Content Note: This story includes descriptions of sexual assault, including of children, and graphic details of injuries. Reader discretion is advised.

Arlene Marciano was woken up at 2:30 am one Wednesday night last October by her specialized ringtone reserved for work. It has been the same for years – sharp, impossible to ignore, almost anxiety-inducing – so she would know that the call was coming from the sexual assault response hotline. When it rang that morning, she responded immediately. There was a case at Harlem Hospital. She called the emergency department and was transferred for about 20 minutes until she reached the right staffer to say that she was on her way from her home in Brooklyn.

She parked her car in the hospital lot and opened her trunk. She pulled out her heavy Dansko clogs that she wears to every exam. 

“When I have my shoes in my trunk, that’s my safety blanket,” she said. “I change my shoes, and then I am ready. It’s a silly thing, but it makes me feel better.”

Rain or shine, Marciano, 41, follows this small ritual to create a boundary between her two worlds – one as a mother, wife, a loved one, and another as a sexual assault forensic examiner, also known as a SAFE.

Throughout her 17-year nursing career, this was the first time Marciano had signed up for a 36-hour shift. She was dreading it because she worried whether she’d be able to handle such a long and demanding stretch on call. Her boss had repeatedly requested her to sign up because there were no other SAFEs on call. Eventually, she agreed to do three consecutive 12-hour shifts across the New York City Health + Hospitals in Manhattan.

Marciano already knew that these 36 hours would test her endurance, focus and emotional control.

Her first patient had declined care because she didn’t want to press charges. Marciano respected her choice, and as she was leaving to go back home, she got a call for a second case at another public hospital in Manhattan. Her next patient was a Turkish woman who was severely injured after being thrown out of a moving vehicle. Marciano waited for a few hours while the woman got CAT scans before examining her to avoid injuring her further. When they finally got to the exam room, they realized that she could not express herself well in English. They used an iPad translator, which allowed Marciano to better understand her, but also made the exam longer and more difficult.

After wrapping up the case around 3 pm, Marciano went to the supermarket near her house. Her phone rang again, the same ringtone.

She went home, quickly ate whatever was in the house, and left. Marciano’s third patient was a woman in her mid-20s. She was there because she had been assaulted by someone who offered her help when she lost her purse. On Marciano’s drive back to the same public hospital, she got another call for a fourth patient – an 18-year-old girl with an infant also waiting for her there.

After four consecutive traumatizing cases in 36 hours, lack of food, and sleep deprivation, she knew she couldn’t drive. But she just really wanted to get home and shower. So, she got into her car – opening the windows and turning the music volume up to keep herself awake until she got home.

“I collapsed,” she said. “My kids came to the room in the morning wanting me to take them to the bus as usual. I said, ‘I love you. I can’t today.’”

When she couldn’t fall asleep after her kids had left, Marciano knew that she needed help. She reached out to a social worker from the Helping Healers Heal team at her hospital and said, “I have an emergency to speak to you.”

She cried for half an hour until she could finally talk. 

SAFEs like Marciano are specialized medical professionals who work in emergency departments, caring for and examining sexual assault victims. SAFEs are often the first medical staffers who interact with survivors. They provide medical care, collect forensic evidence, interact with law enforcement and testify in court if needed. 

During the exam, SAFEs ask for detailed narratives about what happened to their patients to deduce where they should look for evidence. This process is emotionally daunting because they relive their patients’ trauma with them and then recall it to write an intricate report. Therefore, SAFEs are highly exposed to vicarious trauma – the emotional and psychological toll they undergo when hearing about their patients’ experiences and witnessing their wounds. 

Suppressing feelings is a big part of their work, allowing them to maintain a professional boundary with their patients. Sometimes when they are called in the middle of the night when they are exhausted, they may feel frustrated. And some SAFEs, after seeing their patients, experience guilt for feeling that way. 

At the same time, SAFEs are expected to remain neutral and precise to maintain the quality of their exams. 

