Simulated Patient Scenario

Scenario Details

MDT Information

• Non-Urgent Response - Fall / Arm Injury
• 32-year-old female, fell at home
• Partner called, states she is clumsy
• Patient reportedly has minor arm injury
• Patient conscious and alert
• Location: Home address
• Police not initially notified

On Arrival

You arrive at an apartment. A male partner answers the door, appearing slightly agitated but polite. He leads you into the living room where the patient, a 32-year-old female, is sitting quietly on the sofa. She avoids eye contact and appears withdrawn. She has some bruising visible on her upper arm near the shoulder. The partner stays close by, often answering questions directed at the patient.

Initial Impression and Primary Survey

Secondary Survey and Simulation Progression

History (Obtaining history may be challenging with partner present. Attempt to separate if safe and feasible.)

Vital Signs/Assessment (Initial)

Physical Examination (Attempt in private if possible/safe)

• General Appearance: Quiet, subdued affect, avoids eye contact. May appear anxious when partner is present.
• Right Upper Arm: Moderate bruising (possibly finger-shaped) over the deltoid/biceps area. Tender on palpation. Full range of motion at shoulder and elbow but painful. No deformity or crepitus. Good distal CMS.
• Head-to-Toe (Brief): Ask about other injuries or pain. Patient may deny other injuries initially. If assessed privately, look for other bruising in different stages of healing (e.g., on torso, legs - areas usually covered by clothing).
• Mental State: Appears fearful or anxious but oriented. May minimize symptoms or mechanism of injury.

Assessment and Treatment

Appropriate Management Focus

• Recognize Potential DV: Identify red flags (controlling partner, conflicting stories, injury inconsistent with mechanism, patient's demeanor, minimizing). Maintain high index of suspicion.
• Prioritize Safety (Patient and Crew):** Assess scene safety continuously. Note partner's behavior. Create opportunities for private conversation with the patient if safe (e.g., during assessment in ambulance, ask partner to get paperwork). Do NOT confront partner directly about suspicions.
• Build Rapport & Empathetic Communication: Approach patient calmly and non-judgmentally. Validate their feelings ("You seem a bit upset," "It's okay to talk about it if you want to").
• Direct Inquiry (If private and safe): Ask direct, simple questions about safety: "Do you feel safe at home?", "Has anyone hurt you?", "Are you afraid of your partner?". Respect patient's decision if they deny or do not wish to disclose.
• Manage Physical Injuries: Assess and manage the arm injury (e.g., cold pack, sling for comfort). Provide analgesia if required (e.g., Paracetamol, Methoxyflurane).
• Offer Support & Resources: Regardless of disclosure, provide information about DV support services (e.g., provide a card or pamphlet discreetly, mention resources verbally). "There are services that can help people who feel unsafe at home, would you like information about them?"
• Documentation: Document objective findings clearly, including mechanism provided by both parties, patient's demeanor, observed injuries (size, location, colour), and any direct disclosures or denials. Quote patient directly where possible. Document any safety concerns and actions taken.
• Police Liaison: Consider requesting police attendance for safety or if disclosure occurs, following local protocols regarding mandatory reporting or duty of care.
• Transport Decision: Strongly encourage transport to ED for further assessment, even if injuries seem minor. This provides a safe space for potential disclosure and connection with hospital social work/DV services. If patient refuses, assess capacity, discuss risks, explore safety plan (e.g., going to friend/family), ensure they have resource information, and document thoroughly. Involve police if significant safety concerns exist and patient refuses transport.
• Teamwork & Communication: Communicate concerns and plan discreetly with partner. Ensure consistent messaging. Clear handover to ED/Police, highlighting DV concerns and safety issues.