SANE programs (SANE Program Development, Office for Victims of Crime Archives) developed slowly beginning in the early 1970s. Nurses saw that services to victims of sexual assault were inadequate and were not equal to the high standards of care provided to other emergency department patients.6,7 These patients had specific concerns about contracting a sexually transmitted disease or becoming pregnant. Nurses led the effort to provide better, tailored services to victims seeking care after a sexual assault.
The first SANE programs were established in Memphis, Tennessee, in 1976; in Minneapolis, Minnesota, in 1977; and in Amarillo, Texas, in 1979.8,9,10 These nurses worked in isolation until the early 1990s. In 1991, there were 20 known SANE programs in the United States. The initial slow growth of SANE programs was influenced by two factors. First, the role of the SANE was an expansion of the "regular" registered nurse's practice and required additional education beyond the standard nursing education. Second, many professionals who were used to working with physicians in the past, such as prosecutors, were reluctant to support nurses serving in this expanded role.
Two significant events occurred that accelerated SANE program development. First, in 1992, the International Association of Forensic Nurses was formed at a meeting of SANEs at the University of Minnesota in Minneapolis. The formal organization of these nurses led to significantly better communication and collaboration among these concerned professionals. As a result of their efforts, forensic nursing was recognized as a nursing subspecialty by the American Nurses Association in 1995. In 1997, the Office for Victims of Crime (OVC), a component of the Office of Justice Programs at the U.S. Department of Justice, took an important step toward facilitating SANE program development by recognizing that initial research showed SANE programs provided better victim care and facilitated better forensic evidence collection.11,12 These findings resulted in OVC supporting the first SANE Development and Operation Guide.13 In 2016, there are more than 800 SANE programs.
Progress continues toward ensuring that a trained forensic examiner is available to provide care to every sexual assault patient who presents to a hospital. It is now considered the standard of care for medical facilities to identify and provide appropriate and complete services to victims of rape and abuse. The role of the SANE continues to develop as an important component of the emergency medical response to patients reporting sexual assault. Furthermore, the SANE is instrumental in assisting with a coordinated response from advocacy, law enforcement, and prosecution.
Approximately half of the SANE programs provide services for children, in addition to caring for adolescents and adults. With the recognized efficacy of this model, many child advocacy centers now employ SANEs with specialized education and experience working with pediatric populations to conduct the medical forensic examinations once reserved for physicians. These programs are often only open Monday through Friday for scheduled evaluations, so many emergency pediatric cases are still seen in the emergency department, much like the adult and adolescent patients.