During the COVID-19 pandemic, it is important that NSW Health services continue to identify and respond to violence, abuse and neglect, and avoid any disruption to the provision of specialist medical and forensic services. However, some modifications to practice may be helpful to minimise time spent in emergency departments, and to ensure compliance with COVID-19 infection prevention and control protocols.
This clinical pathway is provided as optional guidance to districts/networks to assist in service planning in the context of COVID-19. The pathway will require variation based on local circumstances and the changing risk profile of COVID-19. Sexual Assault Services should:
All Sexual Assault Services (SAS) staff (psychosocial and medical and forensic) who respond to COVID-19 positive patients must have had practical personal protective equipment (PPE) training. Where possible SASs may consider having designated medical and forensic examiners* and counsellors in the SAS who are competent with PPE to respond to COVID-19 positive patients.
In addition to this clinical pathway, SASs may wish to develop telehealth pathways for psychosocial support.
This clinical pathway sits within a broader set of advice and guidance regarding
responses to violence, abuse and neglect during COVID-19.
*Note: throughout this document, the term “medical and forensic examiner” or “examiner” includes both examiners who are doctors and Sexual Assault Nurse Examiners (SANEs).
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No risk factors for COVID-19, plus no fever and no acute respiratory infection symptoms.
Symptoms suggestive of COVID-19 with a negative RAT followed by a negative quick-return PCR.
Confirmed COVID-19 case i.e., positive RAT or symptoms suggestive of COVID-19 with a negative RAT but positive quick-return PCR.
(ie: a patient or health worker who may be at higher risk of serious illness if they contract COVID-19)
A patient or health worker who meets one or more of the following criteria:
List of chronic medical conditions for consideration:
List of significant causes of immunosuppression:
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Where a patient contacts the SAS by phone regarding a medical and forensic consultation, but has not yet presented to an emergency department, in addition to usual intake and screening processes consider:
SASs in partnership with local EDs may need to develop local pathways to safely transfer high risk (red) patients to an appropriate SAS if they present to a hospital without a SAS.
Where a patient who has confirmed COVID-19 presents to a hospital with a SAS, but without a COVID-19 treatment zone, SASs, in partnership with local EDs, will need to consider options based on the circumstances of the patient. Options to be considered include establishing a temporary COVID-19 “red’ treatment zone within the hospital to ensure the patient can receive a timely medical and forensic response or transferring the patient where this would be appropriate (considering the patient’s level of distress, distance to the nearest SAS, the length of time since the assault, and other relevant factors).
Where a patient presents to an ED in a hospital with a SAS and an identified zone for treating high-risk (red) patients, the appropriate clinical pathway will depend upon the patient’s condition and level of individual and epidemiological risk.
If there are no risk factors for COVID-19, plus no fever and no acute respiratory infection symptoms, the SAS consultation will proceed the low risk (green) path.
If the patient has symptoms suggestive of COVID-19 – fever (37.5 degrees Celsius or higher), cough, sore throat, shortness of breath (difficulty breathing), runny nose, loss of taste, loss of smell, fatigue, acute blocked nosed (congestion), muscle pain, joint pain, headache, diarrhoea, nausea/vomiting, loss of appetite1 – the ED will perform a RAT or PCR depending on local processes.
If the RAT is:
If the quick-return PCR is:
During the winter period, if the patient is symptomatic, testing will usually include PCR for influenza A and B.
The following advice applies to SASs:
Note: SASs should ensure that the process described below is approved by local infection prevention and control team
Note: Health facilities can adopt other safe ways of performing a medical and forensic examination with contact and droplet precautions according to local guidelines and procedures.
As above, an in-person response should remain standard practice for medical and forensic consultations, and telehealth offered only in limited circumstances. Where telehealth is considered, in line with the circumstances above:
(Note: this pathway does not address photography, given its complexity. SASs that wish to continue photography may need to develop local processes.)
If undertaking a consultation by telehealth, the examiner should have with them:
The examiner should have the following material in the donning area:
Depending on the patient’s history, the examiner may also need:
The examiner should have the following material in the doffing area:
The examiner may also need: