Notes
1The 1991 number of 20 programs was reported by G.P. Lenehan (1991, February) in “Sexual Assault Nurse Examiners: A SANE Way to Care for Rape Victims,” Journal of Emergency Nursing 17:1.
2The 2006 number of 500 programs was drawn from electronic communication on October 18, 2006, with Carey Goryl, Executive Director of the International Association of Forensic Nurses. This number is indicative of SANE programs in the United States and its territories that are voluntarily registered with the association. There may be additional programs that have not registered with the association. To view the registry, go to www.iafn.org/displaycommon.cfm?an=5.
3Much of the information about the project in this e-publication was drawn from FRIS’s “Mobile SANE Project Final Report” (unpublished). For the sake of brevity, it will not be continuously referenced throughout this document.
4Additional terminology exists to denote medical professionals who are specially trained and clinically prepared to perform forensic medical examinations. Examples are forensic nurse examiner (FNE), sexual assault forensic examiner (SAFE), and sexual assault examiner (SAE). For this bulletin, the term SANE is used.
5Henceforth in this document, the term “forensic medical sexual assault examination” will be referred to as the “examination” unless further clarification is appropriate. For a discussion of what is involved in this examination, see A National Protocol for Sexual Assault Medical Forensic Examinations: Adults/Adolescents, 2004, U.S. Department of Justice, Office on Violence Against Women, NCJ 206554.
6Although most SANE programs are located in hospital emergency departments, some are in other hospital departments or community settings (e.g., a women’s center, a college health department, or a community health clinic).
7When a patient is seriously injured, SANEs must be prepared to work alongside health care personnel (e.g., emergency department physicians) who are stabilizing and treating the patient. SANEs may sometimes need to perform examinations in settings such as an operating room, a recovery room, or an intensive care unit. Drawn from A National Protocol for Sexual Assault Medical Forensic Examinations (Adults/Adolescents): 77.
8This paragraph is partially drawn from N. Hoffman and D. Lopez-Bonasso, “West Virginia Goes SANE” (unpublished article).
9This list of problems was drawn from R. Campbell, 2004, The Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs, VAWnet Applied Research Forum, National Online Resource Center on Violence Against Women: 1; and K. Littel, 2001, Sexual Assault Nurse Examiner (SANE) Programs: Improving the Community Response to Sexual Assault Victims, U.S. Department of Justice, Office for Victims of Crime: 1, 2, NCJ 186366.
10Go to www.iafn.org/displaycommon.cfm?an=5 to learn about locations of SANE programs registered with the International Association of Forensic Nurses.
11The problems cited in this paragraph were drawn from page 2 of the “Mobile SANE Project Final Report” (unpublished), submitted by FRIS to OVC at the end of its grant period.
12WAIC and Hope, Inc., served the counties that decided to implement the project.
13Drawn from FRIS’s “Regional Mobile SANE Project Strategic Plan” (unpublished document).
14Note that Polaroid has discontinued production of the Macro 5 SLR camera, but is still making the film. According to the adult version of the SANE-SART Training Manual, use of a Polaroid, 35mm, or digital camera should be based on what is accepted by the prosecutor/judicial system in a particular area of the country. It is the standard of practice that two sets of prints are made, one for police if the sexual assault is reported and one for the medical record. For further guidance on using photography to document forensic evidence and on the required specifications for camera equipment, please refer to A National Protocol for Sexual Assault Medical Forensic Examinations (2004), chapter 5, “Photography”: 85:
Consult with local criminal justice agencies regarding the types of equipment that should be used (e.g., prosecutors can assess which types of equipment produce results acceptable by the court). In general, any good-quality camera may be used as long as it can be focused for undistorted, close-up photographs and provides an accurate color rendition.* If digital photography is used, the reliability of photographic images must be considered due to technological advances in computer alteration. Also consult with local examiners, because they are often knowledgeable regarding photographic and video equipment used in these cases and their effectiveness in capturing images during the exam.*The California Medical Protocol for Examination of Sexual Assault and Child Sexual Abuse Victims, 2001: 56.
15Initially, the hospital contract stipulated that a participating hospital would be assessed $2,000 if it could not arrange for three nurses to be SANEs. This stipulation was removed from later contracts.
16After the first year, a requirement was added that nurses must have at least 2 years of R.N. experience before practicing as a SANE.
17The project has not yet determined a way to enforce this requirement. The few SANEs who left the project before their first year was completed were not asked to reimburse the project for training costs.
18As a point of clarification, nurses were not required as part of their contract for this project to complete orientation trainings at the other participating hospitals. Nurses working outside of the project for the other hospitals, however, are subject to the policies of those hospitals.