SAFEs face challenges outside the emergency room as well. Working overnight shifts and being on call are very mentally draining parts of their profession. Emotional and physical burnout is elevated because many hospitals are understaffed, forcing the available SAFEs to work longer, more frequent rotations, exposing them to even more trauma. When there is nobody else on call, an individual SAFE might be expected to have very long hours – like Marciano did during her 36-hour shift. 

For cases that wind up in court, SAFEs can be subpoenaed to testify, which can also be a daunting experience for many. 

Nurses who work concurrently as sexual assault forensic examiners and in the emergency department experience the highest level of burnout, according to a 2022 study published in the Journal of Emergency Medicine. Pediatric nurses have an even higher exposure to burnout and have high scores showing feelings of being detached from their body, mind and surroundings.

To provide support to SAFEs and other medical staffers, several hospitals have introduced programs such as Helping Healers Heal. NYC Health + Hospitals launched the peer-to-peer support initiative in 2018. During the COVID-19 pandemic in 2020, hospitals added full-time social workers to serve as a resource for medical personnel in need and to train staff members to talk to their peers. 

SAFEs can often use the aid. Despite working as an examiner for more than a decade, Marciano finds herself praying to God every time the phone rings to “help me make sure I have enough mental ability to help this person who needs me. If you’re broken, it’s hard to help someone else.”

The sexual assault forensic examiners program began in New York State in 1995. To become SAFE certified, candidates must fulfill three requirements– take a 40-hour Department of Health training course, complete a preceptorship with a more experienced professional where they’re hired, and submit an application verifying that these steps have been completed. 

The training course covers a range of topics addressing both the medical and emotional complexities that come with being a SAFE. Trainees learn everything from taking the patients’ medical and assault history and collecting evidence to identifying injuries and properly documenting their findings through photo-documentation. The curriculum also covers working with diverse populations – patients from different ages, sexes, mental conditions or substance abuse status. At the end of each day, trainees engage in role play exercises to simulate real patient encounters. The final session is an hour-long session on vicarious trauma and self-care for the SAFEs themselves. 

Being a certified SAFE in New York is often a per diem job, with the pay varying by hospital. In hospitals that do not have a SAFE program, however, other nurses who haven’t been trained might be completing rape kits while on shift, for which they’re not paid extra. Most people who are certified SAFEs also have regular jobs – such as being an emergency room nurse, a doctor or a physician assistant. Nurses working as forensic examiners are also referred to as sexual assault nurse examiners, or SANEs. Before becoming a SAFE, candidates must have worked in a hospital for at least a year. 

“A lot of people do it because they are passionate about serving the needs of survivors, and it’s a way to earn extra money,” said Silva Sergenian, a SAFE coordinator at Mount Sinai Hospital. 

SAFEs interviewed said that despite the trauma, the care is critical to provide. 

“I’ll come here and I’ll have the docs say, ‘I don’t know why you do this,’” said Kim Reiner, an examiner and coordinator for her SAFE team at a public hospital in Manhattan. “Well, who’s gonna do it? I’m glad there’s people like us that do this, because we really want to do it.”

For some SAFEs, the decision is personal. One day in 1994, three weeks after Karen Carroll’s husband had pulled a knife on her, he broke into her house and raped her at knife point. Carroll was an ER nurse. When she went to the hospital, the doctor did not know anything about a sexual assault forensic exam. She walked him through her own evidence collection because of her experience in the ER and because she had seen other doctors do the exam.

Three years later, when she found out that Westchester County was going to train nurses to do SAFE exams, she decided to sign up.

Carroll was a SAFE for 23 years before she retired in 2020. She now is the Medical Director for two SAFE training sites in New York City, including the Alliance Against Sexual Violence, a leading training provider in the city.

“If I can do my own, I can, sure enough, learn how to do somebody else’s. And that’s why I became a SAFE,” she said. “That whole experience changed my life.”

SAFEs interviewed say that they feel deep compassion for their patients because they recognize how critical support is for someone recovering from a sexual assault. Many of the nurses, physicians and physician assistants working in the emergency department usually have a roster of patients at one time. However, as a SAFE, being able to help patients from the beginning to end without any distractions is an especially fulfilling experience, Sergenian explained.

