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February | 2021
EMERGENCY NURSE
NEW ZEALAND
The Journal of the College of Emergency Nurses New Zealand (NZNO)
ISSN 1176-2691
Image Credit: Natalie Anderson
EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
In this issue
Features
CENNZ Chairperson’s AGM Report Snippets Autumn 2020
07 2020 – Dr Sandra Richardson 28
Irritable Hip in Kids Book Review by Matt Comeskey
09 29
CENNZ Conference 2021 ACEM Conference 2021
26 30
Regulars
A Word from Regional Reports
03 11
the Editor
Chairperson’s College Activities
05 25-27
Report
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
A Word from the Editor
Matt Comeskey
Editor | Emergency Nurse NZ
mcomeskey@adhb.govt.nz
Letters to the Editor are welcome. Letters I feel that collectively, in our work places expanded and improved by having
should be no more than 500 words, with we have demonstrated a capacity to a ‘fresh’ editor every few years. I have
no more than 5 references and no tables absorb change and manage the unknown enjoyed the role and the support I have
or figures. to a degree that I’ve not seen before. This received from a few regular contributors,
gives me some hope that no matter what the CENNZ National Committee and
the coming year throws at us, we will get Sean McGarry - who does a lot to make
through. That’s not to say it will be easy. my shambolic editorial efforts look great.
It probably won’t. There will be family,
colleagues and patients who will struggle.
The big lesson I learnt last year is that the
But if we remain kind to others (and
future isn’t what it used to be.
ourselves), together we will get through
A year ago we could travel without another year of challenges. Matt
restriction, we could openly sneeze
In this issue please check out the Snippets
without being socially shamed and we
section. There’s new research from
could shake hands to greet strangers –
Auckland ED, published in the Annals
because that was, well… normal. The
of Emergency Medicine on commonly
difficulty in predicting the future is that
prescribed analgesia. The findings can
it’s unknown. So, as we stagger away
be easily incorporated into practice
from the year that many would happily
forget, we head at pace towards a year Finally, it’s time for me to move on and
that’s entirely unknown. It feels like the let someone else inject new ideas and
only certainty is more uncertainty. energy. I believe the journal can be further
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Editorial Info
Subscription: Journal Coordinator/Editor: Dr. Natalie Anderson: RN, PhD, Senior
Lecturer, University of Auckland.
Matt Comeskey:
Auckland City Hospital Adult
Subscription to this journal is through a Nurse Practitioner, ADHB
Emergency Department, ADHB.
membership levy of the College of Emergency Email: mcomeskey@adhb.govt.nz
Dr. Sandra Richardson: Dr Sandra
Nurses New Zealand - NZNO (CENNZ).
The journal is published 3 times per year Peer Review Coordinator: Richardson : PhD Senior Lecturer,
Matt Comeskey: School of Health Sciences, University
and circulated to paid Full and Associated
Nurse Practitioner, ADHB of Canterbury.
members of CENNZ and other interested
Email: mcomeskey@adhb.govt.nz
subscribers, libraries and institutions. Deborah Somerville: MN. Senior
Lecturer. Faculty of Medical and Health
Copyright: This publication is copyright in its Peer Review Committee:
Sciences, University of Auckland.
entirety. Material may not be printed without
Margaret Colligan: MHsc. Nurse
the prior permission of CENNZ.
Practitioner. Auckland City Hospital Submission of articles for
Website: www.cennz.co.nz Emergency Department, ADHB publication in Emergency
Lucien Cronin: MN. Nurse Practitioner. Nurse New Zealand.
Auckland City Hospital Emergency All articles submitted for publication should
Department, ADHB be presented electronically in Microsoft
Editorial Committee Prof. Brian Dolan: FRSA, MSc(Oxon), Word, and e-mailed to mcomeskey@adhb.
govt.nz. Guidelines for the submission
MSc(Lond), RMN, RGN. Director
of Service Improvement.Canterbury of articles to Emergency Nurse New
Emergency Nurse N.Z. is the official journal Zealand were published in the March
District Health Board.
of the College of Emergency Nurses of New 2007 issue of the journal, or are available
Zealand (CENNZ) / New Zealand Nurses Nikki Fair: MN. Clinical Nurse
from the Journal Editor Matt Comeskey
Organisation (NZNO). The views expressed Specialist. Middlemore Hospital
at: mcomeskey@adhb.govt.nz Articles
in this publication are not necessarily those Paediatric Emergency Care, CMDHB
are peer reviewed, and we aim to advise
of either organisation. All clinical practice Paula Grainger: RN, MN (Clin), authors of the outcome of the peer review
articles are reviewed by a peer review Nurse Coordinator Clinical Projects, process within six weeks of our receipt of the
committee. When necessary further expert Emergency Department, Christchurch article. CENNZ NZNO Membership:
advice may be sought external Hospital. Membership is $25.00 and due annually
to this group. in April. For membership enquiries
Libby Haskell: MN. Nurse Practitioner.
All articles published in this journal remain Children’s Emergency Department please contact: Kathryn Wadsworth
the property of Emergency Nurse NZ and Starship Children’s Health, ADHB. Email: cennzmembership@gmail.com
may be reprinted in other publications if
Sharon Payne: MN. Nurse Practitioner.
prior permission is sought and is credited to Design / Production / Distribution:
Hawkes Bay Emergency Department,
Emergency Nurse NZ. Emergency Nurse NZ Sean McGarry
HBDHB.
has been published under a variety of names
Phone: 029 381 8724
since 1992.
Email: seanrmcgarry@gmail.com
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Chairperson’s
Report
2020 has been a year of challenging and at times, distressing
events, and one that many of us will be happy to see the end of.
However, there have also been some unexpected opportunities,
and times when emergency nursing has moved forward in
positive and compelling ways.
in aged care and long term or chronic They both involved unexpected, and
care settings, we have faced the reality of horrific scenarios. Both resulted in staff
the outbreaks, the management of these witnessing injuries which, while taken in
and considered the impact on those with isolation, are not unknown to ED staff.
co-morbidities. Serious burns and gunshot wounds are
never pleasant, but are not unfamiliar.
