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What is sexual assault?

Sexual assault is defined as any sexual activity involving a person who does not or cannot (due to alcohol, drugs, or some sort of incapacitation) consent.

According to the U.S. Department of Health & Human Services, "sexual assault can be verbal, visual, or anything that forces a person to join in unwanted sexual contact or attention."  Sexual assault can describe many things, including:

  • rape, including partner and marital rape

  • unwanted sexual contact (touching or grabbing)

  • unwelcome exposure of another's body, exhibitionism, or voyeurism

  • child sexual abuse

  • incest or molestation

  • sexual harassment

  • sexual exploitation of clients by therapists, doctors, dentists, or other professionals

What to do if you have been sexually assaulted?
1. Go to a Safe Place

  • After experiencing a traumatic event such as sexual assault, it is important to find a place where you feel comfortable and safe from harm

   2. Call for Assistance

  • DVIS/Call Rape 24 hour crisis line-  918.7.HELP.ME (918-743-5763)

  • Call 911

   3. Seek Medical Attention

  • To check for injuries; you may have injuries that you can't see or feel

  • To prevent sexually transmitted infections

  • To prevent pregnancy

  • To collect evidence (For adults evidence collection does not require you to place a report with the police or press charges; it preserves these options for the future.)

   4. Preserve Evidence

For the purposes of evidence collection, we suggest that you avoid:

  • drinking

  • eating

  • showering/bathing

  • brushing your teeth

  • combing your hair

  • changing your clothes

If you have done any of these things, evidence can still be collected and it is still important to seek medical attention.  If you have changed your clothes, take the clothes you were wearing at the time of the assault to the hospital in a paper bag (not a plastic bag). 

How do I know if I've been drugged?

It is often hard to tell. Most victims don't remember being drugged or assaulted. The victim might not be aware of the attack until 8 or 12 hours after it occurred. These drugs also leave the body very quickly. But there are some signs that you might have been drugged:

  • You remember having a drink, but cannot recall anything after that.

  • You feel drunk and haven't drunk any alcohol - or, you feel like the effects of drinking alcohol are stronger than usual.

  • You wake up feeling very hung over and disoriented or having no memory of a period of time.

  • You find that your clothes are not on right or torn.

  • You feel like you had sex, but you cannot remember it.

Where can I go for help?

  • Call 911

  • Call DVIS/Call Rape 24 hour crisis line-  918.7.HELP.ME (918-743-5763)

  • Go to a local hospital (Most exams are done in a quiet location within Hillcrest Medical Center)

How can I help someone who has been sexually assaulted? 

You can help someone who is abused or who has been assaulted by listening and offering comfort. Go with her or him to the police, the hospital, or to counseling. Reinforce the message that she or he is not at fault and that it is natural to feel angry and ashamed.

How much does it cost?

There is no charge for the forensic medical exam.

Do I have to report it to law enforcement?

Adults over the age 18 are not required to report their assault to law enforcement.

Emergency Contraceptive

Patients of different ages, social, cultural and religious/spiritual backgrounds may have varying feelings regarding acceptable treatment options for pregnancy prevention.  The various options will be explored in detail at the time of the exam.
Sexually Transmitted Infections

Contracting a sexually transmitted infection is typically a concern of sexual assault patients.  Because of this concern it will be addressed as part of the forensic medical exam.  Testing and treatment will be considered on a case by case basis.  Testing at the time of the initial exam is not typically performed.

When will the results be back?

To give an exact time is virtually impossible but typically takes a few weeks to a few months.  Analysis of the kit is determined by the detective investigating the incident.  The results will be supplied to the detective once the analysis is complete.  Maintaining contact with the investigator is important in assisting with the progression of the case.

How do I find out the investigator in my case?

Contact the law enforcement agency in the city or county where the crime occurred.


Elder abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult. The specificity of laws varies from state to state, but broadly defined, abuse may be:

  • Physical Abuse - Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving them of a basic need.

  • Emotional Abuse - Inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts.

  • Sexual Abuse - Non-consensual sexual contact of any kind.

  • Exploitation - Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder.

  • Neglect - Refusal or failure by those responsible to provide food, shelter, health care or protection for a vulnerable elder.

  • Abandonment - The desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.

In the United States, the issue of elder mistreatment is garnering the attention of the law enforcement, medical, and research communities as more people are living longer than ever before. This trend is expected to increase, as the U.S. Census Bureau projects that more than 62 million Americans will be age 65 or older in 2025, an increase of 78 percent from 2001, and more than 7.4 million will be age 85 or older, an increase of nearly 68 percent from 2001. This aging population will require more care and protection than is currently available or possible.

