ENA Connection - October 2012

INSIDE FEATURES

the Official Magazine of the Emergency Nurses Association

October 2012 Volume 36, Issue 9

connection

Sidestepping Potential Pitfalls in Research PAGE 4

ENA Launches the ENPC Revision Course PAGE 8

Sharing the Innovations and Best Practices of the 2012 Lantern Award Recipients PAGE 26

ENA Foundation’s 2012 Scholarship and Research Grant Recipients PAGE 36

Here Comes the StunPreparing Now Means Your ED Won’t Be Blown Away When Calamity Turns the Community Upside-DownSpecial Disaster Readiness Section, Pages 10-23

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Official Magazine of the Emergency Nurses Association 3

This year at ENA’s Annual

Conference in San Diego,

Karen Daley, president of

the American Nurses

Association and a longtime

friend and emergency nurse colleague, delivered the

Anita Dorr lecture. Her personal story is a poignant

reminder of what could happen to any one of us.

In the summer of 1998, while working in the ED,

Daley was stuck by a needle protruding from a sharps

container. A few months later, she learned that her

flu-like symptoms were because of Hepatitis C and

HIV. She didn’t know whether she would live or die.

What she did know for sure was that her injury had

been preventable. She was determined to tell her

story so others would be protected, and she became

an activist. As the then-president of a state nurses

association, she had a voice, which she used to the

fullest and lobbied for the Federal Needlestick Safety

& Prevention Act of 2001.

Daley’s talk reminded me of how far we’ve come,

but also of how far we have to go.

While the rate of sharps injuries seems to be going

down, in 2010 in Massachusetts alone there were

2,947 sharps injuries among hospital workers (250 of

them in the emergency department), and 53 percent

of the sharps injuries reported involved sharps

without any sharp injury prevention features.1

We do not know how many of those sharps

injuries resulted in illness or even death.

Massachusetts does not have those figures. A 1998

CDC study found that, of health care workers who

had been exposed to blood in the workplace, 2-4

percent developed Hepatitis C infections, which have

a high rate of chronicity and potential for chronic liver

disease and liver cancer.2

Labels for sharps are misleading, since there is no

definition and no standard specification for a ‘‘safety

needle’’ or ‘‘safety device.’’ Some so-labeled can be

even more dangerous than the old needles,

particularly if the device requires a second hand to

somehow cover the needle.

In contrast, look at the attention to the safety of the

public. Over the last few years, as many as 1.5 million

baby strollers have been recalled because three

children sustained fingertip amputations and two

adults smashed their fingers in hinges on the stroller,

according to news reports. There was no need to pass

legislation to reduce the number of dangerous

strollers or increase efforts to educate consumers to

better operate the strollers with retrofitted ‘‘safety

hinge’’ devices.

Would we tolerate a situation in which the general

population was at similar risk in their daily lives, of

being stuck with a needle contaminated with tainted

blood? Would we be as complacent as we have been

with our nursing and physician colleagues?

Look at the attention to the safety of workers in

industry. When a friend who had worked for years as

an occupational health and safety nurse in industry

began to work with a nursing association and visited

hospitals, she was amazed at what she found. Nurses

and other staff might be told to follow a certain

detailed safety regimen, but it was sometimes

followed with ‘‘when possible.’’ If it wasn’t possible to

follow the guideline, the health care worker was told,

‘‘Be careful.’’

The public, and much of industry, is afforded

passive (automatic) protection by such features as

airbags and meat-slicing guards, and nurses deserve

no less.

The authors of an in-depth safety study concluded

that ‘‘we provide clear evidence that passive [fully

automatic] safety engineered devices (SEDs) are more

effective than active [requiring the user to activate]

SEDs for needlestick injuries (NSI) prevention. Passive

devices require no input from the user, and this is

Dates to Remember

PAGE 4ENA Research

PAGE 6Pediatric Update

PAGE 11Feedback Frame

PAGE 28ENA Call For ...

PAGE 31ENA Connected

PAGE 32Washington Watch

PAGE 34Academy of Emergency Nursing

PAGE 36ENA Foundation

PAGE 38State Connection

PAGE 40Board Highlights

Monthly Features

Oct. 8, 2012 Course proposal deadline for those seeking to be selected as faculty for 2013 Annual Conference in Nashville, Tenn.

Oct. 24, 2012 Deadline to apply to become a contributing author of forthcoming Emergency Nurse Advanced Critical Thinking (ENACT) course (www.ena.org).

March 15, 2013 Deadline for proposed bylaws and resolutions for 2013 General Assembly at Annual Conference in Nashville, Tenn.

PAGE 8ENA Launches the ENPC Revision Course

PAGES 10-23Disaster Preparedness Section

10 Board Writes: Are You Ready for the Real Thing? Considerations for Disaster Preparedness Exercises

12 The Use of SBAR to Facilitate Patient Communication During a Disaster

14 Disaster Nursing Education: We Must Be Working, Learning as One 16 Measuring the Effectiveness of a Communitywide Disaster Drill

18 Focus on Hurricane Preparedness

20 Mass Casualty Patient Decontamination

22 Ready or Not: What Does It Take to Make Your ED Ready?

23 Building Relationships in Advance Aids Disaster Planning

PAGE 262012 Lantern Award Recipients: Sharing Innovations and Best Practices

PAGE 30Go Global With TNCC and ENPC

PAGE 35Spotlight on the Nominations Committee

PAGE 37Leadership Conference 2013 Advance Program Is Going Digital

ENA Exclusive Content

An Ounce of Prevention LETTER FROM THE PRESIDENT | Gail Lenehan, EdD, MSN, RN, FAEN, FAAN

Emergency Nurses Week™ – Oct. 7-13Emergency Nurses Day® – Oct. 10

The ENA Board of Directors congratulates all emergency nurses. Emergency Nurses: Every Patient + Every Time = Making a Difference

Continued on page 40

October 20124

Why do we do research?

a) Research is all about getting answers.

b) Research is all about getting the ‘‘right’’

answers.

You have set up your study to answer your

question, gone through the Institutional Review

Board and had your abstract (results pending)

accepted to a conference. You start to analyze

all your carefully collected data, waiting for the

answer to your question to reveal itself. And …

you don’t find what you thought you would

find. Or not enough of what you thought you

would find to analyze properly. Or you don’t

find anything that made a difference. Or not

enough of a difference to justify the cost.

Researchers go to a lot of effort to set up

their studies so that they are using the right

method to answer the right question. Well-done

research studies can take a considerable amount

of time to collect data, depending on the

method. However, once the data is analyzed,

it’s important to look at what the data reveals,

regardless of whether that’s the answer the

researcher is ‘‘hoping’’ for.

For example, we recently did a study of what

we thought was the implementation of nurse-

delivered Screening, Brief Intervention and

Referral to Treatment, using a mentoring system

to facilitate practice changes in emergency

departments. We wanted to find out if the use

of regional remote mentors increased the use of

SBIRT in emergency departments. We had more

than 100 sites agree to participate in the study,

but only 55 sites filled out the initial survey.

After a period of encouragement, and data from

about half the regional mentors, we received

follow-up data from only about 22 sites. This

was not enough data from which to draw any

real conclusions.

Was this a useless study? Once we sat and

thought about what had happened, we realized

that far from giving us no information, this

process had provided enormous insight into

factors that might challenge or enhance other

study protocols conducted in emergency

departments. For example, involving people

remotely was not as successful as we had

expected. Only half of the remote mentors were

able to engage their sites in the project. These

challenges to implementation and data

collection suggest that on-site mentoring might

be a better method, and that on-site

infrastructure and support for these kinds of

practice-changing initiatives are prerequisites to

adequate data collection on the effectiveness of

the project.

We found out that it’s easy to get people to

go to one class or view one webinar, but the

more content that we asked them to absorb, the

less ability there was to maintain consistent

participation over time. Lesson learned:

Condense all the information into one session

when possible. Another lesson learned: If

there’s not a big incentive to participate, it’s not

reasonable to ask people to do a lot of work,

especially for a sustained period of time. These

three really important pieces of information will

allow us to plan the next study based on what

worked, what didn’t and where the gaps in

understanding now lie.

Research studies can look really good on

paper. They can be well planned and well

developed. Before you begin to plan your

study, however, it’s useful to look at any

‘‘lessons learned’’ literature to see if other

researchers may have documented challenging

issues with the implementation of a similar

study. All results are useful. Use other

researcher’s findings to make sure you

approach your own research with the best

possible understanding of potential pitfalls.

ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association

915 Lee Street Des Plaines, IL 60016-6569

and is distributed to members of the association as a direct benefit of membership. Copyright© 2012 by the Emergency Nurses Association. Printed in the U.S.A.Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

POSTMASTER: Send address changes to ENA Connection915 Lee StreetDes Plaines, IL 60016-6569ISSN: 1534-2565Fax: 847-460-4002 Web Site: www.ena.orgE-mail: [email protected]

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Editor in Chief:Amy Carpenter AquinoAssistant Editor, Online Publications:Josh GabyWriter:Kendra Y. MimsEditorial Assistant:Dana O’DonnellBOARD OF DIRECTORSOfficers:President: Gail Lenehan, EdD, MSN, RN,

FAEN, FAANPresident-elect: JoAnn Lazarus, MSN, RN,

CEN

Member Services: 800-900-9659

Secretary/Treasurer: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN

Immediate Past President: AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN

Directors:Kathleen E. Carlson, MSN, RN, CEN, FAEN Ellen (Ellie) H. Encapera, RN, CEN Mitch Jewett, RN, CEN, CPEN Marylou Killian, DNP, RN, FNP-BC, CENMichael D. Moon, MSN, RN, CNS-CC, CEN,

FAENMatthew F. Powers, MS, BSN, RN, MICP, CENKaren K. Wiley, MSN, RN, CEN

Executive Director: Susan M. Hohenhaus, LP.D., RN, CEN, FAEN

All Results Are Useful

ENA RESEARCH | Lisa Wolf, PhD, RN, CEN, FAEN, Director of the ENA Institute for Emergency Nursing Research

Sidestepping Potential Pitfalls

The Research Column in Connection

has been designed to give succinct,

useful information about the research

process and how research can be

useful to the bedside emergency nurse.

Please send topic suggestions to

[email protected].

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October 20126

When a gunman opened fire in a movie theater in Aurora, Colo.,

this past summer, the youngest victim was 6 years old. As emergency

departments in the community sprang into action, each facility

went immediately into disaster response mode. If the same thing

happened in your community, would your facility have the

resources, equipment and staff on hand to care for the child?

IntroductionThe National Pediatric Readiness Project is working to ensure that

emergency departments nationwide know what is necessary to care

for children, and it is building a clearinghouse of resources to help

all facilities become ‘‘pediatric ready.’’

The first step in the project is an assessment. Beginning in

January 2013, emergency departments nationwide will

receive a special online assessment which holds much

promise for improving pediatric emergency care. The

National Pediatric Readiness Project is a multi-phase,

ongoing quality-improvement initiative by the

American Academy of Pediatrics, American College of

Emergency Physicians, Emergency Medical Services

for Children and ENA. It will measure each hospital

emergency department’s readiness to treat children

based on whether it has essential resources identified

by the 2009 Guidelines for the Care of Children in the

Emergency Department Joint Policy Statement.1

Because an ED’s ability to care for children on a

day-to-day basis is linked to its ability to provide care

in the event of a disaster, the National Pediatric

Readiness Project believes that every facility, whether

urban, suburban or rural, should participate.

The goal of this first phase is to survey every

hospital emergency department nationwide that cares for children.

Participating EDs also will receive detailed feedback and have access to

quality-improvement resources, which will help them address any areas

needing improvement. The ultimate goal of the Peds Ready Project is to

ensure that all EDs, regardless of their size and location, are prepared for

pediatric patients.

Assessment Details and BenefitsThe secure, Web-based assessment, which will roll out on a staggered

timeline beginning in January 2013, will serve as the first crucial step of this

project. The state of California served as the pilot for the Peds Ready Project

in 2012, boasting an impressive 90 percent response rate. In 2013, the

assessment will be sent to ED medical and nursing leaders in the remaining

states and U.S. territories; it is advised that the recipients in each facility

collaborate to complete it by printing it before completing it online.

Only one entry per hospital will be permitted. Each participating facility

will receive immediate feedback in the form of a pediatric readiness score

(based on a weighted, 100-point scale). This score will include point

values for the seven sections outlined in the National Guidelines (e.g.,

staffing, QI policies, equipment and supplies). In addition, upon

completion, each participating facility will receive

a gap analysis detailing hospital-specific needs and

recommendations to enhance pediatric readiness.

The assessment will be confidential; no identifying

hospital information will be released. However,

overall results will be available online, thus

allowing participating facilities to benchmark with

other facilities nationwide based on pediatric

patient volume.

ENA’s RoleAs one of the key organizations supporting the

Peds Ready Project, ENA plays a vital role in its

success. ENA is reaching out to its membership

on the national and state levels to help support

the Peds Ready Project by educating themselves,

helping educate others and offering support to

those who will be completing the surveys. Every emergency department,

regardless of size and location, wants to deliver the best possible care to

children. Let’s work together on this national effort to improve pediatric

care by supporting the Peds Ready Project.

The Peds Ready Project represents an unprecedented opportunity to

empower hospitals nationwide, regardless of their size and location, to

provide the best possible care for children seeking their help.

For more information, visit www.pediatricreadiness.org for the

schedule, printable versions of the assessment and supporting resources.

References

1) Joint Policy Statement: Guidelines for Care of Children in the

Emergency Department. American Academy of Pediatrics, Committee on

Pediatric Emergency Medicine, American College of Emergency

Physicians Pediatric Committee and Emergency Nurses Association

Pediatric Committee. Pediatrics 2009;124;1233; originally published

online September 21, 2009.

2) National Pediatric Readiness Project website:

www.pediatricreadiness.org.

PEDIATRIC UPDATE | Elizabeth Stone Griffin, BS, RN, CPEN

A National Assessment of ED Pediatric Readiness

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October 20128

By Kendra Y. Mims, ENA Connection

ENA Launches the ENPC Revision Course ENA is excited to announce that the highly anticipated Emergency Nursing

Pediatric Course 4th edition is now available for participants. The ENPC

Revision Work Team Committee and ENA staff members started the

revision process two years ago. The instructor rollout of the ENPC 4th

edition was launched Aug. 27, and Sept. 1 marked the first day that course

directors could hold 4th edition classes. This is the course’s first revision

since 2004.

ENPC 4th edition provides emergency department personnel with the

knowledge and tools needed to prepare for pediatric patients, following

the Guidelines for Care of Children in the Emergency Department created

by the Emergency Nurses Association, the American Academy of Pediatrics

and the American College of Emergency Physicians. The ENPC 4th edition

is taught using online learning, lectures, videos, group discussion and

hands-on skill stations (i.e., management of the ill or injured pediatric

patient and the pediatric clinical considerations) to encourage participants

to integrate their psychomotor abilities into a patient situation in

a risk-free setting.

What’s New in the 4th Edition Participants will be excited to know that three new chapters have been

added to the 4th edition: environmental emergencies, disaster and

adolescent. The environmental lecture will look at bites and venomation,

and the disaster lecture will use case studies to identify the risks associated

with the pediatric population. The adolescent chapter is an exciting

highlight for emergency nurses, said Nancy Denke, MSN, ACNP, CEN,

FAEN, chairperson for the ENPC Revision Work Team.

‘‘In the adolescent chapter, we talk about the challenges in treating

adolescent patients and the common problems you’ll see with taking care

of the adolescent child,’’ Denke said. ‘‘I think the adolescent chapter has

been one of those chapters that has been lacking. We really need the

information to care for those children better than we have been and make

emergency personnel better at preparing to care for adolescent patients in

the emergency department, whether they work in a rural, urban or

pediatric center.’’

ENA’s Nursing Education Editor, Marlene Bokholdt, MS, RN, CPEN,

CCRN, agrees that the new adolescent chapter is one of the most

significant highlights of the revision.

‘‘I think that a lot of people think of pediatrics as little kids,’’ Bokholdt

said. ‘‘It really isn’t. It is birth to adulthood, and that adolescent population

has kind of gotten lost in the shuffle. It wasn’t part of the previous edition,

so we’re very excited that it’s in the fourth edition and it does have some

excellent information and real concrete tips and information that will help

anyone take care of this population.’’

There are four lectures (pain, environmental emergencies, toxicological

emergencies and stabilization and transport) that are presented in a

webinar format, which the learner is expected to watch and complete

before coming to the live class. Participants will be awarded CEs for these

lectures after watching and completing them online, and they will also

receive separate CEs for their attendance in the live course.

Other notable changes include the behavioral emergencies chapter

(previously psychiatric emergencies), which focuses on accessing children

with behavioral health issues and also includes a section on autism; the

special-needs child section is now integrated with all of the lectures, as

opposed to being a separate lecture, as in the previous editions; and

triage, which was previously part of the ill and injured skill station, is now

an interactive lecture that will include case scenarios and group discussion

of triage. The Jeopardy® game has been eliminated from this edition and

replaced with clinical considerations/vignettes — a brief interactive

overview in which the students will look at rapid-sequence intubation,

airway management, vascular access and more.

One major change that occurred from the revision process is that the

ENPC 4th edition will not offer a reverification course. Due to ANCC

guidelines, ENA is not able to offer contact hours for reverification courses

after Dec. 31. The ENA Board of Directors voted in July 2012 to

discontinue TNCC and ENPC reverification courses after that date.