In short, emergency nurses have assessed,
The quantity, nature and circumstances
responded to, and problem solved across
associated with these events were. The
the breadth of the pandemic possibilities.
overwhelming outpouring of national
We have struggled with the ethics and
concern is tribute to the degree of impact
the implications of some of the decision
associated with both event. While we
making that has occurred, and we have
know that individually and collectively,
spoken out about the need to protect
there was so very much to be proud of in
Too often we are poorly understood by ourselves, and the need to have safe
the responses that resulted, we also need
members of the general public – not working environments. Access to
to be mindful of the impact such events
intentionally, but as a result of the media appropriate PPE and clear, consistent
have. It is increasingly important that
representation of nursing, or our own information, is not a luxury, it is an
as a profession, and as colleagues we are
reluctance to talk about what we do, and essential. And ED nurses, despite the
aware of the effect of our work. For too
what really matters in our work. 2020 difficulties, have worked incredibly hard,
long, it has been an accepted aspect that
was The Year of the Nurse. It was also and worked together, to find solutions.
ED nurses are simply ‘tough’, and nothing
the year of the COVID-19 pandemic, We have been a nationwide team, drawing
really bothers them. Often we appear
highlighting the role of nurses around on experiences and learning from the
that way. But when this is truly the case,
the world, in all specialties. For those of challenges as they have eventuated, and
we should worry. There are long term
us in NZ, the roles of emergency nurses using this knowledge to strengthen other
consequences to being exposed to trauma,
alongside public health and primary care areas in turn.
to violence, to grief. As our health system
nurses have been highlighted in terms
We cannot forget that two devastating continues to struggle, out patient numbers
of providing first contact, screening and
events impacting emergency response rise and the acuity also. We need to be
immediate response to a pandemic.
also occurred recently – the mass shooting responsive, but also responsible, and that
For emergency nurses, ICU and high
in Christchurch, and the Whakaari White includes looking after ourselves.
dependency nurses, we have been looking
Island eruption. While emergency
at the impact and decision making that We have shown how well we can manage in
nurses are capable and competent, both
would follow on from an outbreak and terms of disasters – this is what emergency
of these events, although very different,
the possible scenarios that might follow. nurses do. We have shown how well we
triggered similar responses in many ways.
For emergency nurses and those working
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Chairperson’s
Report Cont.
care for each other – again, the outpouring of violence and aggression against
of support from the EDs around the emergency nurses, and highlighting the
country to those who have experienced risks we face. The establishment of the Dr Sandra Richardson
difficult times is humbling. We can nurse educator’s network is offering a Chairperson
continue to build on the professionalism new forum for the exchange of ideas and College of Emergency Nurses New Zealand
and knowledge we hold as a group – there sharing of experiences, and it is hoped
have been significant advancements in this will continue in a similar manner to Contact: cennzchair@gmail.com
emergency nursing in 2020 as well as that of the Nurse Manager network.
overcoming the problems.
I wish to thank you all for your
We have successfully maintained a contributions to emergency nursing over
platform in the media, addressing issues 2020.
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Chairpersons Report 2020 Annual
General Meeting NZNO College of
Emergency Nurses New Zealand
I am pleased to be able to present identifying new ways in which we collaborations, networks and the
the Chairperson’s Report to the can meet the needs of patients and ability to offer support has become
2020 Annual General Meeting of colleagues. increasingly apparent in all aspects
the NZNO College of Emergency of our professional and personal
We have had to prioritise some
Nurses New Zealand (CENNZ). lives, and we have developed closer
activities, and to limit others – the
links with the Australasian College
This has been an extraordinary year decision to hold an online AGM and
of Emergency Medicine (ACEM), as
for all nurses, and has produced a to cancel the planned symposium
well as exploring areas of mutual
number of specific challenges for this year being examples. However,
interest within NZNO nursing
emergency nurses and for CENNZ. It we have focussed on responding
groups, in particular the NZ College
has also offered opportunities for us to the key needs within the sector
of Critical Care Nurses and Mental
to work together and see significant – speaking out in relation to PPE
Health Nurses Section.
achievements and developments shortages, mixed messages around
within our specialty. 2020 is the expectations during lockdown, the It would take too long to review all
Year of the Nurse – and nurses have implications of quarantine and have the items covered by CENNZ in
certainly been at the forefront of continued to fight for safer EDs and the past year, but before providing
public attention, with the value reducing violence and aggression. a summary of the key achievements
and contribution of our profession A major impact arising from the I do wish to highlight our work with
highlighted in the response to the pandemic has been recognition of regard to violence and aggression,
Covid-19 pandemic. But this is not the need for highly trained triage which remains a priority for the
our only public presence – emergency nurses – a core element of CENNZ committee. As you will be aware,
nurses have also been recognised for business. The triage portfolio has CENNZ has continued to make
their response to natural and man- always been a busy one, but in the submissions on this topic, and this
made disasters, their willingness to current circumstances, the workload includes both written and oral (in
advocate for patients, speaking out has increased significantly as we person) submissions to the justice
on the need to address inequalities, have striven to find ways to offer select committee which considered
and advocating for safer working courses to a greater range of areas. the Protection for First Responders
environments. and Prison Officers Bill. As a direct
In order to support staff working in
result of our submission, changes
CENNZ, through the Committee difficult situations, and to facilitate
were made to the definition of a scene
and its members, has not only the sharing of knowledge and
of emergency, to allow this to include
accepted the challenges of this past innovations around responses to
an emergency department, and a
year, but has been in a position Covid-19 an on-line Charge Nurse
new definition of first responder. We
to respond in an effective and Managers group was established,
are currently awaiting the review of
strategic manner. As the voice of to enable regular zoom meetings
the bill. CENNZ also challenged the
New Zealand emergency nurses, for support as well as mutual
NZNO Strategic Plan at the recent
the College has been privileged to assistance. This has been followed
AGM, successfully lobbying to have
showcase the determination and with the introduction of on line
violence and aggression formally
commitment of its membership, ED educator meetings, and the
included as a specific issue in this
with a highly motivated committee continuation of support for the
document.
who have worked above and beyond, AENN group. The importance of
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Chairpersons Report 2020 Annual General
Meeting NZNO College of Emergency
Nurses New Zealand Cont.
