Emergency Nurses Association and American College of Emergency Physicians

Senate Appropriations Committee

U.S. Government Response to the Ebola Outbreak

November 12, 2014

 

 

As national health care organizations whose members are on the forefront of providing emergency care to millions of Americans, we would like to commend the Senate Appropriations Committee for holding this oversight hearing on the U.S. government’s response, both domestically and internationally, to the Ebola crisis.

 

The Emergency Nurses Association (ENA) and the American College of Emergency Physicians (ACEP) collectively represent approximately 75,000 members who provide emergency care to more than 136 million patients in hospital emergency departments in the U.S. annually.

 

As first responders in this setting, we know our hospitals vary widely in their level of preparedness with respect to range of possible threats to the health and safety of Americans. Therefore, we urge swift action by Congress to ensure that our nation’s emergency care infrastructure and frontline hospitals have the resources to meet the challenges of public health emergencies such as the Ebola outbreak. Specifically, we request sufficient funding for regionalization emergency care systems, trauma systems and the  Hospital Preparedness Program be included in the Fiscal Year 2015 Labor, Health and Human Services, Education and Related Agencies Appropriations bill.

 

Response to Ebola Outbreak

 

Since the diagnosis in late September of the first Ebola patient in the United States, Thomas Eric Duncan, ACEP and ENA have provided its members and the general public with sound, science-based information regarding the disease, and we continue our work to ensure that health care professionals working in emergency departments are properly equipped to handle future Ebola cases.

 

Our two organizations have also formed a panel of experts consisting of emergency nurses and emergency physicians with expertise in infectious disease and disaster preparedness. The panel worked closely with the Centers for Disease Control and Prevention (CDC) in establishing procedures for emergency departments to identify, isolate and manage patients suspected of possible Ebola infection. The resulting guidelines, which CDC published on October 25, establish consistency for emergency care workers and reflect lessons learned from the recent experiences of U.S. hospitals caring for Ebola patients. The guidelines include detailed triage recommendations for processing patients who come to emergency departments.

 

In addition, the CDC consulted with the ACEP-ENA expert panel in developing additional guidelines that provide explicit direction to health care professions for handling possible Ebola patients in ambulatory settings.

 

Both of our organizations will continue to provide our expertise to the CDC as they continue to respond to this crisis and develop guidelines for treating patients and preventing the spread of Ebola to healthcare workers and the general population.

 

Funding and Reauthorization of Regionalized Emergency Care Programs

 

The care received by Ebola patient Thomas Eric Duncan, the infection of two nurses treating Mr. Duncan at Texas Health Presbyterian Hospital, as well as the potential for additional people becoming infected with the Ebola virus, underscores the urgent need for developing a coordinated, regionalized approach to emergency care. It is simply not sufficient to have a hospital-by-hospital response to public health emergencies, whether it is the spread of a viral disease or mass casualty event.

 

As such, we request you include a total of $6 million in funding for the two programs contained in S. 2405/H.R. 4080 - the Regionalization of Emergency Care Systems and Trauma Systems Planning Grants. The first program would design, implement and evaluate innovative models of emergency care systems. The second provides grants to states for developing well-functioning and integrated trauma systems.

 

Both of these programs address dangerous deficiencies that exist in our nation’s current emergency care system. A 2006 Institute of Medicine report, the Future of Emergency Care in the United States Health System, found that hospital emergency departments and trauma centers across the country are severely overcrowded and emergency care is highly fragmented. Most disturbing, the IOM found that the nation’s emergency care system is “very poorly prepared to handle” natural disasters, a disease outbreak or a terrorist attack.

 

To alleviate this situation, the IOM called for a complete overhaul of our nation’s emergency care apparatus by creating a coordinated, regionalized and accountable system of care. According to the report, the “objective of regionalization is to improve patient outcomes by directing patients to facilities with optimal capabilities of any given type of illness or injury.”