Therefore, there can be no 3rd edition ENPC reverification courses or 6th

edition TNCC reverification courses held after Dec. 31.

ENA is exploring new ways to provide ongoing continuing education

related to the courses and has directed that no more than four years will

lapse between each new version of the TNCC and ENPC courses.

Participants will be able to continue to challenge the two-day provider

courses, as allowed by each individual course director.

For more information about the exciting ENPC 4th Edition, please visit

www.ena.org/coursesandeducation/ENPC-TNCC/enpc/Pages/

aboutcourse.aspx.

Course HighlightsHighlights of ENPC include:

• Completing an observational or across-the-room assessment

• Identifying subtle changes that indicate deterioration

• Developmental approach to pediatric care

• Cultural considerations in pediatric care

• Pain assessment and management for children

• Techniques for family-centered care

Names of all involved in the revision process:

Nancy Denke, MSN, RN, FNP-C, ACNP-BC, FAEN, Chair

Paul C. Boackle, BSN, RN, CCRN, CEN, CFRN, CPEN, CTRN

Angela M. Bowen, BSN, RN, CPEN, NREMT-P

Cam Brandt, MS, RN, CEN, CPEN, CPN Julie L. Miller, RN, CENDianne Molsberry, MA, RN

ENA Board LiaisonsDeena Brecher, MSN, RN, APRN, CEN, CPEN

Tiffany Strever, BSN, RN, CEN

ENA StaffBetty Mortensen, MS, BSN, RN, FACHEMarlene Bokholdt, MS, RN, CPEN, CCRNRenee Herrmann, MA

Curriculum ConsultantVicki C. Patrick, MS, RN, ACNP-BC, CEN, FAEN

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October 201210

Disaster Preparedness

Are You Ready for the Real Thing?

Terrorist attacks in the United States, including the Oklahoma City

Bombing on April 19, 1995, and the 9/11 attacks, have caused a renewed

sense of urgency in disaster-preparedness training for emergency

departments across the country. In response to these acts of terrorism, the

Department of Homeland Security developed resources to help health

care providers prepare for disasters, including giving millions of dollars in

grants to health care organizations. However, these grants required that

any disaster exercises resulting from the grant funds must focus on

terrorism threats (U.S. Department of Homeland Security Office for

Domestic Preparedness, 2003). This resulted in a large number of

healthcare organizations focusing on biological or chemical threats, using

the grant funding to assist in the purchase of decontamination equipment.

While these real potential threats deserve our consideration, what does

the actual data say about disasters that have occurred in the United States?

There have been 281 disasters in the United States since 2000 (EM-DAT,

2012) and 16 terrorist-type attacks in the United States from 2002 to 2010

(Kimery, 2011). Clearly the more prominent problem is disasters that do

not involve acts of terrorism. Table 1 highlights the number of fatalities

and injured associated with some of the disasters that occurred since 2005.

To further complicate this issue, the Institute of Medicine (2006) found

that most emergency departments were inadequately prepared for a major

disaster. This is despite the fact that numerous regulatory agencies

mandate that hospitals provide disaster training to their employees.

Goodhue, Burke, Channbers, Ferrer, and Upperman (2010) reported that

emergency-preparedness plans tested by hospitals vary in quality since

the implementation methods range anywhere from tabletop exercises to

full-scale disaster scenarios. Numerous researchers have found that the

focus of these methods typically is on the overall management and

coordination of a disaster rather than the clinician’s role in patient care

and triage (Kaplan, Connor, Ferranti, Holmes, & Spencer, 2012).

Even with full-scale disaster scenarios, hospital personnel often do not

treat the volunteer patients with the same level of attention that would be

required in a real disaster. It is not uncommon to hear comments such as,

‘‘I have real patients to take care of,’’ or, “This is a waste of time because

it is not realistic.’’ Both of these statements have some merit. Yes, staff do

have patients that are already in the emergency department that require

attention, and yes, the scenarios are artificial when using live patients

because the staff cannot insert intravenous lines, obtain blood specimens

and perform other invasive procedures that would be required in a real

disaster. Unfortunately, this prevents fully identifying the challenges that

would arise in a real disaster when surge capacity is reached. So what can

you do about this?

Using unconventional approaches to disaster-preparedness training that

have evolved from modalities used by the military and institutions of

higher education may be the answer. Preparation is essential before

implementing the actual disaster-preparedness scenario. This requires that

staff are informed about the expectations that will be required from them

during the exercise, as well as familiarizing them with the disaster

preparedness plan. It should be stressed that staff should consider

simulated patients as ‘‘real’’ patients as much as possible, even when the

emergency department is busy. This may require that coaches be

strategically placed throughout the department to help staff meet the

needs of the actual patients in the department, as well as meet the

expectations for the disaster exercise. Remember, the goal is to tax the

system to identify problems that may need to be addressed

in the event of a ‘‘real’’ disaster. Implementation of the

disaster exercise is greatly enhanced if simulators are used

in conjunction with live patients.

This type of disaster-preparedness exercise requires

creativity in the planning process. In addition to some of

the issues already identified, planners need to remember

that in a real disaster, supplies and personnel may be

scarce, electricity and water may not be easily accessible,

and disposing of human waste may not be through

traditional venues. Furthermore, 75-85 percent of your

patient volume during a disaster will be self-referred and

not arrive by EMS (American College of Physicians, 2009).

Just because we have always done it this way does not

Date Disaster Location Fatalities Injured

July 20, 2012 Movie Theater Shooting

Aurora, Colo. 12 58

May 22, 2011 Tornado Joplin, Mo. 158 1,000

Sept. 23, 2008 Train Collision in Chatsworth area

Los Angeles 25 135

Oct. 21, 2007 Wildfire Potrero, Calif. 5 55

Aug. 29, 2005 Hurricane Gulf Coast 1,836 Unknown

Table 1: Number of fatalities and injured associated with selected disasters in the US since 2005

Considerations for Disaster Preparedness Exercises

By Michael D. Moon, MSN, RN, CNS-CC, CEN, FAEN, ENA Board of Directors

Board Writes


Disaster Preparedness Disaster Preparedness

Are You Ready for the Real Thing?

The Emergency Nurses Association is proud to present the release of the 4th edition of the Emergency Nursing Pediatric Course.It has been revised and updated, evidence-based, and continues to incorporate various teaching and learning styles.

• A portion of the course will be presented in an online format through ENA’s Center for e-Learning.

• Pediatric Clinical Considerations is nowcase-based using group discussion.

• The adolescent patient is addressed witha separate chapter and lecture.

• Triage is now Prioritization with a focus on the process, rather than the place.

Upon successful completion of ENPC, RN participants are veri� ed for four years, receive a veri� cation card and earn up to 16 contact hours.

This course brings the emergency nurse a resource for treating the pediatric patients arriving to emergency departments every day.

To verify why ENPC is right for you and toview course schedules, please visit

www.ena.org/coursesandeducation

The Emergency Nurses Association is

accredited as a provider of continuing nursing

education by the American Nurses Credentialing

Center’s Commission on Accreditation.

mean that we should continue with the same process.

That just lends itself to obtaining the same outcomes.

Without practice that involves nontraditional

approaches in managing scarce resources, including

personnel, your facility may be unable to maintain

sustained operations for extended periods during

surge capacity (Goodhue et al., 2010). Successful

disaster preparedness training involves creative

thinking in the planning, development,

implementation and evaluation of realistic disaster

scenarios that represent the full continuum of

possibilities. Do not be afraid to step out of the box

and your comfort zone. You will be glad you did in

the event of a ‘‘real’’ disaster.

References

American College of Emergency Physicians (2009).

ACEP best practices for hospital preparedness.

Retrieved August 5, 2012 from www.acep.org/

clinical---practice-management/best-practices-

for-hospital-disaster-preparedness

EM-DAT (2012). Natural disasters in the United States

from 2000-2011. Retrieved August 5, 2012 from

www.emdat.be

Goodhue, C.J., Burke, R.V., Channbers, S., Ferrer,

R.R., & Upperman, J.S. (2010). Disaster Olympix:

A unique nursing emergency preparedness exercise.

Journal of Trauma Nursing, 17(1), 5-10.

Institute of Medicine (2006). The future of emergency

care: Key finding and recommendations.

Washington, DC: Author.

Kaplan, B.G., Connor, A., Ferranti, E.P., Holmes, L., &

Spencer, L. (2012). Use of an emergency

preparedness disaster simulation with undergraduate

nursing students. Public Health Nursing, 29(1),

44-51.

Kimery, A. (2011). Frequency of attacks in US

dropped steadily after 9/11: Increased globally since

2004. Homeland Security Today US. Retrieved

August 5, 2012 at www.hstoday.us

U.S. Department of Homeland Security Office for

Domestic Preparedness (2003). Homeland security

exercise and evaluation program, volume I:

Overview and doctrine. Washington, D.C.: Author

Feed

bac

k Fr

ame

Call for NominationsEmergency Nurses Association/Blue Jay

Consulting Award for Outstanding Emergency

Department Nurse Leader of the Year

To view additional information and submit

a nomination for this award visit www.ena.org

and click on the About tab, then Awards.

Deadline for Nominations is Monday, Nov. 12, 2012

October 201212


Communication

failures are often at

the top of the list of

challenges following a

hospital disaster drill

of real event. Effective

communication, along

with teamwork, is

essential for the delivery of high-quality care,

patient safety and seamless transfer of patients

during the chaos of a disaster.

In September 2008, Hurricane Ike was

predicted to hit the southern portion of the

Florida Keys as a Category 4 hurricane, with

maximum sustained winds of 145 mph (230

km/h). This prediction activated the evacuation

plan of the Lower Keys of Florida, including

Lower Keys Medical Center, the only hospital in

the lower southern chain of the Florida Keys,

roughly 162 miles from Miami.

The logistics of transportation methods, patient

preparation and family notification, receiving

hospitals and fiscal outcomes was the beginning

of a 24/7 assessment and evaluation process on

how to best care for the patients that needed

continued inpatient medical care at a hospital out

of harm’s way.

One key lesson learned from this evacuation

was that a method was needed to communicate

patient information without having to spend days

printing out the complete medical records of a

large number of patients.

As patients move among specialized services

within a hospital, and as shifts of medical

personnel come and go, there are numerous

episodes in which responsibility for the patient

passes from one health professional to another

and where patient information is exchanged.

During a disaster, this normal exchange of

communication is disrupted. As patients are

evacuated to another hospital or facility,

communication of patient information becomes

a challenge. The use of electronic medical

records poses unique situations in both clinical

information sharing and fiscal data validation.

During the evacuation and receipt of patients

from the Florida Keys, the decision was made to

initially print and send with the patient the

medical administration record, a face sheet with

patient demographics and financial information,

and the last 48 hours of progress notes. These

records were placed in a sealable plastic bag,

labeled with the patient’s name and sent with

the patient. Following an after-action-review of

the evacuation event, the nurses receiving the

evacuated patients stated that they had more

questions than answers regarding the patient’s

plan of care and clinical situation.

A solution to this challenge was the revision

and use of the SBAR or Patient Transfer

Summary reporting form. SBAR stands for

Situation, Background, Assessment and

Recommendation (see image below).

The SBAR is a familiar communication and

hand-off reporting tool to many nurses and

allied health professionals. Reports show that

simple, familiar tools will be more readily used

during disasters and with fewer errors. The

SBAR is used in most hospitals in south Florida,

so it was a natural choice for the exchange of

timely, accurate patient information in a way

that is familiar to all members of the health

care team.

The Use of the SBAR to Facilitate Patient Communication During a Disaster

By Sharon Saunderson Coffey, MSN, RN, CEN, CHEP, Emergency Management and Preparedness Committee

SBARRegion VII Health/MedicalPatient Transfer Summary

Patient Name Gender r M r F Age

Transferring Hospital Transferring Hospital’s Pt’s MR#

Transfer Reason:

Transfer Date: Time:

Code Status: r Full r Do Not Attempt Resuscitation (r Documents attached) r Do Not Intubate (r Documents attached)Isolation: r Airborne r Droplet r Contact Organism

Allergies (medication, latex, environmental, other):Allergy bracelet on? r Yes r No

Current Diagnosis(es)

Brief Summary Hospital Stay

P-12148 - 119970 - 8/2009

Current Vital Signs: Time:________ Temp: ________ Pulse Rate:_______ Resp Rate:_______ Blood Pressure:_______ Pulse Ox:_______

Cardiac Rhythm FiO2

Vent Settings Bipap / CPAP settingsCurrent IV’s 1 2 3 4LocationDate of insertionFluid Infusing

Current Medications r MAR Attached

Pain Score at Transfer Time + Route of Last Pain Med Given Med given(Use 0-10 Pain Scale)Current Drains 1 2 3 4

LocationDate of Insertion Pertainent Behav. Health Assessment / Issues

Valuables r Yes r No Clothing r Yes r No Dentures r Yes r NoGlasses r Yes r No Hearing Aids r Yes r No Personal DME r Yes r No List on back /Narrative

Report given to: Phone #: Time:Attending Physician notified of transfer r Yes r No Who _______________________ Phone ____________ Time _______Family notified of transfer? r Yes r No r N/A Who was notified? Complete Medical Record Transferred r Yes r NoSpecial considerations/recommendations:

Transferring Nurse/PhysicianSignature: Print: Date: Time:

Receiving Nurse/PhysicianSignature: Print: Date: Time:

Situation

Background

Assessm

entR

ecomm

endations

(See reverse side for additional information)

SBAR

Patient Hand-Off Reporting Form

Disaster Preparedness Earn Your Mark of DistinctionHighlight your professional accomplishments

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October 201214


Disaster Nursing Education

After returning home from my last disaster

response in September 2011, I decided to review

articles and take a look at some of the

educational objectives of disaster education.

We are all well aware of the American

Association of Colleges of Nursing’s new

requirements to include disaster education in the

nursing curriculum. However, many schools are

not sure how they should accomplish this and/

or how they can meet requirements in an

already bulging nursing curriculum.

The International Nursing Coalition for Mass

Casualty Education created educational

competencies in regard to nurses responding to

mass casualty incidents. The coalition included

accrediting bodies and nurses from different

sectors (i.e., public – governmental and military;

private, academic) and different specialties.

However, the coalition was discontinued due to

the lack of funding, and each university and

group went about interpreting and setting its

own standards for its curriculum. We need to

continue the goal of getting us all on the same

sheet of music.

There are no exact disaster nursing

competencies for nurses. In other words, the

main problem is that all of us think we have the

answer, and no one is taking a stand. Because

of the varied types of nursing educational

programs throughout the United States, and the

different state and federal mandates for nursing,

there is not a clear picture. The goal is to get

everyone ready for a disaster response as a

single entity working toward one goal — the

ability to work as a team in a disaster.

We have an overwhelming amount of interest

in the area. However, what we don’t have is a

consensus of what the educational requirements

are. During this review, it was found that

faculties lack knowledge on disaster response

planning, in which case many students are not

getting the disaster education and those who are

receive only four to five hours (Schmidt et al.,

2011).

In reviewing schools in the tri-state area, we

have found that most students are getting about

two to four hours of disaster education. It is

usually in a lecture format, with little to no

interaction. At Binghamton University, we have

a nursing program that is averaging 12 hours of

disaster education, including lecture material,

online course work through the Federal

Emergency Management Agency, covering

Incident Command System and National Incident

Management System.

Many schools are trying to change the

curriculum but are unsure how. There is a need

for selected core competencies for every student

nurse and nurse in practice. So many regulations

have been placed on today’s educators and

nurses that many nurses feel they are overtasked

with a burdensome workload. In the case of

disaster preparedness, we need to get it right.

We are headed toward catastrophic problems,

as our globe is starting to realize. We have

nurses who need the background and basic

disaster education to be a part of the disaster

response. Plans for disaster nursing education

must not be placed on a shelf and forgotten

after they leave school or take their

examinations.

Many educators have suggested that each

school could mandate a disaster education

course and then allow the student or nurse to

learn in the field.

In an article by Tillman (2010), she discusses

the need for nurses to be a major responder and

be part of a team response. The American

Nurses Association validated the preparation in

its policy ‘‘Standards of Care under Extreme

Condition: Guidance for Professionals during

Disasters, Pandemics and Other Extreme

Emergencies’’ (ANA, 2008). Tillman (2010) also

includes major competencies of triage, a

personal emergency plan, psychological

considerations and ethical considerations.

In another article of interest, Schmidt (2007)

describes a wonderful program and experiment

taking place with the work of the American Red

Cross and 12 universities across the United

States. The students are being asked to take a

course entitled ‘‘Sheltering and Disaster Health

for Nursing Students.’’ This program is only four

hours long, and although it may be helpful to

the Red Cross’ needs to assist in supporting

sheltered patients, we may not really be

We Must Be Working, Learning as OneBy Laura Terriquez-Kasey, MSN, RN, CEN, and Tak Man Yan, BSN, RN

Flight nurses and medics assist members of a disaster medical assistance team as part of the response effort following Hurricane Ike in 2008.

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preparing future RNs, LPNs and students for the

injury and triage concerns related to a large-scale

disaster.

After reviewing the document by Association

of Community Health Nursing Educators (2009)

in the “Essentials of Baccalaureate Nursing

Education for Entry-Level Community/Public

Health Nursing,” the recommendations seem

perfectly appropriate. It contains much of the

required material, including the legal and ethical

concern while providing disaster nursing care. It

needs to expands its view and include the

Disaster Preparedness Cycle and Paradigm as

described and taught in the AMA course on Basic

Disaster Life Support and the Advanced Disaster

Life Support. After taking the BDLS and ADLS, it

is apparent to me that the disaster paradigm

taught in the program should be adopted as part

of the nursing curriculum.