Summary of Work 2019-2020
• Provision of NZ Triage Course remain • Development of the CENNZ media
profile and press releases relating to
office and Suzanne Rolls our NZNO
Professional Nurse Advisor.
a key activity for the College
topical issues, with associated media
• 12 National Triage Courses were held interviews and publications I will shortly step down from the
•
(compared to the usual 8) CENNZ committee as my 4-year
Continuation of the submissions
•
term comes to a close. It has been a
CENNZ Journal continues to flourish process, highlighting our engagement
privilege to represent the Canterbury
in the electronic format, but with with political and professional issues
Westland region and to contribute
sadness we acknowledge that the of relevance to emergency nursing
to the emergency nursing in New
current editor is looking to step down,
and we will be seeking nominations • Recognition of the hard work of all
emergency nurses, and celebration
Zealand. I hope to be able to continue
for a new Journal Editor to contribute to the College, and to
of emergency nursing with the
•
offer support to future committee
Support continues for the Advanced distribution of the international ED
members. Being part of CENNZ,
Emergency Nurses Network Nurses day CENNZ gift baskets.
and having the opportunity to take
• Establishment of on-line CNM
meetings as part of the National
I would like to thank all of the
CENNZ Triage Instructors for
an active role is professionally
challenging but also very rewarding
Charge Nurse Managers Network the success of the Triage Course’s role. I thank the CENNZ committee
• Establishment of
Educator meetings
on-line Nurse undertaken over the past year, and
take this opportunity to welcome
for their support and look forward to
future ongoing opportunities with
• CENNZ as an invited member of
the NZNO Addressing Violence and
the new instructors and thank
those who are leaving. The revenue
the College.
Aggression in Nursing (AVAN) received from the national triage
•
course enables CENNZ to maintain
CENNZ as an invited member of the
its significant grant and education
Dr Sandra Richardson
National Sepsis Core Working Group, Chairperson
programmes. While this has been
Sepsis Trust
limited by the impact of Covid-19
•
College of Emergency Nurses New Zealand
The CENNZ social media platforms and the subsequent travel and group Contact: cennzchair@gmail.com
have of Facebook and Twitter meeting restrictions,
experience increased activity and
provide clinically relevant resources we will continue to support
and communication. individuals where possible, with
• Review and update of CENNZ position
statements: New Nursing Graduates in
regard to educational and leadership
development.
Emergency Departments; Emergency I would like to also acknowledge
Nursing Education the tremendous work, support,
• Development of new Position
Statement: Clinical Nurse Specialists
knowledge and skills of Sharyne
Gordon at the NZNO Wellington
in Emergency Departments
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Irritable Hip in Kids
Transient synovitis, commonly called irritable hip, is the most common cause of limping in
children. Irritable hip is most often seen in children aged between three and 10 years of age.
History Red Flags
In most cases of irritable hip, the child will have recently recovered - Fever
from a viral infection. Sometimes, the condition occurs after a - Night pain
minor fall or injury.
- Constant, worsening pain
Some children may just be refusing to walk, without explanation. - Complete refusal to weight bear
The pain is often worse in the morning on waking and improves post analgesia
over the day
- >8yrs of age
Usually only one side is affected. - Greater than 3 days of symptoms
The child is usually well. - Unexplained bruising.
Assessment: Investigations:
The majority of your exam Repeat examination is essential. Make this
will be focused on the MSK your first priority after analgesia has been
system. given.
- Joint examination using Use both paracetamol (15mg/kg/dose) and
"Look, Feel, and Move" Ibuprofen (10mg/kg/dose)
including joints above and
No investigations are generally warranted.
below area of pain.
X-rays are usually unhelpful except in older,
- Usually able to elicit reduced
The pain is caused by adolescent children (SUFE) or specific
internal and external rotation
inflammation (swelling) of situations such as suspected fracture.
of the affected hip joint on
exam the lining of the hip joint Blood tests are only indicated if red flags
are present (see above). Obtain FBC, CRP
- Assess gait if possible – (Click on image for hyperlink)
and ESR, and consider blood culture if
walking +/- running.
infection is suspected.
Cont. overleaf…
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EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Irritable Hip in Kids Cont.
What is the treatment?
• Pain relief such as ibuprofen and paracetamol should be prescribed and parents should be advised to use this
medication on a regular basis for the first 2-3 days.
• Irritable hip usually gets better with rest and simple analgesia within one week. Pain that has persisted longer than
this should always be reviewed.
• Parents should be advised to bring their child back for review if:
- the pain is getting worse despite regular analgesia
- the pain is waking them at night
- they develop a fever with no other obvious source of infection.
https://www.starship.org.nz/guidelines/limp-assessment-of-paediatric-limp-in-the-emergency-department
Kathryn Johnson NP
Starship Children’s Emergency Department
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Regional
Reports
Northland/Te Taitokerau | Auckland
Midland | Hawkes Bay/Tarawhiti
Mid Central | Wellington | Top of the South
Canterbury/Westland | Southern
Vacancy
The position representing
Hawkes Bay/Tarawhiti
on the CENNZ National
Committee is currently
vacant.
Please see application
information on
page 18
P 11EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Northland/Te Taitokerau Region
Looking back over 2020 has been The interactive workshop focus is
an opportunity to recognise our on de-escalation and staff safety. ED
resilience and teamwork, and to nurses are being rostered to attend
appreciate the knowledge that these courses.
we have gained in meeting the
The challenge of improving equity
challenges of this year. We all had
and culturally appropriate care is
important roles to play in responding
underway with an ED working group
to Covid as well as continuing
established. One of the first steps has
business as usual. It still amazes me
been focused on the use of Te Reo.
how we adapted so quickly (and still
The ED Grand Round presentation
continue to adapt) to new processes
this month was “Decolonising the
and environments.
