Recommended COVID-19 Response Guidance for Medical-Forensic Services

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 medical-forensic services. This information is to provide you with updated resources that will assist you and your SART/ MDT partners in modifying your respective local protocols to best meet the needs of patients and families while accommodating for changes in organizational capacity and factors governing access to medical forensic SANE exams.

“Case-By-Case” Basis

Every medical forensic exam (MFE) should be considered on an individual and case-by-case basis in accordance with screening and triage for public health concerns of COVID-19. Hospital-based MFE services will be directed in accordance with current overarching plans directed by public health. The decision to provide MFE services in a non-hospital facility or independent suite during the current Georgia State of Emergency and Public Health Emergency should be made at the organizational level and should include consultation and governance by the agency’s board of directors.  All communities should evaluate current responses in accordance with public health considerations and include innovative, solution-based adaptability so that a patient’s access to care following a sexual assault is not unnecessarily compromised or delayed. However, the safety and wellbeing of all patients, staff and/or volunteers are of primary consideration. This applies to all hospital and non-hospital services during this time.  

Updated Information

As new information becomes available, information will be updated and made available to you.  We encourage you to contact us with your questions or concerns. Additionally, please remain up-to-date on current and changing information pertaining to COVID-19, and please see the links below.

Georgia COVID-19 “Hotline” – 844-442-2681

If you believe that you are experiencing symptoms of COVID-19 or have been exposed to the novel coronavirus, please CALL your primary care doctor, an urgent care clinic, or locally qualified healthcare facility. DO NOT SHOW UP unannounced.

Protocol Considerations: SANE MFE’s and the COVID-19 Pandemic:

Hospital Based MFE - SANE Services

Due to the very high patient census of COVID-19 patients overwhelming local hospitals, the availability for medical-forensic services typically seen by hospital-based providers may now be seriously delayed or unavailable and deferred.

Non-Hospital Based MFE – SANE Services

During the COVID-19 pandemic, “free-standing” or designated sexual assault “exam suites” may remain open.  It is important that all sexual assault protocols be examined and modified accordingly to meet capacity limitations and or necessary changes.

It is essential that adequate and effective screening measures be consistently implemented before a patient’s arrival, continued throughout the duration of the patient’s exam, and until the SANE exam room is cleared, cleaned, and cautiously disinfected upon the patient discharge from care.

It is recommended that patients be advised in advance of whether family members or friends may be required to wait outside the suite or facility in an effort to reduce exposure risks associated with COVID-19.

Clear guidelines are essential: nurses, advocates, law enforcement, or patient family or friends with symptoms of illness, or those that have sick family members at home should not respond or report for medical-forensic exams, they should instead follow their organization’s notification protocol and communicate with supervisors, etc.. 

Preparation for providing “low-risk” (COVID-19) MFE services, should include the following at a minimum:

  • Consider limiting points of entry to the SANE center.
  • Implement a COVID-19 response that limits foot traffic in the SANE center, including any visitors, support people, and law enforcement.
  • Advocates or SANEs (all MFE responders) with high-risk health conditions or concerns including pregnancy should discuss MFE response duties and limitations with their supervisor/s, and in accordance with their respective personnel policies.  Agencies should consider allowing any MFE responders with a high-risk health condition to opt out of direct care MFE services.
  • Due to uncertainties regarding the risks of exposure for pregnant woman to COVID-19 a MFE responder who is pregnant should discuss their MFE response duties with their personal physician/medical provider and communicate their specific duties with their agency supervisors.   Consideration should be provided to MFE responders to “opt out” of providing direct care MFE services that may elevate their risk of exposure.

Non-Hospital Public Health Triage: Prior to Patient Arrival for SANE Exam

All patients seeking to present for a MFE should be triaged by telephone in advance and prior to presenting to the exam facility. The SANE should screen incoming patients for symptoms of illness over the phone and triage them accordingly.  Example of a telephone triage of a MFE patient prior to their arrival could include but not be limited to the following questions: 

  • Have you been tested for COVID-19 or the flu in the past 14-days?
  • Have you traveled outside of the US in the last 14 days? Where?
  • Have you been in contact with anyone who has traveled outside of the US in the last 14 days?  Where?
  • Have you been in physical contact with anyone who has been diagnosed with COVID-19 or sick with symptoms?  When?
  • Have you had a fever, cough, and shortness of breath?
  • Do you have any other symptoms that are severe or concerning?

It is also important for SANE’s to communicate to the patient the facility conditions they may observe upon arrival for an MFE. These may include: use of various PPE, including masks, signs and instructions to specify hand washing and other precautionary steps during the intake and exam process. Communications to help inform and prepare a patient prior to arrival will help to mitigate anxiety during these times of heightened public health concern.