The other items we should include are the

need for careful, deliberate triage during a mass

casualty situation and the categories of care. There

needs to be an increased level of competency

required for the basics of chemical, biological,

radiological, nuclear and explosion. We need to

include discussions and tabletop drills with

discussion of surge capacity issues and the use of

partnerships with local communities.

We need to mandate the use of FEMA’s

Emergency Management Institute courses. Each

public health department needs to be included

in the essential partnerships. Nurses, as well as

all members of the healthcare teams, need to be

more knowledgeable about their responsibilities.

Recent experiences after Katrina in 2005 and

in upstate New York after the flooding in 2006

and 2011 have left each of us with a desire to

include essential education to the new nurses

coming into the arena of health care. It should

be obvious that we are still unprepared for

disaster work after seeing the lack of

preparedness in some of our excellent schools.

Many schools have good intentions but lack the

expertise in their faculty to provide the education

required. Faculty need to be knowledgeable in

order to assist students in improving their

knowledgebase.

These steps, along with the AACN’s new

recommendations for the nursing curriculum, are

essential to providing the nurses with critical

thinking abilities during an actual event. It is an

important idea that we continue disaster

education. A question that still remains is: How

do we educate the other nurses who have

already been in the workforce and are unaware

of the changing factors or requirements in

disaster preparedness?

References

Dallas, C.E., Coule, P., James, J.J., Lillibridge, S.,

Pepe, P.E., Schwartz, R.B., et al (Eds) (2007).

Basic Disaster Life Support. United States of

America: American Medical Association.

Schmidt, C.K., Davis, J.M., Sanders, J.L.,

Chapman, L.A., Cisco, M.C., Hady, A.R., (2011).

EXPLORING nursing students’ level of

preparedness for disaster response. Nursing

Education Perspectives, 32(6), 380-383.

Schmidt, C.K. (2007). Strategies to Prepare

Nursing Students to Respond to Disasters.

Dean’s Note, 28(3). Retrieved on 7 August 2012

from www.ajj.com/services/publishing/

deansnotes/jan07.pdf

Association of Community Health Nursing

Educators. (2009). Essentials of Baccalaureate

Nursing Education for Entry-Level Community/

Public Health Nursing. Retrieved 5 August 2012

from achne.org/files/

EssentialsOfBaccalaureate_Fall_2009.pdf

Tillman, P. (2010). Disaster preparedness for

nurses: A teaching guide. (2011). Journal of

Continuing Education in Nursing, 42(9),

404-408.

Bibliography

American Nurses Association. (2008). Adapting

Standards of Care Under Extreme Conditions:

Guidance for Professionals During Disaster,

Pandemics and Other Extreme Emergencies.

Retrieved 5 August 2012 from nursingworld.

org/MainMenuCategories/WorkplaceSafety/

DPR/TheLawEthicsofDisasterResponse/

AdaptingStandardsofCare.pdf

Mexican Association of Emergency Nurses

College of Emergency Nursing Australasia Ltd.

Australian College of Emergency Nursing (ACEN)

College of Emergency Nurses - New Zealand

National Emergency Nurses’ Affiliation, Inc. (NENA)

Royal College of Nursing

AFFILIATES:

EMERGENCY NURSES:

Every Patient + Every Time = Making a Difference.

www.ena.org/enweek

Emergency Nurses Week™

October 7-13, 2012

Emergency Nurses Day®

Wednesday, October 10, 2012

12462_EN Week 1-2 pg island ad_FInal.indd 1 7/9/12 9:57 AM

October 201216


Measuring the Effectiveness of a Communitywide Disaster Drill

Consistently seeing and evaluating the different

pieces is part of an effective disaster drill. We

all hope we don’t need the disaster response.

However, more often than not, we are seeing

the terrible effects of not preparing

appropriately for a disaster.

Teamwork and effectively preparing the

different parts of the teams is critical to a good

unified response. What matters is that your

teams work together and that they can work in

a flexible mode. Many of us have had the

rudimentary essential lectures in class and in

the field, but until we experience the actual

event or participate in a realistic drill, we are no

match for the real response necessary when the

disaster strikes us. The ‘‘lessons learned’’

portion and debriefing or ‘‘hot wash’’ are the

key components to the proper evaluation

process of a disaster drill.

In many cases, the leadership potential and

the ability to compromise and critically think

are noted to display, at times, a striking

acuteness to the effect of the education and

training received.

Drill preparation is also critical for an

effective response. Each team must display

good leadership skills and the ability to work

well with others. Everybody needs to get out of

their bubble and work as a team with the ability

to provide continuum of care — triage and

re-triage and effectively treat and respond to

clients’ ongoing needs. Another essential piece

of all of this is the preparation of the groups

before the drill. Planning and placing obstacles

in the way of the providers is critical in order to

test the effectiveness of each group.

Before you start the planning portion of the

drill, all of the essential needs for the drill

should be identified. Designing an effective drill

must include the leaders and community

representatives. Allowing each group to

effectively educate its own group is all part of

the process in preparing for the real disaster.

When the disaster drill is designed, it must be

clear what the objectives of the drill are for

everyone. We also must take the time to

provide the methods and tools we will use in

clearly measuring the response.

The Methods of Measurement must be clear

to each responder and reflect back to the

essentials taught to all responders. Set some

clear learning objectives for the drill.

1. Try to use the Disaster Paradigm (AMA

2007) to assist all responders in learning the

basic concepts. Consider sending faculty

and emergency staff to assist all in the

expansion of knowledge across the health

continuum.

2. Triage procedures, classification of clients

into categories to allow us to respond

rapidly and effectively.

3. Consider educating all in Mental Health First

Aid procedures before a disaster.

4. Prepare all responders with knowledge of

the equipment that will be used.

5. What are the basic emergent skills required

by all staff at their level of education?

6. Carefully clarify roles and responsibilities for

all responders.

7. Test each portion of the responders’

learning process.

8. Review of the policy and procedures: Are

they clearly identified for the team?

9. The actual planning of a drill must reflect

back to the community.

10 Perform a hazard assessment.

11. Consider all awareness-level training to be

reviewed for basic issues related to CBRNE.

Example: Review the idea of (RAIN)

Recognize Avoidance, Isolation, and

Notification.

‘‘Remember each worker responding to an

event can also become a casualty if not taught

to prevent the possibility of being exposed’’

(Ryan, and Glarum 2008). If you live next to a

chemical factory, then perhaps that should be a

thought when you consider planning the drill. If

your disaster drill committee feels the need to

practice responding to a hazardous material

situation, then it should consider the possible

hazards in the community. If there is a large

airport and or train station, then perhaps

considering an airplane crash or a train accident

is appropriate.

12. Review command and control and ICS

roles for everyone.

This is important to make sure each

community prepares itself for the possible

natural disasters and terrorism in its own

community. Most communities should start with

a single event related to a disaster drill. Then all

can focus on the major problems at hand.

By Laura Terriquez-Kasey, MSN, RN, CEN, Emergency Management and Preparedness Committee

Emergency responders test their preparedness in a community mock disaster drill.

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Creating a disaster drill planning team that

includes a member from all parties is critical to

the success of the drill. Make sure you involve

citizens and clients as volunteers. Look around

for volunteers from the community, as they may

have an interest, and it does raise awareness in

the community by having multiple groups

participating.

Consider setting up a clear exercise guideline.

Use a scenario summary or timeline to assist all

the players. Brief each group alone so that all the

groups know what is required of them.

Consider setting up specific evaluation

packets for each evaluation team. Make sure you

have clear, delineated evaluation questions and

guidelines. Review the materials.

This makes the drill more realistic. Example:

Try to have EMS use actual treatment tags for the

triage and role playing.

We need volunteers to play the roles of the

injured. Try to use seniors and children as well

as students and community workers in this role.

It will be important to brief each in their role and

the changes that they must perform if possible.

Use small index cards as coaching cards for the

players. Using simulation mannequins is critical

to the learning process if you cannot perform a

large drill. If possible, have a moulaged team

work with the players ahead of the actual drill.

This may allow each player to look more realistic

and also allow the player time to learn their role.

In some cases it’s necessary to have team

evaluators at different sites throughout the drill.

You may need a team of evaluators at triage, a

team evaluating the EMS portion of a drill,

another team at each nursing care area and

finally a team that evaluates and coaches the

command staff team. Each evaluation team

should have a specific marking on them and be

clearly given yes and no questions/answers.

Consider leaving areas open for judgment and

feedback. Consider allowing each evaluation

team 30 minutes to prepare their return

information for the hot wash of the drill.

After the drill, each team should be asked to

submit an after-action report to the disaster

planning committee to discuss the drill and

review the learning process and be allowed to

make recommendations to the disaster

committee for the next drill.

References

Dallad, C.E., Coule, P., James, J.J., Lillibridge,S.,

Pepe, P.E., Schartz, R.B., et al. (2007). Basic

Disaster Life Support. United States of

America: American Medical Association.

Glarum, J.R. (2008). BioSecurity and

BioTerrorism Containing and Preventing

Biological Threats. In Bio Security and

BioTerrorism Containing and Preventing

Biological Threats (p. 122). Burlington MA.:

Eleseiver.

Tools for Evaluating Core Elements of Hosptials

Disaster Drills. Retrieved Aug. 5, 2012, from

AHRQpublication 08-0019: www.ahrq.

gov/prep/drillelements/

Bibliography

Coping with a Disaster or Traumatic Event.

(2012, Aug 5). Retrieved Aug. 5, 2012, from

CDCMental Health/Trauma and Diaster Event.:

http://emergency.cdc.gov/mentalhealth/

Tools for Hospitals Health Care Systems. (2012,

Aug. 5). Retrieved 2012 from www.AHRQ.

gov: www/ahrq.gov/research/hospdrills.

htm, Johns Hopkins University Evidence

Based Practice Center Baltimore, Maryland

(2008).

Series Public Health Emergency Preparedness

Research Resources and Tools “Hospital

Assessment and Recovery Guide,” AHRQ,

HHS, Prepared by Abt Associates Inc.,

Cambridge MA. May 2010.

Series Public Health Emergency Preparedness

Research Resources and Tools “Hospital

Evacuation Decision Guide,” Prepared for

AHRQ, HHS, Prepared by AbT. Associates Inc.

Cambridge, MA.

.

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October 201218


Weather-related natural disasters, such as

hurricanes, are omnipresent, and their effect

on human lives and property damage is

inevitable. Advances in technology and

meteorology enable public health officials, health care planners and other

organizations to develop advanced warning systems, activate coastal

shelter plan operations and hurricane preparedness in order to decrease

mortality and morbidity.

Hurricane CategoriesA hurricane watch is issued for a coastal area when there is a threat of

hurricane conditions within 36 hours, and a hurricane warning is issued

when conditions are expected in 24 hours or less. The Regional

Specialized Meteorological Centers (U.S. National Hurricane Center,

U.S. Central Pacific Hurricane Center, Japan Meteorological Agency, India

Meteorological Department, Meteo France and Australia & New Zealand

Meteorological Service), Canada Hurricane Center, Philippine Atmospheric

Geophysical and Astronomical Services Administration are responsible for

tracking, naming tropical cyclones and issuing warnings and advisories

to protect life and property.

Hurricanes are categorized according to wind strength using the

Saffir-Simpson Hurricane Wind Scale:

Hurricane ImpactThe American Society of Civil Engineers made a study of the property

damage caused by hurricanes from 1900 to 2005 and placed the Great

Miami Hurricane of 1926 on the top with $140-157 billion in damages

(adjusted for inflation in 2005), and Hurricane Katrina as the second most

destructive storm in U.S. history at a cost of $81 billion in damages.

Although Category 4 or 5 hurricanes can cause serious damage, Category

1 or 2 hurricanes can be as costly and devastating. A Category 3 hurricane,

Hurricane Katrina cost the lives of 1,836 people.

Coastal Storm Plan Sheltering System The hurricane sheltering plan provides an orderly method of evacuating

people living in low-lying areas and moving them into hurricane shelters.

Solar systems are set up with associated hurricane shelters. As the center

of the solar system, the evacuation center serves as the entry point into

the solar system and its respective hurricane shelters. The evacuation

center is the place where all staff report and obtain task assignments and

just-in-time training. The evacuation center serves as the location for the

following activities during an event:

• Central screening for identifying and addressing evacuees with health

and medical, pet and family reunification issues

• Supply requests

• Troubleshooting

• Dispatching training staff and evacuees to a hurricane shelter

• Managing census of the mini-shelter system

• Arranging for the release of evacuees at the closure of the hurricane

shelters

• Reports to the city’s emergency operation center.

On Aug. 25, 2011, with Hurricane Irene threatening a full-force hit, the

governors of New York, New Jersey and Connecticut declared a state of

emergency. New York City was ready with ‘‘evacuation contingencies’’ for

low-lying areas that are home to 250,000 people and made plans to shut

down the transit system. The New York City Office of Emergency

Management ordered nursing homes and hospitals located within the

evacuation zone to evacuate residents and decrease their caseloads.

The Baruch College Evacuation Center was one of the New York City

evacuation centers that demonstrated a well-organized evacuation

operation. The evacuation center was run by staff from the New York City

Housing Authority, a teacher (Angela Becham), New York City Medical

Reserve Corps volunteers (Dr. Eugenia Siegler, Leslie Lieth, PNP, and

Angeli Medina, RN), mental health staff, social workers, Community

Emergency Response Team volunteers and a nurse volunteer from

Sweden. When the worst was over, the mayor lifted the evacuation order

and the 9,000 people who stayed in the hurricane shelters and the 370,000

evacuees were able to return. The New York City coastal storm sheltering

operation worked well during Hurricane Irene; there were no reported

deaths or serious injuries during the hurricane watch.

What to Do Before and During the StormA. Prepare a family disaster plan that outlines what to do and how to

communicate with each other. Make sure that your apartment or home

Focus on Hurricane PreparednessBy Angeli Medina, MPA, BSN, RN, CEN, Emergency Management and Preparedness Committee

Type of Tropical Cyclone

Category Potential Damage

Wind Speed (mph)

Hurricane 1 Minimal 74- 95

Hurricane 2 Moderate 96- 110

Hurricane 3 Extensive 111- 130

Hurricane 4 Extensive 131- 155

Hurricane 5 Catastrophic 156+

The remains of the Biloxi Bay Bridge in Mississippi in the aftermath of Hurricane Katrina, which made landfall as a Category 3 storm.



is properly insured.

B. Know where to go. Stay with friends or

relatives who live outside the evacuation

zone areas; otherwise, report to an

evacuation center.

C. Keep ready a Go Bag that includes the

following:

• Copies of important documents in a

waterproof container

• Set of car and house keys, AM/FM radio,

batteries, whistle, flashlight

• Child care and special needs supplies

• First-aid kit, bottled water, nonperishable

food

D. Have an emergency supply kit. When

instructed to stay home, keep enough

supplies to survive for at least three days.

• One gallon of drinking water per person/day

• Nonperishable food

• First-aid kit, flashlight, battery-operated AM/

FM radio, batteries, whistle

• For disinfecting water ONLY, if directed to

do so by the health officials, keep iodine

tablets or one quart of unscented bleach

with eyedropper

• Phone that does not rely on electricity

E. If you do not live in an evacuation zone,

assemble an emergency supply kit.

F. If you live in a high-rise apartment

outside the evacuation zone, be prepared

to take shelter on or below the 10th floor. If

you live in a high-rise building located in the

evacuation zone, heed evacuation orders.

Other ConsiderationsA. Secure your home

• Keep lightweight objects inside the house.

• Anchor unsafe items, i.e. gas grill (turn off

propane tanks).

• Place valuables in waterproof containers.

• Shutter windows securely and brace

outside doors.

B. Assist persons with disability or special

needs.

C. Evacuate immediately when asked to do so.

D. Address pet care and bring pet supplies

when evacuating with your pet, i.e., leash,

muzzle, food, proof of shots, cage.

Resources

• en.wikipedia.org/wiki/Tropical_cyclone

• en.wikipedia.org/wiki/List_of_United_

States_hurricanes

• National Weather Service (September 2006).

“Hurricanes … Unleashing Nature’s Fury: A

Preparedness Guide” (PDF). National Oceanic

and Atmospheric Administration. Archived

from the original on February 26, 2008.

• National Hurricane Center. (2005). Glossary of

NHC/TPC Terms. National Oceanic and

Atmospheric Administration. www.nhc.noaa.

gov/aboutgloss.shtml

• NYC Office of Emergency Management

www.NYC.gov/oem

• Department of Homeland Security www.

ready.gov

• National Hurricane Center/Tropical Prediction

Center

www.nhc.noaa.gov

• National Weather Service www.weather.gov

• Federal Emergency Management Agency

www.fema.gov, www.floodsmart.com

• Natural Hazards Review, Journal of the

American Society of Civil Engineers,

“Normalized Hurricanes Damage in the

United States: 1900-2005

• New York Regions Prepares for Hurricane

Irene by James Barron, New York Times,

August 25, 2011

• Advance Hurricane Shelter Training for

Operators, Coastal Storm Plan, NYC OEM,

6/5/07

• Hurricane Irene Passes New York, MTA

Scramble to Reset Commute by Colleen Long

and David B. Caruso, 8/28, AP/The

Huffington Post

• Disaster Nursing and Emergency Preparedness

by Tener Goodwin Veenema, 2nd Edition

Established in 1991, the mission of the ENA Foundation is to provide educational scholarships and research grants in the discipline of emergency nursing.

