The sexual assault examination: overview and lessons learned in one program.

This is a description of the process used by the Sexual Assault Nurse Clinician (SANC) in Emergency Departments in Minneapolis, Minnesota, after the rape victim's injuries have been treated. The task of the SANC is to evaluate the care of injuries, collect and protect the chain of evidence, and handle other special concerns of the patient such as risk of pregnancy, sexually transmitted diseases, and crisis intervention. The victim is re-examined for injuries and questioned about the degree of force used. The SANC nurse only needs a brief summary of the assault, since the police obtained the detailed sequence of events. Evidence is collected in 3 categories: documentation of the use of force (photos); identification of the assailant (swabs of sperm, blood, hair); and proof that sexual contact occurred (motile sperm, acid phosphatase). The chain of evidence is a rigid protocol involving signed routing sheets and constant visualization of the evidence when it is not under locks. After the SANC nurse evaluates the patient's risk of pregnancy, she is counseled about postcoital contraceptive treatment and back-up termination. The victim is given the option of taking STD treatment, but is not routinely cultured or treated because of changing legal status of such practices. Most women choose immediate treatment because they feel contaminated and do not want another pelvic exam. If the victim comes for treatment after 36 hours, she is only given treatment of her injuries and referral for testing and counseling. In 417 rape cases in Minneapolis in 1990, 193 assailants were processed by the country attorney, 14 went to trail, and 6 of these were found guilty. Even though a small proportion of the evidence collected is ever used in court, it is important, as is the total care given the victim by the SANC nurse.