 

Unfortunately, the Ebola crisis and the infection of the two nurses in Dallas have exposed the dangers of not moving forward with the development of a coordinated and regionalized approach to emergency care. Such a system will direct patients immediately to the facility that is best suited to provide optimal care. It will also help ensure that hospitals where patients are sent have the procedures and protocols in place to properly protect our health care professionals and the general public.

 

In addition to providing $6 million in funding for the Regionalization of Emergency Care Systems Program and the Trauma Systems Grant Program, we urge you to reauthorize these two programs by passing S. 2405/H.R. 4080 as part of any appropriations bill considered during the lame duck session. Earlier this year, the legislation was approved by the Senate Health, Education, Labor and Pensions Committee and in the full House of Representatives by voice vote. Reauthorization will ensure that support for these important programs will be able to continue through fiscal year 2019.

 

 

Restore Funding for the Hospital Preparedness Program

 

The Ebola crisis has also highlighted shortfalls in the ability of our hospitals to properly respond to a variety of public health threats, as well as the need for ongoing training of health care professionals to prepare for a variety of epidemics, natural disasters or terrorist attacks.

 

The Hospital Preparedness Program (HPP) is a critical tool for improving the capability of our hospitals to handle public health emergencies such as Ebola. HPP provides resources for training staff and running drills and exercises. This preparation includes learning how to safely don and remove personal protective equipment, establishing appropriate isolation protocols and ensuring readiness from the first moments of a crisis through the end of an emergency.

 

HPP has suffered drastic budget cuts in recent years and has been reduced by 50 percent since 2003. We urge Congress to restore funding for HPP to its authorized level of $375 million in fiscal year 2015.

 

Thank you in advance for your consideration of these requests.

 

 

Deena Brecher MSN, RN, APN, ACNS-BC, CEN, CPEN 

2014 ENA President

 

Michael J. Gerardi, MD, FAAP, FACEP

ACEP President

 

 

Contact Information:

 

Richard Mereu

Chief Government Relations Officer

Emergency Nurses Association

2121 K Street, NW

Suite 325

Washington, DC 20037

richard.mereu@ena.org

Tel: 202-741-9373 (office)

 

Brad Gruehn

Congressional Affairs Director

American College of Emergency Physicians

2121 K Street, NW

Suite 325

Washington, DC 20037

bgruehn@acep.org

Tel: 202-370-9297 (office)

  

 

 

 

                      

 

 

                                       

 

 

 

 Please go to the following link for important information and resources regarding ebola from ENA:

 http://www.ena.org/about/media/ebola/Pages/default.aspx 

 

     

 

 

Joint Statement: Specialty Nursing and Leadership Organizations Commit to Partnership

 


Recent events leading to the transmission of the Ebola virus from a patient to two critical care nurses punctuate the importance of the vital partnership that must be diligently fostered between our bedside clinicians, nursing leadership and hospital administrators. 

 

Nurses in our nation’s emergency and critical care settings are the front line professionals who provide and coordinate continual care for the sickest patients in our health care system. While the Ebola virus is new to this country, the complications that can be associated with the virus—such as organ failure, shock and sepsis—are frequently managed by our more than 150,000 combined nurse members. This is what our nurses do every day. Their colleagues in nursing administration are stewards entrusted to ensure that hospital resources and systems optimally support the important work of nurses and their multidisciplinary care partners.

 

To live our value of true partnership, we have called upon the members of our three organizations: 

  • to pledge their commitment to collaborate in identifying resource and system gaps that have potential to harm patients or caregivers,
  • to work together, with urgency, to put solutions in place that will prevent the spread of this disease and
  • to sustain this collaboration to fulfill our promise to patients and their families that they will receive excellent care.