Your Dollars = Your Future Investing in a nurse today is an immeasurable

contribution to the future of emergency nursing and patient care.

Invest in the future of your profession.Support the ENA Foundation.

Donate Now.

www.enafoundation.org

October 201220


4 Questions of Mass Casualty Patient Decontamination

Hospitals across the nation continue to work

hard to improve their preparedness for a mass

casualty incident or a mass contaminated

casualty incident related to either a man-made or

natural disaster. Since Sept. 11, 2001, billions of

dollars have been spent to improve the response

capability for such incidents. The primary focus

has been the incident scene. Thus, the patient

decontamination needs have been incident-

scene-centric.

However, OSHA statistics show that up to 80

percent of patients and others who are

contaminated will leave the scene before first

responders arrive. Almost all of these people

will eventually end up at a hospital

contaminated. The American Hospital

Association report identified that most hospitals

were well prepared for a low-intensity, short-

duration event, but there was inadequate

planning for the true large-scale events that

would require entire community involvement.

They went on to define a mass casualty event to

be a community-wide concern, necessitating a

response that incorporates multiple resources

within the community. This was based on the

possibility that a mass casualty situation may

actually have to be addressed for days or weeks

rather than hours.

Furthermore, the mass casualty incident may

overwhelm the capacity of all the hospitals in the

region, not just the local hospital. This would

greatly impact the capabilities of the local hospital

to provide service. Their conclusion was that

more community-wide planning was needed to

properly prepare hospitals for high-intensity and

long-duration events. While this article was

written in 2000, we still see the same problems.

Most hospitals have improved by embracing

the Hospital Incident Command System, which

provides for better communication and operations

during disasters and mass casualty incidents. There

are four key questions that each hospital needs to

incorporate into its emergency operations plan

regarding patient decontamination:

How Many?How many patients can you decontaminate

during a MCCI? This is a complicated question.

Considerations need to include the following:

1. Your hospital surge capacity.

2. Your plan for moving or dealing with patients

when you exceed both your operating

capacity and your surge capacity. (Are these

capabilities different if on back-up

generators?)

3. Your staffing pool and available staff.

4. Your plan to bring in volunteers to assist staff.

5. The size of your staging/triage area for

decontaminated patients. (You may have

the capacity to decontaminate 100 patients

an hour, but can you treat/release or admit

100 patients an hour? If not, where do you

place these overflow patients where they

can monitored by professional staff and

have access to bathrooms, water and food

as their numbers increase?)

6. The number of injured who are

decontaminated at the scene and

transported clean to your hospital.

7. Basic supply levels.

8. Estimated resupply delivery times and

methods.

9. Where will patients go upon discharge? How

will they get there?

10. Where will you place the discharged patients

who are awaiting transport to shelters? What

if they refuse to leave?

11. How will you deal with family?

12. Will treatment be given before

decontamination? (Note: Any equipment

used will be lost as contaminated – oxygen

tanks, beds, cots and more.)

13. Where will contaminated human remains be

staged? (You will need a separate storage

method and place for contaminated human

remains.)

14. How will your staff communicate within the

mass gathering areas of patients (post-

decontamination, triage and staging area for

discharged patients)?

How Long?How long can your hospital operationally

maintain a mass patient decontamination line?

There are several key components that will be

factors in answering this question. Your

decontamination operation depends on

specialized PPE/equipment which is in limited

supply at your hospital. How long can you

maintain your mass decontamination efforts if

level-C PPE is required? This will be based on

the number of filters, batteries, protective suits

and boots your facility has in stock.

Another factor is the amount of available and

trained staff. During an MCCI, the hospital

patient load is surging. This requires additional

staff in all areas of operation. How many staff

members are required to maintain your mass

decontamination line? How often are they

swapped out? If you are using level-C PPE,

swap-outs will likely be on an hourly basis. In

extreme temperature situations, it may need to

be more frequent. These staff members need

technical decontamination as they swap out.

You should also maintain a partially dressed

safety response team to deal with staff

decontamination emergencies.

What If?What happens to your mass decontamination

line when an anxious, contaminated patient

pulls off a staff member’s PAPR hood, or a

patient decontamination team member goes

down, becomes contaminated or suddenly

displays signs and symptoms of chemical or

radiation exposure? Many patients may feel

personally violated by the decontamination

process. What if the contaminated patients

refuse to disrobe or give up personal items?

What if a group of contaminated patients

becomes violent and/or attempts to storm its

way into the ED demanding treatment?

Rebmann & Mohr report that fewer than 50

percent of Missouri nurses have received training

in MCI or MCCI hospital response. Furthermore,

fewer than 25 percent have received hands-on

training in clinical disaster management. How

will the remaining staff react to this situation? It is

By Paul Meek, MA, BSN, BEd, RN, CEN, CLNC



very conceivable that your decontamination staff

could begin to refuse to don PPE and

decontaminate patients. They may fear for their

lives and voice concern that the level of PPE,

level of training and/or security is inadequate.

Can you force your minimally trained staff to

risk their lives and health to perform patient

decontamination? Remember, as the number of

patients decontaminated increases, so will the

demand on your supplies and staff. What

happens when your facility can no longer staff

the mass patient decontamination line? You must

have detailed in your plan the number of staff

required to safely maintain your mass patient

decontamination line.

What Then?

Having identified needs, we must find

solutions that can prevent or resolve these

situations during an MCCI. You need to develop

a plan to move discharged patients and family

members away from your hospital, as you will

not be able to both surge and shelter. Your

emergency plans need to include requesting a

shuttle that will transport these discharged

patients, worried wounded and family members

to the established local shelters.

Furthermore, you need to plan if you want to

move admitted patients. You can try to call the

local air ambulance, but they will likely be

dispatched from the multi-agency coordination

system. If NDMS is activated and an ESF 8 Aerial

Point of Embarkation is established, you still

will need to request transport or arrange

transport from your hospital to the APOE. If

your mass patient decontamination line fails,

you must have a plan for the contaminated

patients who will continue to arrive at your

hospital. One option would be a shuttle that

would take these contaminated patients,

worried wounded and family members to a

mass decontamination site.

ConclusionEvery hospital in our nation has a limit for

how long or how many patients it can

decontaminate in a MCCI. As such, data needs

to be collected so that emergency preparedness

planners can develop strategies to better assist

hospitals in the MCCI incident. Hospitals need

to embrace their designation as critical

infrastructure/key resources and step forward in

their planning by requesting assistance from

local, state and federal agencies in times of

disaster, terrorist attack and other emergencies.

The 2009 U.S. National Health Security

Strategy states: ‘‘Government at all levels has an

inherent responsibility, particularly in helping

build and strengthen the systems (e.g., plans,

people, and equipment) that help prevent (e.g.,

through biosafety, biosecurity, nonproliferation

of WMDs, and other measures), protect against

(e.g., through community interventions,

including medical countermeasures), respond

to, and recover from health incidents.”

The time has come for hospital MCI and

MCCI plans to develop ways to innovate,

incorporate and communicate their potential

needs to the local and state emergency planners

and their state National Guard before the next

disaster or terrorist attack.

References

Powers, R. (2009). Evidence-based ED Disaster

Planning. Journal of Emergency Nursing,

35(3), 218-223.

(2005). OSHA Best Practices for Hospital-Based

First Receivers of Victims from Mass Casualty

Incidents Involving the Release of Hazardous

Substances: Occupational Safety and Health

Administration, 1-30.

(2009). National Health Security Strategy of the

United States of America. United States

Department of Health and Human Services,

1-44.

(2000). Hospital Preparedness for Mass Casualty:

Final Report. The American Hospital

Association, 1-58.

Darr, K. (2006). Katrina: Lessons from the

Aftermath. Hospital Topics: Research and

Perspectives on Healthcare, 30-33.

Rebmann, T. & Mohr, L. B. (2008). Missouri

Nurses’ Bioterrorism Preparedness.

Biosecurity and Bioterrorism, 6(3), 243-251.

Disaster Nursing and Emergency Preparedness for Chemical, Biological, and Radiological Terrorism and Other Hazards (3rd Edition) Editor - Tener Goodwin Veenema, PhD, MPH, MS, CPNP

This brand new edition has strengthened its pediatric focus with updated and expanded chapters on caring for children’s physical, mental, and behavioral health following a disaster. New chapters address climate change, global complex human emergencies, caring for patients with HIV/AIDS following a disaster, information technology and disaster response, and hospital and emergency department preparedness.

The text provides a vast amount of evidence-based information on disaster planning and response for natural and environmental disasters and those caused by chemical, biological, and radiological elements, and disaster recovery.

760 pagesISBN: 978-0-470-27949-6©2012

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October 201222


What Does It Take to Make Your ED Ready?

The television reporter’s interview in the

Louisiana State University Health–Shreveport

Emergency Department began with a weighty

question: ‘‘So what goes into making the

emergency department prepared for a disaster

or mass casualty like the recent and tragic

shooting in Aurora, Colo.? Are we ready?’’

The reporter was aware of the heroic

response required by emergency nurses, doctors

and other first responders in Aurora in July and

wanted to learn more about local and regional

ED and hospital planning for a similar threat.

We discussed planning and preparedness for

various hazards.

What do you think it takes? What are the

potential hazards, considerations and roles for

the ED?

Recent Incidents and Hazards Threatening the EDImagine yourself as an emergency nurse in the

following incidents:

• Bomb: On July 19, a 50- to 60-pound pipe

bomb was carefully removed from the trunk of

a visitor’s car in the St. Mary’s Hospital

(Rochester, Minn.) parking garage. Threats exist

outside and sometimes within the hospital.

When it comes to bombings, the CDC has

referred to bombings as the ‘‘expected surprise.’’

• Tour Bus MCI: On Aug. 3, 38 people were

transported to local EDs and trauma centers

after a double-decker bus slammed into a

bridge pillar support while speeding down an

Illinois highway. School bus accidents occur

almost weekly somewhere in the country,

resulting in numerous pediatric injuries.

• IT Systems Failure: On Aug. 3, the Los

Angeles Times reported dozens of hospitals

across the U.S. lost access to critical electronic

medical records during a major, five-hour

computer outage later attributed to human

error. The outage raised concerns about data

stability and security weaknesses potentially

compromising patient care.

• Hazmat: On Aug. 1, the Houston-area

Danbury Hospital ED was reported shut down

after word was received of several incoming ill

patients who had been exposed to an unknown

white powder. A decontamination unit was

established by hazmat teams at the hospital.

• Hurricane: On Sept. 2, the East Jefferson

Hospital (Metairie, La.) emergency department

reported seeing the types of injuries associated

with hurricane debris cleanup. Hurricane Isaac

injuries in the ED included traumas resulting

from debris removal, with increased numbers of

lacerations, plus back injuries resulting from

falls from ladders.

• Power Failure: On July 15, Doctor’s

Hospital (White Rock, Texas) was reported to

have experienced an electrical power failure

after a storm. A backup emergency generator

then failed, leaving dependant systems without

power for about two hours.

• Tornado: On June 28, security-camera

video from the ED waiting area of St. John’s

Regional Medical Center in Joplin, Mo., which

was hit by a devastating tornado May 22, 2011,

was posted on the Internet. Viewers can watch

as the still room becomes suddenly engulfed in

the storm, with chairs, curtains and debris

swirling violently.

ED disaster responses can result from

multiple natural, man-made and/or

technological threats. Multiple populations can

be affected, including pediatric, adult and the

elderly. Emergency nurses need to be prepared

for the ‘‘all hazards’’ response. A starting place

for all hazards principles and strategy is found

in the ENA Emergency Management and

Preparedness for All Hazards position statement.

The ENA ‘All Hazards’ Position StatementMany excellent resources for disaster and

emergency management applicable to the

emergency nurse can be found at www.ena.

org. One in particular, ENA’s Emergency

Management and Preparedness for All Hazards

position statement, offers significant

considerations and concepts for an emergency

nurse to ‘‘be prepared.’’

Within the ENA position statement is a

background description of the emergency nurse

role in the phases of disaster mitigation,

preparedness, response and recovery. The

statement also provides 13 focus areas detailing

the ENA position.

Position statement component topics

addressed include the following:

• The primary importance of individual

preparedness

• Considerations for ongoing preparedness

training and education

• The National Incident Management System

• Implications for resource allocation during

disaster

• Importance of the hazard vulnerability

analysis

• Evaluating and testing emergency response

plans

• Recognizing needs of special and

vulnerable populations

• Planning for the ability to self-sustain for

96 hours

• The volunteer response including

Ready or Not?

By Knox Andress, BA, RN, AD, FAEN



deployment and engagement

• Standards of Care in disaster

• Mass Casualty triage

• Continuing education and training

A starting place for appreciating response

needs for emergency nurses is the ENA

Emergency Management and Preparedness for

All Hazards position statement.

Resources

http://kaaltv.com/article/stories/S2696701.

shtml?cat=10151

http://www.usatoday.com/news/nation/

story/2012-08-02/megabus-

crash/56715768/1?csp=hf

http://articles.latimes.com/2012/aug/03/

business/la-fi-hospital-data-outage-20120803

http://www.myfoxhouston.com/

story/19184465/2012/08/02/hazmat-

teams-shut-down-er-of-angleton-hospital

http://www.nola.com/hurricane/index.

ssf/2012/09/high_number_of_injuries_

from_i.html

http://watchdogblog.dallasnews.com/

2012/07/power-failure-sends-regulators-to-

doctors-hospital-in-e-dallas.html/

http://www.wtsp.com/news/national/

article/261482/81/Caught-on-camera-ER-

camera-during-tornado

http://www.ena.org/SiteCollection

Documents/Position%20Statements/

AllHazards.pdf

Readers may contact the

author at [email protected].

Follow Knox Andress @ENAdman.

By Carl Schramm, RN, EMT-B Emergency Management and Preparedness Committee

Building Relationships in Advance Aids Disaster Planning

We all have disaster/emergency response plans for our facilities to address

a wide range of emergencies, ranging from natural disasters to industrial

accidents to terrorist attacks. How realistic are these plans?

A good, comprehensive plan must include not only a facility’s resources

but the resources available from outside facilities and agencies. When a

disaster occurs, one facility’s resources can quickly be stretched to the

limit. Augmenting and replenishing these resources can be extremely

difficult, if not impossible, during a disaster. To strengthen our capabilities,

we need to coordinate with outside facilities and agencies.

The key to successful coordination is building professional relationships

before a disaster occurs, when you have the time necessary to develop a

good working relationship and address potential problems. Emergency

managers need to sit down with the leaders of outside resources to share

their emergency response plans.

External resources need to be evaluated and understood to ensure that

they are going to be able to assist our facilities during emergency

operations. It is important to know exactly what an agency is going to

send when it is called to assist during an emergency. For example, can the

agency send supplies, equipment and/or personnel? Which ones and how

much? Will the type of emergency have an effect on the resources an

outside agency can send?

Evaluate the type of equipment used by an outside facility or agency to

ensure that its equipment is compatible with your own. What brand of

chemical suits does it use, what level of protection do the suits offer, and

how many does it stock? It does no good to call in outside assistance that

cannot work with your existing responders.

Know in advance the types of communication equipment other facilities

and agencies have. Is it possible to communicate with each other if

traditional communication methods go down? If not, can something be

done to accomplish this, such as adding frequencies to existing radios?

Just having contact information for the leaders of these outside facilities

and agencies can be vital during an emergency.

To help operations run smoothly during an emergency, we need to

determine to what level each facility or agency has trained its personnel.

The requirements for these training levels are vague at best, and there can

be a wide range of interpretation of requirements. For example, while the

objective of decontamination is to remove contamination, not every

program teaches decontamination by using the same steps or in the same

order.

During an emergency, the police and fire departments and emergency

medical services each have to address different aspects of an emergency

incident and use resources and personnel differently. Depending on the

nature of the emergency, these outside facilities and agencies may not

always have the ability to send the same assistance to any one facility. We

need to realize that these responsibilities can cause outside agencies to

commit more of their resources to their primary objectives.

Having an understanding of the different responsibilities and objectives

of these outside agencies is beneficial during an emergency. We can better

understand why outside agencies handle an emergency the way they do,

and they will better understand why we do what we do. We can modify

how we handle an emergency to allow us to better coordinate our

operations. Having an understanding that emergency medical responders

have to follow specific protocols when they are in the field, and that they

do not operate under the same rules as the nurses who work in the

emergency department, is important. This understanding and respect of

each other’s responsibilities will prevent conflict during an emergency and

help everyone to use resources as efficiently as possible.

Developing and maintaining emergency/disaster response plans is a

difficult and time-consuming assignment. But without taking these

considerations into account, it will be hard to have a truly effective,

comprehensive plan. When an emergency occurs, no one wants to wait

for help, only to find out it was either not what they were expecting or

not coming at all. We need to prepare as best we can for anything to

happen at any time.

