SANE program for sexual assault victims
Victims of sexual assault and abuse have many faces. They are college students, girls, boys, teens, women, men, and the elderly. They are targets of sexual assault regardless of their sexual orientation, religion, ethnicity, race, and income level. They suffer assault and abuse on dates, on the streets, at work, and in their homes. More often than not, they are assaulted by someone they know and trust.
People can have many feelings after sexual assault, sexual abuse, or rape. They feel confused, scared, angry, helpless, sad, and ashamed. Each person is different and responds individually to their experience. The impact of sexual assault and abuse can include sleep disturbances and difficulty concentrating, and can disrupt relationships at school, work, and in the family. Some victims suffer mental health problems, abuse drugs and alcohol, and experience sexual dysfunction as a result. The SANE program can help you cope with whatever you are feeling.
The Sexual Assault Nurse Examiner (SANE) Program employs a team approach to assist survivors of sexual assault, sexual abuse, and rape with medical, emotional, and legal needs. With the survivor’s consent, a team of nurses, sexual assault counselors/advocates, doctors, and law enforcement work together to support the survivor.
Through the SANE Program, youth and adult survivors of rape, sexual assault or abuse can be examined by specially trained nurses in the Cayuga Medical Center Emergency Department. Nurse examiners provide skilled, sensitive medical care and the timely collections of forensic evidence. If the survivor chooses, law enforcement agencies can use this evidence in the arrest and prosecution of the offender. Care can best be provided as soon as possible after an assault. However, it is never too late to seek care and support after a sexual assault.
Survivors can expect prompt treatment from SANE nurses and the immediate and continued support of experienced counselors-advocates from the Advocacy Center. Family and friends can also receive support and assistance through the program.
All procedures are explained in detail. Treatment to prevent sexually transmitted infections and emergency contraception are available. Survivors are treated with dignity and given choices about their treatment, all in the hope of beginning the healing process.
Participation in all services of the SANE Program is voluntary. It is not mandatory to make a report to law enforcement unless a weapon was involved. In some cases of sexual abuse of children or teens, child protective services and law enforcement must be called.
If a survivor is unsure about whether or not to press charges, evidence collected by a SANE nurse can be held for up to 30 days at the hospital while the survivor makes his or her decision.
SANE is a collaborative project of Cayuga Medical Center and the Advocacy Center.
To find out more about the services of the SANE Program, call the Advocacy Center’s 24-hour hot line at (607) 277-5000 or call our Emergency Department at (607) 274-4411.
Anyone who comes for a SANE exam will be treated regardless of ability to pay. There are no fees for the services of the Advocacy Center.
For more information on the national SANE program, click here.
Stroke Center
Also called a brain attack or cerebrovascular accident, a stroke is a medical emergency caused by an interruption of blood flow to part of the brain. This causes the affected part of the brain not to receive enough oxygen, resulting in some neurological change or loss of functioning; sometimes the effect is subtle and sometimes it’s quite dramatic, but it is almost always sudden. As more time passes, more brain tissue is damaged and eventually dies, which is why we say time is brain and BE FAST!
Stroke is the fifth leading cause of death in the United States and the leading cause of adult disability. There are two types of strokes: ischemic strokes and hemorrhagic strokes. Ischemic strokes are more common, making up 85% of all strokes, and are caused by a blockage in a blood vessel supplying part of the brain. Hemorrhagic strokes, which make up the other 15% of strokes, are caused by a ruptured blood vessel that causes bleeding into the brain itself. Both types of strokes are emergencies where responding quickly can mean the difference between a return or near return to prior functioning and disability or even death.
The Advantages of a Designated Stroke Center
Cayuga Medical Center is designated as a Primary Stroke Center by the New York State Department of Health and the Joint Commission. This designation process raises diagnostic and treatment standards and improves access to high quality care for patients with a diagnosis of stroke or TIA, Studies published in the Journal of the American Medical Association have shown that patients treated at hospitals with a Stroke Center have reduced mortality and morbidity, fewer complications, improved long-term outcomes, and increased patient satisfaction.
The designation as a Primary Stroke Center involves the collaboration of a multidisciplinary group including emergency physicians and nurses, neurologists, radiologists, neurosurgeons, vascular surgeons, and rehabilitation specialists. Team members are available to respond 24/7 in the Emergency Department for the evaluation and treatment of stroke patients.
A Code Gray at Cayuga Medical Center calls the stroke response team into action and things happen very quickly. In the management of acute stroke, the pressing issue is time: our team has a three-hour window in which to administer thrombolytic agents to dissolve the clot blocking blood flow in the brain.
