COVID-19 Shelter in Place Sexual Assault Response Team Protocol
In light of the current Coronavirus public health advisory and CDC recommendations all healthcare providers and patients are faced with elevated risks and challenges in delivering healthcare, including forensic medical exam services.
In the midst of a pandemic, all healthcare facilities must be dedicated to essential health services and Sexual Assault Forensic Exams may not qualify as such. Additionally, it may not be possible to maintain CDC’s Social Distancing recommendations with our community partners inside healthcare facilities, particularly during forensic examinations.
Due to the potential of very high census of COVID-19 patients overwhelming local hospitals, the availability for medical-forensic services typically seen by SAFEs is no longer available except for extremely limited circumstances. Any exams that must be done outside of the victim’s home will be conducted at the Child Advocacy Center and this may only be possible for a limited time.
An alternate method of evidence collection while the patient remains safely sheltered in place protects the health of not only the patient, but that of multidisciplinary members: Sexual Assault Forensic Examiners, Law Enforcement Personnel, and Sexual Assault Counselors.
Adult and Adolescent Patients
Home Exam Flow
Patient contacts law enforcement. Law enforcement calls SAFE and requests a forensic exam. SAFE calls the patient and asks if the patient feels safe in the home and, using the current medical screening exam questionnaire, determines emergent care needs, and appropriateness of exam given time window since the event and types of acts that occurred. If an exam is indicated, SAFE contacts the Law enforcement officer and requests that the officer deliver a kit to the patient’s door. A consent form will be attached. (These kits will be distributed to each agency in Our County). The SANE sets up a HIPAA compliant telehealth connection for the patient, Law enforcement Officer, SAFE, and Sexual Assault Counselor to communicate.
The SAFE interviews the patient as usual, using the Form with Law Enforcement and the Sexual Assault Counselor present, via a secure telehealth connection. After the interview, Law Enforcement leaves the telehealth platform, delivers a kit and the first page of the form for the patient’s consent, and waits in their patrol car. Using HIPAA compliant telehealth, SAFE observes the patient unseal the kit, collect the samples, and seal the kit. No drying time is needed with this type of kit and the process should not take more than 10 minutes. SAFE notifies law enforcement that the kit is ready for pick up, directs the patient to place the sealed kit and signed consent outside their door, and the law enforcement officer picks it up from the patient’s door. Law enforcement delivers the kit to the crime lab within 20 days. The SAFE will scan or fax the completed Form directly to the crime lab and the police.
STI Testing and Medication
If the patient requests STI testing, the SART medical director will contact the patient and facilitate testing. If the patient requests prophylactic medication, the SAFE will arrange to meet the patient in the parking lot outside of the CAC at Natividad and provide medications to the patient who will remain in their car.
Emergent Care Needs
If a patient must be seen in the hospital due to emergent needs (excessive bleeding, strangulation, severe pain, or other concerns) they should seek medical attention in an appropriate healthcare facility. A SAFE will not conduct an exam in the healthcare facility, however, and the exam will be offered after the patient has received medical treatment, and returned to their home.
Suspect and In-custody Exams
The Emergency departments will no longer be used for forensic exams. This means we cannot conduct suspect exams or in-custody exams.
Non-Investigative Reports
We will not be able to offer abbreviated exams at this time.
Pediatric exams
Law enforcement will consult with the SAFE on a case by case basis.
It is amazing how COVID is redefining how we interact with each other and how we as forensic nurses can continue to respond to the patients we serve. This is an example of a new paradigm I'm sure many of us never anticipated and none of us were educated to apply to patient care. Thanks for sharing this example.