ED: An answer to Healthy outcomes
Active recruitment is underway for All?
Sue Stebbeings
to fill several current ED nursing
Nurse Practitioner The ED ‘Peep of the Month’
vacancies. There are many shifts that
nominations continues to be an
Emergency Department are not fully staffed, which increased
excellent way of acknowledging our
the demands on staff. Looking at
Whangarei Hospital colleagues for the ways they make a
recent articles on facilitating
difference - their commitment, input
Contact: sstebbeings007@yahoo. resilience, I was reminded of what
and skills.
co.nz we all know - the importance of
social connection, self-care, and In development: An Assessment
looking for positives in situations. Unit for Whangarei campus was
So heading into 2021, let’s encourage announced in mid-November to
ourselves to prioritise self-care, and relieve congestion in ED – this is
connect with our whanau & our planned to have 12 beds and is part
colleagues so that we can take care of the hospital plan to manage acute
of our communities. demand. The unit is being located
in a renovated medical outpatient
Recent positives: We now have more
clinic, and involves several teams
distraction tools through the efforts
moving to re-purposed areas –the
of a paediatric focused ED group.
medical outpatient team move to
There are two tablets that have
the physiotherapy department
preloaded games and apps, as well
…who are moving to a renovated
as toys and activity kits. A buzzy bee
administration area… who have
to reduce pain during procedures
been moved. The unit will open
involving needles has also been
once staffing has been established.
introduced.
Hopefully, sufficient staff can be
An ED Ball was held in November recruited to allow the unit to function
to connect and relax outside of work. at its planned capacity.
Many thanks to our event organising
Challenges: Whangarei ED has
committee for all their inspiration
experienced sustained high demand
and efforts. There is also Scott’s
and acuity with noticeably high
summer party in early February to
number of trauma presentations.
look forward to.
The last fortnight, in particular, has
CALM – “Workplace violence – It’s seen daily presentation numbers
not OK” training courses are being similar to last summer’s surge
rolled out across the organisation. numbers. Our resources have not
P 12EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Northland/Te Taitokerau Region cont.
been adequate to manage the surges Hokianga Hospital: - This small emergency care clinic alongside the
of people arriving – and despite rural hospital facility is run by doctors and nurses. The paramedic
everyone’s best efforts, our 6-hour the community trust and strongly also works in the community
length of stay was 85% in November. reflects the identity and strengths making home visits including follow
of the community. There are 2 acute up assessments. The establishment
The usual summer seasonal rise in
treatment rooms and a 1 – 2 bed of red and green zones during early
population has been predicted to be
resus room. The local Rawene GP Covid preparations was facilitated by
higher with more people holidaying
clinic is co-located. After hours 2 negative pressure rooms installed
in New Zealand rather than
emergency care is provided from the during renovation in 2019.
overseas. This increase is noticed
10 bed inpatient ward. The nurses
by the smaller services as well as
are supported to develop their skills
in Whangarei. The background
and become PRIME trained. A 12 Sue
increase in population has already
month trial has commenced using
increased overall demand for health
an advanced care paramedic in the
care in the community.
Contributions for Publication
We are always open to receiving submissions for
publication. Submissions in the form of case studies,
research posters and practice guidelines are welcome.
There is a modest contribution for featured articles.
You can find guidelines for publication here: https://www.nzno.org.nz/groups/colleges_sections/colleges/
college_of_emergency_nurses/journal
Alternatively, email and enquire: mcomeskey@adhb.govt.nz
P 13EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Auckland Region
Starship Children’s ED We have had staff celebrate
weddings, a 65th birthday and
After the COVID impacted winter
passing NP panel.
with reduced numbers and the
viruses going into hibernation, We hope everyone has a Merry
November turned out to be our Christmas
busiest on record!
From the regional meeting this week
The viruses came back and with it sounds like Counties have also
a sharp increase so did the kids! been seeing increased numbers and
Croup was the main culprit along the kids’ side has shot up similar to
with some good old D and V likely CED.
Noro.
They are also seeing a lot of croup
We are also seeing an increase in and youth mental health challenges.
Anna-Marie Grace
young people who are struggling
Nurse Unit Manager with the challenges of this year. Anna Marie Grace
Children’s Emergency What a year it has been it does feel
Department like it’s been three years in one and
our team are all looking forward to
Starship Children’s Health some summer holidays!
Auckland City Hospital Whilst its been a challenging
year it has also brought about so
Contact: annamarieg@adhb.govt.nz much poistive- a better way of
communicating with our teams both
ways, a strong morale, our team
really did just kept going and carried
on!
Auckland Adult ED Thanks to all of my colleagues at
Auckland ED, we have not worked
In keeping with all regions,
tirelessly – I see how tired many
Auckland ED has seen an increase
are - but we have worked safely,
in presentations and acuity as 2020
competently and compassionately
draws to a close. We’re proud of
though an unforgettable year of
all we’ve achieved to get through
uncertainty and change.
this year, with major changes to our
Natalie Anderson department staffing, processes and
Staff Nurse Natalie
infra-structure. Although 2020 was
the Year of The Nurse it possibly
Adult Emergency Department,
should have also been The Year of
Auckland City Hospital The Cleaner. We’re grateful for the
incredibly hard-working team of
Senior Lecturer
cleaners who have kept staff and
University of Auckland patients safe with fastidious room
cleaning under time pressure.
Contact: na.anderson@auckland.
ac.nz
P 14EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Auckland Region cont.
