The Emergency Department (ED) is a key source of care for victims of sexual violence but there is little information available about the extent to which EDs are prepared to provide this care. This study examines the structural and process factors that the ED has in place to assist victims. A survey of all 82 publicly accessible EDs in the Commonwealth of Virginia was conducted (RR 76%). In general, the EDs provide the recommended medical care to victims. However, at least half do not have the needed resources in place to effectively assist victims and most (80%) do not provide regular training to their medical staff about sexual violence. Further, almost one-quarter do not have a relationship with a local rape crisis center. It is recommended that each ED partner with local rape crisis centers to provide training to their staff and to ensure continuity of support for victims. It is also suggested that the state government explore ways in which a forensic (SANE) nurse be made available to every victim of sexual violence that presents to the ED for medical assistance. Ideally, each ED would become part of a community-wide Sexual Assault Response Team (SART) in order to provide comprehensive care to victims and thorough evidence collection and information to law enforcement.