The Texas Teleforensic Remote Assistance Center (Tex-TRAC)
Texas has a large population, large geographical area (268,597), and many rural and medically underserved regions. Many Texas rural and underserved communities lack access to Sexual Assault Nurse Examiners (SANEs) and medical forensic exams (MFEs). MFEs conducted by SANEs decrease risk of adverse mental health consequences to victims by providing high quality, patient-centered, and trauma-informed care [1,2]. Exams conducted by SANEs result in more effective evidence collection, greater admissibility of evidence in court, and greater likelihood cases proceed through the justice system [3-8]. In an effort to increase the number of Sexual Assault Forensic Exam (SAFE)-ready facilities, the Center of Excellence in Forensic Nursing at Texas A&M University developed the Texas TeleForensic Remote Assistance Center (Tex-TRAC).
Tex-TRAC, an innovative telehealth program, increases access to high-quality, patient-centered, trauma-informed SAFEs for patients in rural and underserved areas through real-time teleconsultation using a tripartite communication model [9]. Expert SANEs (TeleSANEs) connect with hospital clinicians via the cart hardware and software. An interprofessional team comprised of experts in forensic nursing, engineering, information technology, telehealth, software development, and patient advocacy collaborated to create the Tex-TRAC Cart. The team collaborated to learn with, about, and from each other regarding their respective specialties and the importance of why and how it was essential to develop a cart that was patient-centered and trauma-informed. The cart also needed to be easy to use for hospital clinicians so they could maintain focus on the patient, TeleSANE guidance, and elements of the SAFE. The TeleSANE communicates directly, in real time, with the patient and clinician throughout the MFE, guiding the clinician through the MFE, evidence kit documentation, and evidence packaging. Unique to our patent-pending cart, the TeleSANE remotely views and assists clinicians with identification and photo documentation of injuries.
Tex-TRAC is currently live at three rural hospitals and will be implemented in two more hospitals by the end of August 2021. There have been multiple cases at two of the three hospitals. Having access to the TeleSANE via the Tex-TRAC cart has allowed for the patient to stay in their own community without having to travel several hours to a large, metropolitan hospital with a SANE Program. This reduces additional trauma to the patient and prevents time-sensitive delays in evidence collection and medical treatment. It also allows law enforcement to initiate investigations more quickly, eliminating the need to escort the patient and retrieve evidence from a hospital outside their jurisdiction.