Middlemore Hospital ED smoothed out with the late Dr Chip the addition of two Charge Nurse
Gresham, stepping into the role of Managers (CNM), a new role to
Titiro whakamuri kookiri whakamua
Medical Director/Clinical Advisor Counties ED, and 12 new Associate
Look back and reflect so that you of the National Crisis Management CNMs; many of whom have been
can move forward Centre, as part of New Zealand’s promoted from Staff Nurse Positions.
In 2020, Middlemore Emergency All of Government Response to 2020 has also seen significant growth
Department (ED) mourned the Covid-19; and the introduction within the Clinical Nurse Specialist
loss of Emergency Medicine (EM) of a Counties Covid-19 Response and Nurse Practitioner (NP) team;
Specialist, Dr Chip Gresham. Chips Manager, ex-ED Nurse, Stacey congratulations to Beccy Fenn who
significant contributions went Wilson. Further, Counties Manukau has recently achieved the NP scope
well beyond EM, to toxicology, Health (CMH) is the DHB lead for of practice. While the department
humanitarianism and disaster the Northern Managed Facilities is still on the hunt for a Nurse
medicine just to name a few. on behalf of the region, and our Manager to rise to the challenge
very own Chief Nurse, Jenny Parr of leading Australasia’s busiest dual
No reira e te Rangatira, moe mai, moe was seconded with Rebekah Irwin, ED in providing optimal emergency
mai, moe mai ra. Hoki atu ki te Ukaipo Clinical Nurse Director, to the care to the population of South
o Papatuanuku. Ka hoki inaianei ki te Regional Isolation and Quarantine Auckland; with increased senior
hunga ora, tena hoki tatou katoa. Command Centre, to develop an nursing leadership, and the Staff
Along with every other New effective DHB employed nursing Nurse roster now running at near
Zealand ED, Middlemore rose structure and workforce. While we full capacity, 2021 is already looking
to the many challenges of Covid- still, and will continue to, be subject prosperous.
19, reviewing infection control to further challenges as a result
To the Middlemore ED whaanau,
processes, adjusting models of care, of this deadly virus, Middlemore
thank you for all the hard mahi
and adapting to constant changes in and it’s ED, have demonstrated
in 2020, your work ethic and
practice in order to keep pace with that through living our values of
perseverance have not gone
the current risk posed by the virus. Manaakitanga, Rangatiratanga,
unnoticed.
Situated only 10km from Auckland’s Whakawhanaungatanga and
International Airport, and with six of Kotahitanga, we can get through Kia hora te marino, kia whakapapa
New Zealand’s 31 Managed Isolation this. pounamu te moana, kia tere te
Facilities within its catchment, kaarohirorohi I mua I to huarahi.
In 2020, Middlemore ED bid farewell
including Auckland’s only to many members of the Senior May peace be widespread, may the
Quarantine Facility, Middlemore Nursing team; not least, the Nurse sea glisten like greenstone, and may
ED worked tirelessly to make sure Unit Manager (NUM) and Clinical the shimmer of light guide you on
that additional risks posed by any Nurse Director (CND). While change your way.
necessary movement between these comes with many challenges, it
facilities and the hospital were kept also generates opportunity. So far, Wendy Sundgren
to a minimum. This process, and a new nursing structure has seen
Middlemore’s Covid-19 response was
P 15EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Midland Region
Rotorua ED: Wellness and wellbeing in ED is
becoming our big focus leading into
Heading into summer we have yet
2021. We did plan some work around
to see the usual lull pre-Christmas
wellbeing in 2020, but it was derailed
we would “normally” see. We have
by the need to simply survive COVID
been inundated with large volumes
planning and the impact on our
and high acuity. We are currently
daily work. So, rather than wellbeing
working on a few large projects
feeling like a tick box exercise or a
to enhance the care between the
one-off big impact event we want to
community and the hospital, with
make wellbeing our normal focus.
a focus on developing plans for
We are looking at opportunities to
high ED attenders and building
improve our wellbeing that are large
strong links with our Maori health
or small. Wellbeing means different
Kaidee Hesford colleagues to support these patients
things to each of us, so we are all part
both in and out of the hospital.
Nurse Manager of the conversation about how we
We are working on developing a can improve it in our department.
Lakes District Health Board strong nursing workforce who can We have put up a suggestion box for
Emergency Department work to top of scope. With currently staff to put their suggestions in with
Rotorua Hospital 95% of our ED team efficiently no limits on what can be suggested
trained and working in both resus but trying to stay away from things
Contact: kaidee.hesford@lakesdhb. and triage we are now looking at like “we need more staff ” or “we
govt.nz carrying out regular study days for need more beds” – yes we do need
ED staff to encourage further growth– these - but that is not within the
mental health training, second-tier focus of this project. Suggestions
resus training and practical stations, can be as crazy as they wish –Kaidee
suturing, USS guided cannulation, Hesford.
radiology limb assessment and xray
ordering and second-tier plastering
training. Kaidee
Cont. overleaf
P 16EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Midland Region cont.
I have spent the last 14 years working Waikato ED:
at Middlemore Hospitals Emergency
2020 has brought is share of
Department, 10 of these years as an
challenges and we look forward to
Associate Clinical Nurse Manager. I
2021 and we hope that we will see
have gained invaluable experience
things settle back to ‘normal’
over these years which has made me
the nurse and leader I am today. I In the interim we continue to screen
am also currently studying through all patients who come to our ED and
Auckland University my Master in run two separate areas in our ED,
Health Leadership, which I hope to one for those who are of suspicion
complete by the end of 2021. as per the MOH questions around
COVID 19 and one for all others.
Taupo ED: Moving from such a large Emergency
During these times of change our
Department to a considerably smaller
Introduction of new ED CNM of staff continue to band together and
Rural Emergency Department has
Taupo ED. provide great team work to keep this
been a big learning curve for me;
functioning.
Hello my name is Michelle Knight unlike Middlemore ED I no longer
and I am the new Clinical Nurse have access and resources at my We send all our colleagues New
Manager for Taupo ED. It has finger tips. It has shown me that Zealand wide all the best for 2021.
been a long term goal of mine to no matter what size department you
move to Taupo and continue with a are working in staffing levels are
relevant and all places have their
Naomi Knight
leadership role.
own set of challenges.