Note: A positive answer to any or all the questions should guide the decision to perform a SANE exam on a case-by-case basis; this may include a SANE consulting with another agency supervisor in making an appropriate determination.

If the advance telephone triage reveals a concern for potential COVID-19 exposure or infection, the SANE should defer the exam, and the patient should be referred to their medical provider.  

After the patient has received (and can provide proof of) a medical clearance from a qualified medical professional, consider performing the SANE exam if she/he is still within the appropriate response time for a SANE exam. 

If a patient’s answer(s) to the phone triage questions are all negative but upon arrival exhibits any visible symptoms, registers a temperature of 100.4 degrees or greater, or presents with concerning history/observations: a mask should immediately be placed on the patient and worn throughout the duration of their time in the SANE center. Any patient deemed of “concern” should be further assessed by the SANE, for final determination of whether the MFE should be performed, delayed, or otherwise deferred. 

Non-Hospital: Upon Arrival for MFE SANE Exams

All MFE responders should have their temperatures read prior to the patient’s arrival as a baseline of due diligence.  If the patient is deemed contraindicated for the MFE, or the MFE responders present with concerning symptoms, they should be referred to their medical provider accordingly and if the patient is symptomatic the exam should be deferred.

Upon the patient’s arrival at the SANE suite, the SANE should immediately confirm the triage answers previously provided by the patient by phone.

Once the patient and FME responders are cleared for the exam, the SANE should cover the following precautionary measures:

  • Provide supplies for hygiene (i.e. hand sanitizer) at SANE center entrance and all waiting areas.
  • Post signs and posters at the entrance, waiting room, and bathrooms that provide instructions on hand and respiratory hygiene as well as cough etiquette.
  • Limit the patient’s access to the exam room and avoid moving the patient from room to room.

Hospital MFE, or Non-Hospital High-Risk MFE Precautions

Medical personnel should adhere to Standard and Transmission-Based Precautions when providing care to patients with elevated risks for COVID-19, or exposure hx to COVID-19 – and this includes those presenting for a medical forensic exam, including:

  • Use of N95 masks are recommended as “best practice”, however, due to local and regional situational analysis of PPE supplies, the CDC has temporarily supported use of facemasks (surgical masks) as an acceptable alternative for the provider’s consideration.
  • Eye protection, gown, and gloves continue to be recommended. 
  • Increased emphasis on early identification and implementation of source control (i.e. putting a facemask on patients presenting with symptoms of respiratory infection.
  • Wash your hands often with soap and water for at least 20 seconds (especially after you have been in a public place, or after blowing your nose, coughing or sneezing).
  • Wash your hands before and after all patient contact, and before putting on and after removing PPE.
  • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol.  Cover all surfaces of your hands and rub them together until they feel dry. 
  • Avoid toughing your eyes, nose, and mouth with unwashed hands.
  • Avoid close contact with the patient (maintain a 6 foot distance). SANEs or advocates that cannot avoid a 6-foot distance should severely limit the time they have to be in close contact with the patient.
  • MFE protocol should include how a patient’s clothing or personal property will be handled in the context of the exam and packaging of evidence items.
  • SANE’s must continue mindful changing of gloves when handling items with potential evidentiary value also.

After ALL SANE Exams

Clean all surfaces areas of the SANE suite immediately upon discharge of every SANE patient.  This includes all handles, doorknobs, and surface areas, pay special attention to egress and ingress points or public/ patient access areas. This should also include any chairs, desks, pens, charts, injury rulers, bathroom facilities, etc.

Establish an appropriate protocol for cautious handling of all trash, have a protocol for disposal of PPE, masks, or other items.

ADDITIONAL GUIDELINES:

International Association of Forensic Nurses Recommendations

On Friday, March 13, 2020, the International Association of Forensic Nurses released the following statement: “We want to provide you, our members, and all forensic nurses with guidance for responding to patients who are impacted by violence during this public health emergency:

  • Communicate to patients seeking treatment after abuse that the healthcare system is open and safe for them to access;
  • Connect with your multidisciplinary partners and reassure them that you are still seeing and caring for patients;
  • If your advocacy community provides hospital/exam accompaniment, reach out to discuss any questions, concerns, or limitations they may have in providing services;
  • If an outbreak occurs in your community, take guidance directly from local health officials;
  • If you work in an outbreak area, seek alternate locations (other than the emergency department) to provide care to your forensic patient populations.

Many resources exist to share with your community partners, but the most important message to share is remain creative and flexible so that access to patient care is not compromised or delayed. We are committed to monitoring the situation and keeping an open line of communication with you.

STAY UP TO DATE

 

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