 

 

 

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN joins together the interests of more than 500,000 acute and critical care nurses and claims more than 235 chapters worldwide. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. For more information, visit the AACN website at www.aacn.org

 

About the American Organization of Nurse Executives: The American Organization of Nurse Executives (AONE) is the national professional organization for nurses who design, facilitate and manage care. With more than 8,500 members, AONE is the leading voice of nursing leadership in health care. Since 1967, the organization has provided leadership, professional development, advocacy and research to advance nursing practice and patient care, promote nursing leadership excellence and shape public policy for health care. AONE is a subsidiary of the American Hospital Association (AHA). For more information, visit the AONE website at www.aone.org.

 

About the Emergency Nurses Association: The Emergency Nurses Association (ENA) is the premier professional nursing association dedicated to defining the future of emergency nursing through advocacy, education, research, innovation, and leadership. Founded in 1970, ENA has proven to be an indispensable resource to the global emergency nursing community. With more than 41,000 members worldwide, ENA advocates for patient safety, develops industry-leading practice standards and guidelines, and guides emergency healthcare public policy. ENA members have expertise in triage, patient care, disaster preparedness, and nearly all aspects of emergency care. Additional information is available at www.ena.org.

 

 

 For media inquiries, contact: 

Kristie Aylett, AACN, (228) 229-9472

Stacey Chappell, AONE, (312) 422-2802

Marie Grimaldi, ENA, (847) 460-4090 

 

 

 

 

Teen Alcohol Use Continues to Fall
By MADD | October 20, 2014| Filed in: Underage Drinking , Power of Parents

According to new numbers released by the Department of Health and Human Services, Drug and alcohol use among America's teens continues to decline.

From 2002 to 2013, the rate of regular alcohol use among teens (12 to 17) declined from 17.6 percent to 11.6 percent.

These findings come from the 2013 National Survey on Drug Use and Health (NSDUH),an annual, nationally-representative survey of roughly 70,000 Americans aged 12 and older.

Despite a common myth that “everybody’s doing it,” we know that two out of three teens DON’T drink alcohol. And this new report proves it.

We are excited to hear this trend is continuing, especially with Red Ribbon Week just around the corner Find out how you can help reduce the deaths and injuries that come from underage drinking by visiting www.madd.org/redribbonweek to download all of our free Red Ribbon Week resources and learn how you can get involved in your community.


 

 

Teen Alcohol Use Continues to Fall
By MADD | October 20, 2014| Filed in: Underage Drinking , Power of Parents

According to new numbers released by the Department of Health and Human Services, Drug and alcohol use among America's teens continues to decline.

From 2002 to 2013, the rate of regular alcohol use among teens (12 to 17) declined from 17.6 percent to 11.6 percent.

These findings come from the 2013 National Survey on Drug Use and Health (NSDUH),an annual, nationally-representative survey of roughly 70,000 Americans aged 12 and old

Despite a common myth that “everybody’s doing it,” we know that two out of three teens DON’T drink alcohol. And this new report proves it.

We are excited to hear this trend is continuing, especially with Red Ribbon Week just around the corner Find out how you can help reduce the deaths and injuries that come from underage drinking by visiting www.madd.org/redribbonweek to download all of our free Red Ribbon Week resources and learn how you can get involved in your comm

 As you may know, the current Ebola outbreak is the largest in history and is primarily affecting countries in West Africa, including Guinea, Liberia, Nigeria and Sierra Leone.  On Sept. 30, the Centers for Disease Control and Prevention (CDC) confirmed the first travel-related case of the disease in the United States at Texas Health Presbyterian Hospital in Dallas.


Given this development, we urge all nurses to review resources provided by CDC including: infectious disease guidelines and checklists to understand the disease, how it is transmitted and what precautions are necessary to protect the public and health care providers.


It is critically important that all health care team members have appropriate knowledge, education and personal protective equipment to ensure safety and effectively provide care to patients. ANA also underscores the need to practice meticulous infection control at all times.
 

Furthermore, the Dallas case revealed a critical flaw in the hospital’s electronic health record. This is a call to action for the entire health care team to review its processes and checklists in order to improve the flow of information and continuously improve practices that result in improved safety for everyone involved.
 