Local EMS responders start the process with their assessment of the patient in the field. As soon as the ambulance calls the Emergency Department, the response begins. Our CT imaging technologists prepare the CT scanner and call the radiologist to put them on stand-by alert. Everyone else on the stroke team assembles in the Emergency Department to be ready and waiting at the door to receive the patient.
There are two types of stroke: ischemic (caused by a clot or vessel narrowing that blocks blood flow in the brain) and hemorrhagic (caused by bleeding into the brain or an aneurysm that leaks or ruptures). By examining a CT scan of the brain, a radiologist can determine if the patient has, indeed, had a stroke and which type of stroke it is. If diagnosed in time, ischemic strokes can be treated with thrombolytic (clot-busting) medication to dissolve the clot and restore blood flow in the brain. Additional brain imaging studies can be helpful to determine the extent of the impact of the stroke on the brain.
As soon as the initial CT images are taken, they are transmitted to the radiologist for immediate interpretation. The brain attack protocols set by the New York State Department of Health require than no more than 20 minutes elapse between the time the patient reaches the CT table and the time the radiologist submits their report to the stroke team. At Cayuga Medical Center, our interpretation time is less than half that time.
Signs and symptoms of stroke usually occur suddenly. The easiest way to remember them is to BE FAST:
- B: Balance: Trouble walking, dizziness, or loss of balance or coordination
- E: Eyes: Trouble seeing from one or both eyes
- F: Face: facial droop, one side of the mouth has difficulty moving that is most noticeable when the person tries to smile
- A: Arms: Numbness or weakness of the face, arm, or leg on one side of the body
- S: Speech: Confusion, trouble speaking or understanding
- T: Time: If you have any of these symptoms, call 911 immediately
- Another sign of stroke is a sudden, severe headache, often described as the worst headache of the person’s life, sometimes with nausea or seizures
Do not try to drive yourself to the hospital – your symptoms could get worse while you’re driving. Also, activating emergency medical services (EMS) ensures that your care starts before you even arrive at the hospital, as well as notifying the hospital that you’re on your way. If possible, you or a family member should note the time you were last known to be well or without symptoms: this is a crucial piece of information for your care team to determine what treatments you are able to receive.
Certain risk factors, such as age or family history, cannot be changed, but there are quite a few that you can lower or modify with help from your doctor or primary care provider, such as:
- High blood pressure
- Tobacco use
- Diabetes
- Carotid and other artery disease
- Irregular heart rhythm, such as atrial fibrillation
- Certain substance use disorders, particularly methamphetamines and cocaine
- Transient ischemic attacks (also called TIAs, warning strokes, or mini-strokes)
- Certain blood disorders
- High blood cholesterol
- Physical inactivity and obesity
Certain types of ischemic stroke patients may be eligible to receive a medication that breaks up blood clots, which may help with stroke symptoms if given quickly. Patients experiencing certain types of ischemic stroke may also be eligible to undergo a procedure called mechanical endovascular reperfusion (also called MER, thrombectomy, or EVT), where the clot causing the blockage is removed by a thin tube inserted into the brain through a major blood vessel. While Cayuga Medical Center is not currently able to perform this procedure, we can still start your stroke treatment and get you safely to a facility that can.
Hemorrhagic strokes are often treated without surgery: the patient receives medications to control blood pressure and help prevent seizures while being monitored either in Cayuga Medical Center or, if necessary, at a hospital with neuro-intensive care capabilities.
In the Emergency Department
- If you arrive by ambulance, EMS providers will:
- Assess you on the way to the hospital, including taking your vital signs and checking your blood sugar
- Start an IV so you can receive medications and have certain tests
- Contact the hospital prior to your arrival, which:
- Allows us to activate a Stroke Alert, notifying key staff members and departments to be ready for you
- Even may allow us to pre-register you into the computer system to expedite your care even faster (time is brain!)