When a SAFE reaches the hospital, they must wipe down the room to make sure there’s no other DNA and ready it for the exam before the patient comes in. Then, they meet the patient and check if she or he speaks English. If not, they must get an interpreter. They try to build a rapport with the patient to ease into the exam, rather than first asking to sign papers, and to check how emotionally ready the patient might be for the exam.

The genital exam itself does not take long – most of the time is spent on history gathering, documentation, and taking pictures. Many SAFEs then write the report in front of the patient to make sure that the documentation is accurate. It must be to ensure evidence is readily available and clear if the case goes to court. They review the facts with the patient and make edits if needed. For some cases, if the patient is under the influence, they are given kits that include drug tests where samples – like urine – are collected and must be managed appropriately, which takes longer. There is another questionnaire that they must complete, reporting the patient’s physical behavior, signs, and symptoms in case the person was drugged. The SAFEs must then meet with a physician to discuss possible medications for the patient.

While some SAFEs choose to complete documentation after the exam if they are confident there are no gaps in their knowledge, Marciano fills out the paperwork while with her patients, which takes longer. It is best practice to have an advocate present in the room during the exam to provide legal support. Rarely, a social worker might also be available for logistical aftercare, such as finding a safe place to stay and arranging transportation. 

Due to the nuanced nature of SAFEs’ work, the duration of exams varies. It may depend on the extent of care they’re providing, among other factors, such as language, the emotional state of the patient and the intensity of the wounds. A SAFE exam can take as long as six hours, according to those interviewed.

Not all New York City hospitals have SAFE programs. For the ones that do, SAFEs sign up for 12-hour shifts when they can be on call. During that time, they can go about their day, but they must be prepared for calls from the hotline. SAFEs must respond within an hour and reach the hospital as soon as they can. They work as a part of a team governed by coordinators, who can be fellow SAFEs or social workers that provide them support and supervision. These teams have one hospital as their home base but often work across a range of affiliated hospitals in each borough.

In hospitals that do not have SAFE programs, the exams are typically performed by medical residents. SAFE certification is not required to conduct these exams in New York.

SAFEs are also a vital part of the law enforcement process. However, they are responsible for providing as little or as much care to their patients as needed. This ranges from only tending to their wounds, to collecting evidence and doing rape kits, to handing evidence to the police if the patient decides to press charges.

There are two kinds of rape kits – one that is used in most cases, and another that is used in cases where the victim may have been drugged. A standard rape kit consists of several forms for the examiner and the patient, with very precise instructions. Evidence is collected in 10 steps that include sampling from the skin; collection of underwear and clothes; oral, cheek and fingernail swabs; collection of dried secretion and bitemark swabs from non-genital areas; pubic hair combings; anal, penile, and vaginal swabs, and pad or tampon collection.

Survivors have 20 years to decide whether to give the evidence to the police. During that time, the kits are stored in an upstate New York facility in case the patient decides to pursue legal action, said Rose*, a SAFE and nurse for nearly 10 years. The DNA from the evidence is not tested unless turned over to the police. 

However, SAFEs’ work is not just technical – it is deeply emotional. While they follow meticulous processes and protocol to collect evidence, they are often the first witnesses to some of the most horrifying cases of sexual assault. From adults who have been violently attacked to children who have suffered unimaginable abuse, SAFEs often take in trauma from each of the cases they handle. Each exam, each piece of evidence carries stories that can leave an impact on these caregivers. Many SAFEs recall thinking about particularly traumatizing cases even days after they finished the exam.

 A couple of years ago, just as Marciano was getting home after a chaotic day in the ER, she got called to another hospital for a case.

“I was kind of cranky. I was tired. I was pissed, like come on, I just want a quiet shift,” she said.

When she arrived, she saw a woman sleeping on a stretcher in the hallway of the ER. She was unhoused, disheveled, and smelled of urine – and told the staff that she had been raped. Marciano asked her to walk to the exam room, which was only a short distance away, but the woman refused, insisting that she couldn’t walk.