Robert Breese, CCEMTP, FP-CBehind the Scenes Award

Kathy J. Morris, DNP, APRN, FNP-C, FAANPFrank L. Cole Nurse Practitioner Award

Joyce Foresman-Capuzzi, MSN, RN, CCNS, CEN, CPN, CTRN, CCRN, CPEN, SANE-A, EMT-PGail P. Lenehan Advocacy Award

Diane L. Gurney, MS, RN, CEN, FAENJudith C. Kelleher Award

Sharon McGonigal, RN, CENENA Lifetime Achievement Award

Leslie A. Christiansen, RN, BS, CENNurse Manager Award

Donna M. Roe, DNP, ARNP-BC, CENNursing Competence in Aging Award

Timothy J. Murphy, MSN, RN, ACNP-BC, CENNursing Education Award

Judith Common, RN, CEN, CPEN, CA/CP SANE, SANE-A, SANE-PNursing Practice Award

Anne Stefanoski, BSN, RN, CENNursing Professionalism Award

Michelle A. Marini, RN, MSN, CPNP, CPENNursing Research Award

Amy W. Truog, RN, BSN, CPENNursing Research Award

Joseph M. Lenehan, MDPresident’s Award

Kristen Connor, RN, PHN, BSN, CENRising Star Award

Sandra M. Waak, RN, CENLinda Arapian, RN, MSN, CEN, CPEN, EMT-BLisa Tenney, RN, BSN, CEN, CPHRMAnne May , RN, BSNEmilie Crown, RNPamela S. Fox, RN, BSN, CEN, CPENLucy McDonald, RN, CPEN, CPN, EMT-BTeam Award

Achievement Awards

Meredith Jaye Addison, MSN, RN, CEN, FAEN

Rita T. Anderson, RN, CEN, FAEN

Audrey Elizabeth Cloughessy, AM, MHM, RN, FAEN

Christine M. Gisness, MSN, RN, BC, FNP-C, CEN, FAEN

Diane L. Gurney, MS, RN, CEN, FAEN

Andrew D. Harding , MS, RN, CEN, NEA-BC, FACHE, FAHA, FAEN

Cindy L. Hearrell, MSN, RN, CEN, FAEN

J. Jeffery Jordan, MS, RN, MBA, CEN, CNE, EMT-P, FAEN

Fred Neis, MS, RN, CEN, FACHE, FAEN

India J. Taylor Owens, MSN, RN, CEN, NE-BC, FAEN

Gwyn Parris-Atwell, MSN, RN, FNP-BC, CS, CEN, FAEN

Judith A. Scott, MHA, BSN, RN, PHN, FAEN

Paula Tanabe, PhD, MPH, MSN, RN, FAEN

Mary Ann Teeter , MEd, RN, FNP-C, CEN, CNRN, FAEN

Academy of Emergency Nursing Inductees

Advocate Good Shepherd Hospital Emergency Department (Barrington, IL)

Beaumont Health System – Grosse Pointe Emergency Center (Grosse Pointe, MI)

Boston Children’s Hospital Emergency Department (Boston, MA)

Cedars-Sinai Medical Center, Ruth and Harry Roman Emergency Department (Los Angeles, CA)

Chandler Regional Medical Center Emergency Department (Chandler, AZ)

Children’s Medical Center of Dallas, Seay Emergency Center (Dallas, TX)

Cincinnati Children’s Hospital Emergency Department – Burnet Campus (Cincinnati, OH)

Indiana University Health Methodist Hospital Emergency Medicine and Trauma Center (Indianapolis, IN)

Lantern Awards

Robert Breese, CCEMTP, FP-CBehind the Scenes Award

Kathy J. Morris, DNP, APRN, FNP-C, FAANPFrank L. Cole Nurse Practitioner Award

Joyce Foresman-Capuzzi, MSN, RN, CCNS, CEN, CPN, CTRN, CCRN, CPEN, SANE-A, EMT-PGail P. Lenehan Advocacy Award

Diane L. Gurney, MS, RN, CEN, FAENJudith C. Kelleher Award

Sharon McGonigal, RN, CENENA Lifetime Achievement Award

Leslie A. Christiansen, RN, BS, CENNurse Manager Award

Donna M. Roe, DNP, ARNP-BC, CENNursing Competence in Aging Award

Timothy J. Murphy, MSN, RN, ACNP-BC, CENNursing Education Award

Judith Common, RN, CEN, CPEN, CA/CP SANE, SANE-A, SANE-PNursing Practice Award

Anne Stefanoski, BSN, RN, CENNursing Professionalism Award

Michelle A. Marini, RN, MSN, CPNP, CPENNursing Research Award

Amy W. Truog, RN, BSN, CPENNursing Research Award

Joseph M. Lenehan, MDPresident’s Award

Kristen Connor, RN, PHN, BSN, CENRising Star Award

Sandra M. Waak, RN, CENLinda Arapian, RN, MSN, CEN, CPEN, EMT-BLisa Tenney, RN, BSN, CEN, CPHRMAnne May , RN, BSNEmilie Crown, RNPamela S. Fox, RN, BSN, CEN, CPENLucy McDonald, RN, CPEN, CPN, EMT-BTeam Award

Achievement Awards

Meredith Jaye Addison, MSN, RN, CEN, FAEN

Rita T. Anderson, RN, CEN, FAEN

Audrey Elizabeth Cloughessy, AM, MHM, RN, FAEN

Christine M. Gisness, MSN, RN, BC, FNP-C, CEN, FAEN

Diane L. Gurney, MS, RN, CEN, FAEN

Andrew D. Harding , MS, RN, CEN, NEA-BC, FACHE, FAHA, FAEN

Cindy L. Hearrell, MSN, RN, CEN, FAEN

J. Jeffery Jordan, MS, RN, MBA, CEN, CNE, EMT-P, FAEN

Fred Neis, MS, RN, CEN, FACHE, FAEN

India J. Taylor Owens, MSN, RN, CEN, NE-BC, FAEN

Gwyn Parris-Atwell, MSN, RN, FNP-BC, CS, CEN, FAEN

Judith A. Scott, MHA, BSN, RN, PHN, FAEN

Paula Tanabe, PhD, MPH, MSN, RN, FAEN

Mary Ann Teeter , MEd, RN, FNP-C, CEN, CNRN, FAEN

Academy of Emergency Nursing Inductees

Advocate Good Shepherd Hospital Emergency Department (Barrington, IL)

Beaumont Health System – Grosse Pointe Emergency Center (Grosse Pointe, MI)

Boston Children’s Hospital Emergency Department (Boston, MA)

Cedars-Sinai Medical Center, Ruth and Harry Roman Emergency Department (Los Angeles, CA)

Chandler Regional Medical Center Emergency Department (Chandler, AZ)

Children’s Medical Center of Dallas, Seay Emergency Center (Dallas, TX)

Cincinnati Children’s Hospital Emergency Department – Burnet Campus (Cincinnati, OH)

Indiana University Health Methodist Hospital Emergency Medicine and Trauma Center (Indianapolis, IN)

Lantern Awards

October 201226

The ENA Lantern Awards, first presented in

2011, were envisioned as a means of recognizing

exemplary emergency departments. In addition,

the awards provide an opportunity for

identifying outstanding, novel practices from

those EDs that achieve Lantern Award

designation. Based on a systematic review of

each application, which is subjected to a blinded

review process by multiple reviewers and

evaluated against preset evidence-based criteria,

the awards recognize EDs that exemplify

exceptional practice and innovative performance

in the core areas of leadership, practice,

education, advocacy and research. Here are

some of the initiatives that made these 2012

recipients exemplary:

Advocate Good Shepherd Hospital Emergency Department (Barrington, Ill.)Advocate Good Shepherd Hospital is a not-for-

profit hospital in the Chicago suburbs, serving

almost 34,000 patients in the ED each year. It’s

an accredited trauma and stroke center. Twenty-

one percent of patients presenting to the ED are

admitted. Within the general ED, 5 percent of

visits are pediatric patients under age 18.

Staff and leaders identified opportunities for

planning and collaboration to address the needs

of patients at both ends of the age spectrum.

Following a hazard vulnerability analysis, a

disaster drill was planned to include more than

20 children to test the hospital’s response to a

disaster involving unaccompanied children.

Lessons learned from the multi-disciplinary,

intradepartmental and intra-agency drill resulted

in changes implemented to the pediatric

decontamination process, as well as the child

identification process. Having children

participate in pediatric disaster preparedness

exercises is one effective strategy for meeting

the needs of the community during a disaster

response.

Regarding older adult patients, analysis and

review of data revealed that falls among this

population were the primary causative factor for

trauma admission, with 51 percent of these falls

occurring in the community and 25 percent of

trauma admissions coming from one specific

senior living facility. Staff members embarked on

a training initiative to present the Matter of

Balance program at the identified facility. The

program, which teaches strategies to overcome

the fear of falling, helps set realistic goals for

increasing activity, as well as strength and

balance, with the goal of reducing the risk of

falling. Six months after initiating this

collaboration, there was a 62 percent

decrease in fall admissions, and the affected

facility reported a 77 percent decrease in total

falls. Due to this success, the team has taught

the Matter of Balance program at other senior

living facilities and senior community centers in

10 different cities in and around their service

area.

Beaumont Health System – Grosse Pointe Emergency Center (Grosse Pointe, Mich.)Beaumont Health System in Grosse Pointe,

Mich., is a not-for-profit facility that has nearly

37,000 patient visits to its ED yearly. Sixty-nine

percent of the patients admitted to the hospital

come through the ED, and almost 30 percent of

ED patients are admitted.

The ED at Beaumont Health System – Grosse

Pointe has proven that strong, committed,

involved and visionary leadership can inspire

staff engagement to improve practice, safety and

satisfaction for patients, families and staff. The

staff works collaboratively to own its department

by assuming responsibility for various services,

such as stroke and chest pain certifications. The

ENA Emergency Nursing Scope and Standards of

Practice, as well as ENA position statements and

toolkits, have been cited as foundational

resources for many activities and best practices

implemented in the emergency department. The

ED successfully advocated for legislation in

collaboration with the Michigan ENA State

Council to increase penalties for violence against

health care workers. In addition, Beaumont

described a clear commitment to training of ED

and security staff on de-escalation and

prevention of violent incidents. As a result,

incidents have been declining, and patients and

staff are safer.

Beaumont also described a longstanding

support of family presence that is hospital-wide,

including comprehensive support for patients

and families in a needs-based model. An

impressive component of its family presence

program is family-member follow-up for up to a

year.

Boston Children’s Hospital Emergency Department (Boston)Boston Children’s Hospital is a not-for-profit,

academic medical center that is a designated

trauma center. It is recognized as a Magnet

facility and has also received the Beacon Award.

The ED sees just under 59,000 patients annually,

and 58 percent of hospital admissions present

through the ED.

The team at Boston Children’s Hospital ED

recognizes the challenges immunocompromised

patients pose when they present to the

emergency department with a fever. Time to

antibiotics is critical to outcomes. Clinical

practice guidelines set a target for antibiotic

administration within 60 minutes of arrival to the

ED. A one-year retrospective chart analysis

demonstrated that this time was exceeded more

than 50 percent of the time. A multidisciplinary

team mapped the current process for antibiotic

administration and identified barriers to meeting

the target time. Interventions implemented

included a fast-pass system, ANC pre-notification

calls, communication enhancements between

team members, retraining of nurses on porta-

cath access, pharmacy prioritization of Fever and

Neutropenia template orders and reinforcement

of topical cream application by parents before

ED arrival. As a result, the mean time to

antibiotic delivery dropped from 99 minutes to

49 minutes, and the percent of patients who met

the target time to antibiotics rose from 50

percent to 80 percent.

Cedars-Sinai Medical Center, Ruth and Harry Roman Emergency Department (Los Angeles)Cedars-Sinai Medical Center is a 952-bed,

not-for-profit, non-academic teaching hospital

and is also a designated trauma, chest pain and

stroke center. The Ruth and Harry Roman ED at

Cedars-Sinai serves almost 84,000 patients

annually. Like many hospitals, Cedars-Sinai has

experienced long waits for availability of

inpatient beds. It was noted that it knew its

process needed improvement, as it typically took

more than six hours to admit an ED patient.

The organization implemented a project to

address patient flow called the Toes Out-Toes In

initiative. Using the Toyota Production Process

Improvement Methodology, it engaged a

Sharing Innovations and Best PracticesAuthored by the 2012 ENA Lantern Award Committee: Gwyn Parris-Atwell, MSN, RN, FNP-BC, CS, CEN, chairperson; Denise M. Bajer, MSN, RN, CEN, NE-BC; Jennifer M. Davis, MSN, MPH, RN, EMT-P, CEN; Susan K. Ebaugh, MSN, APRN, CEN, ACNS-BC; Andorra L. Foley, MSN, RN, CEN; Tami L. Morin, MS, BS, RN, CPEN; Teresa O’Neill, MSN, MBA, RN; India J. Owens, MSN, RN, CEN, NE-BC; Cheryl Rourke, MSN, RN, NE-BC; Barbara A. Weintraub, MSN, MPH, RN, APRN, CEN, CPEN, ACNP-BC, FAEN; and Matt Powers, MS, BSN, RN, CEN, MICP, Board of Directors liaison

2012 Lantern Award Recipients


multidisciplinary team to

eliminate waste in its bed

turnaround process. The

team used rapid

improvement events to

make multiple process

changes, leading to

tremendous improvement

in throughput. Changes

were made to the

discharge computer entry,

eliminating steps and

resulting in an average

one-hour reduction in

turnaround times, as well

as providing real-time

notification of the

discharge.

A housekeeping discharge team was also

created, decreasing room cleaning times from

75 to 45 minutes. This department’s staffing was

changed to provide increases at peak times,

mimicking the hotel industry. Only clean and

ready rooms were then assigned for patient

placement. Additionally, a culture change took

place, including having the staff in the medical/

surgical/monitored units call the ED for report

within 20 minutes of an ED admission

notification, essentially ‘‘pulling the patient’’ to

the open bed. Within one year, this organization

had reduced the turnaround time to 110

minutes on average. Drilling down further into

the outlier data, Cedars-Sinai Medical Center has

been able to trim further waste, now averaging

88 minutes to admit an ED patient. One

important change was to eliminate the no-fly

zone where floor nurses would not take report

15 minutes before or after the change of shift.

This initiative helped to eliminate some of the

bottleneck issue of patients waiting to go to

their rooms from the ED and facilitated timelier

placement.

Chandler Regional Medical Center Emergency Department (Chandler, Ariz.)Chandler Regional Medical Center is a 209-bed,

not-for-profit, non-academic teaching hospital in

Chandler, Ariz. Sixty-three percent of hospital

admissions originate in the ED, which serves

nearly 63,000 patients a year.

The emergency nurses are continually

developing and implementing ideas to improve

patient outcomes and quality of care. In

response to news that antivenom was being

discontinued due to a lack of state funding, one

of the nurses became very concerned, as they

see a pediatric and older adult population that

often needs the drug. She took the initiative to

find out about a newly available investigational

antivenom. Steps were taken to design a

research study and get approval from the

Institutional Review Board. The physicians and

nurses in the ED eagerly participated in the

research, and the project became a huge

collaborative effort not just between the ED staff

and pharmacy, but also with other area

hospitals and the Poison Control Center. Many

envenomed patients arrive in a life-threatening

condition requiring transfer to an ICU; yet with

the antivenom protocol developed through the

research conducted, patients are now

discharged within four hours of arrival to the

ED with fewer complications.

Children’s Medical Center of Dallas, Seay Emergency Center (Dallas)The Seay Emergency Center at Children’s

Medical Center of Dallas is a not-for-profit,

academic medical center in the Southwest

serving more than 118,000 children per year.

This designated trauma center and Magnet-

status medical center admits 11 percent of its

inpatients through the ED.

Patient safety is a top priority at this facility.

With more than 88,000 doses of medication

administered in the emergency center in January

2012 alone, medication safety has been a major

focus, with several initiatives implemented to

prevent medication errors, increase reporting

and support a just culture. One initiative

involves ED staff on the hospital’s High Alert

Medication Committee, which shares data as

well as identifies trends and opportunities for

improvement. An initiative to reduce the

incidence of incorrect weights being entered

into the electronic health care record resulted

from the work of this committee. After review

of the issues, improvements were identified,

including the use of an alert activated when a

patient falls outside the normal range for his or

her age, and a request for a second entry. In

addition, steps were initiated to introduce

electronic scales that transfer data directly into

the EHR, reducing human error.

Other efforts to eliminate and reduce the

number of medication errors also have

contributed to a significant decrease in errors at

this facility over the last two years. Some

examples are the implementation of a barcode

system, effective use of the EHR to provide

defaults and prompts for high

alert medications, and the

addition of a pharmacist in

the emergency department

24/7.

Cincinnati Children’s Hospital Emergency Department – Burnet Campus (Cincinnati)Cincinnati Children’s Hospital

is a not-for-profit, academic

medical center that is a

designated trauma center.

The Burnet Campus ED

serves about 89,000 children

a year, with 14 percent of

those patients being admitted.

Cincinnati Children’s employs the innovative

practice of using postcards to close the

communication gap and improve patient

satisfaction. An interdisciplinary team that meets

weekly to review patient satisfaction data

recognized that identifying a patient’s chief

complaint was only a small part of the puzzle.

They began by collecting patients’ and families’

expectations of the visit on postcards. These

postcards are then used as a way to

communicate the families’ unstated

expectations. For example, their child’s primary

physician may have sent them to the ED with

the expectation that the ED would start an IV

and give their child fluids. The cards also serve

as a tool that alerts the staff to the families’

concerns. As emergency nurses, we know that

some of our patients come through our door for

reassurance. Perhaps their cousin was

diagnosed with cancer after exhibiting similar

symptoms. The staff is alerted early on, through

the postcards, that reassurance is a primary

need of the patient and family. This tool has

taken some of the guess work out of meeting

patients’ expectations at Cincinnati Children’s,

resulting in enhanced patient satisfaction scores

and a feeling by staff that it is better able to

meet patients’ needs.

