Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors’ mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors’ future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.

急诊科 (ED) 工作人员与性侵犯 (SA) 幸存者之间的互动可能是幸存者再创伤的来源，增加了他们遭受创伤后压力的风险，并减少了纵向医疗护理的利用。关于急诊部工作人员对幸存者的态度和行为的全国趋势，包括幸存者身份的影响，我们知之甚少。我们进行了一项调查，以确定幸存者身份是否影响急诊部员工的行为。在 2021 年 6 月至 2021 年 8 月期间对 SA 患者倡导者进行了一项全国性调查。倡导者是从强奸危机中心派遣的志愿者或工作人员，以在 ED 护理期间为幸存者提供支持。倡导者参与了一项在线调查，以确定观察六种可能造成再创伤的提供者态度和行为的频率。自适应提问被用来探索幸存者身份对每种态度或行为的影响，以及哪些身份群体更容易受到影响。三百一十五名拥护者对调查做出了回应。不到 10% 的人表示急诊部工作人员经常或总是向幸存者表达怀疑或责备。近 75% 的倡导者表示，他们经常或总是观察到急诊部工作人员对幸存者表示同情。提供者的态度存在差异。超过 75% 的倡导者观察到，幸存者的心理健康状况或物质使用会影响提供者传达的信念。被殴打时醉酒、患有精神疾病、黑人、西班牙裔/拉丁裔或土著或非顺式女性的患者更容易产生怀疑。白人和/或顺性别女性患者更有可能受到急诊室工作人员的压力，要求他们完成法医检查和/或向警方报案。我们的研究根据幸存者身份记录了 ED 工作人员对 SA 幸存者行为的差异。鉴于袭击后急诊室的互动是幸存者未来医疗过程的关键转折点，急诊室护理的差异可能与创伤愈合方面的更大差异有关。