My entire nursing career has been
spent at Counties Manukau Health. I am looking forward to the
I registered in 1996 and my first job challenge of working in and leading
was working in AT&R, following this the team at Taupo Emergency, and
I did a small amount of General providing excellent care to the Taupo
Medicine Nursing, followed by community.
a number of years working on a
General Surgical ward.
Michelle Knight
Having young children during this
time made me decide to leave my
permanent job in General Surgery
and join the Nursing Bureau at
Middlemore Hospital, it was during
this time that I was first introduced
to Emergency Nursing, this is when
I developed a passion for it.
P 17EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021 Hawkes Bay/Tarawhiti Represenative The position representing Hawkes Bay/ Tarawhiti on the CENNZ National Committee is currently vacant. If you have an interest in representing the CENNZ membership of this region and a passion for the professional development of emergency nurses nationally – please contact the board chair Sandy Richardson. cennzchair@gmail.com Article submissions for the mid year issue of the journal are now open. Please contact the Editor Matt Comeskey for more information! email Matt at: mcomeskey@adhb.govt.nz P 18
EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Mid Central Region
No report
this edition
as regional
representative
Katie Smith is on maternity
Nurse Practitioner, ED
(Knowledge & Skills Framework
leave.
& Website/Social Media)
NZDF
Palmerston North Hospital
Midcentral DHB
Contact: katie.smith@nzdf.mil.nz
P 19EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Wellington Region
Advancing roles within nursing are On a positive note, there is some
slowly becoming a norm within our great work happening out there.
areas with interest in postgraduate Hutt ED is working closely and
education now very high. Many staff teaching collaboratively with all front
have been successful in securing line officers in the Police and from
health workforce development next year working with staff from
funding and with this comes wide- Rimutuka Prison. They have also
reaching opportunity to not only celebrated receiving the HVDHB
develop advancing skills but open Quality award in Clinical Excellence
the scope for multiple staff driven - The Chief Executives’ Award for the
quality initiatives and service Whakaari/White Island collaboration
development driven by those within and care Hutt ED contributed to this
it. The Wairarapa has been successful disaster.
Kathryn Wadsworth in supporting another Nurse
Clinical Nurse Manager Practitioner in training for next year The current focus in the Wairarapa
taking the total to three by 2022. Hutt is to identify and facilitate those
Acute Services and Wellington ED is focusing on patients not enrolled in a GP practice
Wairarapa District Health Board implementing pathways for senior and assist them in doing so at the
roles and are also committed to point they present to the ED. This
Contact: Kathryn.wadsworth@ has been a far larger cohort than
developing the advancing nursing
wairarapa.dhb.org.nz expected with wider concerning
workforce.
community issues identified and
As 2020 rolls to an end looking Trendcare within the Wellington addressed. Running alongside this
back seems a little unproductive region is either being discussed, piece of work is the redirection
although the lessons learnt by us all implemented or underway. This piece project which required significant
will without doubt follow us into the of work alone is considerable for those collaboration with our Primary Care
future. The Wellington region is no departments involved and with the colleagues and has saved many
different to all the other ED’s around significant increase in presentations patients hours of wasted waiting time
the country with the need to rapidly being felt particularly in the last two in our department. Audited results
respond to the changing care needs months, the results will be of interest suggest that care is being achieved
within our community this year. The to many. As we all know, ED is not effectively and efficiently in this
toll of that is now being felt amongst always a numbers game with high group.
those team members that were acuity a factor impacting on flow and
workload. Wellington Emergency It feels like it’s nearly safe to breathe
directly faced with the uncertainty,
Department have nearly doubled out as the year draws to a close
risk and management of constant
their ATS1 and ICU admissions from but in the back of all our minds
change. Some staff have moved out of
this time last year. Hutt ED have is the increasing demand we are
the Emergency Department setting
increased their average volume of all experiencing. Summer holidays
because of this prompting a focus
presentations by approximately with closed borders brings another
on wellbeing, leave management
30 to 40 patients per day. All three unanticipated wave of challenge to
and team resilience. This, coupled
hospitals have experienced bed block our doors but gratitude that this is
with multiple pregnancies within the
with areas designed for lower acuity what we are managing and not the
departments, has opened up FTE
patient management being utilised alternative like many countries and
availability and a huge recruitment
for inpatient units. It’s fair to say colleagues in the world.
drive. The result of this has been an
influx of new staff members excited that despite the considerable effort
put into achieving the shorter stays Kathryn
to be part of our teams with a broad
range of experience from novice to in ED health target, it is not being
expert. The challenge of maintaining achieved by any of us.
a safe skill mix is ongoing for us all.
P 20EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Top of the South Region
Hello from NMDHB. We continue ED's. There are plans, however, in
to have increased presentations, Nelson, to create a negative pressure
high acuity and staffing issues. room and more monitored bed
In addition, some of our patients spaces to help mitigate these issues.
are experiencing double breaching A proposal has also been made for
due to a lack of isolation beds on additional staffing and a flow nurse
the wards and overworked medical for our PM shifts. Despite this, we
teams. Most days we are in VRM have a great team of ED nurses and
(Variance Response Management) I want to take this opportunity to
red or orange. We also expect an thank them all for their hard work in
influx of visitors into the region these challenging times.
over the Christmas period which
will put additional pressure on our Louise
Louise Holland
Registered Nurse
Emergency Department,
Nelson Hospital
Contact: louise.holland@nmdhb.govt.nz
If you would like to submit an advertisement
or article for the next issue of the journal
please contact the Editor Matt Comeskey
for more information!
email Matt at: mcomeskey@adhb.govt.nz
P 21EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Canterbury/Westland Region
refurbish and update equipment and patterns across the country.
resources. The staff are now walking
This, in addition to the stresses
a much greater distance each day, so
expected with such a major
the average fitness level is increasing!
re-location, inevitably impact on
The opportunity for collaboration
staff at this time with acuity and
and meaningful interaction between
any staff shortages is likely to be an
what were previously separate area -,
added concern. Considerable effort
for example the integration of acute
is being made to try and support
orthopaedics and paediatric nursing
staff and to ensure best possible care
staff into the main ED - has been well
can be provided for patients. It was
received. Inevitably there are also
recognised prior to opening the new
issues that have arisen that are both
ED that not all the physical bed spaces
frustrating and limiting in the initial
Dr Sandra Richardson would able to be opened, unless
‘settling in’ phase, but these are being
additional staff were authorised, and
Nurse Researcher addressed as quickly as possible.
efforts to achieve this are continuing.