Safety is also a top priority in any high-

functioning ED. The interdisciplinary team at

Cincinnati Children’s recognized that when

stress levels are high, miscommunication is

more common. This led to the implementation

of a shared-mental-model process during

stabilization of critically ill or injured patients.

The shared mental model begins with a history

and primary assessment using a team model led

by a nurse and physician. The physician then

asks for everyone’s attention while a shared

mental model is performed. The physician

shares aloud the initial assessment and plans.

The team quickly reaches agreement on next

steps together. A sharing of the mental model

typically occurs within five to seven minutes of Continued on page 40

October 201228

Watch for ENA’s call for candidates seeking election in 2013 to serve on

the board of directors and on the Nominations Committee. Application

information for candidates will be available this month at www.ena.org.

Open board positions include president-elect, secretary/treasurer and

two three-year-term director positions. The officer positions are one-year

terms with the president-elect continuing on to the presidency the

following year, then an additional year as immediate past president.

Depending upon the outcome of the officer elections, additional director

seats may be available for terms equal to the unexpired terms of the

vacating directors. The candidates receiving the next highest number

of votes would fill these positions.

Qualifications for all board of director positions include current ENA

membership and membership for five consecutive years prior to

submitting a candidate application; a current unencumbered RN license;

attendance within the last three years at one ENA General Assembly as

a delegate, alternate delegate or member of the board of directors; and

having served in an elected or committee position on the local, state or

national level within the past five years. Candidates for the position of

president-elect and secretary/treasurer currently must be serving as a

voting member of the national ENA board of directors. More qualification

details are listed within the current ENA bylaws at www.ena.org.

Application ProcessInterested members are required to complete and submit an application

with a professionally taken digital portrait photograph (details will be

included on the application form) to [email protected]. The deadline for

submission will be posted on the ENA Web site as soon as it is available.

Watch for the application form available this month at www.ena.org.

A candidate screening process is conducted on all board of director

and Nominations Committee candidates. The screening process includes a

limited background check verifying personal identity, professional licensure,

current employer, highest academia and a criminal history check.

Accepted candidates for the board of directors are encouraged to attend

the Candidates Election Forum Saturday, March 2, at Leadership

Conference 2013 in Fort Lauderdale, Fla.

Making a CommitmentServing on the ENA board of directors and Nominations Committee in any

capacity requires a significant time commitment. Board service involves

in-person meetings, reading correspondence, completing projects and

talking to members on a variety of issues.

Prior to running for national office, candidates are encouraged to

discuss the role and responsibilities with their employers and negotiate the

time they will be away from work. The support of the candidate’s

employer and family is essential in meeting the responsibilities of

a board member.

Board of Director ResponsibilitiesThe ENA bylaws determine the official duties of the board of directors.

The major responsibilities of the board include all duties entrusted to

officers and directors of a corporation, including determining association

policy, providing oversight of the financial affairs of the association and

reviewing and evaluating the strategic plan.

The ENA board of directors conducts its official business meetings with

all information and agenda items distributed electronically. Board

members are required to work with this technology.

Board MeetingsBoard members are required to attend scheduled board of directors

meetings. Expectations for these meetings include the following:

• Attendance at the August Nursing Organizations Alliance annual Nursing

Alliance Leadership Academy conference (for incoming officers and

directors).

• Submission of agenda items based upon member needs or current

trends in emergency health care.

• Required attendance at the year-end 2013 board of directors meeting

and board member orientation.

• Thorough review of the board agenda materials prior to the meeting.

• Utilization of contacts, resources, state presidents and other members

to obtain a broader perspective on agenda topics.

• Recommendation of potential strategies, charges and projects for

consideration in the strategic planning process.

• Familiarity with current technology (smart devices) and access to

the Internet.

Committee DutiesEach board member is assigned liaison responsibilities for two to four

national committees or work teams. The role of the board liaison is to

represent the board’s position on the committee’s charges, to participate in

committee assignments, to assist the committee’s staff liaison in reporting

committee activities to the board and to mentor committee members as

future chairpersons and/or board members.

The president also may ask board members to represent ENA at

meetings of affiliate or allied organizations. Typically, assignments are

based upon a board member’s area of expertise.

State ResponsibilitiesEach board member, excluding the president, serves as board liaison for

five to six states. Board members are encouraged to have frequent contact

with state presidents to exchange information about activities and the

needs of members at the local and state levels.

ENA Call for…

2013 ENA Board of Director and Nominations Committee CandidatesNote: Amendments to the current ENA bylaws that may change candidate eligibility requirements were decided at the 2012 General Assembly, Sept. 12-13. For updated information, please check www.ena.org.


Continued on page 39

2013 ENA Board of Director and Nominations Committee CandidatesNote: Amendments to the current ENA bylaws that may change candidate eligibility requirements were decided at the 2012 General Assembly, Sept. 12-13. For updated information, please check www.ena.org.

The ENA General Assembly meets yearly before the start of the ENA Annual

Conference to determine official association policy and positions by reviewing,

debating and voting on proposed bylaws amendments and resolutions.

Bylaws amendments may be proposed by the board of directors, state

councils, association chapters or five active members of the association.

Resolutions may be submitted by any active ENA member. Others who may

submit resolutions include the ENA board of directors, state councils, chapters,

the Journal of Emergency Nursing editorial board and ENA committees.

The Resolutions Committee is available to help ENA members with

developing proposed bylaws amendments and resolutions. This assistance

provides members with the resources to effectively write proposed bylaws

amendments and resolutions in the proper format before the deadline. If you

are interested in bringing a proposed bylaws amendment or resolution to the

2013 General Assembly, it is recommended that you begin drafting your

proposal and working with the Resolutions Committee at least three months

before the submission deadline. Please contact ENA Component Relations at

[email protected] to obtain assistance from the Resolutions

Committee.

All proposed bylaws amendments and resolutions must be submitted in the

proper template form and must follow the format as outlined in the Resolutions

and Bylaw Guidelines. The guidelines may be found at www.ena.org in the

General Assembly area (members only). Final submissions must be e-mailed to

ENA headquarters at [email protected] by 5 p.m. CT, March 11,

2013.

Formal consideration of proposed bylaws amendments and resolutions will

occur at the 2013 General Assembly, Sept. 18-19, in Nashville, Tenn. This is

your opportunity to bring important professional emergency nursing issues to

the 2013 General Assembly.

ENA Call for…

Proposed Bylaws Amendments and ResolutionsSubmission Deadline: March 11, 2013

Nominations Committee ResponsibilitiesNominations Committee Member Election

Members will be elected to serve for a two-year term on the Nominations

Committee by geographic regions 2, 4, 6 and the past board member

position. The state breakout by region is available at www.ena.org/

about/elections/Documents/NomComRegionalMap.pdf.

The Nominations Committee is charged to do the following:

• To review, ratify and present a qualified slate of election candidates for

each position in the election of officers, directors and the Nominations

Committee.

• Review candidate applications for ENA national elections, according to

established policies and procedures.

• Encourage and mentor candidates throughout the election cycle.

• Conduct and facilitate the Candidates Election Forum for the Leadership

Conference 2013.

• Promote membership interest, education and voting participation.

• Provide a status report at ENA board of director meetings.

• Review and provide input on all policies and procedures related to the

elections process.

As we look to the future, ENA remains dedicated to strong leadership

among its members. The nominations process is one step to ensuring that

our national volunteer leaders are highly qualified and prepared for this

responsibility. The Nominations Committee encourages members to vote

in the 2013 election.

If you have questions or need assistance, please contact Executive

Services at 800-900-9659, ext. 4095, or e-mail [email protected].

Barry Hudson, BSN, RN, CPEN, immediate past president of the Texas ENA State Council, addresses the 2012 ENA General Assembly in San Diego.

October 201230

Thinking back

almost 25 years

since finishing my

nursing program, I never imagined doing

anything that would impact health care in

another country.

In 1999 there was an open call in ENA

Connection for members who had achieved

faculty status in TNCC or ENPC to submit a

letter for consideration to be a part of a team of

instructors that would take a course to another

country. The open call did not list where or

when the next course dissemination would

occur.

I remember sitting at my computer on a

Friday morning in November 2001, reading an

e-mail from ENA regarding bringing TNCC to

Portugal in February 2002. Before I hit the reply

key, I discussed with my wife traveling to

Europe in the era of post-9/11 and other

significant terrorist events. As much as this was

a concern, I felt the ability to teach TNCC in

Portugal would be a unique opportunity.

Since that trip, I have been fortunate to

return to Portugal to teach ENPC in 2006, and I

was the team leader for a 2010 trip to teach

TNCC in Korea. Over the last 10 years, TNCC

has spread to 14 countries and ENPC has spread

to six countries. This October, ENA will bring

TNCC to Kenya.

Trips to disseminate TNCC and ENPC are

filled with challenges and a lot of work. The

process starts with a request from the host

country to have either TNCC and/or ENPC

brought to them. The ENA national office has a

screening process for countries requesting the

courses, which validates nursing practice

standards and that the host country has the

infrastructure to maintain teaching either

TNCC and/or ENPC after the initial course

dissemination.

The basic schedule of a course dissemination

is to hold a provider course for 16 students. At

the end of the first course, the team of faculty

will select eight students who will then take the

first instructor course. These eight will then be

mentored and signed off as instructors, teaching

in the second provider course. The team of

faculty will then select four of the new

instructors to be mentored in teaching the

second instructor course. At the end of the trip,

the team of faculty will have taught two

provider courses for 32 students and two

instructor courses, making eight instructors, with

four of them signed off as faculty. This will

allow the course to continue to develop in the

host country. Since my first trip to Portugal in

2002, the Portuguese TNCC instructors have

since taught more than 100 TNCC courses.

Canada, the UK and Australia have very active

TNCC and ENPC programs.

Teaching internationally offers exciting,

memorable moments as well as challenges. On

Go Global With TNCC and ENPCBy Ray Bennett, BSN, RN, CEN, CFRN, CTRN, NREMT-P

A TNP station overseen by new TNCC instructors Maj. Eun-goung Ann and Lt. Col. Myoung-Ran Yoo in Daejeon, Korea, in August 2010.

Alzira Silva leads the scenario and Patricia Gaspar serves as the patient during a 6th edition TNCC instructor update in Oporto, Portugal, in April 2008.


all three of my trips there have been obstacles,

such as translation issues, to overcome. In

preparing for our trip to Korea, we discovered

that they did not have rescue airways, such as

the Combi-tube or King Tubes, so we had to

pack these items. On all trips we found that

while understanding spoken English was

common for our international colleagues, using

English conversationally was not.

We spend approximately nine of the 15 days

on the ground teaching. These are long days,

often lasting 10 hours, in addition to evening

preparation meetings. However, each trip allows

for some down time to explore the host country

and socialize with our new international

colleagues.

As I reflect on each of my three trips, I feel

lucky to have had the opportunity to provide

trauma and pediatric nursing education, which in

turn will improve the quality of health care being

provided in emergency departments around the

globe. E-mail and social networking sites allow

me to maintain contact with my international

colleagues, who are now great friends with

commons goals.

This fall, ENA will post another open call for

TNCC and ENPC faculty for future international

dissemination trips. Even though ENA does not

have any definitive countries requesting a trip

at this time, the organization would like to

maintain a current database of members who are

interested in improving the quality of health care

around the world. I encourage ENA members to

apply. The memories will last a lifetime.

You likely have been in this situation: You notice when checking your

social media channel of choice that one of your friends or colleagues has

posted something questionable. How do you react? It’s a tough situation,

to be sure, especially given the instantaneous nature of social media.

This is the reason that social media policy has become so vital for many

organizations, hospitals and companies.

The pace at which social media networks are growing is

unprecedented, and there are increasing ways for not just text but

multimedia to be shared. Consequently, one of the best strategies is to

create a policy that is specific in its expectations and corresponding

penalties that are applicable to all situations. It’s not so much that policies

need to be reinvented for this technology, but expounded upon to capture

the very nature of what that technology allows its user to do.

Beyond an organization standpoint, a personal level of self-policing

measures can go a long way. The first and most important is to never

share anything with a social media outlet that you wouldn’t want shared

with everyone in your organization. While this may seem to be common

sense, there are a surprising number of cases where those very actions

have occurred with disastrous results.

Another proactive way to maintain privacy, and one that has become

increasingly popular, is simply keeping a private profile that’s completely

separate from your public, or professional, profile. That allows a certain

degree of freedom, though there is still risk in anything that gets

published online.

Because of all of these factors, it is impossible to say one policy works

better than another. However, the best thing that anyone can do is to

always be mindful of what is posted; and if you have clear consequences

in place for those who violate terms, ensure that quick and decisive

actions take place.

As this is a constantly evolving issue, I would be interested in hearing

what you are doing personally or within your organization in terms of

social media policy. There is no right or wrong approach, and it is always

fascinating to hear what else is out there.

Send your feedback to [email protected] or post on the ENA

Facebook page (www.facebook.com/enaorg).

ENA Connected

By Thomas Barbee, ENA Digital Marketing Manager

If this article described something that would interest you, watch for an e-mail – “Call for

TNCC/ENPC Faculty” – coming from ENA in late 2012, asking for TNCC/ENPC faculty who are

interested in participating in an international dissemination.

Ray Bennett presents the SHOCK lecture in Daejeon, Korea, with Taehoon Park assisting with translation.

How Sound Is Your Social Media Policy?

WASHINGTON WATCH | Kathleen Ream, MBA, BA, Director, ENA Government Affairs

In March 2006, the Emergency Nurses Association, along

with the American College of Emergency Physicians, urged

the Senate to exclude Section 202 of H.R. 4437, the Border

Protection, Antiterrorism, and Illegal Immigration Control

Act of 2005, from any bill that was passed on this issue. In

a letter dated March 28, 2006, the two organizations stated

that the language in this section could inadvertently place

emergency nurses and physicians and their hospitals in

untenable positions while attempting to comply with

existing federal laws, primarily EMTALA.

If it had been included in the final bill, which it wasn’t,

Section 202 of H.R. 4437 would have expanded current

immigration law by criminalizing anyone who attempted

to provide “assistance” or “harbored” an illegal immigrant.

ENA and ACEP noted in their letter that providing needed

and legally required health care to an illegal alien could

meet this definition and, thereby, criminalize the care

provided by emergency nurses and doctors.

Six years have passed and emergency personnel are

still faced with immigration legislation that may put

them in untenable positions.

In 2012, America’s attention was focused

on the Supreme Court’s review of Arizona’s SB

1070 immigration law. What many Americans

didn’t know was that other immigration bills

had also worked their way through the

Arizona legislature in 2012. Of particular

importance to emergency department health

care providers was a bill requiring EDs or

hospitals to report illegal immigrants.

SB 1445 stated, ‘‘If a person who

seeks or is receiving emergency or

nonemergency care at a hospital

cannot provide valid health insur-

ance information, the hospital

admissions officer or representative

must reasonably confirm during the

course of the person’s admission or

treatment that the person is a citizen

of the United States, a legal resident of

the United States or lawfully present

in the United States.’’

According to the bill,

if the hospital/ED cannot

confirm legality, it must

immediately contact immi-

gration or law enforcement.

The hospital also would be

required to annually submit

a report on the number of

patients seen who did not

show proper valid informa-

tion and the number of calls

made to immigration or law

enforcement. This bill was

assigned for review to three committees in the legislature:

Health Care and Liability Reform, Government Reform and

Rules. It died in committee (www.azleg.gov, 2012).

The U.S. Department of Homeland Security estimates

that there are 11.5 million illegal immigrants in the United

States.1 In 2009, Modern Healthcare noted that at least one

third of all immigrants lack health care.2 Among Mexican

immigrants, this number is even higher, with an equal or

greater-than-50-percent uninsured rate. Arizona is one of

seven states with the highest illegal immigrant population.

The others are California, Texas, New York, Florida,

Illinois and New Jersey.

Undocumented immigrants tend to use the emergency

department more often than all other uninsured patients.3

The ED is a safety net for all the underinsured and unin-

sured, required by the Emergency Medical Transport and

Labor Act to provide evaluation and emergency care to all

who enter the facility (www.ena.org/government/

emtala/Pages/Default.aspx).

As professional nurses, we are advocates for safe,

competent, available emergency care for our patients.

Certainly, we have multiple reporting requirements in our

practice. A myriad of state and federal regulations requires

us to report child and adult abuse, sexual assault, animal

bites, knife and gun wounds and burns, for example. All

of these are meant to protect patients and society. It

should not be a part of our practice to be responsible for

immigration enforcement.

As emergency nurses, we need to take responsibility for

our profession and our practice. It is imperative that nurses

do not remain legislatively illiterate. We are leaders and

advocates for those who need us most. Become aware of

the bills in your state and have a strong voice on issues.

The Emergency Nurses Association and the ENA Govern-

ment Affairs Committee are here to help you.

As Margaret Mead said, ‘‘Never doubt that a small group

of thoughtful, committed citizens can change the world.

Indeed, it is the only thing that ever has.’’

References

1. United States Department of Homeland Security. (2012).

Statistics. Retrieved July 6, 2012, from www.dhs.gov/

index.shtm.

2. Carlson, J. (2009). Immigrants are missing quotient in

reform talks. Modern Healthcare, 39(25), 18.

3. American College of Emergency Physicians. (2012).

Illegal immigrant care in the emergency department.

Retrieved July 6, 2012, from www.acep.org/content.

aspx?id25206.