The key to preventing the spread of Ebola is to identify and isolate potential cases as quickly as possible. The CDC has multiple resources that provide additional information about Ebola infection control and patient management, including:

 

CDC Health Advisory:  Evaluating Patients for Possible Ebola Virus Disease: Recommendations for Healthcare Personnel and Health Officials 


 CDC Ebola Outbreak Information: :::

 http://lists.ana.org/t/1041925/9191230/12956/29/ 

 

Guidelines for infection prevention control for hospitalized patients with known or suspected Ebola in U.S. hospitals: 

http://lists.ana.org/t/1041925/9191230/12957/30/ 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • CDC HEALTH ADVISORY - Recommendations for Laboratory Testing for Acetyl Fentanyl and Patient Evaluation and Treatment for Overdose with Synthetic Opioids
     
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    Emergency Nurses Report Need for Evidence-Based Discharge Protocols

    No objective measures of discharge readiness found after narcotic medication administration

     
    DES PLAINES, Ill., (August 19, 2014) – Emergency nurses report a surprising lack of consistency in criteria for discharge after emergency department patients receive Schedule II or III narcotic medications. These findings appear in a new study published online today in the Journal of Emergency Nursing, the peer-reviewed journal of the Emergency Nurses Association (ENA) 
     
    Researchers conducted a qualitative study of 19 emergency nurses from around the U.S., who practice in a variety of emergency settings,to understand their perceptions about common practices related to discharge after administering Schedule II or III narcotics. They examined dosage, time,availability of care resources, and other criteria. Schedule II and III narcotics are often prescribed to treat acute pain and include opioids such as codeine, morphine, and Vicodin®.
     
    According to the research by Lisa Wolf, PhD, MS, RN, CEN, FAEN, Altair M. Delao, MPH, and Cydne Perhats, MPH, of the Institute for Emergency Nursing Research at the Emergency Nurses Association in Des Plaines, Ill., all study participants reported their emergency department had no evidence-based discharge policy for patients receiving strong narcotic medications. Few reported having any policy related to discharging these patients.
     

    Drug-to-discharge timeframes ranged from zero to 240 minutes after administration of Schedule II and III narcotics, and the most common reason for a wait was attributed to assessing a patient for a reaction. Criteria used for discharge readiness included assessing physiologic, cognitive, and social conditions. Yet no objective measures for readiness were noted.  
     
    Respondents say the decision about patient readiness for discharge is left largely to the primary nurse. Discharge practices vary, and are often administrative personnel-dependent as opposed to administrative systems-dependent.  
     
    The study reveals these healthcare practices are largely based on tradition rather than evidence. Researchers note that further studies are needed for developing, implementing, and evaluating a discharge tool based on evaluation of patient outcomes, along with nurse satisfaction and confidence.
     

     


    https://drive.google.com/file/d/1DZGnlg91q55ps_Zo2GuGW6zj2o5x03UyH_sevNJgztFlq8_WcMwUKATNmyqA/edit?u 

     

     

    Emergency Nurses Association Launches Free Online Workplace Violence Course 
     

     

     

     

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     Check out the new tabs on the left of the home page for Child Abuse and Burn Injury Reporting. This link provides you with Mandatory Reporting Forms that you can print for reporting Child Abuse and Burns; there is also a direct number to the Louisiana Child Abuse Hotline provided for you!!!! 

     

     

             

     

     

     was approve 

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     https://docs.google.com/file/d/1wTWLM_xMsVsheXQOX1cOOM2NXvfYJm1jnLLMJ7ACQGdzujyXJHPg9FYiItr9/edit?usp=sharing  

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

                

    Emergency Nurses Association Applauds Texas Legislation that Raises Assaults Against Emergency Department Personnel to Third Degree Felony

     

     

     

     

     

     

     

     

     

     https://drive.google.com/file/d/1DZGnlg91q55ps_Zo2GuGW6zj2o5x03UyH_sevNJgztFlq8_WcMwUKATNmyqA/edit?usp=sharing