The Forensic Nurse

In most cases the EIA (enzyme immunoassay), used on blood drawn from a vein, is the most common screening test used to look for antibodies to HIV. A positive (reactive) EIA must be used with a follow-up (confirmatory) test such as the Western blot to make a positive diagnosis. There are EIA tests that use other body fluids to look for antibodies to HIV. These include:

• Oral Fluid Tests – use oral fluid (not saliva) that is collected from the mouth using a special collection device. This is an EIA antibody test similar to the standard blood EIA test. A follow-up confirmatory Western Blot uses the same oral fluid sample.
• Urine Tests – use urine instead of blood. The sensitivity and specificity (accuracy) are somewhat less than that of the blood and oral fluid tests. This is also an EIA antibody test similar to blood EIA tests and requires a follow-up confirmatory Western Blot using the same urine sample.

Rapid Tests:

A rapid test is a screening test that produces very quick results, in approximately 20 minutes. Rapid tests use blood from a vein or from a finger stick, or oral fluid to look for the presence of antibodies to HIV. As is true for all screening tests, a reactive rapid HIV test result must be confirmed with a follow-up confirmatory test before a final diagnosis of infection can be made. These tests have similar accuracy rates as traditional EIA screening tests. Please visit the rapid HIV testing section for details.

Victims Assistance Services of WestCOP, Inc. in collaboration with Barbara Rome, RN, SANE-A will be providing a four-day, 40-hour Adult/Adolescent SANE training course based on the New York State DOH protocol, the National protocol and the IAFN standards for SANE education.

Victims Assistance Services coordinates the Westchester County SANE Program.  This training will take place at their main office in Elmsford from 8am-6pm, on January 28^th, 2010 through January 31^st, 2010.  If you are a RN, NP or PA interested in taking this training, in order to specifically work as a SANE in our county-wide program, please send a cover letter and resume via email to mlaaksonen@westcop.org or via fax to 914-345-3513 to the attention of Michele Laaksonen, Sexual Assault Program Manager I.    The training fee is $250.  The deadline for training registration is January 1^st, 2010.  Due to space limitations, we will be accepting a restricted number of applicants.   

 About the trainer:  Barbara Rome is an Assistant Professor at Westchester Community College and emergency room nurse and nursing supervisor at Northern Westchester Hospital.  She is a nationally and New York state certified Sexual Assault Nurse Examiner and has been practicing as a SANE in both Putnam and Westchester County for over ten years.  Barbara has been called to testify in criminal trial and before the grand jury on numerous occasions.  She holds a Master of Science degree from Mercy College.  

Victims Assistance Services is a component of Westchester Community Opportunity Program Inc., a private not-for-profit, multipurpose social service agency dedicated to helping people and changing lives.

Victims Assistance Services (VAS) of WestCOP, Inc. coordinates the Sexual Assault Nurse Examiner (SANE) Program. The SANE has the responsibility to respond to any one of our nine participating hospitals in Westchester County to provide direct-services to victims of sexual assault, ages 12 and older. The SANE provides immediate, specialized, patient-centered medical care and performs comprehensive forensic medical examinations, including evidence collection, health-related education, and referrals; the SANE may also be called to testify in court as an expert witness regarding the quality of the evidence he/she collects, documentation, and the preservation and custody of physical evidence. The SANE utilizes an interdisciplinary approach through collaboration with hospital staff, advocates, law enforcement, and the DA’s office. The SANE will also attend mandatory continuing education trainings and case review meetings. 

Other Information About This Job:  SANEs will provide on-call services for at least three full shifts a month (shifts are weekdays and weekends, 8am-5pm or 5pm-8am) and commit to the program for a minimum of one year.  The nurses in our SANE program work in all different fields of nursing and choose to work as a SANE during their free time – in order to give back to their communities.  While they do receive a flat stipend per case, our SANEs volunteer their on-call time.  To apply for this position, please send a cover letter and resume via email to mlaaksonen@westcop.org or via fax to 914-345-3513 to the attention of Michele Laaksonen, Sexual Assault Program Manager I.   

TheForensicNurse.com is pre-releasing a program for fundraising groups looking to help create revenue to fund their local SANE/SART programs.

We realize that funding for programs are under more pressure than ever to come up with alternative ways to pay for services rendered. Thats why TheForensicNurse.com is working on trying to help programs find solutions as well as create our own solutions to help.

