit a sexual

act, or acts directed against a person's sexuality, by coercion,
without regard to the relationship between the victim and the
perpetrator or to the location of the incident. This includes rape,
which is defined as forced or otherwise coerced penetration,
however slight, of the vulva or anus with a penis, other body
parts, or objects, by force, using duress, or under threat of
injury.

Sexual assault is a violent behavior primarily motivated by

aggression and anger; most attackers use sexual acts as
a way of gaining power and
control over their victims. It ranges from kissing,
fondling, molestation to rape or attempted rape. Sexual
assault means an incident without the victim's consent,
involving force or a threat of force, as well as actual or
attempted penetration of the vagina, mouth, or
rectum. Statistics indicate that one in eight
women have been raped during their lives and 39% endure
multiple sexual assaults. Most assaults remain hidden due
to guilt or shame on the part of the victims,
or by ignorance on the victim's part as to whether or not it was
a case of spousal or date
rape. Psychological and emotional outcomes of sexual
assault whether reported or unreported, include isolation,
depression, anxiety, somatic complaints, suicide attempts,
and PTSD. These experiences have a significant long-
term impact on the health and well-being of survivors, making
sexual violence a key public health concern.

Survivors often first seek care in EDs, where they may receive
evaluation, evidence collection, medical treatment, and crisis
support. In some municipalities, there are specialized sexual
assault centers or Sexual Assault Nurse Examiners
(SANEs) employed in various locations throughout the
community. However, in most EDs, the role of conducting
the evaluation and care falls to emergency physicians. Thus, it
is essential for EPs
to appreciate the variability of response, including common
injuries seen, as well as undertake evidence-based,
compassionate evaluations
to ensure survivors of sexual assault receive appropriate care a
nd treatment.

Statistics
Recent national telephone surveys estimate that 13% to 18% of
women and 3% of men have experienced either an attempted or
completed rape during their lifetime. However, only 16% of
rapes are reported to law enforcement, leading to significant
under representation in FBI and police statistics. Each year,
between 300,000 and 700,000 adult women in the United States
are sexually assaulted, with approximately 40,000 victims
receiving care in emergency departments.

Contrary to common myths, most sexual assaults are

committed by people who are known to the victim. According
to data from the National Women's Study, 29% of women were
assaulted by acquaintances, 9% by former husbands, 11% by
stepfathers, 10% by boyfriends, and 16% by other relatives.
Only 22% of women reported being assaulted by strangers.
Attacks by an acquaintance tend to be more damaging on the
psychological level, because they are breaches of trust and, in
most cases, abuse that has occurred more than once.

Historical Perspective
Traditionally, rape was defined under British Common Law as
"carnal knowledge of a woman by force and against her will."
This definition is restrictive in that it applies only to women
and excludes men and children and requires the penetration of
the vagina with the penis. It also excluded marital rape, as the
crime was only recognized if committed by a stranger, and
demanded evidence of "utmost resistance." Historically, marital
rape was not considered a crime because women were viewed
as their husbands' property, and a husband could not commit an
offense against himself.

In the 1960s, legal definitions of rape were revised under the

influence of the women's movement. These reforms
incorporated nonsexist language and made sure rape was
considered an act of violence and not the satisfaction of sexual
desire. In the 1980s, further changes included making marital
rape a legally recognized occurrence, a reform now found in all
50 states, although some states continue to require force.
Lastly, shield laws were put into place to ensure the victim's
sexual history could not be brought into court during a trial.

The word "nonconsensual" has replaced the traditional

definition that depended on the presence of physical force,
which, even if no physical injuries have been sustained, the
threat of harm can be coercive. The increased use of drugs in
date and acquaintance rape poses a huge problem, since such
drugs render victims powerless, impair their capacity to give
consent, and in most cases render them unable to remember
events, thus making it hard to identify and prosecute offenders.

