Develop a policy for abandoned children
Develop a policy for abandoned children
The chance your ED will receive an abandoned infant is slight, says Larry Mellick, MD, MS, FAAP, FACEP, chair of the department of emergency medicine at Medical College of Georgia in Augusta. "Nevertheless, because it is a rare event as well as being emotionally charged, one can be assured that some degree of confusion will exist when it takes place," Mellick says.
Delineate a clear policy and a chain of custody, he says. Here are some items to consider when developing a policy and procedure for abandoned infants:
• Make sure the policy is comprehensive.
The following elements should be addressed, Mellick recommends:
— The policy should clarify the legal responsibilities of the ED staff as instructed in the statute.
— The notification process for child protective services and social work services should be delineated clearly.
— Specific information or documentation needed from the parent or individual delivering the newborn to the hospital (if that person is available) should be clearly defined for ED staff. Also, the information desired or required concerning the identity of the infant should be established.
— Establish a process for maintaining a chain of custody.
— Define the infant’s specific health issues and risks and outline their management.
— Complete a medical screening examination as required under the Emergency Medical Treatment and Active Labor Act.
— Arrange provisions for standard neonatal testing.
— Consider screening for nonaccidental trauma.
— Obtain a complete blood count because incorrect management of the umbilical cord can result in significant blood loss to the newborn.
— Admit the child to the appropriate nursery in the hospital to monitor for hypoglycemia, hypothermia, or infection for a minimum of 24 hours. In the ED, place the child in an isolette or overhead warmer. Those actions are needed because the circumstances surrounding a delivery outside the hospital and the lack of sterile conditions could put an infant at more risk for physical stress, hypothermia, and infection.
— Define provisions and resources immediately available to the staff to prevent disruption of the daily operations in the ED. The care of a newborn infant without a parent may cause such disruption.
• Document the circumstances of abandonment.
ED staff should document, to the best of their ability, the circumstances under which the infant was abandoned, stresses Arlo Weltge, MD, MPH, FACEP, associate professor of emergency medicine at University of Texas Houston Medical School. The documentation should include the following, he says:
— whether an emergency medical technician brought the child in or the child was found in the hospital;
— if an EMT brought in the child, the individual and agency name and phone numbers;
— names of individuals who found the child;
— all additional names and contact numbers for individuals who can provide any information;
— the specific circumstances under which the child was found.
• Contact local law enforcement.
In addition to contacting child protective services, an effort must be made to verify that the child is actually abandoned. "Your policy should include contacting the police department to search for the parents," says Weltge. "The problem is a complete lack of information, but the goal is to exclude the possibility of a lost or missing child."
Document the steps taken, which will demonstrate that you are not illegally taking custody of the child, he says. "You’ll need to show that you made efforts to establish that child is not missing or lost."
• Ensure that child protective services has a policy for this scenario.
Since the law was passed, one child was dropped off at an ED in Dallas, reports Dighton Packard. "In that case, the ED knew what to do," Packard says. However, the city services were not ready, he says. "Therefore, my best advice to others is to make sure the social services in your area also have a policy to handle these infants."
• Ensure that staff know whom to contact.
The goal is to ensure a smooth transition of the child from the ED to protective services, Weltge advises. "Ahead of time, the ED should establish a relationship with their local support agencies, specifically child protective services, and create guidelines for how to make the transition from the medical facility to the protective service."
Large urban EDs with a full-time social worker on staff already will have established relationships with social agencies, he says. "In that case, it’s mainly a matter of the ED manager coordinating with the child protective services how to go about handling this particular case."
However, in a suburban ED, managers should set up a formal agreement about how to handle these cases, he says. In rural communities that don’t have full-time protective services available, that agreement will involve much more work to coordinate. "In that case, the ED staff might need to involve the legal system and make arrangements with a judge who could be the contact person after hours," he says.
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