Established in 1998, the Madison County Sexual Assault Treatment Center (MCSATC) is situated on the Community Hospital Anderson campus. The MCSATC is co-located with Alternatives, an emergency shelter for women and children who are victims of domestic violence. The MCSATC operates a 24-hour clinic devoted exclusively to the delivery of comprehensive medical forensic treatment including evidence collection to patients who have been sexually assaulted. The point of entry for a patient is through Community Hospital’s Emergency Department.
Staffing mix and shift lengths
Comprehensive forensic medical services for sexually assaulted patients are provided by sexual assault nurse examiners (SANEs) who are specially trained registered nurses. The 24/7 SANE availability has been achieved by maintaining an optimum staffing level of four SANEs.
A program director and physician medical director provide general oversight and leadership of the center. The SANEs participate in a coordinated, multidisciplinary team approach with law enforcement, prosecution and victim advocates. Collaboration of these agencies streamlines services and expedites interventions on behalf of the patient.
Nursing skill mix
Direct patient services provided by the MCSATC include a thorough forensic medical examination, evidentiary identification, collection and preservation, photo-documentation of injuries, prophylactic treatment of sexually transmitted infections, emergency contraception, tetanus prophylaxis, and a discharge treatment plan with prescribed follow-up care based on the individual needs of the patient.
The SANEs are available to provide immediate services to patients of sexual assault. They conduct a comprehensive medical forensic examination including identification, collection, and proper preservation of vital evidence. They also conduct a forensic history with the patient, and they determine an individualized treatment and discharge plan. In addition the SANEs, on behalf of the patient, coordinate the activation of the sexual assault response team.
The program director’s direct service to patients includes follow-up consultation, either by phone interview or by a face-to-face meeting with the patient, to discuss the patient's individual medical forensic treatment discharge plan. At the discretion of the primary SANE, the program director is available to provide additional direct patient care and assistance if the patient has special needs such as a physical or mental disability.
The medical director typically does not have any direct contact with the sexual assault patient. She is available if the SANE who initially examines the patient feels the patient should be referred to the medical director for further medical consultation as determined by her examination findings.
Patient populations touched
The MCSATC serves not only Madison County’s 131,312 residents, but offers medical forensic service to victims of nearby cities and counties where limited or no 24-hour specialized sexual assault treatment service is available to victims. The targeted counties include Tipton, Randolph, Delaware, Henry, and Hancock which represent, according to STATS Indiana, 225,000 residents. The MCSATC serves primarily female patients, but is equipped and trained to examine adult male patients.
To date, the youngest patient the center has examined was 13 weeks old while the eldest patient examined was 92 years old. The average age of female patients served in 2008 was 14 years old. The center also served 10 male patients in 2008 whose average age was eight. In 2008, five percent of the patients served were African American, two percent were Hispanic, with the remainder Caucasian, which is a fair representation of the county’s ethnicity.
Equipment used at the center
The center employs the use of a digital camera to record any injuries caused by the sexual assault. The SANEs also use a colposcope, a type of microscope, which allows the examiner to look for and photograph genital injuries not typically seen with the naked eye. Also, an ultraviolet light source is used to scan the patient’s body and clothing looking for body fluids which, if identified, can be lifted from the patient’s body and preserved for DNA evidence identification. In addition, SANEs are trained to use various techniques and examination methods which give the examiner the ability to more clearly and fully examine the patient. One example is the use of dental floss which can provide valuable DNA evidence when oral penetration is suspected. These are just a few of the techniques employed and specialized equipment used by the SANE to examine sexually assaulted patients.
SANEs are registered nurses who have completed specialized sexual assault nurse examiner training which includes approximately 40 didactic hours and 40 – 60 clinical hours. After successful completion of the course requirements, a national certification examination is obtained.
What makes the MCSATC special?
The MCSATC offers 24/7 availability. SANEs arrive at the hospital within 60 minutes or less once notified. The center is a secluded, secure, free standing facility on the Community Hospital Anderson campus designed to meet the holistic needs of the patient through a multidisciplinary team approach. The center offers a private waiting area for family and friends, a video-equipped conference room for law enforcement interviews, and an examination room with a bathroom and shower facility for the patient.
Characteristics of outstanding nurses in this area
SANEs are a special breed of nurses who are able to work autonomously, provide compassion and empathy to the patient, are secure in the skills needed to do a thorough medical forensic examination, and can serve as an expert witness when called to court. While not every nurse is destined to be a SANE, there are those special nurses who have stepped forward to accept the challenge. Those nurses who tend to stay in the field tend to have a propensity for both medicine and the law; and they have a deep compassion for the patients they serve.
Exceptional patient experiences
All patients are given a patient evaluation survey to complete. Sixty percent of the patients in 2008 completed the survey with a 100% overall approval of their care and treatment while at the center. Some of their comments were:
- “L. was GREAT. I felt lucky to have had her help.”
- “The nurse was very good with my daughter.”
- “Please don’t ever change a thing here. I feel you are doing a great service to all victims. Thank you so much.”
- “Thank you for being here for me and my daughter. Bless you.”
- “Thanks for helping during this rough time.”
- “The nurse I had was tremendous in my time of need.”