Kim Day

Kim Day

Kim Day, RN, CFN, FNE, SANE-A

I am Kim Day, a registered nurse; I work with the International Association of Forensic Nurses, providing technical assistance to nurses around the country taking care of victims of sexual assault.  I also work in my local community hospital as a SANE.  A SANE is a sexual assault nurse examiner. A growing trend across the United States is the use of sexual assault nurse examiners (SANEs, also SAFE or SAE) to conduct the rape examination.  SANEs are registered nurses who receive specialized training to do these exams.

As a SANE I respond to the hospital when a victim of sexual assault or abuse comes in to the emergency department.  This is the point of entry to care for many victims.  My job is to provide health care to sexual assault patients, which includes the medical forensic examination. The medical forensic examination is complex and time consuming. It requires SANEs to immediately respond to sexual assault patients to provide medical care and conduct the medical forensic examination in accordance with state guidelines. On average the examination takes around 3-4 hours. 

When I do an exam, I start by taking a detailed history from the patient.  The purpose of this is to have a snapshot of the patients existing health status, including medications they may be taking.  There may also be preexisting conditions unrelated to the assault, and it is important for me to be able to understand if findings during my examination are related to them.     The next thing I do is a ‘head to toe’ detailed examination and assessment of the entire body, including an internal examination.  The examination also includes collection, preservation and proper handling of forensic evidence.  I use an evidence collection kit, which I have here with me. Along with swabs of just about every body part, we collect head and pubic hair.  These hairs must be from the root which contains the DNA. We also have to comb through the person’s pubic hair for foreign materials.  The exacting details of the examination are critical to ensure that the evidence is collected and packaged correctly.  Improper handling of evidence can lead to destruction or contamination.    Another part of the examination is taking photographs to also give a record of the examination findings.  These may be of injuries such as bruises, cuts and scraped skin.   All of these steps must be meticulously documented. 

The final thing I do is talk with the patient about treatment for sexually transmitted infections that there may have been exposure to during the assault.  Depending upon the hospital and the state, the victim may receive prophylaxis against as well as referrals for follow-up counseling, community resources and medical care for them post assault.  After the examination I may be called to testify in court about the procedures I followed and my findings during the examination.   

DOJ has created National protocols for these examinations.  If anyone is interested in further information about these Protocols can feel free to call me or the IAFN. 

Individuals who are untrained can negatively impact the quality of evidence and it’s admissibility in court.  Things like sealing the envelope by licking it would contaminate the contents of the kit with the nurses own DNA, or even failing to recognize where evidence is located on the body can result in not finding DNA evidence.   The rape kit then has to be given under chain of custody to law enforcement.  Chain of custody is another way of assuring that the kit will meet criteria for admission in court. 

There are many communities across the US that do not have access to these trained examiners.  {In Oregon last month a 13 year old sexual assault victim had to undergo two medical evaluations because there were no trained examiners in her area}.  The first examination was by an untrained medical professional. The next day she had to drive several hours to have another examination by a trained examiner.  Imagine having the trauma of a sexual assault and then having to undergo an examination twice, something that MOST of us will never have to experience (thankfully).

In, the Justice for All Act’s SANE/SART training funds have not been appropriated for education in the US. These funds, if made available, would allow for of trained examiners across the US, available to provide timely, high-quality and comprehensive health care to victims of sexual assault.