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the dynamics of the mission, the lessons learnt, and proposea way forward for future AUSMAT teams in disaster zones.

Abstracts

episodes of bypass and off-stretcher times; improve clini-cal handover and relationships between wards and ED; andincrease documentation compliance

Significance: The PAH ED sees 46,000 patients/year(09/10) with 36% admitted to hospital. With 41% of patientswaiting >8 h to be admitted this is a risk to patient safetyand decreases patient satisfaction

Strategy and implementation: Using lean-thinking thecurrent state was mapped, patients ready for admissionwere tracked, staff were surveyed and documentationaudited. After analysing the results the strategy was tohave clinical unit nursing staff manage the admission ofthe patient instead of ED staff. Implementation included amarketing campaign to all staff. This included A3 posters,general media communication, screen savers, tours to ED,presenting at all staff forums leading up to the imple-mentation. Development of 24-h communication links formanagement of patients to be admitted. This includedgeneric email address, designated hotline phone number.Implementation of a green (READi) line on the floor to actas a visual cue to direct staff to the collection point in ED.Development and implementation of checklists, workplaceguidelines outlining roles and responsibilities of each mem-ber of the team. Finally the development of daily and weeklyfeedback loops and an evaluation processes

Evaluation: The average time for a patient to leave EDonce identified as ready to leave significantly improvedby an average 32 min (p = 0.000). Documentation demon-strated improvement in most components including clinicaldocumentation and patient property with significance fromp = 0.000—0.003. There is a daily saving on average of 10 hadditional emergency nursing time related to not being outof department on ward transfers.

Implications for practice: READi has shown that stream-lining systems to improve the journey of patients from EDto the clinical unit has significantly improved patient careand reduced risk of harm. It has fostered a whole of hospitalapproach to management of ED capacity and throughput ofpatients. It has significantly improved the nursing time spentin ED directly related to not being on ward transfers.

doi:10.1016/j.aenj.2011.09.024

Intraosseous access and the emergency nurse

Kane Guthrie

Sir Charles Gairdner Hospital, 2/115 Lockhart Street,Como, WA, 6152, AustraliaKeywords: Intraosseous; Difficult access; Intraosseousroute; Christchurch earthquake disaster

E-mail address: kaneguthrie@gmail.com.

The use and role of intraosseous access in the adultpatient has dramatically changed over the past decade.Originally used in the child with difficult vascular access,is now readily supported by literature highlighting its effec-tive use in the adult patient. The humble manual needle

device as a means of access has come a long way when com-pared to current intraosseous devices consisting of powerdriven bone injection guns that can insert an intraosseouscatheter in under 10 s with first pass success rates between

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2 and 97%. Recently published case reports have demon-trated successful administration of fibrinolysis in a STEMIatient, massive transfusion of blood products in the resus-itation of massive obstetric haemorrhage, and successfuldministration of computed tomography contrast in a multirauma patient all via the intraosseous catheter route. Thentraosseous catheter has changed the way we look at vas-ular access in the difficult vascular access patient in bothmergent and non-emergent situations, and should be a coreomponent in every emergency nurses’ armamentarium.

The presentation will cover:

Review of the literature surrounding intraosseous use inthe adult patients.Notable published case reports demonstrating the effec-tiveness of intraosseous access.The indications for intraosseous use in adult patients.The role of the emergency nurse in insertion and manage-ment of the intraosseous device.

oi:10.1016/j.aenj.2011.09.025

hristchurch earthquake disaster. The lived experienceUSMAT deployment February 2011

ob McDonald-mail address: robvmcdonald@iprimus.com.au.

12:51 h New Zealand time, a 6.3 magnitude Earthquaketruck the second largest city in New Zealand. Christchurchuffered large scale destruction, injury and loss of life. Atate of civil Emergency was declared and the New Zealandovernment made a request to Emergency Managementustralia for medical assistance.

Emergency Management Queensland in conjunction withueensland Health were tasked to provide an AUSMAT teamo respond to the health needs of the affected people ofhristchurch.

A 24 person team comprising of Medical, Nursing anddministration specialists were deployed and landed inhristchurch within 36 h. This team aligned themselvesith a 6 person Queensland Ambulance Service, Specialperations Response Team (SORT) and established a ‘Fieldospital’ in the eastern suburbs of Christchurch — a lowocioeconomic area with vast cultural diversity that wasignificantly impacted by the earthquake with no runningater, sewage, power and limited access to medical assis-

ance.This presentation will focus on the lived experience of

he staff responding to a disaster for the first time. It willeflect on the Emergency Nurses ability to adapt and respondo new situations. It will also detail challenges faced, whatas achieved and consider the emotions felt and individualreparedness when being deployed to a disaster for the firstime.

Another member of the AUSMAT nursing team will explore

oi:10.1016/j.aenj.2011.09.026