Health Sequelae of Sexual Assault

The sexual assaults can have immediate as well as long-term
effects on physical, mental, sexual, and reproductive health.
Physical consequences in the short run might include injuries
such as concussions, gunshot wounds, fractures, or any more
minor abrasions and bruises, with the risk of STIs during
sexually transmitted infections, followed by pregnancy. It is
estimated that about 5% of pregnancies from rape cases are
possible, and these cases are more common in adolescents.
Pregnancies due to rape cases are usually terminated by the
victims.

This will depend on regional prevalence and the nature of the

assault. The most common STIs reported among survivors
include Chlamydia trachomatis, gonorrhea, and trichomoniasis.
These can be associated with pelvic inflammatory disease and
infertility if left untreated infections like chlamydia and
gonorrhea. Another significant risk is the risk of HIV
transmission through vaginal intercourse.

Survivors of sexual assault are at a higher risk of developing

post-traumatic stress disorder (PTSD), and disclosure is often
associated with increased symptoms of PTSD. Military
personnel who experience military sexual trauma are
particularly at risk for PTSD. Survivors also have higher rates
of depression, anxiety, substance use disorders, eating
disorders, sleep disturbances, suicidal thoughts, and attempted
suicide.

Trauma-Informed Care as a Guiding

Framework

A trauma-informed and survivor-centered approach in the care

of sexual assault survivors is critical. Clinicians must be aware
of the effects of trauma and its immediate and long-term health
consequences and create a safe, supportive environment for
survivors. The approach shifts from "What is wrong with you?"
to "What happened to you?"

The Substance Abuse and Mental Health Services

Administration has also provided with a trauma-informed care
framework that may be modified for clinical environments. It is
based on the "Four Rs": recognition of the widespread impact
of trauma and understanding recovery pathways; recognition of
signs and symptoms of trauma in patients; response by
applying knowledge of trauma in policies and practice; and
active working toward preventing re-traumatization at all times.
By implementing this framework, clinicians can improve the
patient experience, strengthen patient-provider relationships,
and achieve better health outcomes. Examples of applying
these principles in practice can provide further guidance for
creating a trauma-informed clinical environment.

Screening for Sexual Violence

The World Health Organization, the American Medical
Association, and the American College of Obstetricians and
Gynecologists recommend screening all women for a history of
sexual violence. The U.S. Preventive Services Task Force
recommends universal screening for intimate partner violence
among women of reproductive age but does not make specific
recommendations for more general screening for sexual
violence.

Most survivors would not disclose experiences of sexual assault

without being prompted, and most of them prefer clinicians to
ask for such histories. Validated tools, such as the Two-
Question Screening Tool, are effective in identifying survivors.
The tool is appropriate for use in primary care and contains two
questions: one concerning intimate partner violence and the
other addressing sexual violence.
"Have you ever been hit, slapped, kicked, or otherwise
physically hurt by your partner?"
"Have you ever been forced to have sexual contact?"
Survivors may be willing to share information at different
times. Some may do it at once, while others might take time.
Clinicians should use uniform and sympathetic approaches
when dealing with disclosures. One such structured method is
the SAVE (Screen, Ask, Validate, Evaluate) method, which
serves as a guide for clinicians in such situations.

Principles of Trauma-Informed Care

Principle Description Examples
Safety Focus on ensuring - Always meet with
both physical and the patient in a
psychological private space.
safety. - Knock on the door
and ask permission
before entering.
- Use empowering
language to build
trust.
Trustworthiness Build and - Explain what to
and Transparency maintain trust expect during and
between the after the visit.
patient and care - Share all
team by being recommendations
honest and clear and the reasons
about processes. behind them.
- Avoid medical
jargon.
Peer Support Engage trauma - Connect patients
survivors to with community-
provide hope and based resources.
reassurance in the - Use supportive
care process. language like, “I’m
here to help you in
any way I can.”
Collaboration and Foster teamwork - Introduce all care
Mutuality by leveling power team members
dynamics and involved.
encouraging - Ask for and
active incorporate the
participation from patient’s input into
the patient. care decisions.
- Sit and face the
patient.
Empowerment, Encourage shared - Ask permission
Voice, and Choice decision-making, before any physical
respecting the examination.
patient’s - Offer choices and
autonomy, and respect decisions.
promoting a sense - Use phrases like,
of control. “How can I best
support you?”
Cultural, Historical, Acknowledge and - Elicit the patient’s
and Gender Issues integrate the values and concerns
patient’s and incorporate
individual values, them into care.
culture, and - Avoid assumptions
experiences into and respect
their care. individual contexts.