Emergency Department, What has proven especially The ED is also trialling the Trendcare
challenging is the increase in patient program, and while this had only just
Christchurch Hospital
presentations that has occurred, been introduced prior to moving, it
Canterbury District despite widespread publicity asking is hoped it will prove a useful tool to
Health Board the general public to be mindful of capture some of the staffing issues as
the shift, and to limit attendances they arise. However, this is still not
Contact: sandra.richardson@cdhb. where possible. It had been hoped fully embedded, and is not a priority
govt.nz that with this publicity, numbers at this time. The importance currently
might be reduced so that staff could is to let staff become familiar and
adapt to the new systems and layout comfortable in the new environment,
Christchurch ED more easily, instead we have seen and to develop workable and effective
patient numbers reach highest ever models of care.
There has been a lot happening in
levels, with 365 presenting patients
the Christchurch ED since the last It was great to see some of our
in one 24 hr period recorded in the
update, with the move into the new staff on the cover of the recent Kai
first week, over 80 patients still in
build (Waipapa) finally occurring, Tiaki, celebrating international
the department at 4 in the morning.
and the transfer into the new ED emergency nurse’s day, and the gift
Pre-November, there was an average
complete. While this has not been boxes provided by CENNZ were well
of 286 patients per day, this has
without its challenges, there is no received in the department.
now increased to 312. Much of this
doubt that the venue is larger and well
is acute care, rather than urgent Sandy
laid out, with a light and modern feel,
or emergency, and mirrors similar
and has provided the opportunity to
The New Christchurch ED - (Images by Natalie Anderson)
P 22EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Southern Region
What a year 2020 has been! A more Dunedin News:
settled 2021, should definitely be on
16th November, saw the opening
the cards. I have only been on the
of Wāhi Taupua (Ambulatory Care
CENNZ committee since February
Unit) in Dunedin’s Emergency
2020 and I have to say they are a
Department. This has been in
wonderful group to work with and
the pipeline for some time and
the committee members have a
was delayed due to Covid, as our
wealth of knowledge that they are
department continues to try to
willing to share with everyone. The
make do with the current physical
work going on behind the scenes is
restraints. In Wāhi Taupua, there
amazing.
are eight reclining chairs that allow
A huge thanks to the Triage patients who are able to walk and
Tanya Meldrum co-ordinator and the triage have been appropriately assessed,
instructors for running a successful not be confined to a bed, to be more
Associate Charge Nurse
course in the Southern region in comfortable and to be reviewed
Manager late August, to meet the need of or discharged by the emergency
the Southern region. We appreciate department team.
Southland District Health Board
the time and effect that goes into
The department has seen a significant
Dunedin Hospital Emergency organising these courses, especially
increase in violence toward staff,
Department when there was several flight
these are being followed up with
cancelations and changes.
through the appropriate channels.
Contact: Tanya.Meldrum@
CENNZ recently appointed four There is currently a Security review
southerndhb.govt.nz
new triage instructors, three of taking place within the Southern
which came from the Southern DHB. We are looking forward to the
region. This will be a great asset outcomes of this.
for Southern region, as these nurses
Recent Awards in the Department:
have a wealth of knowledge and are
keen to share this with other nurses. CENNZ AGM Kristy Morton Award
Two are based in Dunedin and one (Achievements in the New Zealand
is based in Invercargill. Triage Course): Erica Panelo (RN -
Dunedin Emergency Department).
Southland Medical Foundation's
Thursa Kennedy Memorial Award
for 2020. (The award recipient is
nominated by course tutors and
takes into consideration academic
achievement and contribution
to excellence within the class
environment): Ben McDowall (Nurse
Educator – Dunedin Emergency
Department).
P 23EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Southern Region Cont.
Invercargill News:
There have been some recent
changes to the Senior Nursing team
in Invercargill, with the appointment
of a new Nurse educator. I know they
will be making you feel welcome.
There has been significant increases
in Mental Health presentations in
southern emergency departments
and we have been implementing
the guidelines from CENNZ Triage
around appropriate patient safety
and waits. Southern DHB has
Thanks CENNZ, from the Southern Region (Invercargill, Dunedin, Lakes and Oamaru) for the
recently employed into the role
Goodie Boxes!
of Mental Health & Addictions
Crises Support nurse educator in
the Emergency Department, which
is exciting and we look forward to
the evolution of this role. They will
be working across the Southern
region, starting initially in Dunedin
and Invercargill. The departments
are looking forward to having this
additional support and guidance.
Next year, I am hoping to run a
Southern CENNZ Study in
September. It would be a great
opportunity for members in the
Southern area to network and learn
from each other.