The National Research Council defines elder abuse and mistreatment as (a) intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder, or (b) failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm.  This definition includes financial exploitation of the elderly as well as physical abuse or neglect.

For more information:


You will find a wealth of information at this website for anyone caring for American Indian victims of sexual assault and Interpersonal violence:


STM Learning's SANE/SAFE Forensic Learning Series: Adolescent and Adult Sexual Assault Assessment is designed to challenge the critical thinking skills of sexual assault examiners responsible for identifying injuries, collecting evidence, and treating patients reporting a history of sexual assault or abuse. They are available for purchase either separately or as a bundle. For a complete description of this resource visit:

Nursing Approach to the Evaluation of Child Maltreatment is a guide for medical professionals to identify all physical abuse, sexual abuse, and maltreatment of children.

Though the title focuses on crimes against women, the scope of its information includes the effects of intimate partner violence (IPV) on men, children, and adolescents as well.

Non reports--
Although every sexual assault victim has the right to report the crime, not all choose to do so.  Patients 18 years of age and older, have the option of reporting the incident or not.  Regardless of whether they report the incident, all victims have the right to a medical forensic examination, crisis intervention, counseling, support groups and medical care.  Whatever the circumstances, you did not deserve it, it is not your fault and you do not have to cope alone.

120 hrs for adult and adolescent--
A sexual assault nurse examiner can evaluate an adult or adolescent victim whose assault has occurred within the previous 120 hours (5 days).


  • Sexual assault medical and forensic exams

  • Domestic violence exams

  • Drug endangered children exams

  • Elder abuse and neglect exams


  • Convicted offender DNA collection

  • Suspect exams 


Intimate partner violence (IPV) occurs between two people in a close relationship. The term "intimate partner" includes current and former spouses and dating partners. IPV exists along a continuum from a single episode of violence to ongoing battering.

IPV includes four types of behavior:

  • Physical violence is when a person hurts or tries to hurt a partner by hitting, kicking, or other type of physical force.

  • Sexual violence is forcing a partner to take part in a sex act when the partner does not consent.

  • Threats of physical or sexual violence include the use of words, gestures, weapons, or other means to communicate the intent to cause harm.

  • Emotional abuse is threatening a partner or his or her possessions or loved ones, or harming a partner's sense of self-worth. Examples are stalking, name-calling, intimidation, or not letting a partner see friends and family.

Often, IPV starts with emotional abuse. This behavior can progress to physical or sexual assault. Several types of IPV may occur together.


Strangulation is not new however the realization of how dangerous and the knowledge about long term consequences is. Strangulation also frequently referred to as choking is a form of asphyxia in which the blood supply into and out of the brain is impaired. Anyone that has experienced strangulation should contact the nearest emergency department if they experience any of the following symptoms:

  • Loss of Consciousness

  • Trouble seeing, "flashing lights", "spots", "tunnel vision"

  • Pinpoint red spots in/on eyes, face or mouth

  • Cord or rope burns on neck

  • Neck pain, tenderness or swelling

  • Loss of bladder control, "wet yourself"

  • Trouble breathing, can't lie flat

  • Mental changes, seizures

  • Severe headache, numbness or weakness on one side of the body

  • Dizziness, loss of balance or coordination

  • Trouble talking or understanding what people are saying


Most people do not have observable signs of strangulation. However, these other symptoms can indicate very serious injury inside the neck and head.

Who should you see after being checked at the hospital or if you think you have no symptoms?



  • 600 Civic Center, Suite 103 Downtown Tulsa 918.742.7480

  • Monday - Friday

  • 8:00 a.m. to 4:00 p.m.

For more information:


Sexual Trafficking is the recruitment, transportation (within national or across international borders) transfer, harboring, or receipt of persons for the purposes of commercial sexual exploitation.  Sexual trafficking is accomplished by means of fraud, deception, threat of or use of force, abuse of a position of vulnerability, and other forms of coercion.

Trafficking of persons exists in two distinct types: labor trafficking and sexual trafficking. Worldwide, it is estimated that somewhere between 700,000 and four million women, children and men are trafficked each year, and no region is unaffected.  An estimated 14,500 to 17,500 women and children are trafficked into this country each year. There have been reports of trafficking instances in at least 20 different states, with most cases occurring in New York, California, and Florida.