Table 1 Principles Of Trauma Informed Care

Sexual Violence Screening Tools

Screening Tool Description
Abuse Assessment Screen A five-item questionnaire
designed to evaluate physical,
sexual, and emotional abuse.
Available in English and
Spanish.
Screening Tools - Sexual A five-item questionnaire that
Assault examines sexual assault
history and understanding of
risk-reduction strategies.
Sexual and Physical Abuse A 10-item questionnaire, with
History Questionnaire six items specifically focusing
on sexual abuse.
Two-Question Screening Tool A two-item questionnaire,
with one question addressing
sexual violence.
Universal Violence Prevention A six-item questionnaire that
Screening Protocol - Adapted investigates recent incidents of
physical, sexual, and
emotional abuse.
Victimization Assessment A five-item questionnaire
Tool assessing various types of
violence, including sexual
violence.

Table 2 Sexual Violence Screening Tools

SAVE Model: Components and

Implementation Tips
Component Tips for Implementation
SCREEN - Screen all patients for sexual
assault while assuring
confidentiality.
- Inform patients that sexual
violence will only be reported
if a dependent person is at risk
or the survivor wishes to report
it.
- Use direct, nonjudgmental
questions and normalize
discussions about sexual
violence.
- Avoid technical language,
maintain eye contact, and
refrain from minimizing the
patient’s experience.
- Never blame the patient for
the violence, even if they
express self-blame.
ASK - Ask questions in a supportive
and understanding manner to
encourage open
communication.
- Use inclusive, validating
language and normalize the
conversation to reduce
discomfort.
VALIDATE - Use empowering and
supportive language to validate
the patient’s feelings and
experiences:
- “Thank you for telling me.”
- “It took courage to share
this with me.”
- “I’m truly sorry that
happened to you.”
- “It’s not your fault; you
didn’t deserve this.”
- “You’re not alone. I care
about you and want to help in
any way I can.”
- “You decide what is best for
you.”
EVALUATE - Evaluate the immediate
danger posed by the assailant.
- Assess the physical and
psychological impact of the
incident on the patient.
- Screen for psychological
 safety and suicidal thoughts.
Table 3 SAVE Model

Evaluation of Acute Presentation

Most sexual assault survivors who require immediate care will
present at the urgent care facility or emergency department. If a
patient calls their physician ahead of time to visit the medical
facility, the provider should listen carefully to the patient's
concerns and respect their autonomy. A patient should be made
aware of where to seek medical care and that certain acts,
including bathing, changing clothes, urinating, defecating,
douching, or delaying care may interfere with evidence
collection.

Once on the scene, informed consent should be obtained before

starting any assessment or collection of evidence. The first
assessment should be focused on identifying and treating life-
threatening conditions, severe injuries, or urgent psychiatric
needs. In those patients needing immediate stabilization,
hospitalization, or surgery, all measures to protect the evidence
must be strictly taken, like wearing nonpowdered gloves and
avoiding procedures that would compromise evidence, such as
collection of urine, if not absolutely necessary, or oral or rectal
medication unless absolutely required by the clinical condition
of the patient.
Family physicians often form the first point of contact for
survivors who present acutely. In this evaluation process,
clinicians must respect medical as well as legal procedures.
Such a person who is not an expert in handling such a case
should be referred to those experienced. It is the health care
providers that should conduct the medical forensic
examination, evidence collection, and documentation since
wrong collection may hamper the case in court. Many hospitals
make use of Sexual Assault Nurse Examiners (SANEs) or
Sexual Assault Forensic Examiners (SAFEs) to provide
trauma-informed care while following the protocol for evidence
collection.