Article by Rita Anderson, RN, CEN, FAEN, ENA Government Affairs

Massachusetts ED Costs Increase DramaticallyA new report finds that unnecessary ED costs in

Massachusetts have gone up by about 35 percent, or

nearly $150 million between FY 2006 and 2010. The

From the States

October 201232

Be Alert for State Legislation Impacting ED Nursing Practice

Division of Health Care Finance and Policy report

found there were nearly 2.5 million ED visits in

FY 2010, and about half those visits were

preventable or avoidable.

State lawmakers say that they expect the costs

to go down. The Senate’s Health Care Financing

Committee Chairman, Richard Moore, says the state’s

new health care law will promote access to primary

care doctors and reduce ED visits.

Despite increasing costs, the report found that the

number of ED visits is decreasing. It also recommends

that there should be a greater availability of health

care services to reduce unnecessary costs.

Massachusetts Law Includes Ban on Mandatory OvertimeOn Aug. 6, Massachusetts Gov. Deval Patrick (D)

signed into law the state’s much-anticipated health

care cost containment bill – SB 2400 – that includes

a ban on mandatory overtime for RNs. Under the

new law’s provision banning mandatory overtime,

a hospital cannot, except in the case of a declared

emergency, require a nurse to work beyond his or

her scheduled shift, and no nurse can be required

to work more than 12 hours in a 24-hour period.

Hospitals that assign a mandatory overtime shift are

required to report those incidents to the

Massachusetts Department of Public Health, along

with the justification for its use. Any nurse can

refuse overtime without fear of retribution or

discipline of any kind from his or her employer.

A number of scientific studies published in the

last decade have documented the dangers and costs

of mandatory overtime. The studies included

findings that nurses working mandatory overtime are

three times more likely to make costly medical

errors, and that such overtime was associated with

an increased risk of catheter-related urinary tract

infections and bedsores, both preventable medical

complications. In addition, a report issued by the

Institute of Medicine in 2002 linked mandatory

overtime and the under-staffing of nurses to

thousands of patient deaths each year, and called

for prohibition of the practice.


ENA wishes to express its sincere gratitude to these 2012 sponsors.* Thanks to their generous support, ENA is able to continue to provide relevant

services and educational programs to improve your practice of emergency nursing.

Strategic Sponsors

Strategic Supporters

Conference Sponsor

*As of print time

Conference Supporter

October 201234

We are all back at work after being

professionally refreshed, revitalized

and invigorated at the 2012 ENA

Annual Conference in San Diego.

The 1st Annual Awards Gala was a

wonderful way to conclude our time

in sunny California. Terry Foster, MSN,

RN, CEN, CCRN, FAEN was an excellent master

of ceremonies as we welcomed our eighth class

of fellows into the Academy of Emergency

Nursing.

Now is the time for our 2013 class of fellows

to start preparing their application for admission

into the AEN. Will you be in the ninth class of

inductees? Information and applications are

now available at www.ena.org under “Calls

and Opportunities.” The deadline to submit

online applications is 5 p.m. (CT) on Friday,

Nov. 30, 2012.

Are You Ready to Apply?One criterion for admission into the AEN

requires substantial and enduring contributions

to the emergency nursing profession.

Contributions and impact can be in broad

categories of practice, education, research,

leadership and/or public policy. This requires

being active not only on the local level but also

on the regional, national and/or international

level as well. Have you been an active member

of ENA for the last three consecutive years

without any gaps in membership? (International

applicants must be ENA members for one year

and members in their country’s emergency

nurses association for the last three consecutive

years.) Has your substantial and enduring

contribution made a significant impact on

emergency nursing? Is your curriculum vitae

current and, most important, does it reflect your

significant contributions to our profession?

Another criterion requires potential for future

contributions. Admission into the AEN truly

honors your impact on the profession. Moving

forward as a fellow, you will be called upon to

freely share your expertise with ENA and its

members.

Have you cultivated two sponsors? One

sponsor must be a current fellow of the AEN. If

you do not know a current fellow, there are

ways to meet and work with one. Fellows are

active on national ENA committees and in all

areas of practice. Consider applying for the

EMINENCE mentoring program, where you are

paired with a fellow to work on your project of

choice. Network with fellows at national

conferences. It is often so surprising to discover

that your clinical problem is a national clinical

problem, and there are fellows who can

collaborate with you or guide you to new

heights.

In these times of economic hardship, it

would be remiss not to mention financial

readiness. The AEN budget is maintained by

fellow annual dues and ENA. To be a fellow in

good standing requires maintaining membership

in ENA and paying annual AEN dues (currently

$100). You might want to consider lifetime

memberships in both.

The Academy of Emergency Nursing’s ninth

inductee class will be required to attend the

induction in Nashville, Tenn., during the 2013

ENA Annual Conference. Inductees’ presence

also is requested at AEN annual business

meetings held in conjunction with the ENA

Annual Conference.

If after some consideration you have

discovered that your body of work as an

emergency nurse has been substantial and

enduring with a significant impact, you have a

plan for potential future contributions and you

have two sponsors who know your work, this

may be the year for your application. The

following are some tips to help you realize your

professional goal as you complete the

application process:

DeadlinesBe aware of the deadlines. Communicate these

deadlines to your sponsors. Allow yourself

enough time to write, rewrite and edit a

thoughtful statement. Fall is a busy time of year

for everyone. Do not expect your sponsors to

drop everything to meet a short deadline. Your

poor planning does not create an emergency for

your sponsors.

Content and Word LimitsBe aware of the word limits for each section:

• Criterion 1, Active Involvement –

400-word limit

• Criterion 2, Enduring and

Substantial Contributions –

750-word limit

• Criterion 3, Potential for Sustained

Contributions – 300-word limit

Do not exceed word limits. Your application

and two letters of support are the only materials

used to determine eligibility. Even if your

contributions are known but not included in the

statements, they cannot be considered.

Proofread your application. Have an

uninterested party proofread it as well. In this

day of abbreviated e-mail messages, it is easy to

omit a verb or noun or include an incomplete

sentence. Be sure spelling and grammar are

correct and use correct punctuation.

Criterion 3, Potential for Sustained ContributionsPay special attention to this section. Rather than

restate items from the enduring and substantial

contributions statement, outline clear and

attainable goals that demonstrate how you will

impact the future of emergency nursing. Future

contributions can be made in the areas of

practice, education, research, leadership or

public policy.

SponsorsSponsors should be individuals who know you

and your professional contributions. Share your

criterion statements with your sponsors so their

statements enhance and highlight the impact of

your contributions. Letters of support should

speak to these items and not simply restate your

three criterion statements. Make the most of

your statements so your AEN reviewer can truly

understand why you are an excellent candidate.

Before You Hit Send• Did you follow the application instructions?

• Did you e-mail your CV separately?

• Have you budgeted money to attend the 2013

ENA Annual Conference in Nashville?

By keeping these tips in mind, you will avoid

common pitfalls that can derail a worthy

application to the Academy of Emergency

Nursing. As a current fellow and member of the

Academy Board, I look forward to welcoming

you among the ninth class of inductees.

Tips for a Successful Application to the Academy of Emergency NursingBy Maureen Curtis Cooper, BSN, RN, CPEN, CEN, FAEN AEN Board Member at Large, Academy of Emergency Nursing


The ENA Nominations Committee is the

only committee elected by the ENA member-

ship. While the committee members are very

visible during election time, especially at the

Candidates’ Election Forum at Leadership

Conference, the members continue working

on the election process throughout the year.

In fact, as soon as one election is completed

in mid-June, the committee begins working on

the next election, said Louise Hummel, MSN,

RN, CEN, CNS, 2012-2013 Nominations

Committee chairperson.

“I don’t know if the membership under-

stands what goes on behind the scenes,” said

Hummel, as she prepared to attend the 2012

General Assembly, where the committee was

presenting bylaws amendment proposals to

the delegates gathered in San Diego. “We’re

reviewing candidate applications; we work

with the candidates to help them prepare for

the forum; and each candidate has a

committee member assigned to him or her,

and that person acts as the intermediary

throughout the election process.”

Monthly – or even more frequent – confer-

ence calls are just part of the committee’s

ongoing commitments. Prior to writing and

submitting proposed bylaws amendment(s) to

the General Assembly for consideration,

committee members must review current

election rules and conduct necessary research.

The committee looks at election candidate

applications for completeness, which includes

verifying that each candidate’s membership is

current and that the candidate has the qualifi-

cations to run for ENA office, said Hummel.

The Nominations Committee also has the

responsibility for writing the questions the

candidates will answer at the Candidates’

Election Forum, which is held annually at

Leadership Conference.

“We write questions that are specific to the

president-elect, questions that are specific to the

secretary/treasurer and questions that are

specific to the director candidates,” said

Hummel.

In deciding which topics to cover in their

questions for the various candidates, Hummel

said the Nominations Committee considers

current issues in emergency nursing, hot topics

in the association, as well as national trends in

the practice. The committee also solicits

questions from the audience via a questionnaire

distributed during the Candidates’ Election

Forum for consideration in using at the next

year’s forum.

“We ask the audience what they would like

to hear addressed by the candidates, and then

we compile them, look them over and say,

‘Maybe this would make a good question for

next year,’” said Hummel. “We may tweak it a

little bit, but we enjoy taking suggestions from

the membership, because they are voting for

their future leaders. We want to be able to find

out what issues they want addressed.”

The Nominations Committee – which

increased its visibility with a new badge holder

ribbon at the 2012 Annual Conference in San

Diego last month – has been working tirelessly

to improve the voting turnout for the ENA

national election. Hummel was thrilled when

the election results jumped an entire percent-

age point this year. She credits several reasons,

including moving to an all-electronic ballot

and broadcast e-mails sent to remind members

to vote as well as e-mails highlighting the

election candidates.

“We are always open to suggestions from

the membership,” said Hummel, adding that

members can contact the committee at

[email protected].

Hummel also thanked the dedicated

Nominations Committee members whose

terms of service recently ended: Gail Carroll,

BSN, RN, CEN, and Carlene Kincaid, BSN, RN,

CEN.

The Nominations Committee’s responsibili-

ties include but are not limited to the

following:

1. Conduct a fair and equitable national

election, including the review of all

candidate applications and ratifying the slate

of candidates according to established ENA

bylaws, policies and procedures.

2. Review and update election rules and

procedures as needed.

3. Collaborate with staff to investigate ideas

and invest in methods that may promote

greater voter interest, visibility of candidates,

exchange of information and participation

in the election process.

4. Review and update the national candidate

application for content, ease of use and

effectiveness and assist potential candidates

throughout the election cycle.

5. Plan, promote and facilitate the 2013 Candi-

dates’ Election Forum at the annual

Leadership Conference.

6. Provide progress reports to the ENA Board of

Directors throughout the year.

ENA Nominations Committee: The Work Doesn’t End After the Votes Are TalliedBy Amy Carpenter Aquino, ENA Connection

Louise Hummel, MSN, RN, CEN, CNS Chairperson

Region 1

Cathy C. Fox, RN, CEN, CPEN Region 4

Ellen E. Ruja, MSN, RN, CEN, FAEN Region 6

Terry M. Foster, MSN, RN, CEN, CCRN, FAEN Region 3

Lucinda W. Rossoll, MSN, RN, CEN, CPEN, CCRN Region 5

Tiffiny Strever, BSN, RN, CENPast ENA Board Member

Scott E. Stover, MSN, MBA, ACNS-BC, CENRegion 2

October 201236

The ENA Foundation would like to extend a special thank you

to the individuals, state councils, local chapters, industry and

friends of emergency nursing who have supported the profession

through their generous donations. Because of your contributions and

passion to promote the advancement of the profession, our applicants are

afforded the opportunity to receive educational scholarships and research

grants in the discipline of emergency nursing.

The ENA Foundation is excited to announce the following 2012

scholarship and research grant recipients and share how our donors

are making a difference:

Academic Scholarship RecipientsNon-RN Scholarships• California State Council – Bryan Stow Scholarship – $5,000

Nathan Dreesmann, EMT – Washington

• New York State ENA September 11 Scholarships – $2,500 each

Khristeen Sproul, EMT – New York

Jon Manzano, NREMT-B – California

• ENA Foundation Non-RN State Challenge Scholarships –

$2,500 each

Deya Montalvo, EMT-B, Paramedic – California

Dana Johnson, EMT-B – Colorado

Matthew Onofrio, NREMT-P – Iowa

Jillian Conley, EMT-B – New Jersey

Undergraduate Scholarships• Charles Kunz Memorial Undergraduate Scholarship – $3,000

Rita Anderson, RN, CEN – Arizona

• Betty J. Smith, RN (Lt. Army Nurses Corps, WWII) Memorial

Scholarship – $3,000

Mark J. Smith, RN, CEN – North Carolina

• Board of Certification for Emergency Nursing (BCEN)


Adam Bruhn, RN, CEN – Nebraska

Graduate Scholarships• Stryker Masters in Healthcare Scholarship – $5,000

Kristen Connor, BSN, RN, CEN, PHRN – California


Masters in Healthcare Scholarship – $5,000

Cheyenne Brown, BS, RN, CEN – Utah

• AnnMarie Papa Stretcherside Miracle Scholarship – $5,000

Kimberly Johnson, BSN, RN – Michigan


Scholarships – $5,000 each

Diane Blackman, BSN, RN, CEN – Pennsylvania

Joyce Fuss, BSN, RN, CEN, CPEN – Indiana

Jonathan Green, BSN, RN, CEN, CCRN – New York

Lynn Sayre Visser, BSN, RN, CEN, CPEN – California

• Colorado State Council – Colorado Rocky Mountain


Cindi Warburton, BSN, RN, CEN – Oregon

• Kentucky State Council – Kentucky ENA Founders


Dawn McKeown, BSN, RN, CEN, CPEN – Louisiana

• Maryland State Council – Maryland ENA State Council


Megan Doede, BSN, RN, CEN – Maryland

• Minnesota State Council – “Pathways IV” Scholarship – $5,000

Mary Jagim, BSN, RN, CEN, FAEN – North Dakota

• Mississippi State Council – Sonja O. Adkins Mississippi State


Jennifer Denno, BSN, RN, CEN – California

• New Jersey State Council – Emergency Care Scholarship – $5,000

John R. Stott II, BSN, RN, CEN, CPEN – New Jersey

• New Jersey State Council – New Jersey State Challenge


Julie Ann Dale, MSN, RN, CEN – Missouri

• Northern Chapter (NJ) – Mary Kamienski Scholarship – $5,000

Dawn M. Sullivan Wright, BSN, RN, CEN – Indiana

• West Central Chapter (NJ) – Jeanette Ash Scholarship – $5,000

Jill McLaughlin, BSN, RN, CEN – New York

• South Carolina State Council – Antoinette Ruff-Johnson Memorial


Kathy Van Dusen, BSN, RN, CEN – California

• Tennessee State Council – Tennessee State Challenge


Kylie Kersten, BSN, RN – Arizona

• Texas State Challenge – Vicki Patrick Legacy Scholarship – $5,000

Tiffany Young, BSN, RN – North Carolina

• ENA Foundation Graduate State Challenge Scholarship – $5,000

Jennifer Lechota, BSN, RN – Michigan



Reagan Norman, BSN, RN, CEN – Indiana

• Physio-Control, Inc. Scholarships – $3,000 each

Nancy Alexander, BSN, RN, CEN – Ohio

Andrew W. McLuckie, BSN, RN, CEN, CPEN, CCRN – Pennsylvania

• Gisness Advance Practice Scholarship – $3,000

Terry Stigdon, BSN, RN, CPEN – Indiana

• Karen O’Neil Memorial Scholarship - $3,000

Theresa Sexton, RN, CEN – Massachusetts

• ENA Foundation State Challenge Scholarships – $3,000 each

Amanda Brothwell, BSN, RN, CEN, CPEN – Nevada

Lori L. Carlen, BSN, RN, CEN – Nebraska

Theresa Del Biondo, RN – Pennsylvania

Jenna Hannity, BSN, RN, CEN – Washington

Ruth Keniston, RN – California

Rachael M. Young, BSN, RN, CEN – Illinois

Katie Zielinski, BSN, RN – California

2012 Scholarship and Research Grant Recipients


Doctoral Scholarships• Pamela Stinson Kidd Memorial Doctoral Scholarship – $10,000

Laura E. Gallagher, MSN, RN, CNS, CEN – South Carolina

• Board of Certification for Emergency Nursing (BCEN) Doctoral

Scholarships – $5,000 each

Linda Roney, MSN, RN-BC, CPEN – Connecticut

Jennifer Williams, PhDc, RN, ACNS-BC, CEN – Missouri

• Hill-Rom Doctoral Scholarships –

$4,000 each

Kayla Thompson, BSN, RN, CEN – North Dakota

Patti Van Auker, MSN, RN, CEN – New York

Continuing Education Scholarship Recipients• Vidacare Annual Conference Scholarships – $500 each

Janice Alley, RN, CEN – Virginia

J. Richard Beshore, BSN, RN – California

Brandon “Kit” Bredimus, BSN, RN, CEN, CPEN – Texas

Teresa Brunt, RN – Utah

Kaleigh Byrne, BSN, RN – Virginia

Jenny Edmonds, EN, RN – United Kingdom

John Fraleigh, BSN, RN, CFRN – Arizona

Peter Giordano, BSN, RN – Illinois

Crista Jimenez, BSN, RN, CEN – Florida

Sherri Mimbs, RN – Florida

Andrea Rich, BSN, RN, CEN, CFRN – Arizona

Shannon Mazza Roberson, BSN, RN, CPEN – North Carolina

Deborah Robichaux, RN, CEN, CCRN – Georgia

Laura St. Clair, MA, BSN, RN – Wyoming

Jeanne Venella, DNP, MS, RN, CEN, CPEN – New Jersey

Michael Zonak, RN – New Jersey

Research Grant Recipients• ENA Foundation / Sigma Theta Tau International Research Grant

– $6,000

Jessica Draughon, MSN, RN – Maryland

• ENA Foundation / Sigma Theta Tau International Research Grant

– $3,000

Mary Johansen, PhD, NE-BC, RN – New Jersey

• Industry Supported Research Grant – Supported by Stryker – $5,000

Recipient not selected as of press time.

