Chapter 02 : Experience in Emergency Management
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Description
Dr. Porter begins this chapter by observing that she was a trauma nurse for ten years before taking on opportunities in emergency management. She notes that trauma parallels emergency situations, and she was intrigued by the need for quick thinking and fast decision-making.
She served as Manager of Emergency Services at Englewood Hospital in Englewood, New Jersey (1991 – 1997), an institution situated near a busy highway. She focused on response strategies around hazardous materials. Next, she was recruited to set up a Trauma Center at Good Samaritan Hospital in Suffern, NY and served as Director of Critical Care and Emergency Services (1997 – 1999). She explains why this hospital needed a trauma center. She also discusses how the hospital worked with the Hasidic Jewish population, to ensure effective healthcare delivery. She also notes that this hospital was located near Indian Point Nuclear Power Plant, necessitating that the hospital conducts nuclear drills.
In 1999, she explains, she was recruited to Lenox Hill Hospital in New York City to serve as Director of Emergency Services, Emergency Preparedness, and also as the Bioterrorism Coordinator. She explains that the hospital was receiving terrorist threats and also dealing with concerns about the impending millennium.
Dr. Porter then returns to her discussion of her work at “Good Sam” and explains that she had the valuable opportunity to work with a military emergency management specialist at this time. She notes that she provided about 300 instructional sessions for dealing with hazardous materials and threats.
Identifier
PorterC_01_20180104_C02
Publication Date
1-4-2018
City
Houston, Texas
Interview Session
Carol Porter, DNP, RN, FAAN, Oral History Interview, January 04, 2018
Topics Covered
The Interview Subject's Story - Professional Path; Overview; Professional Path; Evolution of Career; Leadership; On Leadership; Professional Practice; The Professional at Work; Character, Values, Beliefs, Talents; Women and Minorities at Work; MD Anderson Culture; Working Environment
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Carol Porter, DNP, RN, FAAN:
I was a trauma nurse when I was a clinical nurse, and trauma nursing is very similar to emergency management. When you have a trauma patient come in the door, the first half-hour or so is so vital, and you can’t not know what you’re doing. So it’s the same thing, in an emergency, you have to be with somebody at least that knows what they’re doing, or a group that knows what they’re doing. It’s the same thing in trauma nursing. You’re part of a team, but you have to make sure that there’s people with experience on that team, as well as people coming into the field, but many people that have experience. It’s the same thing here.
T.A. Rosolowski, PhD:
Well, let me ask you the question that the Executive Committee asked you, which is kind of where it started. When was the moment when you decided to pursue emergency preparedness, emergency leadership, as part of your career?
Carol Porter, DNP, RN, FAAN:
I was a nurse for about ten years and had been fascinated, trying to understand what emergency nurses do, and so I used to, whenever I had a break, I would go down to the Emergency Department and kind of watch them.
T.A. Rosolowski, PhD:
What was it that intrigued you about that scenario?
Carol Porter, DNP, RN, FAAN:
I think the thinking on your feet in seconds. I think the challenge to—it challenges everything you’ve learned and you have to know—you have to be a generalist. At most emergency centers, you have to know a good portion about everything. So, I found that challenging, I found it very rewarding, watching them save people’s lives of if they couldn’t save their lives, how they handled that piece of it, but I didn’t have the nerve to go into emergency nursing for ten years. When I hit about ten years, I transferred to the Emergency Department as a clinical nurse and fell in love with it, I mean totally fell in love with it.
T.A. Rosolowski, PhD:
What institution were you with at the time?
Carol Porter, DNP, RN, FAAN:
This was a hospital in New Jersey, it was a small community hospital, probably about, I don’t know, three hundred beds. It’s called Wayne General Hospital, now it’s called Wayne General Hospital. At that time, it was called Paterson General, but it was in Wayne, New Jersey, the same hospital. So I went there and it was the physical location, geographically, we were in the suburbs of a city, in a catchment area, where we got a lot of trauma. We were not a trauma center but we got a lot of trauma, and I became expert at that, I just loved it. And that was the teamwork, you know? You knew the physicians who were on, the surgeon on call, it worked seamlessly.
