Survivor Safety: Sexual Assault Forensic Exams and Ensuring the Health of Survivors

Feb 01st, 2024

By Natalie Scott, SAFE/SART Policy Advocate

Sexual Assault Forensic Exams (SAFEs) are a crucial part to the sexual violence response process. These exams include evidence collection as well as medical examinations and care to help promote the health and well-being of survivors. SAFEs are conducted at specific hospitals throughout the state, with approximately one hospital providing this service in each county. They are administered by specially trained nurses and qualified medical professionals, known as forensic nurse examiners (FNEs). FNEs work to keep survivors safe by providing acute injury care and treatment and prevention for sexually transmitted infections (STIs). It’s important to note that while SAFEs do include the collection of evidence, the safety of a survivor is the priority, and the care related to a patient's health and physical well-being are addressed first.

When survivors arrive for an exam, medical staff should assess the safety of the survivor by developing an understanding of any threats or dangerous situations the survivor may be in. The FNE may collaborate with a Rape Crisis Center advocate for these safety assessments and referrals for ongoing support. Safety considerations should also be taken prior to the discharge of the survivor to help ensure their well-being after departing from the hospital.  Following this assessment, FNEs work to care for the physical needs of survivors. It’s important to note when considering the safety of survivors that certain injuries may not be visible, but could be extremely harmful, such as non-fatal strangulation cases.

In these cases, external injuries may not be detectable by the naked eye but FNEs or medical professionals will conduct a thorough examination with the use of an alternate light source (ALS). ALS technology allows FNEs to assess any damage to the survivors soft tissue (Holbrook and Jackson, 2013).  A 2013 study found that 93% of 172 patients who reported strangulation to an FNE had no visible evidence of external injuries on physical examination. However, with the use of ALS, it was discovered that 98% of that group had injuries below the skin that were not visible to the naked eye (Holbrook and Jackson, 2013). Furthermore, an additional study found that women who have experienced nonfatal strangulation have a greater likelihood of becoming victims of homicide (Glass et al, 2008). This further demonstrates the importance of screening for non-fatal strangulation when caring for survivors of abuse.

In addition to care for injuries, SAFEs also provide the opportunity for survivors to receive STD/STI prevention and treatment, including HIV prophylaxis, or nPEP. It’s noted in the National Protocol for SAFEs, that FNEs should talk with survivors about the possibility of HIV exposure from the assault (Office on Violence Against Women, 2013). If the medical provider and the survivor determine it may be necessary, the survivor has the opportunity to be given nPEP, which is medication given after 72 hours of HIV exposure to prevent the development of a HIV infection (Office on Violence Against Women, 2013).

Hospitals with SAFE programs also take crucial steps to ensure the safety of survivors. For example, some hospitals have private suites for sexual assault survivors. These suites are only accessible by medical staff, law enforcement personnel, advocates, and the survivor and their support system. Hospitals without these suites may implement other security measures to ensure both the safety and privacy of the survivor.  It’s important to note that in Maryland, SAFEs are primarily provided at designated hospitals. However, various states have found that offering this care in other settings such as family justice centers, military bases, or campus health centers, can further increase safety and access to this critical and life saving care.

Overall, SAFEs are designed to provide care for the physical well being of survivors. To learn more about sexual assault foresnic exams, please visit our getting medical attention page here:


Glass N, Laughon K, Campbell J, Block CR, Hanson G, Sharps PW, Taliaferro E. Non-fatal strangulation is an important risk factor for homicide of women. J Emerg Med. 2008 Oct;35(3):329-35. doi: 10.1016/j.jemermed.2007.02.065. Epub 2007 Oct 25. PMID: 17961956; PMCID: PMC2573025.

Holbrook DS, Jackson MC. Use of an alternative light source to assess strangulation victims. J Forensic Nurse. 2013 Jul-Sep;9(3):140-5. doi: 10.1097/JFN.0b013e31829beb1e. PMID: 24158151.

U.S Department of Justice, Office of Violence Against Women. A National Protocol for Sexual Assault Medical Forensic Examinations Adults/Adolescents. Second Edition. April 2013.

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