Sexual Assault Forensic Examiners Program
The Gail Burns-Smith Sexual Assault Forensic Examiners (SAFE) Program is both a response program and a training program. As a response program, it provides specially trained sexual assault forensic examiners to participating hospitals for the purpose of providing care and the collection of evidence for patients, ages 13 and older, who report sexual assault.
What is a Sexual Assault Forensic Examiner?A Sexual Assault Forensic Examiner (SAFE) is a health care provider who has completed specialized education and clinical preparation enabling them to conduct knowledgeable and skilled medical-forensic exams, ensure the integrity, preservation, and documentation of forensic evidence, and testify knowledgeably in court.
What are the qualifications to become a SAFE?
- An unrestricted CT license as a Registered Nurse, Advanced Practice Registered Nurse, Certified Nurse Midwife, Physician’s Assistant, or Physician.
- At least two years of current or recent clinical practice, preferably in acute care. Excellent patient assessment skills are essential to the role.
What is the scope of practice for a SAFE?
- The scope of practice is that of a Registered Nurse or higher.
- SAFEs are clinically trained to conduct genital assessment and speculum exams.
- Pelvic exams are not within the scope of practice for a SAFE at the RN level.
- SAFE practice is not within the scope of practice for a paramedic or License Practical Nurse.
What is the training to become a SAFE?
- The SAFE training is comprised of didactic and clinical training components.
- The didactic curriculum includes (but is not limited to):
- Overview of Forensic Nursing and Sexual Violence
- Victim Responses and Crisis Intervention
- Collaborating with Community Partners – A Multidisciplinary Approach
- Medical-Forensic History Taking
- Medical-Forensic Examination and Findings
- Evidence Collection
- Medical-Forensic Photography
- Sexually Transmitted Infection Testing and Prophylaxis
- Pregnancy Testing and Prophylaxis
- Medico-Legal Documentation
- Discharge and Follow-up Planning
- Regulatory issues regarding HIPAA, EMTALA and Other Regulatory Issues
- Courtroom Testimony and Legal Considerations
- The clinical curriculum includes (but is not limited to):
- Language and cultural sensitivity skills
- Specific structures of the female and male genital anatomy
- Preparation and set-up for the ano-genital exam
- Proper positioning and draping of the patient for the ano-genital exam
- Ano-genital assessment, including differentiation of normal variations from abnormal findings
- Ano-genital injury identification
- Speculum assessment and visualization techniques. Learning takes place with both simulation models and live models
- Evidence and Sexually Transmitted Infection specimen collection techniques
- Documentation of findings
Is the SAFE Training Program accredited?The International Association of Forensic Nurse’s SANE Education Guidelines (current edition) sets national training guidelines. The IAFN SANE Educational Guidelines require a minimum of 40 hours in the didactic portion of the training.
The SAFE Training Program is approved for continuing nursing education by the International Association of Forensic Nurses, an accredited approver by the American Nurses Credentialing Center (ANCC) Commission on Accreditation. A certificate for CEUs is awarded at the completion of the didactic portion.
Both didactic and clinical components must be completed to practice as a SAFE.
What is the time commitment to take the SAFE Training Program?The clinical portion of the course is divided into three components:
The didactic portion of the course is 6 days in length. Classes are held two days per week for three consecutive weeks. Content experts teach on the various required curriculum topics.
Once training is completed, SAFEs that are joining the SAFE Response Program are required to precept at least one case with an experienced preceptor prior to becoming a fully trained SAFE are able to schedule on-call hours.
- Clinical Training Evening: students develop taught genital assessment skills, speculum exam techniques, and correct evidence collection technique utilizing simulated pelvic trainers.
- Clinical Training Day: students develop competency in genital assessment, speculum exams and evidence collection utilizing medical models acting as patients who report sexual assault.
- Mock Exam: students combine didactic and clinical learning in a table-top case scenario during which students explain and demonstrate how to do a complete, beginning to end, medical-forensic exam. During the Mock Exam students can ask “what if” questions and resolve any technique issues.
What are the dates of the next SAFE Training Program?
The Fall 2023 Training will be announced in early Spring. Please check this webpage later for updates.
What is a medical-forensic exam?
A medical-forensic exam is a comprehensive exam with several components:
- A verbatim history of the assault from the patient: Intended to guide the physical exam, it is medical in nature, rather than investigative.
- Physical Exam: There are two parts: a head-to-toe physical assessment and a genital assessment. Physical findings help to identify assault-related injury, if present, as well as location of evidence to be collected. The absence of physical findings does not mean that an assault did not take place.
- Evidence Collection: There are two general types: Physical/Biological and Toxicology. The CT100 is used for the collection of physical and biological evidence and the CT400 is used for toxicology screening and evidence collection.
- Sexually Transmitted Infection (STI) and Care: Based on current Centers for Disease Control Guidelines, prophylactic medications are offered to prevent a sexually transmitted infection from the assault. Testing at the time of the exam is of limited forensic value if the adult/adolescent patient is sexually active and could have acquired an STI prior to the assault.
- Emergency Contraception: Along with prophylactic medications, emergency contraception is also offered to all patients with reproductive capability.
- Discharge, Referrals and Follow-Up: Discharge and follow-up instructions are individualized to meet the specific needs of the patients.
Will I be paid for my services as a SAFE?On-Call
For state fiscal year 2022-2023, the following reimbursement rates have been established for new Program SAFEs:
- Weekday shift (Monday 7:00 am to Friday 7:00 pm) - $8 per hour
- Weekend shift (Friday 7:00 pm to Monday 7:00 am) - $9 per hour
- Holiday shift $16 per hour for both weekday and weekend responses
Training Activities including, but not limited to, the following. The number of hours vary per meeting ($17 per hour):
- Standard response - $225 per response
- Standard response (CT100 is not opened) - $125 per response
- Night shift differential (response calls from 11:00 pm to 7:00 am) – an additional $125 per response
- Weekend shift differential (response calls from Friday 7:00 pm to 11:00 pm, Saturday and Sunday 7:00 am to 11:00 pm) – an additional $75 per response
- Holiday shift differential (case response and holiday differential) – an additional $200 per response. A shift differential applies to the following holidays (the 24-hour period begins 12:00 am and ends 11:59 pm): July 4th, Labor Day, Thanksgiving, Christmas Eve, Christmas Day, New Year’s Eve, New Year’s Day, Easter, and Memorial Day.
- Preceptees are not eligible for differential pay.
Court Related Activities - $400 per case
- Monthly case review/quality assurance meetings
- Refresher training – mock exams, etc.
- Individual supervision meetings
- Annual staff training day