Some key points of a plan should include:
Explore This IssueACEP Now: Vol 39 – No 06 – June 2020
Social Service Agencies: Victims in the emergency department should have access to key social service agencies including rape crisis centers, domestic violence agencies, and child and adult protective services. Due to access issues, stay-in-place orders, and classification as nonessential personnel, video conferencing services may be utilized to provide virtual consultation, screening, and counseling. The agencies should come up with a plan for use of these modalities as well as access to hotline services. Remember, these services should be secured and HIPPA-protected. Women’s shelters may be overwhelmed or unable to accommodate their usual numbers of persons due to social distancing guidelines. Alternative shelter locations, such as hotels, should be designated.
Forensic Services: Victims of GBV, especially sexual assault, should have access to forensic nurses. Hospital-based programs may need to designate alternative sites to conduct medical forensic examinations such as a clinic examination room, an inpatient site, or even an alternate location. It may prove necessary to have a plan with multiple alternatives because space and availability may be become tighter as a pandemic continues.
If a mobile/regional SANE service exists, there should be assurances the nurses will have access to the emergency department for medical forensic care. This may include parking access, entry screening, specialized regional ID tags, and adequate space and resources to conduct examinations. Once again, alternative locations either at the hospital site or within the community may need to be considered and designated during a crisis.
Telehealth SANE services may be a viable alternative solution. There are a variety of models for its use, but essentially it can bring the SANE to the patient remotely while another health care professional conducts the examination and evidence collection. Telehealth SANE programs require agreements in advance and have specific state licensing restrictions that should be considered during disaster planning.
In the absence of these resources, staff not accustomed to providing sexual assault exams may be the only option. In that case, those workers should be provided with simple, easy-to-understand instructions on how to conduct examinations and how to collect, package, and store evidence. This should be described in a clear, easy-to-read manner and be part of the emergency department’s disaster plan.
Regardless of the SANE model, nurses should have access to the appropriate personal protective equipment to conduct the examinations. This can be provided by the hospital, sponsoring agency, or community as part of the planning process. During a pandemic, patients should be screened for potential disease/infection and the SANE notified of the results prior to patient contact. Laboratory testing for the disease/infection should not be required for an examination to occur.