As a donor, you can make a difference in the future of emergency

nursing. Your donation will help to provide funding for research that can

improve the quality of patient care, build future leaders, support education

that can change the practice of medicine in the future and much more. If

you would like to join others in making a difference in emergency

nursing, the ENA Foundation has opportunities. Please visit

www.enafoundation.org to find out how you can contribute to

advancing emergency nursing.

With the ever-changing landscape of our

members who are becoming more

technologically savvy, ENA has listened by

putting the Conference Program for Leadership

Conference 2013 online at www.ena.org/lc.

Traditionally, we have

mailed out the Conference

Program with the October

issue of ENA Connection,

but by putting the program

online, you are guaranteed

to have the Conference

Program at your fingertips 24/7. This also

allows us to make the latest updates to the

program anytime, day or night.

Besides putting the Conference Program

online, we are also refreshing and updating the

look and feel of the program for a better

overall read. We are boiling over with

excitement about the new Conference Program

and we want to share some of those new

features, such as:

• Bulleted copy – For more detailed and

precise course information with more focus

on the objective of the course.

• Easier read – More course listings on a page

which will help you determine which

courses to take. This allows us to have fewer

pages in a more condensed format.

• Schedule-at-a-Glance – Think ‘‘TV Guide’’

format: better visual with side-by-side

information on when and where education

sessions and special events occur.

• Social media – A much larger social media

presence for not only ENA but to follow

keynote speakers, etc.

• Much more!

We could not be prouder of the

accomplishments we made this past year at

our Leadership and Annual conferences, but

there is much more work to be done to make

2013 even better. We hope you enjoy this

digital Conference Program.

Leadership Conference 2013 Conference Program Is Going Digital

October 201238

Arizona ENA State CouncilSubmitted by Tomi St. Mars, MSN, RN, CEN, FAEN

One of the many challenges that emergency nurses face on a daily basis

surrounds the management of pain for patients coming to the emergency

department. The patient with chronic pain is especially challenging for

emergency physicians and nurses alike. The ED is not the best environment

to fully assess, diagnose or provide definitive pain management.

Recently, AZ ENA representatives attended a collaborative, one-day

forum to discuss the scope of the problem, barriers in proper management,

standards of care and the resources in place to monitor ED prescription

drug use. The goal is to develop statewide guidelines for care of the

chronic pain patient and increase prescriber participation with the

prescription drug monitoring program. Currently, only 15.6 percent of all

prescribers are registered to use the system.

The July 18 forum was organized by the Arizona Department of Health

Services and provided representation from more than 60 health care

providers, which included ACEP, the Board of Pharmacy, AZENA, AHCCCS

(Arizona Medicaid), Indian Health Services, behavioral health organizations,

nursing and executive management from hospital systems throughout

Arizona, as well as DEA enforcement personnel. This collaborative activity

began with two emergency physicians recognizing a problem, developing

a program and providing insight to the implementation program currently

in use at one hospital system. Through education, a spark has ignited. One

such presentation to the AZENA membership in January 2012 grew to

include the forum in July and a proposed resolution presented at the ENA

General Assembly in September.

Florida ENA State CouncilSubmitted by Pattie Stadler, MS, BSN, RN, CEN, CCRN,

and Terri McGowan-Repasky, MSN, RN, CNS, CEN

Leading by Example

Every new year brings an opportunity to develop and grow strong leaders

within our organization. In the spring, the Florida Emergency Nurses

Association Executive Committee presented our Chapter Leaders

Orientation program. Chapter leaders from around the state were invited.

Florida is a three-tier state with 16 chapters. Two leaders from every

chapter were invited to attend the all-day workshop.

Topics included the following:

• Overview of ENA and FENA, including responsibilities of GA delegates

• Chapter Management/Responsibilities and Strategic Planning

• Responsibilities of Treasurer (chapter and state)

• Responsibilities of Secretary (chapter and state)

• Government Affairs and Resources

• Overview of ENA and FENA websites

This day offered more than just education; it provided an opportunity

to network and put faces and names together. State leaders had the

opportunity to meet and exchange ideas with the executive team in

a comfortable setting.

Florida: Manasota ChapterSubmitted by Jennifer Sweeney, MSN, BA, RN, CEN

On May 10, the Manasota Chapter of the Florida ENA State Council

co-provided the 2012 Nurses’ Week Research Conference with Sarasota

Memorial Healthcare System in Sarasota, Fla. The theme of the conference

was ‘‘The Power to Change Using Research.’’ This event brought together

nurses from all over the west coast of Florida to celebrate the value of

evidence-driven professional nursing practice. The event included

presentations from several nationally recognized speakers, as well as 14

poster presentations from local nurses who have made a meaningful

impact on professional nursing practice through the implementation of

evidence-based initiatives.

Poster presentations

highlighted evidence-based

projects, including the use of

high-fidelity simulation to

enhance ACLS team training,

Neonatal Abstinence Syndrome,

Preventing Falls, Emergency Obstetric ACLS skills, nursing knowledge of

geriatric-specific issues in acute care, and more. The Manasota Chapter was

thrilled to have the opportunity to collaborate with Sarasota Memorial

Health Care system in this highly successful professional nursing event. In

total, more than 50 nurses from all over the southwest Florida area joined

us in celebrating and supporting the value of evidence-based nursing

practice. We look forward to an even larger event in 2013.

North Carolina ENA State CouncilSubmitted by Mary Lou Forster Resch, BSN, RN, CEN

North Carolina had a great time in San Diego. We are honored and proud

to have had a voice in the decision-making process of our professional

organization. Thanks to everyone who stopped by our fundraising booth

and supported our endeavors.

Our membership blitz ran Sept. 1-30. We will award a free ENA

membership to the nurse who recruited the most new members.

We invite you all to Wrightsville Beach on Nov. 9 for our 8th Annual Fall

Conference. The planned presession is an ENPC Instructor Course, which we

hope to present at a very affordable fee. We have borrowed the ‘‘pay it

forward’’ concept from Leadership Conference and incorporated it into our

State of the State presentation. For more information, visit www.nc-ena.com.

Texas ENA State CouncilSubmitted by Christine Russe, MSN, RN, CEN, CPEN

The TENA Nursing Practice Committee was charged in 2012 with

submitting two position statements:

1 - Position Statement: Social Networking (statement addresses social

networking and potential privacy issues in the emergency care setting).

2 - Position Statement: Wireless Telecommunication Devices (statement

addresses any device that makes or receives phones calls, leaves

messages, sends text messages, capable of browsing the internet, or

downloads and allows for the reading of and responding to e-mail).

These ratified position statements were presented to and unanimously

approved by the TENA State Council on July 14.

These two Texas ENA position statements are a first for the Texas ENA.

They are the results of more than two years of diligent work by the Texas

ENA Nursing Practice Committee. The TENA Nursing Practice Committee

plans to provide additional position statements in the future. Thank you to

everyone who contributed to these TENA statements. These new TENA

position statements will soon be posted at www.txena.org. A Nurse’s

Guide to the Use of Social Media pamphlet by National Council of State

Board of Nursing was also disseminated to attending members. If you are

ENA STATE CONNECTION

Manasota (Florida) Chapter members Maribeth Desiongco, MA, RN-BC (left) and Jennifer Sweeney, MSN, RN, CEN, present the poster “A Hybrid Program Utilizing Heart Code ACLS & BLS with Simulation to Validate Competency.”


interested, additional copies may be obtained

free from NCSBN website.

Submitted by Rhonda Manor-Coombes,

BSN, RN

On July 14, the Texas ENA 3rd Quarter State

Council Meeting was held in Lubbock, Texas,

with two members attending the meeting via

WebEx. As press secretary/media chair, I was

charged with making participation possible for

those members unable to attend a state council

meeting.

WebEx is a Web conferencing tool that

combines desktop sharing via Web browsing and

phone conferencing. The only need is a

computer and reliable Internet access. I was able

to share my documents with the attendees after

they logged in. I could intermittently send chat

messages to the attendees to make sure that they

were still participating. The attendees were also

able to send me questions or comments that I

would then share with the council and delegates.

Monitoring participation is crucial, especially if

the member is to receive credit for attending a

state quarterly meeting. The only issue was

sound quality. While the attendees were able to

hear using a USB microphone I had attached to

my computer, they had a hard time hearing those

members who spoke softly.

One of ENA’s Strategic Plan priorities is to

expand and fortify ENA’s membership. I truly

believe that with remote access, this can be

accomplished. All in all, I would say that this

was a success. The idea of members remotely

accessing the meeting is a huge step and a

benefit for our members.

Virginia ENA State CouncilSubmitted by Janice McKay, RN, CEN, CFRN

Emergency department nurses see the

consequences of alcohol-related crashes, the

loss of life or crippling injuries and are in favor

of methods to decrease and prevent alcohol-

related crashes. Members of the Virginia State

Council were asked to support the House Bill

279 and Senate Bill 378 and contact their state

legislators to have these bills passed to prevent

drunk driving in Virginia.

Effective July 1, first-time driving-under-the-

influence offenders in Virginia may be

mandated by the court to have an ignition

interlock device installed in their vehicle for

resumption of driving privileges. Previously, the

law was a fine no less than $250, jail time and

suspension of their driving license for a year,

with stricter penalties determined by the blood

alcohol content of the offender. The ignition

interlock system was used as an option for

second-time offenders but is now required by

the court. Currently, 15 states have laws

mandating the use of interlock systems for

first-time convictions, and now Virginia joins

these states.

The ignition interlock system is used to limit

drunk driving since it has been documented that

DUI offenders will continue to drive under the

influence. The ignition interlock device requires

the driver to take an alcohol breath test every

time he or she gets behind the wheel, and it will

also do random tests or ‘‘rolling retest’’ while

driving to ensure the driver isn’t drinking while

driving. These devices are more effective than

license suspension because DUI offenders will

continue to drive under a suspended license.

Studies have shown that states using the ignition

interlock system can decrease DUIs by 66 percent.

Linda Whitt, BSN, RN, CEN, an emergency

nurse of more than 40 years, has seen the

consequences of driving under the influence

and the tragedies from alcohol-related crashes;

knowing her mother was an offender of

drinking and driving, she had an ignition

interlock device placed in her mother’s vehicle.

Whitt believes this device works and said, ‘‘I am

happy to say that she never hurt anyone

because I had the ignition interlock device

installed on her car to keep her from being able

to start the car while intoxicated.’’ Whitt said

she would not have been able to live with

herself if something happened while her mother

was driving under the influence, knowing she

had a problem and didn’t do anything about it.

Virginia’s goal is to decrease the number of

alcohol-related crashes and fatalities. Although

these have decreased over the years, the

ignition interlock can prevent more lives from

being lost in senseless crashes from DUIs.

Statistics from the Virginia Department of Motor

Vehicles and the Virginia Highway Safety Office

for 2011 reports that Virginia had more than

8,400 alcohol-related motor vehicle crashes

resulting in 245 fatalities and 5,465 injuries.

Although we won’t totally eliminate driving

under the influence, having a voice to decrease

DUI-related crashes by showing our support of

these bills acknowledges ENA’s mission in

injury prevention and saving lives.

New ENA monthly offering for FREE Continuing Education with contact hours for our members.

• Available October 1 – Improving the ED Flow 1.0 contact hour Barbara Weintraub, RN, MPH, MSN, APN, CEN, CPEN, FAEN

Don’t miss out on enhancing your education. Go to www.ena.org/FreeCE for additional free continuing education opportunites.

The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

October 201240

2012 Lantern Recipients Continued from page 27

ENPC 4th Edition Instructor Update

the beginning of care; however it can be

requested at any time, by anyone on the

treatment team. Performing a shared mental

model keeps the team grounded, allowing for

focus on the primary needs of the patient and

allows staff to hone in on the plan, providing the

opportunity to contribute suggestions.

Indiana University Health Methodist Hospital Emergency Medicine and Trauma Center (Indianapolis)Indiana University Health Methodist Hospital

Emergency Medicine and Trauma Center is part

of a not-for-profit, Magnet-designated academic

medical center and has an annual census of

108,000 emergency patients. Forty-nine percent

of hospital admissions come through the ED.

Success in improving patient flow is

demonstrated by the fact that the emergency

department has no boarded patients. Through a

strong shared governance model, collaborative

decision-making and staff nurse autonomy were

utilized in developing evidence-based strategies to

solve barriers to throughput and patient

satisfaction.

As part of a throughput improvement project,

a multidisciplinary team was established to

develop an escalation plan that included senior

leadership. All nursing directors were educated

on the National ED Overcrowding Score.

Through review of their processes, they realized

the need for a new nursing position, director of

operations. New processes were developed

following a root cause analysis which revealed

bottlenecks and discharge barriers. Their analysis

also showed the need for an upgraded bed

tracking system to expedite and improve bed

turnaround time, length of stay and ED length of

stay. As a result of these initiatives, the ED

decision-to-admit to arrival-in-an-inpatient-bed

time has been reduced by two hours. In

addition, ED door-to-provider time has decreased

from 17 minutes to four minutes, and the LWBS

rate dropped from 2 to 1.3 percent.

ENA Lantern Award ProgramFor more information about the ENA Lantern

Award Program, please visit www.ena.org/

IQSIP/LANTERNAWARD/.

particularly important when

healthcare personnel are working

long hours or night shifts, as well

as in emergency situations, all of

which are associated with a

higher rate of NSIs. Furthermore,

passive devices eliminate the

need for intricate training. The

drawback of higher cost might

be offset by lesser training

requirements and by cost savings

associated with a reduction in

NSIs (eg, serological tests,

counseling, post-exposure

prophylaxis, time off work, and

treatment).’’ 3

These costs don’t even include

the cost of one nurse who

becomes infected with HIV or

hepatitis C, or the human toll. If

we take safety seriously, we need

to recognize that products that are

not passively designed and

require training put nurses at risk.

In this study, “passive devices

were associated with the lowest

NSI incidence rate. Among active

devices, those with a

semiautomatic safety feature

were significantly more effective

than those with a manually

activated toppling shield, which

in turn were significantly more

effective than those with a

manually activated sliding

Shield.”3

A syringe with a retractable

needle is one example of a

passive device. When the

plunger of the syringe is pushed

down to deliver medication, it

triggers the needle to

automatically retract from the

patient before it is pulled out. So,

in the end, there is no

contaminated needle to harm

anyone. The needle is

immediately and safely enclosed

in the syringe. This type of

syringe has been available for

years, and yet, is still not

standard in hospitals.

The prevention of sharp

injuries and resulting illnesses

should begin long before nurses

hold a device in their hands.

Manufacturers have a need and a

responsibility to make devices

that are truly safe. Emergency

nurses are at special risk. They

deserve the same robust

protection that the public and

industry enjoy.

Letter From the President Continued from page 3

Board Meeting Actions and HighlightsThe ENA Board of Directors met July 18 via teleconference. All board

members were present and took the following actions:

• Approved the June 21 board of directors meeting minutes as written.

• Approved the Leadership Conference 2013 budget as presented.

• Approved a request to support the American College of Emergency

Physicians’ clinical policy: Critical Issues in the Prescribing of Opioids

for Adult Patients in the Emergency Department.

• Referred board governance policy 3.14, Board of Directors Stipends,

back to the Governance Committee.

• Approved a restructure of ENA committees as amended.

• Approved the following actions related to Trauma Nursing Core Course

and Emergency Nursing Pediatric Course Reverification as presented.

° TNCC and ENPC reverification will no longer be offered after

Dec. 31, 2012.

° Continuing education updates will be offered in place of the

reverification courses.

° New editions of the courses will be available every four years.

• Ratified Judith Halpern, MS, RN, APRN, as a replacement member for

the Emergency Nursing Resources Committee as presented.

• Ratified Carey Goryl, MSW, CAE, chief executive officer (International

Association of Forensic Nurses) and Kim Day, RN, FNE A/P, CFN,

SANE-A, SANE-P (IAFN) as the replacement Forensic Special Interest

Group co-facilitators as presented.

• The board agreed to continue appointing ENA representatives to the

American College of Emergency Physicians’ committees.

Highlights of the next scheduled board of directors meeting will be

published in a future issue of ENA Connection.

July 2012

References

1. Massachusetts Department of Public

Health Occupational Health

Surveillance Program. (2010). Sharps

Injuries among Hospital Workers in

Massachusetts, 2010: Findings from

the Massachusetts Sharps Injury

Surveillance System.

2. NIOSH Alert: Preventing Needlestick

Injuries in Health Care Settings.

(n.d.). Retrieved from

www.cdc.gov/niosh

3. Needlestick Injury Rates According

to Different Types of Safety-

Engineered Devices: Results of a

French Multicenter Study

William Tosini, MD; Celine Ciotti,

RN; Floriane Goyer, RN; Isabelle

Lolom, MSc; Franc¸ois L’Heriteau,

MD; Dominique Abiteboul, MD;

Gerard Pellissier, PhD; Elisabeth

Bouvet, MD.

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