Emergency nursing doesn’t always take place within safe hospital walls. Increasingly, emergency providers must be ready to manage and care for patients in environments that are remote, austere or in some way unfamiliar.
“The biggest skill is adaptability,” said Jamla Rizek, DNP, MBA, RN, CEN, CPEN, NHDP-BC, NRP, FAAN, FAEN, a global health and disaster nurse leader. “In the ED, we are used to having equipment, medications, diagnostics, specialists and additional staff nearby. In an austere environment, you may not have those things.”
Jamla Rizek, DNP, MBA, RN, CEN, CPEN, NHDP-BC
Rizek will co-present the session “Surviving the Wild: Wilderness and Austere Medicine for the Emergency Nurse” at Emergency Nursing 2026 with Travis Kaufman, DMSc, PA-C, FIBODM, a leader in global health and disaster response. As disaster medicine experts who often work together in austere environments, Rizek and Kaufman have a deep understanding of the obstacles ED nurses commonly encounter in these situations.
Participants should come prepared to consider how their assessment skills, clinical judgment, resourcefulness, ability to pivot and spirit of collaboration can set them up for success when nursing in a challenging environment — one in which typical resources are scant and providers may not have all the information they need.
Beyond knowing the basics, such as hemorrhage control, airway and respiratory management, circulation, hypothermia prevention and pain management, ED nurses in resource-limited environments should pay attention to how patients are trending. “One set of normal vital signs doesn’t mean your patient is OK,” Kaufman said. “Anticipate deterioration. In an austere environment, reassessment becomes one of your most important diagnostic tools.”
Relying on other clinicians is also key. “We cannot work in silos, and in disaster medicine, we have to collaborate with everyone,” Rizek said, stressing her synergistic relationship with physician assistants like Kaufman and the pharmacist who accompanies her on deployments. “Communication, situational awareness and knowing when to ask for help are incredibly important.”
Training for the Unexpected
Travis Kaufman, DMSc, PA-C, FIBODM
Session attendees will be encouraged to take themselves out of the familiar ED environment and pursue education on nursing in austere conditions. This may be connecting with other ED nurses who have experience and can serve as mentors or finding courses that teach wilderness and disaster skills, such as how to “package” a patient (immobilize them and plan for safe evacuation), move them safely and keep them warm.
Because disaster nurses may work long stretches without a break for food, warmth or rest, Kaufman suggests incorporating this reality into practice. “Train when you’re tired,” he said. “When you’re cold, tired, hungry, overwhelmed, caring for multiple patients or you’ve been working for 12 or 18 hours, decision-making changes.”
Building personal readiness for nursing in these kinds of extreme environments can be challenging but incredibly rewarding. Rizek wants session attendees to not underestimate how much nurses make a difference in disaster zones or discount the idea of austere nursing because it wasn’t taught in school. “We want nurses to leave the session understanding that their greatest tools are often their knowledge, assessment skills, adaptability and ability to problem-solve,” she said.