If there are no available trained personnel, clinicians can

contact the SAFE Technical Assistance Program or refer to
comprehensive guidelines from the U.S. Department of
Justice's Office on Violence Against Women. When care needs
to be transferred, every attempt should be made to reduce
delays and loss of evidence. Family physicians can stay with
the survivor to provide emotional support.

A comprehensive history is essential. The clinician should

approach the survivor with compassion and nonjudgment and
document the details in the survivor's own words. Information
about the assault, including sexual contact and exposure to
bodily fluids, should be documented. A gynecological history,
including the date of the last consensual sexual activity, is also
relevant.

The physical examination begins with an assessment of

injuries. Approximately half of reported sexual assaults involve
physical injuries, with nongenital injuries being more common
than genital ones. A thorough examination of the entire body
should be performed, documenting injuries through
photographs or detailed drawings. In cases without severe
trauma, evidence collection can occur alongside the physical
examination.

Evidence Collection and Documentation

Evidence can be collected up to five days after a sexual assault.
Prior to any examination or collection, the patient should be
informed and thus be able to give consent. This process helps
the survivor regain a sense of control over their body and the
situation, and it makes the evidence admissible in court.
Physicians should guide the survivors into consenting to
evidence collection as crucial information can be lost if the
collection is not done promptly. It should also be noted that
gathering evidence does not obligate the survivor to follow up
with legal actions. Survivors should also be told that the
process may be stopped at any given point if it becomes too
painful or uncomfortable.

Most states use standardized evidence-gathering kits for proper

preservation. A full physical exam should include recording
cuts, bruisings, tenderness, or swelling anywhere in the body.
That ranges from the back and butt cheeks. For legal matters,
proper recording of bruises is essential, as this can be one of the
major factors of a possible conviction since minimal physical
hurt is a likely indicator.

Clothing must be collected as the survivor undresses over a

white sheet, and all items along with any debris are placed in
appropriately labeled paper bags. Saliva samples on filter paper
and swabs from all relevant orifices-oral, rectal, and vaginal -
are a must part of evidence collection. In-depth pelvic
examination is required despite the absence of pain, since it has
been revealed through various studies that up to one-third of
survivors will have genital injuries without causing noticeable
symptoms. The posterior fourchette and fossa tear, abrasion on
the labia, and bruising on the hymen are common among
survivors.
Significant genital injuries are more common with
postmenopausal survivors. If available, colposcopy should be
used to identify subtle injuries in the cervix and vagina.
Research has shown that employing colposcopy in emergency
settings increased the detection rate of genital trauma from 6%
to 53%. A Wood’s lamp can aid in detecting semen on the skin,
which should then be collected using moistened cotton swabs.
Sperm analysis should be left to forensic specialists for more
precise identification.

Blood samples should be taken for typing purposes to

distinguish the survivor's blood type from the criminal's. Once
all the evidence has been collected, it should be sealed, signed,
and placed in a safe place so that the chain of custody is
maintained. Evidence must either remain under direct
supervision or be locked in a safe place so that it maintains its
integrity throughout the process.
 Table 4 Procedure For Examination And Collection Of Evidence

Diagnosis and Treatment

Diagnostic evaluation should be based on the circumstances of

the assault and potential exposures. Table 5 shows some
diagnostic tests applicable for victims of sexual assault.

All survivors of sexual assault should receive timely care for

pregnancy prevention and disease prevention, as needed (see
Table 6). For survivors of childbearing age with a negative
urine pregnancy test at the time of presentation, emergency
contraception should be offered within the recommended
timeframe.

The CDC guidelines are available for the prevention and

management of STIs in sexual assault survivors. Empiric
treatment for chlamydia, gonorrhea, and trichomoniasis is
recommended for all survivors. PEP for HIV should be
considered based on the nature of the exposure and the known
HIV status of the assailant, if known.