While trying to reason with her, another case came in: a teenage girl. Marciano asked if she could address that case first, and the woman agreed, asking to rest in a nearby room. Hours later, Marciano returned, but the woman still refused to move.

At this point, Marciano felt her frustration rising. She stepped out of the room to take a breath. Once she regrouped, she returned and said, “I’m going to expose you. I want to look at your vagina. You’re telling me you can’t walk. I want to take a look. Let me take a look, and I will see what’s going on.”

The patient agreed to be examined in the room by the hallway. As Marciano pulled down her pants, she saw something she could have never imagined.

“I see that she is sliced from her vagina to her anus,” she said.

The patient told her that she had been trading sex for drugs. When she refused to have anal sex with a client several days earlier, “He stabbed me in my pussy.”

Marciano could not stop her tears. She apologized repeatedly and tried to help her as much as she could but had to get a surgery consultant and additional staff to assist.

“Emotionally, I was done. I went home, I cried. I almost didn’t examine her,” she said, her voice breaking.

While adult cases like this are harrowing, pediatric cases can impact SAFEs in a different way – they are left worried about the wellbeing of their loved ones, particularly children and young adults – especially if they are parents, said Katherine Manners, co-director of Resilience Works – an organization that supports trauma-exposed professionals.

Sarah Moy, a SAFE at Mount Sinai Hospital, once shadowed someone for a pediatrics case. A mother had brought in her 3-year old daughter, suspecting sexual abuse, due to signs of trauma after returning from her father’s home – she didn’t want her mom to change her diaper or take off her pants or clothes, and she didn’t talk much. During the exam, they couldn’t find other physical evidence of abuse, but Moy recalls seeing that the vaginal opening was bigger than it should’ve been – a possible confirmation. 

She said that she has never been affected like that after a case. 

This case stayed with her for much longer than her other cases do. She described feeling unusually shaken – physically nauseous and disillusioned about the world.

“Which is why I don’t do peds [pediatrics]. I was thinking about it, and I’m like, no, never,” she said. “I’m not gonna do that. That was really difficult for me.”

Patients might cry when they’re recalling the incidents. But SAFEs have to maintain their composure in that moment to ensure that they focus on providing the care that they are certified to give.

Many say that it is easier to control their emotions because of their experience working in emergency rooms and hospitals. They are hardened by their experiences as healthcare professionals who witness disturbing cases on a daily basis.

The SAFEs interviewed say that they keep in mind that every patient is there for a purpose. The patients don’t want to be there any longer than necessary, and as medical professionals, the examiners know they must conduct an exam respectfully and accurately, especially since that documentation may help the survivors in court months later.

This perspective helps them keep their composure, even when they have to listen to violently traumatizing narratives of assault. Reiner, 62, stays focused on the job at hand – which she believes is accurately documenting the assault.

Oftentimes, when patients are traumatized, they may not talk about what actually happened to them. Keeping one’s composure is especially important to give the patient appropriate care.

“You get their story, but when they go off on tangents, you want to bring them back to the purpose. You know, the reason why we’re here today,” Reiner said. “You don’t want to make them think that those other things are not important. So you listen as best as you can, but you have to refocus them.”

Adding to their emotional burden, some SAFEs said they feel responsible for how their patients act, as well as how they react to their patients’ behavior. This leads to frustration, but also internal guilt and anxiety. 

One morning, Reiner received a call at 3 am. She had to drive from her Staten Island home to Harlem. She was cranky, tired, and felt miserable. However, when she got to the hospital, she met her patient – a rape survivor.

“I became ashamed of myself. Like, what happened to me? Nothing. I lost a couple of hours of sleep. Big deal,” she said. “This lady was raped, and I’m complaining about my salary. I’m complaining because I’m tired, you know? I’m complaining because I had to drive. I got teary eyed, and I truly, truly became ashamed of myself.”

Sometimes, cases are especially difficult not just because of the trauma and violence, but also because it may affect the SAFEs more personally. Marciano also experienced a similar situation during her 36-hour shift where she knew she needed to step away.

