Health

Telemedicine on sexual assault in rural areas


Originally published by the 19th.

Amanda Shelley was sitting in the dentist’s waiting room when she received a call from the police. A local teenage girl has been sexually assaulted and needs to be examined.

Shelley, a nurse in rural Eagle County, Colorado, went to her car and called a telehealth company to schedule an appointment with an assault assessment nurse. sex, aka SANE. Medical examiners have extensive training in how to care for victims of assault and gather evidence for possible criminal prosecution.

About an hour later, Shelley saw the patient at the Colorado Mountain Medical urgent care clinic in the small town of Avon. She used a tablet to connect video to a SANE about 2,000 miles away, in New Hampshire.

The telemedicine nurse used video technology to talk to the patient and guide Shelley through each step of the two-hour examination. One of those steps is colposcopy, in which Shelley uses a magnifying device to closely examine the vagina and cervix. The remote nurse saw, in real time, what Shelley could see, with the help of a video camera attached to the machine.

The service, called “teleSANE,” is a new service at Shelley’s hospital. In the past, sexually assaulted patients faced mountains of obstacles – quite literally – when they had to go to a hospital in another county for care.

“We are asking them to be able to drive through snowy roads and then [be there] Shelley said. “They want to start the healing process and go home and shower.”

To avoid this scenario, teleSANE services are being expanded nationwide in rural, sparsely populated areas. Research shows that SANE programs encourage psychological healing, provide holistic health care, enable professional evidence collection, and improve the chances of successful prosecution.

Jennifer Pierce-Weeks is the Executive Director of the International Association of Forensic Nurses, which has created national standards and certification programs for sexual assault nurse examiners. She said every victim of sexual assault faces health consequences. Attacks can cause physical injury, sexually transmitted infections, unwanted pregnancy, and mental health conditions that can lead to suicidal ideation and drug abuse, and Alcohol.

“If they are taken care of from the ground up, all of the risks of those things can be greatly reduced with the right intervention,” says Pierce-Weeks.

Pierce-Weeks said there are no comprehensive national data on the number and location of SANE-trained healthcare professionals. But she said studies show there are shortages across the country, especially in rural areas.

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Pierce-Weeks said some rural hospitals have difficulty creating or maintaining in-person SANE programs because of staffing and funding shortages.

Training costs money and takes time. If rural hospitals train nurses, they still may not be enough to provide round-the-clock coverage. And nurses in rural areas cannot practice their skills as often as those employed in busy urban hospitals.

Some hospitals that do not have a SANE program refer victims of sexual assault elsewhere because they feel they are not qualified to help and are not always required by law to provide treatment. comprehensive and collect evidence.

Avel eCare, based in Sioux Falls, South Dakota, has been providing telehealth since 1993. It recently added teleSANE to its services.

Avel provides this service to 43 primarily rural and small-town hospitals across five states and is expanding to Indian Health Service hospitals in the Great Plains. Native Americans face high rates of sexual assault and may have to travel hours for care if they live in one of the region’s vast rural reserves.

Jen Canton, Avel’s teleSANE program supervisor, said going to a local hospital and being transported elsewhere can be damaging for sexual assault survivors. “You just went through what could be the worst moment of your life, and then you have to travel two or three hours away to another facility,” Canton said. “Even going to the hospital first takes a lot of courage and says what happened to you and asks for help.”

Patients receiving care in hospitals that do not have a SANE program may not receive care when trauma information becomes available, which focuses on identifying the source of the injury, determining if the experience may be possible. affect people’s health and prevent patients from re-injury. Emergency department staff may not have experience with internal testing or evidence collection. They may also be unaware of the patient’s police-related options.

Patients arriving at a second hospital may have difficulty arranging and affording transportation or child care. Other patients don’t have the emotional bandwidth to make the trip and tell their stories.

That’s why some survivors, like Ada Sapp, don’t have the test.

Sapp, the healthcare executive at Colorado Mountain Medical, was assaulted before the hospital system started the SANE program. She was shocked to learn she would have to drive 45 minutes to another county to take the test. “I don’t feel comfortable doing it alone,” Sapp said. “So my husband will have to come with me, or a friend. The logistics make it feel insurmountable.

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Sapp’s experience inspired her to help bring SANE services to Colorado Mountain Medical.

Shelley and several other hospital system nurses have been trained in SANE but appreciate telehealth support from more experienced telemedicine nurses. “We are a rural community and we don’t do these things every day,” Shelley said. “A lot of my nurses will get really nervous before the exam because maybe they haven’t done the test for several months.”

“Second eyes” from a distance increase the confidence of the immediate nurse and provide peace of mind for the patient, she says.

Avera St. Hospital. Mary of Pierre, South Dakota, recently started using teleSANE. Rural towns, farms and ranches surround this capital city, home to some 14,000 people. The nearest metropolitan area is about a three-hour drive.

Taking a break from a recent busy morning in the emergency department, nurse Lindee Miller deployed the Avel eCare mobile teleSANE trolley and colposcope. She pulled out a thick file of instructions and forms and opened drawers filled with swabs, evidence cards, measuring devices, and other forensic materials.

“You’ll never take the same test twice,” says Miller. “It’s all driven by what the patient wants to do.”

She said some patients may just want the pill to prevent pregnancy and STIs. Other patients opt for a physical exam. And some may want her to collect forensic evidence.

Federal and state laws provide funding to cover these sexual assault exams, but some survivors are charged because of legal distance and lack of awareness of the rules. A proposed federal law, the No Surprising Survivors Act, would close some of those loopholes.

SANE programs, including telehealth versions geared toward rural communities, are expected to continue to expand nationally.

President Joe Biden this year signed a bill providing $30 million to expand SANE services, specifically those that use telehealth and serve rural, tribal communities and other underserved communities. The law also requires the Department of Justice to create a website that lists the locations of programs and provides an opportunity to start them.

Kaiser Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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