History of Emergency Nursing

1. History of Emergency Nursing Mary Corcoran RN,BSN,MICN Clinical Nurse Educator ARMC-ER

2. Who are you? • What’s YOUR history? • Why ER?

3. “The Father of Modern Medicine” • Western European concepts of nursing were first practiced by male Catholic monks who provided for the sick and ill during the Dark Ages of Europe. • In fifth century BC, Hippocrates was one of the first people in the world to study healthcare, earning him the title of "the father of modern medicine".

4. Nursing • In 17th Century Europe, Nursing care was provided by persons serving punishment. It was associated with prostitutes, and women serving time for other crimes • These persons had a reputation of being drunk and obnoxious, a view amplified by the physicians of the time to make themselves seem more important and able

5. France By the 1600’s the French Sisters of mercy was one of the first organized nursing orders that responded to care for epidemic victims.

6. France • During the French Revolution (1789), after seeing the speed with which the carriages of the French flying artillery maneuvered across the battlefields, French military surgeon Dominique Jean Larrey applied the idea of ambulances, or "flying carriages", for rapid transport of wounded soldiers to a central place where medical care was more accessible and effective. Larrey manned ambulances with trained crews of drivers, corpsmen and litter-bearers and had them bring the wounded to centralized field hospitals, effectively creating a forerunner of the modern MASH units. Dominique Jean Larrey is sometimes called the father of emergency medicine for his strategies during the French wars

7. USA • Nurses in the United States Army actually started during the Revolutionary War when a general suggested to George Washington that the he needed female nurses "to attend the sick and obey the matron's orders. In July 1775, a plan was submitted to the Second Continental Congress that provided one nurse for every ten patients and provided that a matron be allotted to every hundred sick or wounded"

8. Florence Nightingale • It was not until Florence Nightingale, a well-educated woman from a wealthy class family, became a nurse during the Crimean War, and improved it drastically that people began to accept nursing as a respectable profession.

9. Foundation of Nursing Schools • On the heels of Florence Nightingale Agnes Jones worked to establish Nursing Schools in the US • Linda Richards was the USA’s first professionally trained nurse to graduate from Boston’s New England Hospital for Women and Children in 1873.

10. WW1 http://www.youtube.com/watch?v=T3bzQELnCH0&feature=related • As the country grew and suffered war the skills of nurses around the country improved and the profession took hold in the military

11. WWI and “The Great Influenza” • The Spanish flu out break in 1918 killed 50-100 million people world wide • Nurses and physicians were prime targets, as the disease killed people between ages 20-40 • Nurses and physicians of the time discovered if they separated patients washed their hands, after touching infected persons, and wore masks to protect themselves it spread slower

13. WWII • The Profession of nursing was transformed by WWII • Integrating the concept of tender and caring nursing, with skilled well-trained efficiency

14. WWII • All branches used enlisted men to care for wounded in the field (a precursor to modern day paramedics), and the nurses were used to supervise, and provide specialized care. • In military units, male doctors supervised female nurses, and both were officers, while the women in practice supervised large numbers of enlisted men

15. WWII • There were no male nurses in the American military until years later • Army and Navy nursing was highly attractive and a larger proportion of nurses volunteered for service higher than any other occupation in American society

16. Post War Care The military nurses returned home as the nation’s experts in blood transfusion and the application of new drugs like penicillin. When the nurses returned home they used the previously powerless American Nurses Association to take control of the nursing profession

17. Post War Care • Prior to the war ER’s were staffed on an “as needed” basis. • 15-30yrs after the war the ER’s changed in to a more specialized model, and the family physician was no longer required to be available 24/7

18. Post War Care • Hospitals became more community sources of help and information instead of institutions only for the seriously ill or injured • As more patients arrived to ED’s hospitals were forced to assign increasing numbers of nursing staff to provide care, even though the roll was not clearly defined

19. Paramedics At the same time ER’s were becoming more recognized, transport of patients to hospitals for care was also gaining attention

20. Paramedics Community leaders recognized that lessions learned from WWII and the Korean Conflict about triage, field care and rapid transport could be translated to civilian practice During Korea Air ambulance transport was initiated

21. Korean “War” • http://www.youtube.com/watch?v=kN7_xLte2Yk • One of my favorite TV shows (MASH) depicts the Korean War • Several medical advancements were made during this time including the discovery of normal saline

22. Vietnam War Launched “operation nightingale” and intensive recruiting effort for the war Due to the shortage of staff, nurses usually worked twelve-hour shifts, six days per week and often suffered from exhaustion

23. 1960’s-1970’s As the roots of ER care took hold, several nursing associations and groups developed to continue the advancement of Emergency nursing as a specialty The EDNA (now ENA) published the first Core Curriculum standards of Emergency Nursing Practice and the Journal of Emergency Nursing

24. EDNA At the end of the 1970’s the EDNA continued to validate the specialty of emergency nursing , and ED nurses were beginning to further define their roles in flight nursing, Mobile intensive care nursing (MICN), administration, education, and providing much needed research.

25. 1980’s First CEN exam given TNCC (Trauma Nurse Core Course) began Emergency Nurses day Created

26. 1990’s • Characterized by Innovation and Leadership • Guidelines published to support ER nursing and patient care • Mandated Universal Protection Equipment • Continued Educational innovations • Studies and Research done on Workplace and patient safety

27. 2000’s and Beyond • Continue to address concerns with ED overcrowding, holding patients, rising costs, safety in the workplace, and nursing shortage • After 9/11 Bioterrorism and WMD training emphasized • 5 level triage system implemented in many ER’s around the country

28. The Future… As ER nursing becomes more complex, and specialized, the need for research, and continued growth is vital. We will be forced to continuously grow and adapt to overcome the challenges we face everyday. Guiding our profession into the next decade.