During the exam with the 18-year-old patient with the infant, the young woman shared a lot with Marciano – such that Marciano felt overwhelmed. The patient told her how she navigated public benefits – from housing in a brand-new high rise to free childcare and gym access – and how much assistance she was able to access as an undocumented single mother who wasn’t employed. For Marciano, who had been raised to value hard work, self-sufficiency, and still had a significant portion of her 36-hour shift ahead of her, it was a lot to process.

“Maybe my threshold was low, and I really had a hard time being neutral in that moment,” she said.

She stepped out of the room and called her boss, Reiner, to vent her frustrations. When Reiner validated those feelings, Marciano finally felt like she could help her patient without any biases.

But as she conducted the physical exam, her outlook shifted. The patient had strangulation marks and was covered head-to-toe in bite marks and bruises. By the end of the exam, she had collected evidence, documented, and photographed each wound.

“My heart broke for this girl,” she said, recalling the moment.

On the way back to the emergency room, this young woman gave her a big hug – tears trickled down Marciano’s cheeks. She was upset with herself for being frustrated initially, she said.

SAFEs have to practice control on both ends of the emotional spectrum – they can neither let their sympathy for the survivor take over, nor can they let their biases towards the patient affect their exams. These examiners are often trapped in a tug-of-war between their emotions and professionalism. Sometimes, their feelings and biases may win.

One summer 15 years ago, a SAFE at a public hospital in Queens examined three teenage girls who claimed they were abused or raped. She believed them and examined them as she would any other patient. However, she later learned that the girls hadn’t been truthful to her during the exam. Eventually, she started looking for signs of deception in her other patients, despite knowing that it was for law enforcement to decide who was lying and who wasn’t. When she began doubting her patients, she knew she needed to take a step back.

“I’m not doing my job as a SAFE examiner,” she said, who, after consulting her supervisors, requested her name not be used to protect her program and the people they serve. “This is the prejudice that I’m coming in with before even meeting the survivor, yeah? So, I said, ‘No, I can’t do that.’”

She decided to stop participating as a SAFE on call soon after – she would only attend to survivors who came in while she was working her regular job at the hospital.

However, she went to a conference in 2024, where she talked to several other SAFEs who had experienced the same doubts. And so, she resumed on call shifts in early 2025. Now, as a sexual assault response team coordinator at her hospital, she tries to provide her team with the support she was too ashamed to seek years ago.

“I tell them, I’m their mom. You come to me. I’m 24/7. You talk to me, and we will go through this,” she said, while showing a picture of her team on her office wall right by those of her children.

SAFEs examine a range of people – female and male survivors of sexual violence and assault, psychiatric patients, prisoners who may be claiming that they were abused, and even suspects in sexual assault cases. Not all of them tell the truth or treat SAFEs with respect.

Reiner recounts how patients have said that they were raped by a doctor on rounds, but no doctor had entered the room that day. Another patient once said that he had been raped by Michael Jackson in a supermarket.

“It’s more than one time prisoners are masturbating while I’m trying to examine them,” Reiner said. “It’s really, really upsetting. You know you want to flip out and yell and scream, but we stay professional.”

She realized that SAFEs must remind themselves that their job is to simply collect evidence to support the patient without any biases. So, if a patient comes in and says that Michael Jackson raped him, she still takes him seriously – with the understanding that the person might not be entirely capable of expressing themselves due to mental health issues.

“I listen to them. I document what they told me. I mean, I have my personal feelings and bias, but I don’t act on any of that. It’s the job of the police to decide if this person was raped or not by Michael Jackson,” Reiner said. “So, I keep that stuff to myself. My personal feelings never come out of my mouth.”

As a SAFE team coordinator, Reiner has to be on 24/7 oversight, which makes her the default if nobody else is on call, which happens once or twice a month. (The hospital is currently training two examiners so all shifts should be covered soon.)

At many hospitals, understaffing in SAFE programs has long been a problem. 

