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Implementing SANE Programs in Rural Communities: The West Virginia Regional Mobile SANE Projectsubnavigation
Publication Date:  June 2008
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Office of Justice Programs Seal   Office for Victims of Crime, Putting Victims First

Assessing Project Feasibility

Expect the Unexpected

FRIS learned during the feasibility study not to cling to an idea if data indicate the need for something different. Its research, for example, led FRIS to select a project site that had not been considered prior to the study. Also, the information FRIS gathered led it to discard its original plan for a self-contained mobile unit.

Defining Project Elements

Is a Vehicle Necessary to a Mobile SANE Project?

FRIS originally envisioned that a motor vehicle, similar to a bloodmobile, containing the space, equipment, and supplies needed to perform forensic medical examinations would be the linchpin of the project. But the coalition needed first to assess whether a mobile unit was the best model for West Virginia. Because FRIS knew of no existing mobile units for forensic medical examinations, it researched mobile units used for other medical procedures, such as x-rays and dialysis, and for nonmedical purposes, such as libraries. By examining these units, FRIS pieced together a list of elements necessary for conducting forensic medical examinations. These included bathroom facilities, accessibility features for people with disabilities, security, space for a victim advocate, mechanisms for ensuring confidentiality, medical support, liability issues and insurance, and a way to cover the costs of project startup and ongoing operation. Given this comprehensive list, FRIS questioned whether a self-contained mobile unit was appropriate for this project. Most worrisome were the facts that a mobile unit would not provide adequate security and could isolate victims with acute injuries from the treatment available in emergency departments. In addition, outfitting a mobile unit with all these elements would make it large and unwieldy, and difficult to maneuver and to park inconspicuously—in short, a challenge to maintaining victim confidentiality.

Revise the Plan, If Necessary

Based on these concerns, FRIS revised its original plan. Instead of performing examinations in a self-contained mobile unit, its new plan called for a smaller, less conspicuous vehicle to transport SANEs and equipment to different hospitals, where SANEs would perform the examinations. FRIS found a prototype for such a mobile unit at Memorial Hermann Hospital in Houston, Texas. The project coordinator, Rusty Rooms, shared information about the hospital’s mobile unit, which was in the final stages of development. Memorial Hermann Hospital was part of a seven-hospital system that would be served by this unit. The hospital volunteer association donated the vehicle, a Chevy Blazer, and the hospital system agreed to be the vehicle’s owner and to pay for insurance and gas. When a patient presented as a sexual assault victim at any one of the seven hospitals, the hospitals’ existing dispatch system would contact the on-call SANE. The on-call SANE could take the vehicle home or leave it at one of the hospitals and pick it up if dispatched. SANE training, payroll, and liability insurance would be handled by the hospital system. The project coordinator worked 20 hours a week to monitor and coordinate services and had an assistant for 8 hours a week.

Examining the Houston project allowed FRIS to consider how a mobile SANE project in a rural area might differ from one in an urban area. Based on the information it gathered, FRIS identified questions that it would need to answer during project development:

  • What strategies might best promote the participation of hospitals that are not in the same system?

  • Should hospitals contribute to the project equally or in proportion to their size, financial capacity, and the number of SANEs they provide?

  • How could the logistical challenges presented by a mobile unit be addressed? For example—
    • Where should a shared vehicle be parked when it is not in use?

    • How would the vehicle get to the on-call SANE?

    • How would the costs of insurance, gas, and maintenance be shared?

    • What issues would arise when serving hospitals across a sizable, mountainous region?

    • How is timely response facilitated?

    • Is one vehicle adequate?

    • How should the purchase of equipment be arranged?

  • How could logistical challenges in administering the program be overcome? For example—
    • How would SANEs be recruited and trained?

    • How would the training and clinical preparation be made consistent across hospitals?

    • Other Regions/Other Issues

      Other regions may have different or additional questions they need to answer during project development. They may find that emergency department physicians are reluctant to embrace a SANE practice, and may need to consider ways to overcome this problem. One solution might be to include in the contract with participating hospitals a stipulation that their physicians are required to work with SANEs to provide patient care and facilitate forensic evidence collection.
    • Who would hire SANEs and cover the cost of training?

    • How would payroll be arranged?

    • How would medical records be retained?

    • How would SANEs be dispatched?

    • How would liability for SANEs and the vehicle be addressed?

    • How would patient privacy issues be addressed and the Health Insurance Portability Act of 1996 (HIPAA) be implemented?

    • How would medication be dispensed if the SANE was not a hospital employee?

    • Would project policies be consistent across different hospitals?

  • How could a financially self-sustaining program be created?

When FRIS discussed these issues with the region’s decisionmakers (see “Inviting Stakeholder Participation”), the impracticality of sharing a vehicle over a large geographic area became obvious. Law enforcement and prosecution also questioned how using a mobile unit might affect jurisdictional issues. In the end, it was decided that the most practical and cost-effective plan was to move only the nurses among hospitals, with the on-call SANE going directly to the hospital where the victim presented.