Intimate partner violence (IPV) is a global public health concern characterized by physical, sexual or emotional abuse or controlling behaviors inflicted by a current or former spouse or intimate partner. Approximately 80% of police-reported victims of IPV in Canada are women and Manitoba has the second highest rate of police-reported IPV among the Canadian provinces. Among the most common yet often under-recognized injuries sustained by victims of IPV is traumatic brain injury (TBI), which can range from concussion to more severe structural injuries (e.g. intracranial hemorrhage or bleeding). Furthermore, survivors of IPV can experience episodes of non-fatal strangulation that can result in hypoxic-ischemic brain injuries. In addition to TBI, survivors of IPV can also experience injuries to the face including complex orbital, maxillofacial, and mandibular injuries as well as injuries to other parts of their body. Those who experience IPV are also at risk of developing mental health conditions such as anxiety, depression, post-traumatic stress disorders as well as other medical conditions.
Optimizing clinical outcomes following acute IPV TBI requires timely access to emergency medical care and multi-disciplinary healthcare professionals including those with expertise in neurosurgery, plastic surgery, ophthalmology, orthopedic surgery, psychiatry, neuropsychology. It is also important that survivors receive coordinated access to shelters and temporary housing as needed as well as victim, family, criminal justice, legal, and culturally-based mental health and wellness services that can support patients and their families. Without access to this coordinated standard of care, patients are at risk of developing persistent and untreated symptoms or returning to environments where they are at risk of recurrent abuse that can result in additional and potentially life-threatening injuries.
As a first step towards optimizing the care of patients with acute IPV TBI living in Manitoba, we have established a novel Intimate Partner Violence Traumatic Brain Injury Pilot Clinical Pathway.
Intimate Partner Violence Traumatic Brain Injury
Pilot Clinical Pathway
Patients must meet the following inclusion criteria to receive care through this pilot program:
1) Youth or adults diagnosed who sustain head trauma that is directly caused by intimate partner violence including those with head injury, concussion, structural injury (eg. intracranial hemorrhage, skull fracture) or injury secondary to strangulation;
2) Clinical presentation to the Health Sciences Centre (HSC) emergency department within 10 days of date of injury;
3) Initial medical assessment performed in HSC Emergency Department;
4) Residence within Manitoba
Emergency department physicians, trauma surgeons and SANE nurses at HSC may refer patients who meet the above criteria for evaluation at the Pan Am Concussion Program including those patients who sustain head injuries or periods of strangulation that are not associated with a loss of consciousness and those who present with mild or transient post-concussion symptoms (headache, dizziness, neck pain, fatigue, blurred vision, difficulty swallowing etc.).
Patients who are referred to the Pan Am Concussion Program will undergo medical assessment and longitudinal follow-up care by a neurosurgeon. Patients will also be connected to other multi-disciplinary professionals as needed (eg. neuropsychology, plastic surgery, ophthalmology, orthopedic surgery, physiotherapy, psychiatry, addictions medicine, psychology). Patients will also be connected to community-based support services as needed.
Patients who live in rural and remote communities within Manitoba may have the opportunity to receive some of their care through telemedicine (in-person videoconferencing).
The results of the pilot clinical pathway will provide important insight into what steps may be needed to expand the program to other IPV TBI patient populations in Manitoba.
For more information
For more information on the pilot clinical pathway please contact the Pan Am Concussion Program at 204.927.2766
For more information on domestic violence supports in Manitoba please visit the following links:
Province of Manitoba Domestic Violence Support Service
Manitoba Association of Women's Shelters
Winnipeg Police Service Domestic Violence and Intimate Partner Violence Resources
Health Sciences Centre Sexual Assault Nurse Examiner Program
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