SANEs may have other clinical duties that prevent or limit their ability to provide on-call coverage or conduct a medical forensic examination while on duty. A backup schedule with two or three nurses on-call may be needed. There should also be an emergency credentialing procedure to utilize forensic nurses from other hospitals or agencies at an institution during a crisis/pandemic.
Explore This IssueACEP Now: Vol 39 – No 06 – June 2020
Given the stress of the pandemic as well as the usual work of a SANE, resiliency and mitigation of vicarious trauma resources should be made available to the SANE.
Law Enforcement: During a crisis, disaster, or pandemic, the focus of law enforcement often changes. The plan should include provisions for the continuation of crucial services such as detectives, child abuse units, special victims’ units, and crime lab services. Investigations may need to use video and virtual interviews. This also holds true for forensic interviews conducted by children advocacy centers. Arrangements should be made for the prompt pick up and processing of evidence from the hospital or forensic examination site; however, hospitals may need to store evidence until it can be transferred to law enforcement.
Do-It-Yourself (DIY) Rape Kits: Several years ago, companies developed a DIY rape kit as a way to allow evidence to be collected on the survivor’s terms. There was harsh backlash from social service agencies, district attorneys’ offices, and states’ attorney general offices, and DIY rape kit use is still not endorsed by many of these entities.5 However, during the COVID-19 pandemic, the kits have started to make a comeback. One California county has actually included it in its pandemic response plan.6 In this plan, the police bring the DIY kit to the patient. The person is virtually connected to a SANE, who provides guidance on evidence collection, and an advocate who provides emotional support and counseling. The police then pick up the kit from the person.
Not every region has as sophisticated a response to using DIY kits, and the victim is often not linked to additional community resources. Because evidence collection is only part of comprehensive care for sexual assault victims, the use of DIY kits is not ideal. The main arguments against their use includes the lack of injury determination, lack of access to sexually transmitted disease/HIV testing and prophylaxis, lack of pregnancy prophylaxis, and lack of emotional support and healing that is often afforded through the usual exam process. In addition, because these kits must be purchased, they may prove difficult to obtain in a crisis and technically violate the Violence Against Women Act, which ensures people receive sexual assault exams at no cost. Finally, there may be legal challenges to their admissibility. For all of these reasons, DIY kits are not recommended.
Disasters and pandemics have major effects on emergency departments, including changes in how they provide care to patients experiencing GBV. As these cases increase, there may be several barriers to survivors accessing care and resources.