The US Department of Defense (DoD) recognizes the importance of warfighter brain health with the establishment of the Warfighter Brain Health Initiative and Strategy. For a warfighter, also known as a service member, to perform at their highest level, cognitive and physical capabilities must be optimized. This initiative addresses brain health, brain exposures, to include blast overpressure exposures from weapons and munitions, traumatic brain injury (TBI), and long-term or late effects of TBI. The DoD’s pursuit of maximal strength hinges on the speed of decisions (neurocognitive) and detection of brain injury when it occurs. The strategy creates a framework for deliberate, prioritized, and rapid development of end-to-end solutions for warfighter brain health. Through this strategy, DoD is addressing the needs of our service members, their families, line leaders/commanders, and their communities at large. The implications of this initiative and strategy are noteworthy for practitioners because the DoD Warfighter Brain Health construct lends itself to nurse practitioner engagement in clinical practice, patient education, policy development, and emerging research.

This keynote lecture will discuss considerations for driving evidence-based practice in trauma care, with special consideration of translating the American College of Surgeons (ACS) recommendations for rehabilitation care of people with spinal cord injury or brain injury to prepare them for rehabilitation and optimal outcomes.

Objectives:

• Discuss the important considerations and role of the clinician scientist in a trauma care setting
• Consider how to build an evidence-based culture for ongoing knowledge translation activities in the trauma center to facilitate the clinician scientist
• Apply the concepts for adoption of best practices to prepare people with spinal cord injury or brain injury for rehabilitation and optimal outcomes

This session will focus on applying the transformational leadership theory in promoting process improvement lead by Trauma and ED nursing leadership. With the development of a workgroup, we were capable of establishing clinical excellence expectations surrounding MTP and lead the charge by developing a committed team invested in breaking down barriers, utilizing data, and developing a realistic and sustainable action plan to achieve and sustain success.

Objectives:

• Identification of barriers to timely and accurate MTP in a trauma resuscitation
• Review of data to confirm barriers
• Creation and implementation of an action plan by trauma and ED nursing leadership applying the transformational leadership theory
• Evaluation and evolution of action plans

Babak Sarani is a Professor of Surgery and Emergency Medicine and the Chief of Trauma Surgery at the George Washington University School of Medicine. He graduated from the George Washington University School of Medicine and Health Sciences in 1997. He then completed his training in General Surgery at GW in 2004. Following this, he completed fellowship training in Trauma and Critical Care Surgery at the University of Pittsburgh. He began his career as an Assistant Professor of Surgery in the Division of Trauma, Emergency Surgery, and Critical Care Surgery at the University of Pennsylvania. He was recruited back to GW in 2011 where he is the Founder and Director of the Center for Trauma and Critical Care Network at The George Washington University Hospital, a Level 1 Trauma Center, and at Virginia Hospital Center, a soon-to-be level 2 trauma center. His research interests include measurement of coagulopathy following injury, chest wall injury and reconstruction, and processes to mitigate.

Timeliness of trauma transfers out to a tertiary level of care is a challenge for many Level III or IV trauma centers. Identifying the multifactorial causes of delays in transfer is difficult at best, as many of the data points rely on precise and timely documentation. Drilling down on data from each step of the process utilizing tools such as Microsoft Power BI, the trauma registry, and Lean Six Sigma methodology can assist in identifying opportunities for improvement and effective resolution.

Objectives:

• Learn to develop time goals for each step of the transfer process.
• Comprehend how data can drive effective performance improvement process.
• Understand how tools such as Microsoft Power BI can identify and clarify performance improvement.

This presentation will be of interest to anyone caring for the injured adolescent. It will encompass the care journey of several teenagers from the scene of a traumatic injury through rehabilitation and discharge.

Objectives:

• Identify children at risk for PTSD
• Discuss the impact of traumatic injury in the teenage population
• Discuss interventions designed to minimize risk of PTSD in injured teens

Trauma nurses can work in any unit that cares for critically injured patients. This includes, but is not limited to, the ED, OR, Interventional Radiology, SICU and pre-hospital or transport settings, as REBOA patients can be an inter-facility transfer.

Objectives:

• Identify the most common reasons REBOA is utilized.
• Describe how REBOA is inserted and deployed.
• Identify the 5 most common complications associated with utilizing REBOA.

This session will discuss using technology for Injury Prevention in the mist of a pandemic, and converting an in-hospital, in-person teen injury prevention program into a virtual option for teachers and students. This presentation will discuss how to create a virtual option to promote injury prevention education. We will discuss options for converting your current injury prevention programs to a virtual format, maintain the ability to collect data, while growing your injury prevention program.

