SANE help for sexual assault victims

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More than a decade ago, physicians and nurses would “scatter like ants” when a rape victim came to the emergency room.
But that was before Memorial Health Center established the state’s first Forensic/Sexual Assault Nurse Examiner program. The program started from a single nurse’s concern that rape victims weren’t getting the care they needed.
“Historically, hospitals have not provided specialized care for sexual assault victims,” said Valerie Sievers, director of the program.
After years spent working in surgical neurotrauma and intensive care units, Sievers was familiar with the well-orchestrated response of surgical teams to gunshot wounds or heart attacks, and wanted to create the same kind of response for sexual assault victims.
So a group of ER nurses developed the forensic/SANE program at Memorial. Training for nurses includes not only how to gently and carefully gather forensic evidence, but also how to be an objective witness in court and present evidence about victims’ wounds.
Memorial has the only SANE program in El Paso and Teller counties.
A team of 14 experienced nurses, who typically also work in pediatrics or the women’s pavilion at Memorial, rotate being on 24-hour call. In general, the team receives more calls Thursdays through Monday — and calls increase during long weekends.

The process

As soon as a sexual assault or domestic violence victim arrives in the emergency room, the on-call SANE nurse is paged, and the patient is moved to a separate care unit room. Nurses work closely with ER physicians regarding patients’ allergies or other medical concerns.
Before the exam begins, the SANE nurse gives the patient an overview of the exam, which is performed only with informed consent. She asks the patient to describe the assault and does a head-to-toe assessment to find hidden injuries — such as bruises behind ears or injuries inside mouths.
The entire exam is conducted in a “compassionate and gentle” manner, Sievers said.
Patients are given prophylactic medications for the prevention of sexually transmitted diseases and are offered emergency contraception.
Some of the exam’s 14 steps include swabbing the mouth for a patient’s DNA, taking head and pubic hair samples, a pelvic exam for women of childbearing years, a clothing exam, a genital exam for males, females and children, and photo documentation of visible injuries and microscopic injuries.
If, for instance, head stitches are required, an ER physician will come to the SANE care unit — the patient does not have to leave the care room for any stage of the treatment.
Afterwards, the exam kit and clothing are given to law enforcement.
The care unit at Memorial has a room for patients to shower after an exam. The Assistance League of Colorado Springs provides an “Assault Survivor Kit” that includes clothing, underwear and toiletries for each patient.

Assault — an on-going problem

According to the Colorado Coalition against Sexual Assault Web site, one in four Colorado women and one in 17 Colorado men have experienced a completed or attempted sexual assault in their lifetime.
“This equates to over 11,000 women and men each year experiencing a sexual assault in Colorado,” the Web site said.
Domestic violence occurs in America every 15 seconds, claims a woman’s life every 21 days, and is the leading cause of injury among women ages 15 to 44, according to TESSA, a local organization for the prevention of sexual assault and domestic violence.
Annually, the Colorado Springs Police Department investigates approximately 350 felony sexual assaults. Of course, this number does not reflect the number of actual sexual assaults.
“Sexual assault is the most underreported felony in the nation — only 16-18 percent are reported,” Sievers said.
Sgt. Mike Velasquez, head of CSPD’s sexual crimes unit, said that after a victim-services investigator takes the exam kit to the police station, the kit is sent to the Colorado Bureau of Investigation to be processed for trace evidence.
If DNA from the sample is established, the information is stored in a database and compared with other samples.
“If we have a known suspect, the DNA can be used to confirm what other parts of our investigation have led us to believe — or the DNA can help exonerate someone who is wrongly accused of a crime,” Velasquez said.
Velasquez said it would be great if all communities had hospitals with experts in forensic examination.
“These nurses are invested and
interested in forensic (evidence). They do quality work which assists the victims and police for court purposes,” he said. “The time and effort Val Sievers has invested is very clear. The credit needs to go to her for the SANE program.”

Follow-up care

Trained SANE Nurses conduct forensic exams on sexual assault, domestic violence or elder abuse victims, and on suspects. Fortunately, not many victims are severely injured. Most injuries include bruises, minor genital injuries, and, of course, emotional trauma.
But nurses don’t merely collect evidence — treatment is holistic.
“For sexual assault or domestic violence victims over age 18, we call TESSA. They are a great support for us and our patients,” Sievers said.
A TESSA volunteer stays with patients before and after the exam to provide emotional support.
TESSA has a good working relationship with Memorial, said Director of Advocacy Andrea Wood. TESSA offers group and individual counseling and ensures that the patient has a safe place to go to: home, a friend’s house or to TESSA’s safe house. TESSA volunteers also assist abuse victims with filing restraining orders or other documents and go to court with them.
To preserve their anonymity, patients who need follow-up treatment (for acute or severe injuries, or to make sure anti-STD medicines are working) are referred to the El Paso County Health Department, if they are not comfortable seeing their family physician.
“I feel good about having a committed team of nurses and providing this community with compassionate service. We focus on caring for and returning control to the patient,” Sievers said.
Rebecca.Tonn@csbj.com