Waterloo Healthcare Newsletter – September 2024

Sexual assault is a traumatic experience that leaves victims vulnerable, both physically and emotionally. When a survivor presents at an emergency department (ED), they require immediate and comprehensive care that addresses their medical needs, psychological well-being, and legal considerations. One critical tool in providing this specialized care is a dedicated Sexual Assault Nurse Examiner (SANE) cart. This article explores the immense value of having a SANE cart in the ED and how it enhances the quality of care provided to survivors.

Understanding the Role of a SANE Cart

A SANE cart is a mobile unit that contains all the necessary equipment, supplies, and documentation tools needed to perform a forensic medical examination on a sexual assault survivor. It is designed to ensure that the examination is conducted efficiently, with respect for the survivor’s dignity, and in accordance with legal standards.

The cart typically includes items such as evidence collection kits, swabs, sterile gloves, medications for preventing sexually transmitted infections (STIs) and pregnancy, photographic equipment, and detailed documentation forms. The organization of these materials in a single, easily-accessible location streamlines the process and allows the SANE nurse to focus on the patient rather than searching for supplies.

Enhancing Patient Care and Comfort

The presence of a SANE cart in the ED has a direct and positive impact on the care provided to sexual assault survivors. First and foremost, it reduces the time spent gathering materials, allowing for a quicker response to the survivor’s needs. Speed is crucial in these situations, not only for the preservation of forensic evidence, but also for minimizing the emotional distress that can be exacerbated by delays.

Moreover, the use of a dedicated SANE cart helps create a more organized and calm environment. Knowing that everything they need is readily available, the SANE nurse can approach the examination with confidence and composure, which can be reassuring for the survivor. This organized approach also reduces the likelihood of errors in evidence collection or documentation, which are critical in cases that may proceed to court.

Supporting Legal and Forensic Requirements

In cases of sexual assault, the ED serves as the initial point of contact for evidence collection, which can be pivotal in any subsequent legal proceedings. A SANE cart is specifically designed to meet the stringent requirements of forensic evidence collection. The standardized kits and documentation tools included in the cart help ensure that the evidence is collected, handled, and preserved correctly, and “chain of custody” protocols are followed.

By having all necessary forensic tools in one place, the SANE nurse can perform a thorough examination without interruption. This continuity is essential for the integrity of the evidence, as any breaks or inconsistencies in the process could potentially compromise the legal case. The cart also typically includes photographic equipment, which allows the nurse to document injuries or other physical findings that may not be immediately visible, further supporting the legal process.

The addition of an electronic lock (eLock) on a SANE cart can further enhance the “chain of custody” when handling evidence by providing an audit trail of cart access.  Electronic locks track who has been in and out of a cart and can help paint a picture as to how collected evidence has been handled.  Reports and audit trails can be run that may prove valuable when tracking evidence through the system.

Electronic locks can also be programmed to automatically relock after a preset period.  This feature can provide additional evidence protection in a SANE cart.

Improving Workflow Efficiency

From an operational standpoint, a dedicated SANE cart contributes significantly to the overall efficiency of the ED. Emergency departments are often busy and chaotic, with multiple cases requiring attention simultaneously. In this environment, having a specialized cart ensures that the SANE examination does not disrupt the general workflow of the department.

The cart allows the SANE nurse to conduct the examination in a designated area, minimizing the impact on other ED operations. This separation also helps maintain the survivor’s privacy, which is crucial for their comfort and trust in the care they are receiving. Additionally, the standardized setup of the cart means that multiple staff members are familiar with its contents and organization, allowing for seamless handovers if necessary.

Supporting SANE Nurses and Staff

SANE nurses are specially trained to provide care to sexual assault survivors, and their role is both physically and emotionally demanding. The availability of a dedicated SANE cart supports these professionals by reducing some of the logistical burdens associated with their work. With everything they need at their fingertips, SANE nurses can focus on providing compassionate care and building rapport with the survivor, which is essential for effective treatment and evidence collection.

Furthermore, the cart acts as a training tool for other ED staff who may be involved in the care of sexual assault survivors. By having a standardized setup, the cart helps in educating and familiarizing other healthcare professionals with the necessary procedures, ensuring that the entire team is prepared to assist in these sensitive cases.

