A Sexual Assault Nurse Examiner (SANE) exam is a specialized medical-forensic procedure performed by a registered nurse trained in trauma-informed care and evidence collection. The primary purpose of this exam is twofold: to address the patient’s immediate medical needs and to meticulously collect forensic evidence. This evidence may be used later if the patient decides to pursue legal action. The duration of the exam is highly variable and depends on many factors, but the central goals are quality care and the preservation of evidence.
Understanding the Components of a SANE Exam
The SANE exam begins with the nurse obtaining a detailed medical history to ensure any immediate injuries are addressed. This initial phase includes gathering a non-forensic history, such as current medications, pre-existing health conditions, and recent consensual sexual activity. This information helps interpret any DNA evidence collected later. Following the medical intake, the nurse obtains a detailed forensic history by asking specific questions about the assault event. This verbal account guides the nurse in knowing where to look for potential injuries and trace evidence.
A systematic head-to-toe physical assessment is then conducted to identify and document physical findings, such as bruises or lacerations. Injuries are precisely documented on body diagrams and through photographic evidence using specialized camera systems. Evidence collection is the most time-intensive part of the examination. This involves the careful swabbing of various body areas, including oral, genital, and anal cavities, hands, and fingernails. These swabs, along with collected clothing and hair samples, are systematically packaged into a sexual assault evidence collection kit.
The final component of the exam focuses on prophylactic medical intervention and testing. This includes offering medications to prevent sexually transmitted infections (STIs) and emergency contraception. The nurse also discusses Post-Exposure Prophylaxis (PEP) for HIV, a regimen that must be started quickly to be effective. These medical treatments are provided regardless of the patient’s decision regarding law enforcement reporting.
Typical Duration and Variables Affecting Time
A SANE exam typically takes between two and four hours to complete, but the process can extend up to six or eight hours in complex cases. This variation is tied to the specific circumstances of the assault and the patient’s physical and emotional state. For example, a patient’s ability to recall and communicate details impacts the length of the history-taking phase. The nurse provides necessary breaks and slows the pace as needed.
The severity and extent of physical trauma influence the time required for documentation and evidence collection. If the patient has multiple injuries, the nurse must dedicate more time to careful photography and detailed written descriptions. If trace evidence is suspected in multiple locations, the number of swabs and collection procedures increases substantially. The need for specialized medical attention, such as X-rays or surgical consultation, may pause the forensic portion of the exam, extending the overall time spent.
External factors, including the availability of a SANE nurse and hospital policies, also affect the total duration. If law enforcement is involved and the patient consents, a police interview at the facility is incorporated into the overall time spent. The forensic evidence collection must follow a strict, sequential protocol to maintain the chain of custody. This process requires meticulous attention to detail and cannot be rushed.
Preparation and Patient Rights During the Exam
Patients are advised to take certain steps before the exam, if possible, to help preserve potential evidence. It is recommended to avoid showering, bathing, changing clothes, using the bathroom, or cleaning up the assault scene. If clothing was changed, bring the clothes worn during the assault, placed in a paper bag, to the facility. Even if a patient has taken any of these actions, the exam should still proceed, as treatment and evidence collection remain possible.
A patient maintains complete autonomy throughout the SANE exam process, which is a key element of trauma-informed care. Patients have the right to have a trained advocate or support person present for emotional support. The exam is entirely voluntary, and patients have the right to decline any portion of the examination, such as photography or an internal swab, without providing a reason. The patient is also empowered to ask the nurse to stop the exam at any time or to take a break if the process becomes overwhelming.
Immediate Next Steps Following the Exam
Once the SANE nurse completes the medical care and evidence collection, a discussion about reporting options takes place. The patient can choose to report the assault to law enforcement immediately, file an anonymous report, or not report at all. This choice is respected, though mandatory reporting laws apply in some jurisdictions for vulnerable populations like minors or the elderly. The collected evidence kit is safely stored for a legally determined period, allowing the patient time to decide if they wish to move forward with reporting later.
A plan for follow-up medical care is established to ensure continued physical and psychological well-being. This typically includes scheduling appointments for repeat testing for STIs and pregnancy, often at three and six months post-assault. The SANE nurse provides referrals to local community resources, such as sexual assault advocacy centers and mental health services. Finally, the nurse helps coordinate a safe discharge plan, ensuring the patient leaves the facility securely and with necessary support.