That is set to change – at least on paper. Starting in May 2027, an update to New York’s public health law will require every hospital with an emergency department to maintain certified SAFEs on call 24 hours a day, every day of the year. Hospitals also must designate SAFE coordinators – like Reiner – to ensure oversight.

Professionals working in the field said they aren’t entirely sure how hospitals will meet this requirement, given the long-persistent understaffing issues and the fact that not all hospitals require their SAFEs to be certified. Recruiting new SAFEs is primarily the responsibility of the SAFE program in each hospital.

It might be possible if hospital administrators provide more financial support for sexual assault care, said Carolyn El Serafi, the senior SAFE-TI coordinator for the Alliance Against Sexual Violence.

“I think the problem is that hospitals currently have no incentive to meet that mandate,” said El Serafi, who runs the Alliance’s SAFE training programs. “There is not strong oversight and monitoring of the way hospitals manage these cases.”

NYC Health + Hospitals, NYU Langone and Mount Sinai did not reply to several requests for comment. To support hospitals in meeting new requirements, the state Department of Health said in a statement that it will create a statewide resource center to provide training, technical assistance, and guidance for hiring and maintaining SAFE staff. 

The lack of sufficient SAFE-certified workers is leading to “suboptimal care” for survivors, Emily Miles, the Alliance’s executive director, said in a written testimony during a state budget hearing in February 2025. The problem is compounded by the lack of training programs in the state.

Understaffing is a significant contributor to the high mental cost of being a SAFE, said Manners, the co-director of Resilience Works. 

If there are no SAFEs on call when a patient comes in, the hospital reaches out to other SAFEs who are not on call, or SAFE team coordinators – asking them to come in. If no SAFEs are available, a registered nurse or medical resident is assigned to do the sexual assault exam and rape kit.

When there are not enough SAFEs, individuals face overwhelming workload without breaks or peer support and are exposed more frequently to patients’ trauma.

On her rare days off, Reiner said, “I just want to stay in my pajamas on the couch with my cats and watch Netflix.”

But even then, she doesn’t completely avoid work – she likes watching medical shows like The Pitt.

Work often spills over into their personal lives – and not just in the form of TV shows.

Several SAFEs talked about having sleep anxiety while they are on call – even after years of doing this job. Some of them liken it to having a chore on one’s subconscious mind that keeps lingering. Others say that it is related to the anxiety of not knowing what the next shift will bring.

Rose described having anxiety at night – dreams where she’s scrolling through her phone and she hears it ring. When she wakes up to answer though, she realizes that it was only a dream. When she can’t fall back asleep, she looks out the bedroom window, overlooking the New York skyline. She doesn’t have her glasses on, and all the New York lights appearing blurry give her some kind of peace.

When she’s really tossing and turning, she cuddles her dog, Scallion.

While some SAFEs face anxiety issues, some others may feel paranoia.

“It can show up in feeling as though you need to take care of the people in your circle because they’re at risk, and they don’t realize how much risk they are in,” said Manners.

This vigilance is exactly what Marciano has described while thinking about her young daughters – torn between shielding them from the world and warning them about its dangers.

Marciano, whose daughters enjoy playing Roblox, notes her constant worry about reports in the news about children going missing. There are all kinds of predators who could be grooming children and then meeting up with them to kidnap or assault them, she said.

 “And I disable all the chats on my kids’ apps, and it’s still, like, they’re so resourceful. I feel like there’s no control, and your kids want to do what kids do, and it’s just scary,” she said. 

Reiner, on the other hand, warns her friends’ children about taxis and Ubers and has concerns about dating apps because she sees many people getting assaulted during those encounters.

“I have my goddaughter. She’s 20,” said Reiner. “She goes out in Manhattan, she’s on dating apps. I’m like, ‘Don’t leave the house.’”

Anxiety also follows them to another aspect of their job – testifying in court.

The worry stems from the fact that the 40-hour course that prepares SAFEs for their profession does not include any sessions on testifying in court, said Carroll. She has conducted more than 3,000 SAFE exams and testified 80 times in court as a SAFE and as an expert. The course has one lecture from the district attorney that touches on basics about what sex crimes, fact witnesses, and expert witnesses are.

