In 2001 the North Carolina Office of EMS conducted a pre-conference train-the-trainer workshop at Emergency Medicine Today. A total of 83 students participated and received the training program, along with a scripted slide presentation and a Polaroid Law Enforcement camera kit to assist in photo documentation of family violence. Part of the training session included the completion of a survey instrument on child abuse identification, as well as three true/false questions. Survey questions included questions about the number of times the participants had identified child abuse in the clinical setting, as well as how many times s/he had reported suspected child abuse and/or neglect to the Department of Social Services (DSS), and other questions about interactions with DSS. While the complete results of the survey will be published at a later date, the answers received on the true/false questions deserve some attention.

The first question:

My responsibility regarding suspicions of child abuse is to tell a charge nurse or physician. They will contact the reporting agency.

The North Carolina General Statute (G.S.) reads:

"(a)ny person or institution who has cause to suspect that any juvenile is abused, neglected, or dependent, as defined by G.S. 7A-517, or has died as a result of maltreatment, shall report the case of that juvenile to the Director of the Department of Social Services in the county where the child resides or is found."

EMS Health Care providers in any setting are mandated reporters. Each agency should have a written policy on reporting child abuse and neglect.

The second question:

Child abuse by definition is an injury to a child by any person who takes care of a child.

In general, the juvenile code considers a juvenile "abused" when that child’s caregiver, custodian, or caretaker acts in certain specified ways: "inflicts- or allows someone to inflict-on the child a serious, non-accidental physical injury". In general, a child is considered to be neglected when the child does not receive proper care, supervision, or discipline from his or her parent, custodian, or caretaker." There are other definitions as well under each category, but a more thorough discussion is beyond the scope of this article. The key to this question is that "abuse" is perpetrated by the previously mentioned caregivers.

Because a person, in order to be a caretaker, must be in a residential setting, the definition does not include schoolteachers, coaches, club leaders and others with similar temporary caretaking responsibilities for children. If someone suspects that one of these "noncaretakers" has harmed or neglected a child or placed the child at risk, a report can be made to a law-enforcement agency. If a person reports the "noncaregiver" to DSS, the department has no authority to investigate. The law, however, requires the department to relay the information to the district attorney and to law enforcement if the report involves criminal conduct that results in physical harm to a child. If in doubt, contact DSS for assistance.

And the third question:

About 90% of child maltreatment cases that are reported in NC are neglect-related.

How do you report a case of child abuse in North Carolina? Place a call to the County DSS in person, in writing or by phone. Most EMS providers will make the report by phone. Each county in North Carolina has a county DSS. Include as much as you know of the following:

1. What is your "cause to suspect" abuse or neglect?

2. What other information do you have? The child’s name, age and address; name of parents/guardians; the names and ages of other children in the home, the child’s location of the child is not in the home; the nature and extent of injury or condition resulting from abuse or neglect are all helpful information if it is available to you when you are making the report.

Although the matters for which reports are required may involve criminal offenses, North Carolina’s law is not a crime-reporting law. Rather it is part of the state’s child protective services system; created to respond to children’s needs for protection or assistance. Children are entitled to protection and services under North Carolina law. Whether they receive these services depends on whether people who are aware of their situations know about the reporting law and how to make reports. The most obvious reason to report a case of child abuse or neglect is to prevent further harm to the child or other children.

If you are interested in more information about the North Carolina EMS for Children Child Abuse Recognition Education (C.A.R.E.) program, contact Gloria Hale at the Office of EMS at 919.855.3952, or by email at gloria.hale@ncmail.net