T.A. Rosolowski, PhD:
What were the particular gifts that you brought to that team? Everybody brings something different.
Carol Porter, DNP, RN, FAAN:
Well, in the beginning I just, I guess because I was so interested in it, I was so excited by it, because I didn’t know it. I knew critical care but I didn’t know the quick decision making, the fast action, thinking on your feet like that. I was always with nurses and doctors, the doctors who were emergency certified doctors, and the nurses were experienced ER nurses. I had one particular nurse that was—I thought she just knew everything about it, and she took me under her wings and she just taught me everything.
T.A. Rosolowski, PhD:
What was her name?
Carol Porter, DNP, RN, FAAN:
Kathy Lindsay, L-I-N-D-S-A-Y. So I never was in a position where, if I didn’t know something, I couldn’t turn to the person next to me and say listen, what do I do? And then once you go through a couple of scenarios of patients that are really on the edge of death and you get them back, that’s like, that’s what feeds that, it’s amazing. So from there, I went to another Emergency Department, as a supervisor, eventually, and this is how I got into the emergency management piece. This was the emergency nursing piece, but the emergency management piece was that when I went to a different hospital that was close to two major highways, and they were transporting hazardous chemicals on the major highways. So, hazardous materials preparedness started to be what everybody was learning, all the EDs [Emergency Departments]. So we had a drill and we had to get prepared, and we had to know how to protect ourselves and how to decontaminate patients. It was kind of the very beginning of all the hazards, HAZMAT they ended up calling it. That, combined with the trauma, combined with—that started to change, it was ever-changing, so I never got bored with anything. Then, I was recruited—well then I became a Director of Critical Care in another hospital.
T.A. Rosolowski, PhD:
And let me just see, because I have that down. Which institution was that, Director of Critical Care? Oh, here it is, Good Samaritan Hospital in Suffern [New York]?
Carol Porter, DNP, RN, FAAN:
Yeah.
T.A. Rosolowski, PhD:
Okay. You were there 1997 to 1999.
Carol Porter, DNP, RN, FAAN:
Right, right. I was recruited there to build a trauma center, to partner with the physician chair of the ED and to build a trauma center. I had never done that, so I thought that would be really exciting.
T.A. Rosolowski, PhD:
You’re a new challenges kind of person.
Carol Porter, DNP, RN, FAAN:
I love it, I love new challenges, I’m out of the box, totally out of the box, totally data driven. So, it was a community hospital, right over the border, in New York State, but the location, even though it was close proximity to a trauma center, the trauma center was on the other side of a mountain and the weather patterns sometimes wouldn’t allow the helicopter to land in the trauma center, so that’s why we had to build a trauma center, as a secondary trauma center, because it happened pretty frequently that they couldn’t land. So there, I gained a lot about emergency management and I worked with the community, because it was a very community-based hospital, with the physicians. I’m looking at blueprints, and the architects, it was a lot of fun and exciting.
T.A. Rosolowski, PhD:
What about working with the community, what did that involve?
Carol Porter, DNP, RN, FAAN:
Well, we were in a community with 40 percent of our patient population was Hasidic, Jewish, and I did not have much experience with that culture, and I found that the hospital didn’t train the employees at the level they should be, so they were misinterpreting customs, versus understanding them. So I went to some of the rabbis in the community and told them I understood, and I wanted to understand how I could learn more, and how I could have the nurses and doctors understand their customs, we could give better care to the patients. That was embraced, because that was a different take. They were usually trying to tell you why they do things and I was saying please tell me what you do.
T.A. Rosolowski, PhD:
Can you give me an example of how you made that interface happen, around what kinds of customs.
