University Medical Center was one of 35 statewide hospitals represented at a training session earlier this month designed to help hospitals develop protocols for dealing with domestic violence cases in emergency rooms.

The conference, held Nov. 7 and 8 in Scottsdale, was organized by the Arizona Health Care Coalition on Domestic Violence in response to a survey released in January by the Arizona Department of Health Services, said Ann Tarpy, coalition member.

The survey looked at hospital protocols dealing with domestic violence cases in the emergency room. While hospitals are required to have some sort of plan, Tarpy said, the survey found that most of those responding did not have comprehensive protocols for detection, prevention and referrals. Sixty-four of the 66 emergency room hospitals returned the surveys, she said.

Tania Graves, director of communications for the Arizona Medical Association, said a national survey found that one-third of all females admitted to the hospital from emergency rooms are victims of domestic violence, but as few as 5 percent are actually identified as such.

The survey found that UMC, one of four Tucson-area hospitals who sent representatives to the conference, did not have a comprehensive protocol.

Dan Judkins, registered nurse and UMC's trauma coordinator, said UMC will first set up a team to write the protocols for the hospital and then train the rest of the staff.

"Over the years, we have always had ongoing training, but now we are going to make it more explicit and pay more attention to it," Judkins said.

The hospital plans to use information from the conference to train its personnel to better recognize domestic violence cases and to teach them how to help victims, he said.

"If emergency room personnel are not attentive to (signs of domestic violence), they may not pick up on that fact and would therefore not be of the most help to the patient," he said.

Signs of abuse that hospital personnel can look for include a patient's frequent visits to the emergency room, bruises and lacerations that are not easily explained or when the explanation doesn't fit the injury, as well as behavioral clues such as anxiety, depression and a minimization of injuries, Judkins said.

Hospital staff will be told to bring the subject up, he said. They will have to ask patients, using a list of suggested questions from the training session, if they are being abused. He said the hospital will have a better program for referrals to the social services department.

"We want the staff to provide support for these women, to let them know that somebody cares and that it is not their fault. They will also give victims some general information on domestic violence," Judkins said.

He said domestic violence is not defined as being between married couples, but can also occur between people living together, dating or even among relatives living in the same house. He said a rising trend nationwide is the number of violent relationships between teen-agers who are dating.

The training session was conducted by the Family Violence Prevention Fund in San Francisco, which has put on similar seminars in California, Tarpy said.

"The sessions were customized for Arizona, and there were some panels with local representatives helping to provide guidelines to hospitals on developing protocols," she said.

Thirty teams, each consisting of an emergency department physician, a nurse, a social worker, an administrator and a community domestic violence worker, represented 35 hospitals and hospital systems during the training, Tarpy said. Seven American Indian health facilities were also represented, she said.

"What we found that was great was that these hospitals were not required to do this, but that they did it because it was the right thing to do," she said.

Each hospital paid a $100 fee per person to attend the training, Tarpy said. The fee covered lecturers and lodging, but the Arizona Health Care Coalition on Domestic Violence was willing to reduce it, she said. The Arizona Department of Health Services funded the rest of the cost.

Tarpy said the coalition is asking hospitals that participated to come back for a second session in May, where each will present what it has accomplished.

Hospitals will also be asked to give feedback on what worked and what could be improved from the first training session. The coalition also plans to hold another session next fall for other Arizona hospitals.

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