So please visit our Fundraising pages at:

http://www.theforensicnurse.com/fundraising

Trying to

Often SANE programs go unnoticed and unpraised for their efforts. Most people would tell you that its not really polite conversation to talk about the needs for such programs.  

But the Chicago Tribune recently published an article about a SANE program in cook county. There is a phenominal qoute in the article by Tom Fleming Jr of the Park Forest Police department:

“We know that a SANE nurse who is trained in evidence collection has done the correct work for us,” he said. “Our goal is to not have a trial. Our goal is to get a confession from that offender. And we’re best equipped to do that with medical evidence. If we can do that, if we can get an offender to take a plea and not go to trial, then we’ve served that victim right at that very moment.”

Read the Full Article here:

http://www.chicagotribune.com/news/local/chi-sex-assault-treatment-sw-zon.ar0apr08,0,7944054.story

North Georgia College, on of the partners in the upcoming Adult SANE Training  at Northside Hospital Forysth in May 2009, is announcing another training opportunity.

Course: The Investigation of Mass Fatalities & Human Identification

When: March 16-17 2009

Where: North Geogia College campus

Overview: Topics to be covered will be mass fatality incident response, processing and management of mass fatality scenes, critical stress management for responders, human facial reconstruction, DNA applications for human identification, and forensic odontological identification methodologies.

Learn from experts who have worked at many major national and international disasters as they share their first-hand experiences and explain how this information can benefit you in your daily work.

Presenters:

Human Facial Reconstruction
Mary Manhein
Professor Mary H. Manhein will discuss the role of the forensic
anthrolopologist in a mass fatality event and the utilization of digital
resources in the identification of skeletonized human remains.
Manhein has handled more than 1,000 forensic cases and works with
law enforcement agencies all over the country. She is the author of
The Bone Lady: Life as a Forensic Anthropologist and Trail of Bones.
Manhein has over 27 years of experience as a forensic anthropologist.
She is also the director of the FACES Lab at Louisiana State University,
director of the Louisiana Repository for Unidentified and Missing
Persons Information Program, and professional in residence at LSU.

Mass Fatality Incident & Scene Management
Cotton Howell
Cotton Howell will give insight into all facets of command and
control of mass fatality events. Howell has been deployed to
numerous recent disasters such as the floods in North Carolina,
Egypt Air crash, Alaska Air crash, the World Trade Center on
Sept. 11, 2001, the crematory incident in Georgia in 2002, and
Hurricane Katrina. He has been featured in the Discovery Channel
documentary on disaster response teams.
Howell is a Certified Emergency Manager (CEM) and has been the
director of the York County (SC) Office of Emergency Management
since 1983. He is a registered nurse and a member of the
Department of Homeland Security, Federal Emergency Management
Agency, and the Disaster Mortuary Operational Response Team, of
which he is the commander of DMORT Region 4.

Mass Fatalities & Post-mortem Dental Examination
Dr. Richard A. Weems
Dr. Richard A. Weems will discuss dental identification in a major
loss of life event. He will share his experience in conducting dental
identification at the site of the World Trade Center disaster.
Weems is a forensic odontologist and assistant professor of
dentistry at UAB. He has been a dental consultant to the Alabama
Department of Forensic Sciences since 1987. In this time, he has
investigated over 100 cases involving criminal human bitemark
analysis and victim identification through dental remains resulting
from homicide and accidental death.
Critical Incident Stress and PTSD
Dr. Grady Bray
Dr. Grady Bray brings over 30 years of experience to the lectern
regarding critical stress debriefing of police, fire, and emergency
workers at the scenes of mass fatality events. Additionally, Bray
possesses a unique expertise in the recognition and diagnosis of
PTSD in mass fatality workers.
Bray established the Family Assistance and Training program for
Kenyon International Emergency Services, where he served as vice
president from 2000 to 2006. During this period, he responded to
many major world disasters, including the 9/11 attacks on the World
Trade Center, the tsunami in Thailand, Hurricane Katrina, and the
Helios Airways crash in Athens, Greece.
HAZMAT and Bio Terrorism Response
FBI Hazardous Materials Response Unit
Experts from the FBI’s Hazardous Material Response Unit (HMRU)
will address attendees regarding federal response and coordination in
the event of chemical and bio-hazard fatalities. The HMRU responds
to criminal acts and incidents that involve hazardous materials. The
unit also develops technical proficiency and readiness for crime
scene and evidence-related operations in cases involving chemical,
biological, and radiological materials and wastes, as well as training
US and international law enforcement in these skills.
Applications of DNA for Human Identification
Dr. Mark Wilson
Dr. Mark Wilson will discuss identification through the utilization
of state of the art DNA techniques. Wilson is an internationally
recognized expert on the topic of mitochondrial DNA and human
identification. He is also the director of the forensic science program
at Western Carolina University. Wilson is a retired special agent in
charge with the FBI’s DNA Laboratory.

