Adapting to Chaos: Emergency Nurses Practicing on the Front Lines

September 11, 2019

SCHAUMBURG, Ill. (Sept. 11, 2019) – In the emergency department, every day brings a different crisis. Fortunately, health care professionals have the skills, training and resources necessary to deliver lifesaving care.

But what happens when the resources, even the basics of electricity or running water aren’t available? How can emergency care be delivered on the front lines of a war-torn country or a city decimated by a hurricane? The realities, challenges and successes within the resource-constrained world of austere medicine will be showcased during Emergency Nursing 2019 – the Emergency Nurses Association’s annual education conference – coming up Sept. 29-Oct. 2 in Austin, Texas.

Back by popular demand, Global Response Management members Alex Potter, BSN, RN, and former Army nurse Helen Perry, MSN, RN, ACNP-BC, CEN, will share their stories of delivering trauma care in Iraq during the battle for Mosul in 2016 and 2017. GRM, an international medical non-government organization, delivers pre-hospital emergency medical care in the field to those living in or having been displaced by conflict zones, focusing specifically on the Middle East.

“First-world medicine doesn’t happen in the third world,” said Perry. “In the United States, about 53 percent of patients entering the emergency department are minimally injured. Our data from these conflict zones show that 53 percent of our patients are critically injured. It means we must anticipate the injuries we’ll have to treat before we get there – blast injuries, burns, gunshot wounds or effects from chemical weapons – and be prepared for the worst with limited resources.”

But delivering urgent trauma care requires setting up on the front line. It pushes the envelope – getting as close to the danger as possible while staying relatively safe.

“If we’re too far from the people we need to treat, we aren’t going to save lives,” said Potter. “The first 10 to 60 minutes is when we can do the most good and if we’re set up far away, it could take 45 minutes to reach the impacted area. That doesn’t help anyone. We have to find safety in proximity. Dilapidated classrooms, old homes, anywhere we can safely but efficiently use to create a makeshift trauma center, we will use. It’s allowed us to deliver a pre-hospital survival rate of ninety-four percent. That’s on par with the U.S. military and one of the best among other NGOs committed to this type of work.”

While the work of ENA members Perry and Potter with GRM is very specific to militarized zones and areas with limited resources, their practices are not lost on the rest of the medical community. Catastrophic health care failures are seldom, but do occur in the United States, most notably the aftermath following Hurricane Katrina in New Orleans when 45 bodies were recovered from Memorial Hospital because they were unable to complete an evacuation.

“We want emergency nurses to learn from our experiences and ask themselves how prepared they are,” said Potter. “What plans are in place if their emergency department experiences a catastrophic disaster? Are they prepared to evacuate an entire hospital at a moment’s notice? Are they prepared to care for patients without electricity or running water? There is so much we take for granted in this profession and we have to ask ourselves, ‘What will I do if it is all taken away?’”

ENA President Patti Kunz Howard, PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN, sees an important linkage between austere experiences and their relevance in the traditional ED setting.

“Emergency nurses have the unique ability to adapt and meet challenges head on,” Howard said. “We do that daily in a hectic but controlled environment. Helen and Alex experienced chaotic conditions most of us cannot imagine. Their stories and experiences pose a new challenge to our nurses: to go back to their emergency departments and determine how prepared they are for the unthinkable.”

For more information on Emergency Nursing 2019, visit the

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 43,000 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 all aspects of emergency care. Additional information is available at

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