“But unless you’ve actually been in an actual courtroom in New York City, or unless you’ve actually either testified or even observed a trial, you don’t really have a concept,” she said.

Reiner still remembers the first time she went to testify in court. She was left alone in a tiny room to wait for hours, and finally, when she was called in, it was a nerve-wracking experience. Reiner was then brought to a courtroom, full of people.

“Everyone is just dead on, staring at you,” she said. “They put your chart up for everyone to see. So your spelling errors, your sloppy handwriting, everything on display. My Brooklyn accent came out because I was nervous – you’re saying ‘vagina’ and ‘penis’ and ‘ejaculation,’ and I could see the jurors were uncomfortable.” 

To help them cope with these and other stressors, many SAFEs rely on peer support or structured support systems, like Marciano did after her 36-hour shift.

The Helping Healers Heal program at the New York City Health + Hospitals system is a very good resource, many SAFEs interviewed say. The program, available to all medical professionals, volunteers and students in the system, offers a three-tier support system. The first tier consists of those who have knowledge of secondary trauma and the effects of victimization, equipping them to support one another.

The second tier is trained peer support – healthcare workers prepared to talk to and guide colleagues in times of need. The final tier provides an expedited referral process, connecting individuals with social workers or psychiatrists.

SAFEs come in mostly after really difficult or back-to-back cases, said Alyson Helfand, the wellness program director at Bellevue Hospital’s Helping Healers Heal. They often tell her they have trouble separating their work from their personal lives.  

“I think the biggest thing, to be honest, is listening,” she said. “Most people don’t really have the opportunity to talk these things through and talk out loud to another person of how they feel after responding to cases like this.”

The program provides a dedicated space where SAFEs can debrief and process their experiences. It also connects people with outside mental health resources if needed, giving them options to seek professional support, Helfand said.

Mount Sinai Hospital provides debriefs with SAFE team coordinators as a form of support and oversight for examiners. At NYU Langone, staff can activate a Code Lavender for very traumatic events at the hospital – such as a difficult case or death – so that a team of behavioral health nurses can provide support.

It is important for an organization to recognize vicarious trauma in its employees, said Brian Bride, an expert in secondary traumatic stress. 

“A big piece of that is having some form of supervision so that the workers can process, kind of like exposure therapy, to process the experiences they’ve had with the other people’s traumas and learn how to deal with that,” Bride said. “Having colleagues that are very supportive is really helpful as well.”

Many SAFEs find the biggest support through their teams, where they can foster friendships and share each others’ experiences.

“I think through Covid, it was like me and one other SAFE nurse, she was like one of my best friends at work,” Rose said. “And so we would do a lot of debriefing with each other and support each other, but it’s not formal.”

However, after the draining 36-hour shift, Marciano needed more than a peer. She reached out to Helping Healers Heal after experiencing “something between sadness, exhaustion, and overwhelming helplessness. You feel like you cannot control the amount of emotions you’re having.” 

All she remembers is crying until she felt better. When she talked to Reiner after, Reiner asked her why she didn’t call her for support instead. Marciano said that she was her friend – she knew Reiner would validate her feelings. Talking to someone on the outside and knowing that they still understood her, gave her immense relief – that she wasn’t wrong for feeling the way that she did, she was human. 

Despite all the trauma and anxiety, Marciano feels fulfilled in this job. Some moments remind her why she continues doing the work. Even on the hardest days, she said, knowing she helped someone makes the emotional toll worthwhile. 

“I feel a sense of fulfillment when I get that call that I helped put a rapist in jail, that my job that I did was good enough for them to convict a rapist and put him away,” she said. “I also feel fulfilled when a patient – and it’s the worst day of their life – they hug me and they tell me that it was like a godsend that I was sent there for them today.” 

Muskaan Darshan

*Rose is a pseudonym. At her request, the SAFE’s real name has been withheld to protect her privacy.

NB: The featured image for this story is a stock image from Pexels. It is for illustrative purposes only and does not depict the scene from the reporting.