Our Take
SAFE-T solves a concrete access problem with clinical evidence and hospital economics aligned, not marketing claims—but the real test is whether rural communities will fund their own SANEs once the pilot funding ends.
Why it matters
Sexual assault survivors in rural areas often face transfer to distant hospitals or skip care entirely. This model shows remote expertise can improve outcomes and convince hospitals to pay for services they historically lost money on.
Do this week
Rural hospital administrators: audit your sexual assault care delivery pathway this week and cost out SAFE-T training against your current transfer rates and ED bottlenecks.
A telehealth platform puts certified examiners in the room—remotely
Sheridan Miyamoto, a forensic nurse and PhD researcher, built SAFE-T System to close a structural gap in American rural healthcare: many communities lack certified sexual assault nurse examiners (SANEs) to conduct forensic exams, collect evidence, and provide trauma-informed care. Survivors are transferred hours away or skip care entirely.
SAFE-T pairs local nurses with remote, experienced SANEs who guide examinations in real time. Before a survivor enters the exam room, the local nurse and remote expert meet to review the case. During the exam, the tele-SANE watches magnified, high-resolution images on a custom-built imaging platform and directs the local nurse through evidence collection and documentation.
The platform grew from eight years of research at UC Davis, where Miyamoto led what she describes as the first experimental evidence showing telehealth-supported sexual assault programs could match or exceed comparable rural hospitals without that support. That research led to the SAFE-T Center, launched in 2017 with Department of Justice funding. SAFE-T System is now a spinoff of Penn State.
The network currently operates 24 partner hospitals across seven health systems in two states, running around the clock. Partner hospitals have reported care-seeking increases ranging from 25% to 280% in the first year after launch (company-reported). Across the network, more than 533 comprehensive examinations have been completed.
Pennsylvania's Sexual Assault Emergency Service Act, signed in 2023, was informed by SAFE-T outcomes data and prioritizes rural and underserved hospitals for future implementation funding.
Hospital economics and nurse retention now favor the model
The largest barrier was cost: hospitals already lose money on sexual assault services and emergency departments operate under constant pressure. SAFE-T addressed this with operational data.
Hospitals using SAFE-T report a 75% nurse retention rate after one year and 50% after two years, against a national specialty average of 8% (company-reported). SANEs assume leadership of sexual assault care, freeing physicians to focus on other patients. Ninety-two percent of patients reported improved care under SAFE-T support (company-reported).
The outcome: hospitals that once depended entirely on grants began paying for the service themselves out of operating budgets. Miyamoto called this "the hardest result we have achieved."
According to SAFE-T data, 89% of acute examinations in an earlier pilot study resulted in changes to forensic evidence collection that otherwise might have been missed or improperly documented (company-reported). That matters for prosecutors: rural cases often lack properly trained forensic experts to testify, and evidence collection errors can collapse a case.
SAFE-T has trained 164 SANEs across partner communities, representing a 353% increase in the local forensic nursing workforce in underserved areas (company-reported).
Verify sustainability before scaling local capacity
Miyamoto explicitly stated that the long-term goal is not permanent dependence on remote experts. The model aims to develop local expertise with telehealth serving as mentorship and support. That framing is honest but also the key risk: grant-funded pilot success does not guarantee rural hospitals will sustain local SANE programs once federal or state appropriations end.
Practitioners evaluating deployment should separate the short-term access win (survivors receiving expert care within hours instead of being transferred) from the long-term workforce build. The evidence shows telehealth-guided exams improve outcomes and reduce ED bottlenecks. Whether rural communities will retain and pay for trained SANEs independently—especially in low-volume settings—remains the open question.