Post-Traumatic Stress Disorder, self-harm, dissociation, and various physical and behavioral disorders, these can be just a handful of effects for survivors of sexual assault.

Throughout April, sexual assault awareness is emphasized to raise public awareness about sexual violence and educate on prevention. Many service members attend Sexual Harassment/ Assault Response and Prevention training on annual, quarterly or even monthly basis.

But what happens once the crime is committed? Should you go to the hospital? If you do, does the sexual assault become an unrestricted report?

To help individuals understand the process of the Sexual Assault Forensic Examination (SAFE), William Beaumont Army Medical Center's sexual assault medical management discusses the process once the crime is committed and a survivors chooses to seek medical treatment.

"We're trying to inform our public so that if they have to come to the emergency room for sexual assault, it's the most efficient experience for the survivors," said Letty Sprinkle, program manager and forensic nurse with WBAMC's Sexual Assault Medical management program. "Every Soldier gets a lot of SHARP training, there's a lot of focus on prevention and resources, but they never know what to expect if they come here."

First, survivors of sexual assault should find a safe location, away from harm.

Although DOD total strength has remained about the same, in September 2008 total active duty personnel was estimated at 1,058,587 while the active duty total in December 2018 was estimated at 1,166,375, according to Defense Manpower Data Center, sexual assault cases have risen significantly. At the end of fiscal year 2008 a total of 3,109 cases were reported, including restricted and unrestricted, while fiscal year 2017 saw 6,769 cases, both restricted and unrestricted, both figures involved service member and their dependents as either victims or subjects, according to Department of Defense reports.

"Survivors undergo a medical exam first, (forensic examiners) don't just go in and collect evidence," said Sprinkle. "We do a head to toe assessment, all the (forensic) examiners are still nurses."

Sprinkle emphasizes survivors should seek medical treatment, regardless of their intention to provide a restricted or unrestricted sexual assault report, so they may get any needed medical treatment, to include a forensic examination should a survivor choose it.

If possible, survivors should preserve any evidence of the assault by avoiding bathing, brushing teeth, eating, smoking, or going to the bathroom and should bring in the clothes worn during the assault.

"During the evidence collection, which is a very crucial part of these cases because that's what is going to be taken to the crime lab and used in court, there are some things that are important like the sooner they come the better," said Sprinkle. "Sometimes survivors don't come in (to receive medical treatment) because they are thinking about (reporting the sexual assault), but they may not have all the information they need to make those decisions. We will brief them on everything that is available."

While survivors are advised to be evaluated within seven days of the crime for evidence collection, it's recommended to be seen as soon as possible, or at least within 72 hours.

"Once survivors receive any medical care they need, we can treat for possible (Sexually Transmitted Diseases) with a prophylaxis to prevent the some of the most harmful STDs," said Sprinkle.

According to the Centers for Disease Control and Prevention (CDC), compliance with follow-up visits is poor among survivors of sexual assault. As a result, the prophylaxis, and if necessary an emergency contraceptive if the assault could result in pregnancy.

"The emergency contraceptive only has 72 hours to be effective," advises Sprinkle. "It's not an abortion pill, if the survivor is pregnant before the sexual assault they'll continue to be pregnant."

Time is also significant if the assault involved any loss of consciousness or drugging.

"Even if survivors don't remember what happened, they don't know what they would say because they don't remember, that is very normal," said Sprinkle. "They just need to understand that something happened, if they have a feeling that something happened, or somebody tells them they saw something happen, that is a time-sensitive issue because drugs are metabolized in the body and these drugs may leave your body very fast. What doesn't help is not knowing, it messes with your head."

Providing evidence that a survivor was drugged may help them with the healing process.

"We'll contact law enforcement if they want but if they want a restricted report then we don't," said Sprinkle. "Their choice of reporting is honored here, so we don't call the chain of command or law enforcement and they still get all the other services."

The only alibi is if a weapon was involved, then medical staff are required to report the assault.

"Sometimes survivors may not want to come in because it will be part of their records," said Sprinkle. "As far as the sexual assault forensic examination, none of that goes to their electronic health record, it's kept in a physical chart to protect survivors, for their privacy and they have a right to a copy."

Sprinkle warns the exam does take anywhere from one to four hours, so survivors should understand it is a long procedure, but it should not stop them from coming forward.

"We here to take care of active-duty service members, their dependents and even staff members. If the assault happened on post or off post, even pediatric cases," said Sprinkle. "Survivors don't have to have forensic evidence collected to come in and get medical treatment, they can stop (treatment or exam) any time they want. They are in charge of the visit, if they don't want medicines, pictures or something to be collected, they are in charge, and nothing is forced."

Additionally, Sprinkle extends resources to those affected by the assault on a family member after each exam.

"It is a very stressful situation for the survivor and the (family member), they are also victims themselves," said Sprinkle. "I know. I know how it is to go home, there is fear, spouses don't want to talk about it, and they have a hard time addressing the circumstance."

Currently, a total of nine forensic nurses are employed at WBAMC, and remain on call 24/7. If a sexual assault does occur, survivors are urged to call the Fort Bliss 24 Hour SHARP Hotline at (915) 245-8991. For more information on the Forensic Examination, contact Letty Sprinkle at (915) 742-3424.