The postexposure prophylaxis for hepatitis B includes, either as

monotherapy or as combination with hepatitis B
immunoglobulin, should depend on the hepatitis status of the
assailant and the survivor's vaccination history. Human
papillomavirus (HPV) vaccine is given in females survivors
aged between 9 to 26 and, on clinical judgement also to some
females of aged between 26 and 45 years.

Tetanus vaccination is recommended for individuals with

breaks in the skin or mucous membranes, depending on their
immunization history, as listed in Table 6.

Testing Recommendations After Sexual

Assault
Test When to Consider Timing
Urine Pregnancy All survivors On presentation;
Test repeat if there is a
missed menstrual
period
Nucleic Acid All survivors On presentation;
Amplification Test repeat in 1–2
(NAAT) for weeks if untreated
Gonorrhea and or symptomatic
Chlamydia
NAAT for All survivors On presentation;
Trichomonas repeat in 1–2
Vaginalis weeks if untreated
or symptomatic
Wet Mount for Symptomatic On presentation;
Bacterial Vaginosis survivors repeat if
symptoms persist
Serum HIV Test All survivors On presentation;
consider repeat
testing at 6 weeks,
3 months, and 6
months if assailant
status is unknown
Serum Hepatitis B All survivors On presentation;
Antigen Test repeat at 6 months
Serum Rapid Plasma All survivors On presentation;
Reagin (RPR) for consider repeat
Syphilis testing at 4–6
weeks and 3
months if assailant
status is unknown
Serum Hepatitis C All survivors On presentation;
Test consider repeat
testing at 3 and 6
months if assailant
status is unknown
Urine Drug Screen When drug- On presentation if
(includes chloral facilitated assault assault occurred
hydrate, gamma- is suspected, within 72 hours
hydroxybutyrate, especially with
ketamine, and partial or complete
benzodiazepines) amnesia

Table 5 Testing After Sexual Violence

Treatment Recommendations After Sexual

Assault
Category Criteria for Treatment Regimen
Consideration
Pregnancy All survivors with - Ulipristal (Ella):
Prevention a negative 30 mg within 120
pregnancy test hours of
result unprotected
intercourse
- Levonorgestrel
(Plan B): 1.5 mg
within 72 hours (up
 to 120 hours off-
label)
- Copper IUD:
Insert within 5 days
of unprotected
intercourse
STI Prophylaxis All survivors - Ceftriaxone
(Empiric) (Rocephin): 250 mg
IM as a single dose
- Azithromycin
(Zithromax): 1 g
orally as a single
dose
- Metronidazole
(Flagyl): 2 g orally
as a single dose
- Tinidazole
(Tindamax): 2 g
orally as a single
dose
Hepatitis B - Survivors - Single Booster
Postexposure previously Vaccine for
vaccinated with previously
known or unknown vaccinated
hepatitis B antigen survivors with low
status risk
- Survivors with - Vaccination Series
unknown for those with
vaccination status unknown
- Survivors vaccination or
exposed to an immunity
assailant with - Vaccination +
known or unknown HBIG for exposure
hepatitis B antigen to a hepatitis B-
status positive assailant
HIV Postexposure Survivors with - Preferred
Prophylaxis significant Regimen:
exposure (e.g., - Tenofovir 300
direct contact with mg daily
semen, vaginal - Emtricitabine
fluids, or blood, or (Emtriva) 200 mg
bites with visible daily
blood) - Raltegravir
(Isentress) 400 mg
twice daily or
Dolutegravir
(Tivicay) 50 mg
daily
HPV Vaccination Survivors aged 9– Age-appropriate
25 years who have vaccine series
 not completed the
vaccine series;
shared decision-
making for those
aged 26–45 years
Tetanus - Survivors with - Tetanus Vaccine:
Prophylaxis skin abrasions and Booster dose
unknown - Complete Tetanus
immunization Series: If
status or last immunization status
tetanus vaccine is unknown
over 10 years ago
- High-risk wounds
with unknown
status or last
vaccine over 5
years

Table 6 Treatment After Sexual Violence

Delayed presentations

Delayed presentations are common, particularly when the first

disclosure occurs in a primary care setting. A study of women
who received mental health services for childhood sexual
assault found that the average time to disclosure was 16 years.
A systematic review of healthcare professionals' reactions to
delayed disclosures of sexual assault identified both helpful and
unhelpful responses. Helpful responses included validation of
the disclosure, offering emotional support, and assistance in a
practical and informational nature. Responding in an unhelpful
manner involved blaming the survivor, minimizing or
dismissing the experience, and treating the survivor differently
following disclosure.

