What To Expect During a Sexual Assault Exam

April is Sexual Assault Awareness Month and in recognition of that, I want to talk about the Sexual Assault Nurse Examiner (SANE) program at Denver Health and what a person can expect if they come in for treatment following an assault.

Who I Am and Why I Do This

I have been the coordinator of our SANE team since 2011, but my Denver Health career started much earlier. In total, I have been at Denver Health for the last 19 years, starting out as a paramedic in the Emergency Department and later becoming a registered nurse. While I was still working as a paramedic, I went to a trauma conference and listened to a nurse who talked about sexual assault nurse examiners and became very interested in eventually becoming one. Hearing her speak with such passion about taking care of patients after they had been assaulted and how this specialized care could make a difference for long-term healing was very exciting, and I knew it was something I wanted to be a part of.

At that time, when someone was sexually assaulted, we did not have a specialty team to care for them. The community realized how important it was to have a more victim-centered approach – providing care specific to victims of assault. In 2005, Denver Health began developing a SANE program, and I was lucky enough to be one of the nurses chosen to be a part of the first team.

Nurses who choose to add this specialty to their career paths all have a deep desire to provide the best care possible to patients who have been victims of interpersonal violence, and they go through many hours of additional training to be a part of the team.

What Patients Should Know About Sexual Assault

It is important to realize that sexual assault is not about sex; it is about power and control. It has nothing to do with what a person is wearing, who they talked to, where they are or if they’ve been drinking. Unfortunately, it is a crime where the victim frequently feels shame and self-blame.

We hear about “fight or flight” but rarely do people talk about “freeze.” The majority of patients I’ve taken care of report that they froze during the assault. During the exam, I’m able to tell them that that is absolutely normal. It isn’t unusual for a patient to wait a couple of days after an assault to come in, and that is okay. We perform exams up to seven days after an assault happens.

What Happens at the Hospital

When a patient comes to Denver Health and says they were assaulted:

• They are escorted to a specialized private suite in the Emergency Department
• A nurse will take their vital signs and make sure there aren’t any health concerns that require seeing a physician in addition to a visit from the forensic nurse
• A social worker will come in and speak with the patient about their options

Options For Patients in Colorado

In Colorado, patients can choose from four different options if they have been assaulted:

1. Report to law enforcement and have a medical forensic exam
2. Medically report – which means that law enforcement will have their identifying information, and they can have the evidence collected and tested; however no investigation will be initiated unless the patient consents
3. If a patient is between the ages of 18-69, they can choose to be anonymous. With an anonymous report, law enforcement does not get any identifying information about the patient and no investigation will be started, including not testing collected evidence, unless the patient consents.
4. A patient can choose not to have a medical forensic examination but instead be seen by a physician and given medications to prevent disease and pregnancy.

If a patient would like to have an exam, the social worker will call in the nurse along with a hospital advocate from the Blue Bench (our local rape crisis organization).

What Happens During the Exam

A medical forensic (SANE) exam isn’t just about swabbing for DNA. First and foremost, we make sure our patients are okay. Then, we will:

• Get the patient's medical history and a history of the assault
• Do a thorough head-to-toe examination, looking for potential injury and evidence
• If there is any injury, address and document it
• Provide medication to prevent disease and, if indicated, pregnancy
• Provide patients with resources for continued care
• Provide specialized, individualized medical care for our patients

At Denver Health, we know how important it is to do our best to give back power and control to that patient, which starts from the moment they walk into the Emergency Department.

This is Your Exam

Making sure that patients are empowered and have control is a very important part of the medical forensic examination. The first thing I say to a patient after I introduce myself is that this is their exam, not mine, and if there is anything they are unsure about or don’t want to do, I’ll explain why we do it, but they are in control and can say "No" at any time.

Patients are never charged for a SANE exam, whether they have insurance or not.

Denver Health's Sexual Assault Nurse Examiners Team

I am incredibly proud to be a part of Denver Health’s SANE team and provide the right care to our patients.

Last year, our 20 nurses cared for more than 400 victims of sexual assault; these patients came from all ages, backgrounds, gender identities and sexual orientations. Some chose to participate in the criminal justice system and some did not, but every one of them received the best care we could give.

I’m thankful to be a part of this team and organization.