Carol Porter, DNP, RN, FAAN:
There’s a lot of customs during birth and death, that are very, very unique to their culture, and I didn’t understand the importance of the rabbi in a Hasidic community. The rabbi really brokers care, at least in those communities, they were the broker of healthcare, and the patients really listened to the rabbi’s direction. So, I didn’t understand that in the beginning. I actually interpreted it as, was the rabbi interfering with their care, but it wasn’t, they wanted that. That’s what they do, that’s what they did in that group, that community. And so once I realized that the rabbis really were the brokers of healthcare and were so important to Hasidic families, that’s when I really started partnering with the rabbis, and myself, in the medical [team], we were partnering with the rabbis. The Hasidic communities, they all have educators, and so I asked them to bring their educator to the hospital, rather than us using our educator, that would have to learn. Bring the Hasidic educator in to have sessions with the doctors and nurses, which was great.
T.A. Rosolowski, PhD:
They could really more fully answer every single question that would be raised too.
Carol Porter, DNP, RN, FAAN:
Right. The other custom that really was a problem until they realized what it was, was the husband would be by the wife’s stretcher and would ask the nurse to do something that he could have just reached over and done, but at that time period of the month, he wasn’t allowed to do that. So, understanding that, or if he’s on an elevator on the Sabbath, he can’t push the button, so people would say, when they would say “could you push four,” they would think well why can’t you push four. Well, he can’t, so just push four. So, we kind of took the mystery out of it, and I think because of that, we gained a lot of respect in that community and 40 percent of our patients were from the community. So that was a whole other learning but, we opened up the trauma center, it was a great community event. We were also ten miles away from Indian Point [Nuclear Power Plant], so what I gained besides helping them build a trauma center, I was just part of the team, but I think I was an important part of the team, is that we fell in the required distance from a nuclear plant to have radiation drills. I had never done a radiation drill. That’s a national regulatory agency that comes in and so I learned. The team came in and for a couple days they taught us, and then we had to perform a drill and they evaluated us. One of the physicians, I wish I remember his name, because he had me mesmerized. He had actually been at Chernobyl.
T.A. Rosolowski, PhD:
Oh, wow.
Carol Porter, DNP, RN, FAAN:
I had read about that but he had been there, and I couldn’t learn enough from him. Then at the end he wanted to hire me, and I said no. But I was fascinated by it, because it’s a skillset that again, you have hazardous materials and now you have radiation. You have to be really secure on how you don and doff protective equipment. Personal protective equipment came and really started to advance, because you had to have impervious, PPE, so that nothing can get through, you had to know how to decontaminate people.
T.A. Rosolowski, PhD:
PPE means?
Carol Porter, DNP, RN, FAAN:
Personal protective equipment. Before that, it was kind of loose but, and so we—
T.A. Rosolowski, PhD:
Tell me about, because I’m sure that—I mean, I am sitting here not really visualizing exactly what you would have to deal with in a nuclear situation, so a couple of examples would really help.
Carol Porter, DNP, RN, FAAN:
Well, if there was a leak, if there was a spill at the plant—I have to send you my slides because I don’t have it right in front of me, but there’s certain circles.
T.A. Rosolowski, PhD:
Kind of the hazard rings?
Carol Porter, DNP, RN, FAAN:
Right. The first circle, you would have to evacuate. The second circle, which would have touched New York City, it would be contaminated water and food, so it’s really a big deal. We played the part and we happened to be within the ten mile circle, so workers would come to us. They would be decontaminated there, but they could also be decontaminated by us.
T.A. Rosolowski, PhD:
How do they get decontaminated?
Carol Porter, DNP, RN, FAAN:
With water, but in a decontaminated—that’s when all the emergency centers started building decontamination areas, and people didn’t have that before. I learned about that, how do you build it? You have to pitch the floor, you have to have an outside entrance. You can’t come into the ED and go that way, you have to come outside. All that just kind of added—I was telling the Faculty Senate, the Executive Council, is that it’s like layers. I was an ER nurse, I was a trauma nurse, and that teamwork and camaraderie, and then you throw in hazardous material, okay, and then throw in radiation, that’s another level. And then after, when I left that hospital—I mean it wasn’t just me learning, it was the nurses and doctors and aides and everybody else, and the community. I learned how to bond with the EMS, the Emergency Medical Services, because they also had to be trained, so they’d decontaminate themselves on the way in. Their vehicle had to be decontaminated. So it was a lot, it was a lot. Then from there, I was recruited—that’s when I was recruited into New York City, that was 1999, and within four weeks of me started my job there, I was recruited as a Director of Emergency Services and Medicine.