Full Brochure Download: http://www.theforensicnurse.com/FS_NGSCU_2-10-09.pdf

Many people know that the color of your skin can have an effect on almost every aspect of your life. But what about being raped?

Researchers at the University of Pennsylvania School of Nursing have released a new study that shows dramatic results when it comes to identifying injuries that may have occurred during a sexual assault depending on the color of the victims skin.

The Researchers conducted a study of 120 volunteers who were predominatly white or african-american and conducted examinations after they had engaged in consentual sex. They found that 68% of the white women had incurred at least one external injury (tearing, abrasions, or swelling), but only 43% of the darker skinned women showed the same levels of injury.

Because physical injury as a result of sexual assualt is usually the exception rather than the norm, being able to clearly show an injury often has a positive effect on people “believing” the victims story.

Being a Sexual Assault Nurse Examiner or SANE, I have heard countless times from law enforcement officers, social workers, other nurses, and even the victims own family members that they dont believe the victims story.

Sexual Assualts usually happen one on one, in a private setting with no other witnesses, cameras, or other ways to try and help determine if the sex was consentual or not.

Because most of these cases come down to a he said / she said scenario the ability to produce accurate forensic evidence is critical. There may or may not be DNA evidence and if injuries are harder to detect on darker skinned victims that puts them at a distinct disadvantage both clinically and in the criminal justice system.

The Los Angeles Daily News recently reported that the LAPD is a backlog of more than 7,000 rape kits waiting for processing by the LAPD DNA lab.  Some of these cases are nearing the ten year mark, at which time they become inadmissible as evidence due to the statute of limitations law in california with regard to evidence testing. In California, if the kit is tested within two years of the sample collection date, then there is no statute of limitations for it.

The main reason that these kits haven’t been tested yet, is simply manpower and funding. In just five years the demand for kits to be tested has doubled.  According to the article. “In about 2000, the department ordered analysts to keep every shred of cell evidence in rape cases, just in case they might need to test it. Before the change, rape kits were regularly purged from the property division, with the permission of an investigating officer.”

The City of Los Angeles recently approved the hiring of 16 addtional criminalists, but these positions have yet to be funded.

Often I hear the question, “how do I become a forensic nurse?”. There are many sexual assault centers around the country, and even around the world. But not all of them offer the same standards of care.

Lets say you wanted to remodel your basement. You could open the phone book and find a wide array of contractors who would happily come and try to meet your needs. Some of them are licensed, bonded, and insured….and others…..well they try their best.

When it comes to sexual assault victims services you may find yourself in a similar situation. Depending on where you live, there may be a full service facility with fully trained and certified SANE’s, counciling services, advocates and more. 

It is also quite possible that you have no formalized services at all. in several areas (counties, cities, etc) of the country do not recognize SANE expertise. A lot of this has to do with the expierence that local district attorneys and law enforcement have had with others who may or may not have had any formalized training at all.

Although the IAFN has served as an example of standards of care, there is no regulating body that makes sure these standards are taught and  mandated for nursing sexual assault practice. Forensic Nursing is now recognized by the ANA as a specific dicipline these days, but the formalized standards of care vary greatly from facility to facility. 

There are many facilities that allow nurses without any forensic nursing credientials or formalized training to practice as a sexual assault nurse.  This variance in education and training often leads to botched cases, misleading or inaccurate collection of data, and is detremental to the SANE cause. 

Part of what makes a forensic nurse such a valuable tool for law enforcement, district attorneys, and their patients is adhering to a standard of care. Allowing nurses to practice as a SANE, without giving them the tools they need to succeed is harmful to SANEs everywhere, and worse yet to the patient.

Failure to properly follow a standard of care, and the established rules of evidence collection could very easily lead to the rapist going free or even the wrong person being arrested. Rape and Sexual Assault touches lives forever.

Over the last few years more and more convictions are being overturned because of faulty evidence collection or DNA. We owe it to our patients, and we owe it to the accused to make sure that we get it right.