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Evaluation and Management of the
Sexually Assaulted or Sexually Abused Patient
After years of effort on the part of SANEs, the American Nurses’ Association (ANA) officially recognized Forensic
Nursing as a new specialty of nursing in 1995 (Lynch: 96). Forenic nursing is the largest subspecialty of forensic
nursing. At the 1996 IAFN meeting in Kansas City, Geri Marullo, Executive Director of ANA, predicted that within ten
years the JCAHO would require every hospital to have a forensic nurse available (Marullo: 96).
Today, forensic nursing practice includes:
• Interpersonal Violence
— Domestic Violence
— Elder Abuse/Neglect
— Child Abuse/Neglect
• Sexual Assault (Adult and Pediatric)
• Correctional Nursing
• Death Investigation
• Forensic Mental Health
• Legal Nurse Consulting
• Public Health and Safety
• Emergency/Trauma Services
Over the past several years, hospitals have transitioned their SANE programs into “Forensic Care Programs” which
respond to the evidence collection and injury documentation of ALL victims of violence.
Chapter 3
Minimum Core Content
Wendy Wooley, DO
At a minimum, health care professionals practicing in the area of sexual assault should receive
instruction on the following topics, especially as they relate to specific local, legal, clinical, and follow-up
While the growth of the SANE concept was slow in the 1970s and 1980s, the undeniable value of the SANE resources
for comprehensive quality care of the sexually assaulted patient has encouraged continued development of programs
into present day. Both selective triage to specialized treatment centers as well as providing SANE resources for the
rape victim are endorsed in ACEP policy. It is important that programs that are beginning today have access to the
lessons learned by the programs that were developed more than twenty years ago. It is the purpose of this manual to
make that information readily available in over the Internet
Unless otherwise noted, the references for this chapter can be found in the historic references appendix of this handbook.
Multidisciplinary Team Concept
Dynamics of Sexual Assault
— Myths and realities
— Rape Trauma Syndrome, Post-Traumatic Stress Disorder (PTSD)
Sexual Assault Forensic Examination
— Communication skills
— History
— Physical assessment
— Detailed genital examination
— Physical evidence collection
— Forensic photography
— Documentation
Criminal Justice System
Anatomy and physiology as it relates to sexual assault/abuse
1. Normal male and female genital structures, from birth to reproductive age to the aged adult
2. Effect of hormones on the genital structures
3. Effects of the human sexual response cycle on the body
4. Anatomic sequelae of nonconsensual sexual acts plus associated physical trauma
5. Medical conditions, anomalies, or pathology that may influence the physical examination
Psychological aspects of sexual assault
Medicolegal forensic examination
1. Patient assessment/patient history
2. Evidence collection: physical examination/enhanced visualization/evidence collection kits/preservation of
The role of the forensic examiner in the criminal justice system
Medical management of sexually transmitted diseases, HIV, and pregnancy
Referral services available for the victim
Curriculum excerpts based on the “Sexual Assault Nurse Examiner Education Guidelines” of the International Association of Forensic Nurses.
(Complete curriculum outline on adult and children available from the IAFN on request.)
Curriculum based on the “National Training Standards for Sexual Assault Medical Forensic Examiners” of the U.S. Department of Justice/
Office for Violence Against Women, 2006.
Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient | ACEP
Minimum Core Content