EMS Have Best Opportunity to Detect Signs of Child Abuse

EMS is an important point of contact for children who suffer from child abuse, which is also called non-accidental injury (NAT).  In North Carolina, and many other states, EMS is required to report suspicion of child abuse to the local department of social services (DSS). 


Not only is detecting and reporting child abuse important from a legal standpoint, but it is even more important to protect the safety of the child.  If a child with NAT presents to a health care provider, but the abuse is not recognized then that child is at high risk for further severe injury or death.

This is an area that affects both urban and rural EMS providers. In North Carolina, rural counties have the highest rates of child abuse. The absolute numbers of abused children are higher in urban areas because more people live there, but the rates per 100,000 people are much higher in rural counties.  Because EMS personnel visit people in their homes they are in a unique position to detect possible signs of NAT.  Most healthcare providers do not have the access to patient’s living environments that EMS has.  EMS must be aware of signs of NAT because EMS might be the only ones in a position to detect child abuse.

In 2015 1,585 children died from abuse and neglect nationally. There were 7,857 victims of child abuse in North Carolina and 14,856 in South Carolina in 2015.  In North Carolina, 1,780 of the abuse cases were physical abuse and 1,595 were from sexual abuse.  In South Carolina, 6,929 of the abuse cases were from physical abuse and 1,595 of the abuse cases were due to sexual abuse.  This data came from the U.S. Department of Health and Human Services, Children’s Bureau.

It is important to define what abuse is.  The official definition of child abuse is: “Any recent act or failure on the part of a parent of caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which represents an imminent risk of serious harm.”  Signs of physical abuse might include unexplained burns, bites, bruises, broken bones or black eyes.  The child might shrink at the approach of adults.  An abused child might seem frightened of parents or protest when it is time to go home.  Abusing animals or pets can also be a sign of child abuse.  Some children will also report a history of abuse.  Just a few of the signs of sexual abuse might include difficulty walking or sitting, pregnancy or sexually transmitted diseases before age 14, running away, or attaching very quickly to strangers or new adults. Also any pre pubertal female with a vaginal discharge should have possible sexual abuse in their differential.  It’s also important to remember that child abuse causes 50 to 69 percent of all fractures in children less than one year of age.  Substance abuse also has a very high association with physical abuse and neglect.

EMS has the best opportunity to detect the signs of child abuse.  By detecting child abuse EMS can make a huge difference in a child’s life.   In North Carolina it is the law that if EMS suspects child abuse then they must report those suspicions.  This is another example of how important EMS is in the lives of society and especially children.

For more information visit: https://www.acf.hhs.gov/sites/default/files/cb/cm2015.pdf.Dr. Winslow graduated from Emergency Medicine residency from UNC-Chapel Hill in 2002 and completed his EMS Fellowship in 2003. He has worked at Baptist Hospital in Winston-Salem for the past 11 years. He was appointed as the Medical Director of the NC Office of EMS in 2011. This document contains all protocol, procedures, and policies for all EMS agencies in North Carolina.

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