Tanya
Ben McDowall – Dunedin Nurse Educator
P 24EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021 College Activities P 25
EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
CENNZ Conference,
Christchurch 2021
Save
the Date
The 29th College of
Emergency Nurses New
Zealand Conference
5th & 6th November 2021
Christchurch, NZ
(Venue TBC)
P 26EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Triage Courses 2021
Please continue to check the CENNZ web page for ongoing updates / details:
https://www.nzno.org.nz/groups/colleges_sections/colleges/college_of_emergency_nurses/courses
Region Dates Venue Closing date
for booking
Waikato 11/12 April 2021 Clinical Skills Centre (under the library) Waikato Hospital 15th February
Campus, Corner Selwyn and Pembroke Street, Hamilton 2021
West
Tauranga 15/16 May Tauranga Hospital Education centre, 889 Cameron Road, 20th March
2021 Tauranga. 2021
Wellington 12/13 June Education Centre, Level 11, Ward Support Block, Wellington 17th April 2021
2021 Hospital, Riddiford Street, Newtown
Christchurch 10/11 Manawa Building [Registration 3rd Floor] Health Education 16th July 2021
September & Research Facility, 276 Antigua Street, Christchurch
2021
Wellington 25/26 Education Centre, Level 11, Ward Support Block, Wellington 31st July 2021
September Hospital, Riddiford Street, Newtown
2021
Waikato 9/10 October Clinical Skills Centre (under the library) Waikato Hospital 14th August
2021 Campus, Corner Selwyn and Pembroke Street, Hamilton 2021
West
P 27EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
Snippets
Summer 2021
Chest ultrasonography versus supine chest The Safety and Effectiveness of On-Site
radiography for diagnosis of pneumothorax in Paramedic and Allied Health Treatment
trauma patients in the emergency department. Interventions Targeting the Reduction of
Emergency Department Visits by Long-Term
Cochrane Systematic Review. July 2020 Care Patients: Systematic Review. Prehospital
Emergency Care. 2020 Jul 20:1-10.
The diagnostic accuracy of Chest Ultrasonography (CUS)
performed by frontline non-radiologist physicians for the
Social Science and Medicine. Jan. 2020
diagnosis of pneumothorax in ED trauma patients is superior
to supine CXR, independent of the type of trauma, type of CUS This study is a review of pre hospital care with the objective
operator, or type of CUS probe used. being to decrease ED visits. The study identifies five types of
programs/interventions which all demonstrated a decrease
https://www.cochranelibrary.com/cdsr/
doi/10.1002/14651858.CD013031.pub2/full in ED visits or hospitalization. However, most studies were
observational and few assessed patient safety. Many identified
A Pilot Trial of Topical Capsaicin Cream for programs focused on increased primary care for patients, and
interventions addressing acute care issues, such as community
Treatment of Cannabinoid Hyperemesis
paramedics, deserve more study.
Syndrome. Academic Emergency Medicine. 2020
https://www.tandfonline.com/doi/full/10.1080/10903127.20
This exploratory study examined the potential effectiveness of 20.1794084
topical 0.1% Capsaicin in patients with nausea and vomiting due
to a suspected Cannabinoid Hyperemesis Syndrome (CHS)
exacerbation. Can an Emergency Department-Initiated
Intervention Prevent Subsequent Falls and
This double-blind, randomized placebo-controlled trial had a Health Care Use in Older Adults? A Randomized
small sample size (30). Adults who presented with vomiting Controlled Trial. Ann Emerg Med. 2020 Aug 24th.
suspected to be from CHS were eligible for enrollment.
Following randomization, topical 0.1% capsaicin or placebo The authors determine whether an emergency department
cream was applied to the anterior abdomen in a uniform (ED)-initiated fall-prevention intervention can reduce
manner. subsequent fall-related and all-cause ED visits and
hospitalizations in older adults.
The study concluded the application of topical capsaicin
cream was associated with a significant reduction in nausea at They conclude that a multidisciplinary intervention with
60 minutes and provided more complete relief of nausea. pharmacists and physical therapists, reduced 6-month ED
encounters in 2 urban EDs. The intervention could provide a
https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14062 model of care to other health care systems aiming to reduce
costly and burdensome fall-related events in older adults.
https://www.evidencealerts.com/Articles/
AlertedArticle/94406
P 28EMERGENCY NURSE NEW ZEALAND COLLEGE OF EMERGENCY NURSES NEW ZEALAND - NZNO FEBRUARY 2021
The Quick and the Dead.
Cynric Temple-Camp. 2020
Book Review I’m usually loathed to read medical or nursing books in my
down-time. However this book was given to me as a birthday
present and I felt I should take a tentative dive into it out of
politeness. It grabbed my attention quite quickly.
I’ve always marvelled at how some patients can be subjected to
By Matt Comeskey the most extreme, violent trauma and survive – and yet another,
equally fit person, may be unlucky enough to have a single
microorganism lodge in the wrong place, at the wrong time and
be dead within hours. I’ve seen both happen and in recalling
those patients I can’t help but marvel at how robust and yet
incredibly fragile we are. The same conundrum is addressed in
this book.
The author, Cynric Temple-Camp is a pathologist, trained in
Zimbabwe and practicing for many years in Manawatu. He is an
easy story teller – clearly passionate about his job and also taken
with the mystery of why some die and others don’t. The book
is in chapters related to cases he has worked on. These include
medical misadventure, high profile crimes, sad misfortune and
disease. The cases read in-part like mysteries – the unexpected
emerging from the seemingly obvious, to present an unlikely
conclusion. There are salient lessons here – listen carefully to
your patients, don’t swim with crocodiles, be wary of walking
through stinging neetle bushes and always thoroughly iron the
seams of your shirts. That last, unlikely piece of advice applies
to living in East Africa where strange burrowing insects can
wreak havoc on those, like me, who seldom iron our collars. The
subject of the life cycles of maggots and crawly things is dwelt
on a little too extensively for my liking – but it is equally both
informative and revolting at the same time.
My only misgiving in this book is that the people involved are
named. The details of their deaths are sad reading. Despite
the author’s respectful tone, there is no attempt to disguise
identity and yet there’s no explicit statement in the text of
permission having been given to disclose quite intimate detail.
Presumably this must have been done - but it’s not mentioned.
This significant point aside, this book is a reminder of how
lucky we are to simply wake up and greet each day. If I’m ever
lucky enough to get back to the remote, but equally stunningly
beautiful East African wilderness, – I will definitely take an iron
for my shirts.
P 29You can also read