For more information:


Tulsa's Forensic Nursing Program is a community partner within the Tulsa Institute for Trauma, Abuse and Neglect (TITAN) which is an interdisciplinary institute committed to evidence-based education, scholarship, research, and service that reduce the incidence and impact of trauma and adversity.


  • U.S. Department of Justice Award for Public Service 1994

  • Innovations in State and Local Government from the Ford Foundation and John F. Kennedy School of Government at Harvard University 1994

  • NOVA (National Organization of Victim Assistance) Distinguished Service to Victims of Crime 1995

  • Recognized again in 2002 by the Innovations in Government for continued efforts


Kathy Bell MS, RN
Forensic Nursing Administrator
Tulsa Police Department
600 Civic Center
Tulsa, Oklahoma 74103

Patient with Healthcare Nurse


The Tulsa Police Department introduced the Sexual Assault Nurse Examiners Program (SANE) in 1991 to ensure more timely medical treatment and accurate collection of forensic evidence. SANE is a unique, community -based team approach that has become a national model for the dignified and compassionate treatment of sexual assault victims.

As soon as a rape is reported, a police officer is dispatched to the victims location. Simultaneously a SANE nurse and a rape crisis advocate are called to a quiet, comfortable suite of rooms donated by one hospital to serve the entire community as a site in which the examinations are to be performed. When the victim arrives with a law enforcement officer, she/he is examined immediately by a nurse that has received specialized education in the examination of patients that have been raped. The rape crisis advocate provides support to the victim and family throughout the examination. The twelve member corps of nurses examine approximately 350 adult and adolescent individuals per year. 

SANE received the 1994 Innovations in American Government Award.  The program received $100,000 to use in replication activities. Since that time communities throughout the United States as well as other countries have consulted with the program to develop and implement strategies in order to provide similar services. In 2002, SANE was once again recognized by the Innovations program for significant accomplishments since receiving the original award.

Long waits in emergency departments that were previously experienced by the victims and law enforcement have been eliminated therefore getting the officers back out on the street to perform their duties. The forensic lab has reported a dramatic improvement in evidence collection and preservation. There has been a steady increase in the number of cases that result in judicial proceedings. A significant increase has been seen in plea agreements that are reached.

Funding for the program comes from a variety of sources. The Oklahoma Crime Victim Compensation Board pays for the examination and medications. Day to day operation is supported by the City of Tulsa. Private foundation funds and grants have supported the purchase of necessary equipment.

Tulsa SANE has for many years provided professional treatment to rape victims in our community and has transferred many of the philosophies and procedures to other victims of crime that need a medical forensic evaluation.

In 1997, the Pediatric SANE program was implemented. The focus of this program is on sexually assaulted prepubescent children that have been assaulted within the previous 72 hours. The program is administered in the same way as the adult and adolescent SANE program. In addition to the education required for the adult examiner the nurses that perform the examinations attended an additional course specific to children and adolescents. A clinical component is required and the nurse completes this with an experienced nurse and at the Children's JUSTICE Center. The JUSTICE center is a Child advocacy center that houses the Tulsa Police Department child crisis unit, members of the Department of Human Services, forensic interviewers, pediatric physicians with OU College of Medicine, and the Tulsa District Attorney office. The medical staff provides the appropriate medical follow-up of the children seen by the sexual assault examiners and through the association with the Center the children have all the services necessary for support following an assault.

The combined SANE programs have provided services to approximately 6500 sexual assault patients since operations began in 1991.

The Drug endangered children program (DEC) was developed in late 2001 and early 2002. This program was designed to provide forensic medical examination to children removed from methamphetamine homes. When a child was discovered, usually by the narcotics investigators, in an active meth lab they are placed in protective custody of law enforcement. A coordinated response is then activated involving the child crisis detectives, DHS, and a nurse that has been educated in evaluating children living in these environments. At the time of the examination the child is assessed for general health status, medical needs, development and  signs of abuse and neglect. Urine is collected as evidence and the examination is documented and the child is prepared for and sent to a location determined to be safe.

Many of these children test positive for methamphetamine or the metabolites of the drug.  Their follow-up medical care is provided by the JUSTICE Center. In 2004 Oklahoma became the first state in the country to enact a limit on the amount of pseudoephedrine that could be purchased by one person. Because pseudophedrine is one of the major components necessary in manufacturing of the drug, over the next few months there was a drastic decline in the number of meth labs discovered and consequently the number of children examined fell to just 1-2 a year. In  2009 there was the beginning of  a resurgence in the amount of methamphetamine manufactured. A different manufacturing technique has been incorporated making it easier, cheaper and much faster to obtain the methamphetamine high. The program developed a few years ago is now being resurrected to address the issues facing this community.