Conclusion

The implementation of a dedicated Sexual Assault Nurse Examiner (SANE) cart in the emergency department is invaluable. It not only enhances the quality of care provided to sexual assault survivors but also supports the legal process by ensuring that forensic evidence is collected and preserved accurately. Additionally, the cart improves workflow efficiency within the ED and provides essential support to SANE nurses and other healthcare professionals. In an environment where time, precision, and compassion are critical, the SANE cart stands as a crucial component of comprehensive and effective care for sexual assault survivors.

After that experience, Willa re-launched Willcare Associates with her husband Roger Moats in 2001. Willcare has successfully put many companies on the map in New York and New Jersey by being knowledgeable about the products and market and fixing customers’ problems with service and education so they were able to provide better service to end users. Having won many awards, Willa knows the industry and is another great asset for customers.

Willa shared, “With over 40 years of experience and all the knowledge gained, plus a lot of energy, we are very excited about representing Waterloo Healthcare! We are professional, CPMR certified, and only sell quality reputable products whether it be medical equipment or medical disposables.”

Trapper John, M.D., ER, Grey’s Anatomy, Nurse Jackie, Chicago Hope, House, St. Elsewhere, The Good Doctor, Scrubs, General Hospital, Awakenings, Flatliners, Outbreak, John Q., Contagion… Some of the most popular television shows and movies in history have been centered around healthcare providers working in hospitals. While they are meant to entertain audiences, people who work in that same environment often notice some totally outrageous occurrences in Hollywood’s handiwork.

Here is a list of 3 of the most unrealistic things in medical dramas.

In-Hospital CPR Success Statistics

Somewhere between about 55-75% of patients in medical dramas who receive in-hospital CPR for their cardiac arrest are basically fine right afterwards, or at the very least, survive. In reality, the true survival rate is a much lower 15-20%. While that seems a bit dismal in comparison, in-hospital CPR saves 112,500-150,000 American lives each and every year!

“ASYSTOLE!!! PADDLES!!! CHARGE TO 360…AAAAAND…***CLEAR***!!!”

This is a two-for-one! The heart monitor screen shows a flatline, and McDreamy yells the above. We have here perhaps the most egregious of medical errors and lack of realism. First, the flatline indicates asystole, so they have that part right; however, asystole means the heart is no longer beating, and shocking it can’t help it start beating again. There are shockable heart rhythms, but asystole isn’t one of them. Supraventricular tachycardia is, but those 11 syllables just don’t roll off the tongue quite as easily as a-sys-to-le does.

The other issue with this scenario is the chaotic, loud melodramatic announcement and whirlwind in the hospital that follows. Yes, it is a very serious thing, and the entire team needs to be made aware of the code, but yelling and being in a frenzy won’t help the patient, their loved ones, or the other medical professionals doing CPR and administering epinephrine (which are appropriate treatments for asystole).

And While We’re on the Topic of Shocking the Heart…

Defibrillation must not only be done in the correct circumstances – it must also be done correctly. One of the more baffling things seen in a medical drama is the practice of rubbing together the defibrillator paddles. Is it for good luck? Is it to create some static electricity for a bit of extra shock? Or is it just a ridiculous, unnecessary tradition of TV doctors? It’s definitely the last option. Rubbing the paddles together doesn’t do anything except maybe cause some damage to them.

Whether using the older paddles or the newer stick-on pads, placement is key. According to a National Institutes of Health (NIH) article, one paddle / pad should be placed on the right-center chest above the nipple and the other slightly below the left nipple and left of the ribs. Clearly, not everyone involved in medical dramas reads this article because in some shows and movies, parallel placement of the paddles / pads is what you’ll see.

Despite the issues mentioned, we still love these TV shows and movies, and we’re not suggesting not to watch them. It is important though to realize that while they do contain some very accurate scenarios and information (which we will delve into in future newsletters), there are also some serious errors. Some viewers don’t know what is accurate and what isn’t, as being a medical professional in a hospital is not their career, and sometimes they take what they see as factual. The last thing a doctor needs to hear while performing CPR or defibrillation on a patient is “That’s not how Dr. Carter did it!” or “Why didn’t you rub the paddles together?!”. Expectations of loved ones need to be carefully managed, especially when to many in the TV or movie audience, a flatline on the heart monitor is almost always something from which the patient can recover. Actual CPR training will always yield better results than someone trying to emulate the procedure as they saw it during prime time or on the silver screen. What have you seen in medical dramas on TV or in the movie theater that left you scratching your head?