I would love to see more discussion on this and learn more about how different hospitals and communities are implementing a complete sexual assault response team (SART) to address the real need for a united effort to care for sexual assault victims.
I recently started the IAFN course and do plan to finish and take the exam to be SANE-A. I am a full time staff RN at a local trauma center so I am looking at this issue from an ER point of view, a womans point of view, as well as a member of the community in which I live.
I have long believed that the ER is a horrible place for a woman to end up after a rape. Generally speaking our ER's are overcrowded and understaffed and the nurses and physicians aren't trained to collect forensic evidence and for the most part, many of the staff see it as outside of our scope of practice. We aren't trained in law enforcement (many don't want to be, which is fine) and we are totally unprepared to care for the victims who are trusting us to help them.
The ER is the first stop for LE with these victims and usually the first place a family member/friend will bring a loved one who has been sexually assaulted. The action or inaction of the ER staff in those critical hours after an assault quite literally sets the scene for future prosecution of the perpetrator. The best legal team in the world can't convict without evidence. There must be a process in place that insures consistent standards of care for these pts, just as we have for MI's,CVA's, traumas etc.
This must also be a collaborative effort. Everyone involved in the legal process must work together to insure the very best possible care is given to these victims and that everything possible has been done to assist in prosecution of the perpetrator.
As I previously stated, I am fairly early into my training, and the more I learn the more questions I have. I am very impressed with the effort thus far. I have spoken with our local prosecutors. I had a chance to ask them what they needed from me, what I can do to insure the best possible outcome of these cases. I have spoken with our crime lab and was able to learn the best ways to collect evidence, the proper way to store the evidence, and the correct way to transfer evidence from person to person or agency to agency. I was able to speak with my local victims advocacy center to get their input on what resources they have available and how to best facilitate them. I spent time with law enforcement to better understand their roles/regulations as well as for them to understand mine.
Again I'm very impressed with efforts put forth by my hospital and community thus far. It seems to me that the most "resistance" is coming from the medical community. As sad as it may sound, in my experience, the relationship between the legal community and the medical community has always been an "us vs them" type of attitude. We have all been taught from day one to "CYA", document, document, document. Most of us would agree that lawyers are the bane of our existence, and make our roles as care providers much more difficult that we feel it needs to be. The idea of working as a team with the legal community, with a common goal, is really very foreign to many of us. I hope that with continuing education, and a collaborative effort on all our parts, we can change that.
I will be interested to follow this discussion as I continue on my educational experience. I would love to hear what issues have come up with others who have already implemented a similar system in their hospital or community. I would love to share ideas, what worked, what didn't work, what policies must be in place to make this effective. As I said, the more I learn the more questions I have and this would be a great venue to explore the options available and discuss the many issues I can for see as this process unfolds in my community.