The Domestic Violence Nurse Examiner Program was developed in response to the recognition that intimate partner violence (IPV) remains one of the biggest  public health issues today.  Oklahoma continues to struggle with a high rate of IPV. According to the 2007 Domestic Violence Fatality Review Board Annual Report an average of 78 domestic violence homicides occur each year in Oklahoma.  The number of persons presenting to the Family Safety Center continues to increase. The Family Safety Center is a location similar to the JUSTICE Center housing many services that a person experiencing domestic abuse needs. The Family Violence detectives reside there, a nurse is there 4-6  hours per day 5 days per week, domesctic violence advocates,  a court hearing is held each day and individuals can obtain and emergency protective order. A minister is onsite to provide spiritual support to anyone that desires it and civil legal attorney are available onsite to help victims with those needs. The forensic nurse entails a forensic medical exam, a danger assessment and  safety planning as basic services to everyone that is seen.  Over 2000  individuals have been examined by a nurse specifically educated in the care of patients experiencing intimate partner violence.

Victims of interpersonal violence are most open to change immediately after a crisis or episode of violence. Change is a process not an event so our goal is to promote optimal change and provide a plan that will decrease the number and severity of episodes of violence. If this opportunity is missed or delayed, many victims will employ defense mechanisms (minimization of the event, denial, ambivalence) leaving themselves and their children in danger of future harm.

The Domestic Violence Nurse Examiner Program was implemented in February 2006. It consists of a core group of nurses educated in the care of individuals that have experienced interpersonal violence. They provide forensic medical examinations that address gaps in and limitations of current services provided to these patients.  This was the first specialized program of its kind in the State of Oklahoma. The program was modeled after the highly successful and nationally recognized Tulsa Sexual Assault Nurse Examiner (S.A.N.E.) Program.


In November of 2007 the sexual assault non-report program began. This program was developed to address the federal and state mandate that sexual assault patients be afforded a free forensic medical examination without the requirement that they report to law enforcement. The examination is completed just as if the patient was going to report. The exception is that the items and documentation made at the time of the examination is turned over to the police department with only an identifying number.  If and when a person changes their mind about reporting, an authorization form to release the information is signed. The investigation proceeds with the evidence and the history provided to the nurse shortly after the incident secured and available to the investigation even if the report was made weeks later.

Education is another major component of the Forensic Nursing Service. Formal nursing contact hour courses are offered for SANE, Pediatric SANE, and Domestic Violence. Additionally presentations are made at healthcare, law enforcement, and community meetings and conferences. Feedback and evaluations are commonly positive. We have partnered with Oklahoma State University Health Science Center specifically with the Forensic Science department and are developing an online SANE course. This will offer nurses some flexibility in taking the course. Currently nurses have to be away from their patient care duties 40 hours consecutively. This is very difficult for many healthcare facilities so they do not send nurses for education or make them take vacation and pay for the course themselves.

The Tulsa Institute of Trauma, Abuse and Neglect (TITAN) is a partner in evaluating services. Currently four research projects are underway.  A sexual assault case tracking study began in 2008. Researchers visited the police department to collect data from sexual assault cases through the SANE case files. Additionally the Oklahoma State Courts Network (OSCN) were accessed looking at what transpired in the court system. The data entry is complete and analysis is underway this spring. More than 50 interviews with SANE coordinators around the country have been done, extensive participant observation, and textual analyses are being utilized to explore ways that SANE nurses frame their role in the reponse to rape victims.

Another project that explores the relationship between victimization and psychological health is assessing patients for anxiety prior to the exam, and after the exam. An additional component presents a short video intervention that addresses anxiety and response issues. The patients are randomly selected to participate is this component and if selected will be assessed again after viewing the video. DNA swabs are collected in consenting participants that will be looked at from the perspective that genetics plays in development of post traumatic stress disorder.

Another  evaluation research project is addressing the organizational procedures used by SANE. Recruitment and retention is typically a difficult issue for nursing units. This program is somewhat immune to this problem. In an effort to understand the organizationa processes that contribute to the success, the hiring practices, compensation, training and supervision is to be evaluated. They will also be looking at the personality characteristics of the SANE nurses related to the stabilithy of this program. This program will be weighed against other programs of comparable size. A literature search has been completed and the tools to utilize are being investigated.

Strong basic philosophies with victim needs positioned in the center of most of what happens developed in the early 1990's has made it relatively easy to replicate the SANE program. Those same philosophies have been transferred to other victim populations with great success.

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