Exploration of "out of hours" calls to the Child and Adolescent Sexual Assault Treatment Service in Galway over a one-year period to quantify need for continued extended hours service.

Introduction: The Galway Child and Adolescent Sexual Assault Treatment Service (CASATS) operates within a Barnahus model on site on weekdays from 08.00 to 16.00 h with 24/7/365 out of hours on call availability. The service is localised to West and Mid-West Ireland for "in hours" examinations but covers the whole of Southern Ireland for "out of hours" examinations. Whilst CASATS supports children under 18 years of age, "out of hours" forensic medical examinations (FME) are predominantly children under 14 years of age as the adult sexual assault treatment units (SATU) in Ireland offer acute FME to patients from 14 years up. The overlapping 14-18 age group between adult SATU and CASATS makes commissioning challenging. Service specifications in Ireland recommend working towards provision of a 12/7 (08.00-20.00 h) service for paediatric FME, but do not detail recommendations for "out of hours" care for children under 14 years after 20.00 h. This review sought to quantify the number of "out of hours" telephone queries from professionals exploring the need for a paediatric FME for suspected sexual harm and the number of children subsequently examined "out of hours" by Galway CASATS in 2024 to determine the need for a continued extended hours service. "Out of hours" included Saturdays, Sundays, bank or public holidays and between 16.00 and 08.00 on weekdays.

Methods: Data were collected anonymously through retrospective review of medical notes and from records of telephone queries received from January 01, 2024 to December 31, 2024. Inclusion criteria were (a) All telephone queries to Galway CASATS ("in" and "out of hours") relating to the need for FME in children (<18 years) where sexual harm had been disclosed, witnessed or strongly suspected (b) All "in" and "out of hours" FMEs undertaken in Galway CASATS for children (<18 years) including those where agreement had been reached that FME would be beneficial, following discussion ("in hours") at Barnahus West Interagency planning meetings. Exclusion criteria were (i) Children for whom FME was not indicated, following "in hours" interagency Barnahus discussion (ii) The 41 Children 14-18 years in 2024 supported through the adult sexual assault treatment units, all eligible for Barnahus support.

Results: The number of telephone queries and requests for FME arising from Barnahus West in 2024 related to 126 children. Thirty-eight telephone queries concerning 42 children were received outside of Galway CASATS' normal workday of 08.00-16.00 h. Seventeen calls concerning 20 children were received outside the 08.00-20.00 h 12/7 paediatric FME service specifications for Ireland. Of the 93 children who attended for FME in Galway CASATS in 2024, 19 (19/93 = 20 %) required urgent "out of hours" examination (outside of 08:00-16:00 Monday to Friday workweek) of whom 5 (5/93 = 5 %) required examination outside of 08.00-20.00 h 12/7 paediatric FME service specifications for Ireland. All 19 children who required urgent "out of hours" FME in Galway CASATS in 2024 were under the age of 14 years.

Conclusion: This review supports the need for continued 24/7/365 on call services for FME for sexual assault in children under 14 years of age. There will be no immediate change to the current Galway CASATS service and the findings of this review will be presented to national committees to support ongoing extended hours service provision.