- You will stop in the Emergency Department (ED) for a quick assessment by the ED provider and/or neurologist
- If you come by private vehicle:
- After you are registered, the triage nurse will assess you and take your vital signs
- If they think you may be having a stroke, they will activate a Stroke Alert
- You will be moved temporarily to a hallway bed within the ED, close to triage
- The ED provider and/or neurologist will assess you and enter orders so your care can progress
- The nurse will start an IV, draw labs, and check your blood sugar
- You will receive a CT scan of your brain, which is a series of x-ray slices that will show if there is a hemorrhage or bleeding
- You may undergo a CT angiogram (CTA) also, where special dye is injected through a vein that shows the blood vessels in your brain and can be useful for finding a blocked or narrow artery
- The radiologist, a physician expert in reading medical images, will review the CT studies and call the ED provider with the results as soon as possible, usually within minutes
- If you are eligible to receive the clot-busting medication:
- The neurologist or ED provider will talk to you or your family members about the risks, benefits, and alternatives of the medication, and obtain consent to give it
- The nurse will give you the medication through your IV, which takes less than a minute and does not hurt
- If you are eligible for endovascular thrombectomy treatment:
- The ED provider will contact one of our Comprehensive Stroke Center partners through the transfer center
- At the same time, the transfer center will determine whether you can go by air (helicopter: faster, but dependent on the weather) or by ground (ambulance)
- The images obtained in the CT and CTA will be transmitted automatically to the receiving hospital
- Once the receiving hospital and transportation service accepts the transfer, nursing gives report to both the receiving hospital and to the transport crew and you depart
Admission to the Hospital for Stroke
- Whether you receive the clot-busting medication or not, it is likely that the ED provider and neurologist will recommend admission to the hospital for monitoring and further testing
- If you receive the clot-busting medication, you will be admitted to the Intensive Cardiac Care Unit (ICCU) for at least 24 hours for close monitoring
- If you do not receive the clot-busting medication, you will be transferred to the Stroke Unit on the 4th floor
- Different staff members perform various, important tasks to ensure the best care for both the stroke survivor and their family:
- Internal Medicine (Intensivists, Hospitalists, Residents) and Neurology
- Oversee your care and work with you and your family’s goals for treatment
- Order tests and medications vital for diagnosing stroke, reducing risk factors, and managing complications
- Educate you and your family about options and expectations
- Consult other specialties as needed to manage other health problems you may have (such as cardiology if you have heart problems)
- Nursing:
- Monitor you via telemetry of heart rate and rhythm
- Assess your neurological status check vital signs regularly
- Perform initial bedside screening to make sure you can swallow food and liquids safely
- Provide ongoing education about your medicines, treatments, and disease process
- Case Management
- Work with you and your family to ensure the smoothest possible transition out of the hospital
- Arranges for you have the equipment at home that you’ll need once you are discharged
- Organizes transfer to a skilled nursing or rehabilitation facility if it’s appropriate
- Collaborates with visiting nurse service to set up home visits if needed
- Helps sort out insurance issues as needed
- Physical Therapy
- Performs assessment of your strength and mobility, including how well you were able to move your body prior to the stroke
- Assists you with bed mobility, sitting, standing, transferring to a chair, and walking
- Teaches you exercises to do both in the hospital and at home to maximize your independence
- Occupational Therapy
- Assesses your ability to carry out activities of daily living, such as feeding yourself, washing yourself, using the bathroom, and brushing your teeth
- Works with you to either improve these areas through exercises or adapt to changes in ability resulting from the stroke
- Speech Language Pathology
- Performs detailed evaluation of your ability to swallow food and liquids and/or your ability to speak
- Develops a plan with you and your family to make eating and drinking as safe as possible
- Dieticians can work with you and your family, as well as Speech Language Pathologists, to make sure you’re getting the best nutrition for your needs
- Chaplains can help you and your family find spiritual meaning regarding your stroke
- You will likely undergo more testing while admitted to the hospital, including:
- Magnetic Resonance Imaging (MRI): very detailed images of your brain that can help the neurologist determine not only the size and location of the stroke, but sometimes what caused it
- Echocardiogram: an ultrasound of your heart looking at the structure and function of the heart muscle and valves, as well as any holes or defects inside your heart
- Electroencephalogram (EEG): examines brainwaves using electrodes to look for seizure activity or other abnormalities
- Some of the new medications that may be started in the hospital to prevent another stroke include:
- Anti-platelet drugs: usually a combination of aspirin and clopidogrel, to help prevent clots from forming
- Cholesterol lowering medications: having certain kinds of high cholesterol increases your risk of having a stroke, so you may be put on a statin to keep your cholesterol down
- Anti-coagulation drugs: if you are diagnosed with atrial fibrillation, you may be started on blood-thinning medications that work differently than aspirin and clopidogrel to help prevent blood clots from forming and traveling from the heart to the brain
- Blood-sugar-lowering drugs: if you are newly diagnosed with diabetes in the hospital, in addition to education about diet, you may be started on medications to keep your blood sugar from climbing too high
The American Heart Association/American Stroke Association has a wealth of resources for stroke survivors, all of which may be found at https://www.stroke.org. Here are some of them:
