Domestic violence and out-of-hospital providers: A potential resource to protect battered women

Objective: The primary objective was to determine the prevalence of domesti c violence (DV) in a subset of women presenting to the Boston emergency med ical services (EMS) system and to evaluate documentation. A secondary objec tive was to determine the rate of refusal of transport to the hospital for DV-positive patients, compared with the general population. Methods: A retr ospective chart review of ambulance run sheets from a nonconsecutive, conve nience sample between July and December 1995 was performed. Women presentin g with injury, obstetric/gynecologic complaints, or psychiatric complaints were included. Records were reviewed, and labeled as positive, probable, su ggestive, or negative for DV, based on a previously used classification sys tem. A weighted kappa test was performed, and data were analyzed using chi- square and t-test. Results: Among 1,251 charts reviewed, 876 met criteria f or inclusion. The percentage of positive cases was 5.4% (95% CI = 3.9% to 6 .9%), probable 10.8% (8.8% to 12.9%), suggestive 2.6% (1.6% to 3.7%), and n egative 81.2% (78.6% to 83.6%). Among DV-positive patients, the refusal to transport rate was 23.4% (11.3% to 35.5%), compared with a 7.1% (5.8% to 9. 3%) rate for the entire study population (n = 876), and 4.7% for the genera l Boston EMS population during the same year. More DW patients presented du ring the night shift compared with other shifts. Conclusions: Domestic viol ence is common in this high-risk population. A substantial proportion of wo men in this population refuse transport to the hospital. Out-of-hospital pe rsonnel should be trained with the tools to identify and document DV, asses s patient safety, offer timely resources, and empower victims to make choic es.