Expanding Access to Sexual Assault Care in Rural Areas with Virtual SANE Exams

By Becky Vande Kieft, Vice President and General Manager of Emergency, Avel eCare

Sexual assault is uncomfortably common in the United States, with harassment or assault affecting up to 80 percent of women and 43 percent of men at some point during their lifetimes.  The National Sexual Violence Resource Center estimates that one in five women will experience attempted or completed rape during their lifetimes, but this number may even be higher due to the number of assaults that go unreported.

Among some rural communities, and especially among American Indian and Alaskan Native populations, the data gets even worse.  American Indians are 2.5 times more likely to experience sexual assault crimes.  More than one in three Native women acknowledge being raped during their lives.

Healthcare providers are crucial for breaking that cycle and supporting sexual assault survivors as they consider their legal options with Sexual Assault Nurse Examiners (SANE).  These are registered nurses or nurse practitioners who have received additional training in how to conduct exams and collect evidence in an approved rape kit. 

By providing immediate clinical care and correctly collecting necessary samples for potential use by law enforcement, SANEs can preserve evidence and offer options to survivors of sexual assault. 

But in many rural regions, SANE  professionals are few and far between.  Survivors in remote regions may have to drive for hours to reach a hospital, then wait until a SANE is available to work with them.  The exam itself can be a lengthy process, increasing the feelings of stress and anxiety for survivors during a vulnerable and traumatic moment in their lives.

Increasing the availability of SANE exams in rural communities should be a top priority for healthcare providers, including those in South Dakota and other Great Plains states.  Fortunately, digital tools are now available to significantly increase connections between remote healthcare facilities and trained sexual assault clinicians.

Virtual SANE exams, which leverage telemedicine technologies to create a hybrid model of care, are key for ensuring that survivors have access to the specialized services they need, whether or not they decide to report the event to law environment.      

Using telemedicine to blend in-person care with remote SANE services

In South Dakota, one of the least densely populated states in the nation, the nearest emergency room may be hundreds of miles away.  When a sexual assault survivor reports to the ED, clinicians will naturally address any emergent issues, such as heavy bleeding or severe pain.  

However, since South Dakota hospitals are not required to have a SANE on staff, survivors have historically lacked options for what to do next if they wish to preserve evidence to use during prosecution of the perpetrator.

Transferring to a different hospital with an available SANE is one option, but the logistics can be difficult to manage for a traumatized patient who may lack the time, social support, or financial resources to complete the process at a new facility.  

The better choice is to keep the patient in the same place and bring a qualified nursing professional to them, 24 hours a day.

Telemedicine technology can make this happen quickly and easily.  Instead of hiring, training, and retaining a dedicated SANE nurse, rural hospitals can partner with virtual care services to access an experienced sexual assault nurse when and where they need one.

Using a telehealth cart that includes exam devices equipped with high-resolution cameras and two-way audio and video, the virtual SANE nurse can work closely with an on-site colleague to complete the exam.  Because the SANE nurse is directly supervising the procedures and completing all the necessary documentation on their end, the evidence is typically admissible in court in the same way that a fully on-site exam would be.

After the physical exam, the SANE and their on-site counterparts can recommend appropriate treatment for sexually transmitted infections, HIV, and potential pregnancy, as well as explain their options for reporting the event to law enforcement. 

Expanding SANE care for American Indian and Alaskan Native communities

With such high rates of sexual assault in American Indian and Alaskan Native communities, extending virtual sexual assault care capabilities to the Indian Health Service (IHS) is an incredibly important step toward empowering survivors to recover from assaults and pursue all available legal rights.

During the next five years, the IHS and Avel eCare will expand their existing partnership to add SANE services, as well as enhanced psychiatric support, to emergency departments serving American Indian populations in the Great Plains area.

IHS facilities will be able to use these virtual resources to overcome persistent staffing shortages, expand their clinical competencies, and provide timely, thorough, and culturally sensitive care for individuals who have recently experienced an assault.

While there is much broader work to be done with the US and tribal legal systems to ensure that crimes are appropriately prosecuted, leveraging telemedicine to gather clinical evidence needed for legal action will hopefully encourage more survivors to report events and increase the likelihood of receiving justice.

Equipping IHS facilities and other rural emergency departments with around-the-clock access to qualified SANE nurses will be instrumental in changing traditional patterns of sexual assault care and ensuring that all individuals can access the services they need to process and recover from a traumatic event.