Prevention
The primary prevention of sexual violence must be
multifaceted; it involves individual, relational, community, and
societal factors. The Centers for Disease Control and
Prevention created the STOP SV technical package, which
identifies effective approaches to preventing sexual violence as
shown in Table 7. Effective programs challenge societal
attitudes about love and sexuality, and promote conflict
resolution skills. Initiatives that engage boys and men as allies
and focus on bystander intervention can help prevent sexual
violence. Empowerment-based programs for college-aged
women have been proven to reduce the risk of victimization.
Transportation policies, campus safety initiatives, and crime
prevention programs have also been effective in reducing the
rates of sexual assault.

Early recognition by clinicians after an assault and proper

support and care for survivors can prevent long-term health
consequences and revictimization. Survivor-centered services,
such as rape crisis centers, provide a healing environment and
help survivors connect with advocates and resources. Survivors
who engage with advocates report better experiences with the
medical and legal systems. Clinicians can refer survivors to
advocates through the National Sexual Assault Hotline (1-800-
656-4673) for local rape crisis center referrals or to the
National Sexual Violence Resource Center
(https://www.nsvrc.org/), which offers a directory of support
organizations.

Sexual Assault Prevention Strategies: STOP

SV Mnemonic
Strategy Examples of Evidence-Based
Approaches
S (Promote social norms that - Empower young people to
protect against violence) intervene in peer groups
through bystander training.
- Engage boys and men as
allies in preventing sexual
violence.
T (Teach skills to prevent - Implement social-emotional
sexual violence) learning to reshape attitudes
towards violence in children
and adolescents.
- Provide comprehensive sex
education focusing on consent
and respect.
- Teach safe and healthy
relationship skills to
adolescents using programs
like Safe Dates.
- Offer empowerment-based
training to help participants
identify and mitigate risky
situations.
O (Provide opportunities to - Enhance economic support
empower girls and women) for women and families.
- Create leadership and
empowerment opportunities
for girls.
P (Create protective - Improve safety in physical
environments) spaces and increase staff
monitoring in schools.
- Establish workplace policies
to prevent harassment and
violence, ensuring proactive
measures for safety.
SV (Support victims to lessen - Offer survivor-centered
harms) services such as rape crisis
centers.
- Provide comprehensive
mental health treatment for
sexual violence survivors.
- Deliver interventions for
children exposed to violence
to reduce the risk of
perpetration.

Table 7 Sexual Assault Prevention Strategies: STOP SV Mnemonic

SORT: Key Recommendations for Practice

Clinical Evidence Rating Comments
Recommendation
A survivor-centered C Based on expert
and trauma-informed opinion.
approach should be
used when providing
care to survivors of
sexual assault.
Clinicians in acute C Based on expert
care settings should opinion and legal
follow medical and standards.
legal guidelines for
examination,
evidence collection,
and documentation.
Survivors of sexual C Based on expert
assault with opinion.
childbearing potential
and a negative
pregnancy test should
be offered emergency
contraception within
the appropriate
timeframe.
Survivors of sexual C Based on expert
assault should receive opinion and
treatment to prevent consensus
sexually transmitted guidelines.
infections.

Note: Evidence ratings are based on the SORT system:

- A: Consistent, high-quality patient-oriented evidence.
- B: Inconsistent or limited-quality patient-oriented evidence.
- C: Consensus, disease-oriented evidence, usual practice,
expert opinion, or case series.
For more information, visit https://www.aafp.org/afpsort.

Table 8 Short Key Recommendations For Practice

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