T.A. Rosolowski, PhD:
And that was at Lenox Hill Hospital.
Carol Porter, DNP, RN, FAAN:
Yes. Within four weeks of my arriving on the scene, in what we would call the orientation period, the city started getting threats, terrorist threats, and also, combined with the fact that we were changing from 1999 to 2000, which there was a lot of concern across the world about that. There was also concern that somebody would do some kind of event on that time period. So, because I had some experience, as a matter of fact, when I was at Good Sam, I had the opportunity, during the radiation drills, I had the opportunity—besides the physician, I had an emergency management, ex-military emergency management specialist that worked side by side with me and taught me a lot through that. He was not just radiation, he was all emergency management, so when I went to New York City, of course I kept contact with him. I went to New York City and we started having threats and they knew I had an emergency management background, and they knew I had participated in providing some education and that I had a colleague that was an expert, so we were asked to provide classes for all the providers and the nurses and anybody that would be taking care of patients, on different hazards, different threats that potentially could hit New York City, in bioterrorism, chemical, nuclear, the rest of the gamut. You know blast, think about a blast, like a dirty bomb, et cetera. So we did probably, I don’t know, three hundred sessions, while I was on orientation, [laughs] and it was good.
T.A. Rosolowski, PhD:
Now why are you laughing? You’re remembering something about that time.
Carol Porter, DNP, RN, FAAN:
Well because in orientation—orientation, for a nursing leader, it’s really, it’s not defined, because if something happens, you have to go into your role. So I think that just like Hurricane Harvey, anybody you hadn’t met, you met. You know, doing three hundred sessions on week four of your employment, or week five, I met all the providers, I met all the people that were taking care of patients and it was great. Then, I can’t remember whether the city required bioterrorism coordinators before or after 9/11, but sometime in the early 2000s, the city of New York required every hospital to designate a bioterrorism coordinator, so I became the bioterrorism coordinator, besides being the directing of nursing, everything else, for Lenox Hill. I also was a member of the Greater New York Hospital Association Emergency Council, which was, we all got together every month and shared education and everything else, and really formed another link, which I was totally fascinated with because there were really experienced emergency management people there. It was led by a very experienced attorney, I mean it was very high level, and I felt like I was a toddler in that room.
T.A. Rosolowski, PhD:
What was it that distinguished their level of expertise?
Carol Porter, DNP, RN, FAAN:
Well, some of them, that was their sole job, so some of the emergency management, that’s what they did full-time. I also had medicine, I had nursing, I had policies, I had a lot of other things. And then the woman who was running it completely, she worked through Greater New York Hospital Association as an attorney, but I was fascinated that an attorney was so knowledgeable about emergency management. So it was a great group to me. I was there every single meeting, I couldn’t wait to get there. So, and then 9/11 happened, and so I don’t know whether that bioterrorism coordinator role was before or after 9/11, it was right around it. Then we had been drilling and educating and everything, at Lenox Hill, and when 9/11 occurred, again, everybody went into their mode because they knew what to do. I can stress that enough. You can’t just do an infrequent drill, it’s got to be part of your fiber. Anyway, so 9/11, of course everybody knows how bad it was, but because I was in charge of emergency management and the bioterrorism coordinator, and I was a director of the ER as well, so that was probably the first real horrific emergency that people were looking to me for leadership, so I learned a lot about that.
Recommended Citation
Porter, Carol DNP, RN, FAAN and Rosolowski, Tacey A., "Chapter 02 : Experience in Emergency Management" (2018). Interview Chapters. 1376.
https://openworks.mdanderson.org/mchv_interviewchapters/1376
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