Most SANE programs use a pool of SANEs who are on call 24 hours a day. The on-call SANE is paged whenever a sexual assault victim enters the community's response system⁹ and usually responds within 30 to 60 minutes.¹⁰ The SANE or other medical personnel (e.g., emergency department physicians or nurses) first assess the victim's need for emergency medical care and ensure that serious injuries are treated. After the victim's medical condition is stabilized or it is determined that immediate medical care is not required, the SANE can begin the evidentiary examination. During the course of exams, SANEs—

• Obtain information about the victim's pertinent health history and the crime.

• Assess psychological functioning sufficiently to determine whether the victim is suicidal and is oriented to person, place, and time.

• Perform a physical examination to inspect and evaluate the body of the victim (not a routine physical exam).

• Collect and preserve all evidence and document findings.

• Collect urine and blood samples and send them to designated laboratories for analysis in cases where drug-facilitated sexual assault is suspected.¹¹

• Treat and/or refer the victim for medical treatment (a SANE may treat minor injuries such as minor cuts and abrasions, but further evaluation and care of serious trauma is referred to a designated medical facility or physician).

• Provide the victim with prophylactic medications for the prevention of sexually transmitted diseases (STDs) and other care needed as a result of the crime.

• Provide the victim with referrals for medical and psychological care and support.

In many jurisdictions, community-based sexual assault victim advocates are involved in the initial medical-legal response to sexual assault victims. SANEs often collaborate with these advocates during examinations to ensure victims receive crisis intervention, help with safety planning prior to discharge, and referrals for other types of assistance and ongoing support.

SANEs should interact with victims and their families in an objective and neutral manner that promotes informed decisions regarding evidence collection and available treatment options.¹² To facilitate decisionmaking, SANEs provide information regarding evidence collection procedures and reporting options. An exam is never done against the victim's will, no matter what age.¹³ SANEs release evidence to law enforcement agencies only with the victim's consent in cases where the victim has agreed to report or has already reported the crime. SANEs are mandated, however, to report to the proper authorities in cases of sexual assault of vulnerable adults (e.g., an older person dependent on a caregiver); sexual assault of minors by family members, caretakers, or persons in positions of authority over them; or sexual assaults of minors that were the result of parental neglect.¹⁴ Depending on state statutes and local enforcement policies, SANEs may or may not be mandated to report cases of statutory rape if adult perpetrators were not caretakers or were not in positions of authority over minors.¹⁵

In cases where victims are uncertain whether they want to report, the evidence can be collected and held in a locked refrigerator for a specified time, as mandated by state statutes. Victims should be informed of the time period in which they must decide how the evidence will be disposed if they choose not to report. If victims choose not to report and do not have evidence collected, the SANE ensures that they receive appropriate medical treatment and community referrals and are informed about advocacy services.

SANEs also conduct evidentiary examinations of suspects in sexual assault cases. These exams are usually conducted at local law enforcement agencies or jails. Meticulously collected evidence in suspect exams can be invaluable in case investigation and prosecution because the evidence can corroborate the victim's account of the assault.