SANE-A common mistakes
SANE-A · Understand the traps and how to avoid them.
Turning the patient away from forensic evidence collection solely because more than 72 hours have elapsed, without checking which evidence windows apply to each specimen type and local policy.
Candidates memorize a single '72-hour rule' and apply it uniformly, forgetting that vaginal/cervical/anal specimens, oral specimens, and clothing or other physical evidence each carry different recommended timeframes, and that some jurisdictions allow collection beyond 72 hours or up to 5-7 days for certain samples.
What to do instead
Build a one-page matrix of specimen type vs. recommended collection window per your program's policy and the current national guidance, and practice applying it to scenarios with presentation times of 24 h, 72 h, 96 h, 5 days, and 7 days. Remember that a late presentation still warrants assessment, documentation, injury identification, STI/HIV/pregnancy prophylaxis, and often clothing or other trace evidence collection even when body swabs are outside the window.
Documenting 'no visible injury to the neck' as a complete strangulation assessment and closing the finding without a structured strangulation evaluation or medical escalation.
Candidates equate absence of external marks with absence of significant injury; external signs of strangulation are often absent or delayed, and candidates have not practiced a structured assessment (voice change, dysphagia, breathing difficulty, cough, subconjunctival petechiae, neck pain, loss of consciousness, incontinence, and reported mechanism).
What to do instead
Memorize and rehearse a structured strangulation assessment tool so every strangulation-related presentation triggers a consistent symptom and mechanism history, close inspection of the neck, scalp, mouth, and eyes, and automatic consideration of medical evaluation or imaging per protocol, regardless of the presence of visible marks. Document the specific findings and the escalation decision, not just the absence of marks.
Offering emergency contraception only when the patient states she is not using any contraception, or skipping HIV non-occupational post-exposure prophylaxis because the patient presents near the end of the window or initially declines.
Candidates reason clinically ('she has an IUD or takes oral contraceptives') instead of forensically - contraception in use is not protection against a specific assault exposure, and candidates may be uncertain about the 72-hour window for post-exposure prophylaxis and the requirement to offer it even when the patient may decline.
What to do instead
Treat emergency contraception and HIV post-exposure prophylaxis as standard offers, not conditional ones: offer emergency contraception to every patient at risk of pregnancy regardless of current method, offer HIV post-exposure prophylaxis within the eligibility window, and document the offer, the patient's decision, and the referral source. Drill scenarios with prior contraception use, late presentation, and initial refusal.
Treating the patient's signature on the medical examination consent as authorization to release the medical record or evidence kit to law enforcement.
Candidates conflate consent to examine and treat with consent to disclose, and are unfamiliar with the separate authorization, statutory reporting exception, or court order that may be required before evidence or records change hands.
What to do instead
Learn the difference between consent to treat and consent to disclose, and confirm the specific legal route (patient authorization, statutory permission, subpoena, or court order) before releasing anything. When the patient declines reporting, follow jurisdiction-specific rules on whether a kit may be stored, for how long, and under what conditions it may later be released, and document the patient's choices verbatim.
Sealing the evidence kit but leaving it unsealed on a counter, storing it in an unlocked room, or creating a gap in the chain-of-custody record when evidence is transferred between the examiner, a law enforcement officer, and the laboratory.
Candidates focus on the collection steps during the exam and lose attention after the last swab, treating the kit as finished once the seal is applied; handoffs to officers are often informal and time-pressured, so signatures and times are omitted.
What to do instead
Practice the post-collection workflow as a distinct checklist: seal in the patient's presence, record the seal number, log each transfer with date, time, receiving party, and purpose, and store in a designated locked refrigerator or locker with limited access. Rehearse a mock handoff to an officer, including what to do if the officer arrives without proper identification or an evidence receipt.
Performing procedures outside the SANE's legal scope - such as writing prescriptions, ordering imaging, performing colposcopy, or making medical diagnoses - because 'the protocol says the patient needs it.'
Candidates prepare from clinical guidelines that describe what the patient should receive but not who is authorized to provide it in that state or facility, so they substitute clinical necessity for scope authority.
What to do instead
Study the scope-of-practice framework (statute, regulation, facility privileging, and protocols) alongside the clinical guidelines, and for each intervention ask 'who can legally perform or order this here, and what is my documented pathway - standing order, physician order, or referral?' Confine answers to the SANE's authorized role and name the referral pathway for anything outside it.
Writing conclusions and judgments into the record, such as 'patient was raped,' 'patient is not credible,' 'there was no use of force,' or 'patient was uncooperative.'
Candidates believe the record should convey their overall clinical impression, and they may absorb informal language from peers or from law enforcement framing of the case; they also use pejorative terms like 'alleged victim' or 'compliant' without realizing their effect.
What to do instead
Rewrite a sample note as a translation exercise: convert every evaluative statement into an objective observation with the patient's own words in quotation marks. Practice phrases such as 'patient states,' 'no injury observed on the external genitalia,' and 'patient declined.' Remove causation, credibility, and force conclusions, which belong to the legal fact-finder, not the examiner.
Starting the examination with the speculum or proceeding through the sequence without explaining, checking in, offering a support person, or giving the patient a way to stop.
Candidates master the technical sequence of the exam and rehearse it for efficiency, so under time pressure they default to a clinician-driven order and forget that the patient's control over pace and body positioning is itself part of the assessment.
What to do instead
Rehearse a patient-led script: explain each step before it happens, ask permission before each touch, name a stop signal, offer a support person and a chaperone, and present options such as a modified lithotomy position, sitting up, or inserting the speculum themselves. Debrief any scenario where the examiner moved faster than the patient consented to.
Focusing the physical assessment only on the anogenital area and omitting a general head-to-toe examination with attention to the scalp, ears, oral cavity, posterior neck, breasts, and concealed areas.
Candidates assume the assault history defines where injuries must be, and anogenital findings are the ones they have studied most; time and patient discomfort also push toward a shortened exam.
What to do instead
Use a fixed head-to-toe survey order with a body-map diagram so no region is skipped, and remember that oral, scalp, and posterior neck injuries are commonly missed. Link the assessment to mechanism: where the patient reports impact, restraint, or strangulation is where to look. Practice on a full-body annotated diagram until the order is automatic.
Completing the medical exam without screening for suicidal ideation, intimate partner violence risk or safety concerns, or language and cultural needs, and without confirming the patient knows how to reach follow-up.
Candidates treat psychosocial screening as part of a separate mental-health role and prioritize the forensic steps within limited exam time; they may also avoid asking about suicidal ideation or safety because they feel unskilled in responding to an affirmative answer.
What to do instead
Make a short, fixed screening set part of every exam - safety at home, current suicidal or self-harm thoughts, need for an interpreter, and cultural or religious considerations affecting the exam - and rehearse a scripted response for positive screens, including warm handoff to a crisis or advocacy resource. Close every exam with a written follow-up plan covering who to call, when, and what symptoms warrant immediate return.