Objectives:

• Discuss use of technology options for injury prevention programs
• Identify key Stakeholders for virtual option
• Identify pitfalls and pearls of converting to a virtual platform

This session will look at the risk factors, mechanism of injury, hemodynamic resuscitation and the need for early and serial surgical intervention. These infections are characterized by tissue destruction, signs of toxicity, and high mortality. They can transition to life threatening infections very quickly. There will be a discussion of biologic dressings, negative pressure wound care and hyperbaric oxygen. There will be a discussion of novel pain management, fecal diversion and nutrition.

Objectives:

• The participant will be able to discuss the risk factors and co-morbidities that put a trauma patient at risk for developing a NSTI.
• The provider will leave this session with a working knowledge of these risk factors and therefore be better poised to prevent NSTI or provide early and effective management/intervention should it arise in their patient.

Coming soon...

Participants will learn of the impact of the coronavirus pandemic on trauma centers and systems around the globe. Discussion will include the impact of the coronavirus pandemic on the delivery of trauma care, changes to clinical guidelines and policies specific to trauma, impacts to administrative and operational functions for trauma programs/centers, and the most pressing concerns for trauma care providers at this time.

Participants will learn of the current and newly created educational programs and resources that the Society of Trauma Nurses offers. Participants will learn of ways to implement these opportunities into their area of the world.

Participants will learn of personal experience of resiliency during times of multiple disaster.

Presenters: Pamela Bourg, PhD, RN, TCRN, FAEN
Alice Gervasini, PhD, RN
Jacob Higgins, PhD, RN, CCRN-K
Vicki Moran, PhD, RN, MPH, CNE, CDE, PHNA-BC, TNS
Judy Mikhail, PhD, MBA, RN
Michelle Price, PhD
Linda Scheetz, BSN, MA, EdD

Agenda

Agenda

Presenters: Jill Volgraf, MSN, RN
Melissa Loughran, MSN, RN
Cynthia Blank-Reid, MSN, RN, TCRN, CEN
Linda Reinhart, MSN, RN, CNS, CCRN, TCRN

Burns are expensive catastrophic injuries to treat. Caring for burn patients offers many challenges for nurses no matter what the setting. Many patients are transferred to burn centers but many are not. By understanding the types of burns and how to assess and manage them, the trauma nurse can help patients along the continuum of care and prevent complications. This session will provide the trauma nurse with information and tools they need to improve outcomes for burn patients.

Objectives

1. Identify the different types of burns and determine the percent of body surface injured and other injuries.
2. Describe what populations are at high risk for burns and how injury prevention programs can be tailored to benefit them.
3. Identify the 5 most common complications associated with burn injuries.
4. Discuss at least 5 issues burn patients face upon discharge.

Leadership and trauma center/healthcare operations requires constant education and adaptation in order to be knowledgeable in evidence-based practices and the current state of the healthcare climate. Due to the ever changing healthcare landscape, specifically in the care of the injured patient, leaders can easily struggle to remain current in their knowledge base due to the need for constant adaptation required. This course will provide leadership solutions for the ever changing health care landscape. Attendees will be able to articulate methods of incorporating leadership skills into their daily practice which include: leading high reliability organizations, performance improvement in trauma center operations, crew resource management, starting with why, and resilience.

Agenda

Patients with spinal cord injuries can have long and fulling lives, but commonly acquire preventable hospital complications which can shorten their life expectancy. At UF Health Jacksonville, struggled with hospital acquired complications in the adult acute spinal cord injuries. Utilizing a few very easy interventions, they were able to accomplish the goal of zero harm. This session will be a guide through the performance improvement project to achieve zero.

Objectives:

• Recognize the importance of getting to zero harm in spinal cord injury patients
• Identify the needs of spinal cord injury patient population
• Understanding the performance improvement process

Leadership is everyone’s job. Trauma nurses are accountable and must exercise leadership traits. We should know what strategies are successful and should be followed. By identifying and understanding successful methods in those we follow, we can anticipate successful outcomes and emulate those traits for ourselves. The learner will receive practical, realistic and easily applicable tools that can be used right away to assess a leader’s contribution and to improve everyone’s leadership skills.

Objectives:

• Appreciate the distinction between true leadership and popularity or prestige.
• Understand the leadership traits of several highly successful leaders throughout history.
• Apply these traits to your own situation in order to influence others to obtain individual and collective success.

When a trauma patient is critically injured, as a trauma center we may have to bypass the body itself and take control in order for there to be survival. ECMO is not a new intervention, but when used for trauma patients specifically, it can provide a life-line that we never thought was possible. This session will provide a review of the latest research and literature for optimal outcomes, while digging deep into a case study that incorporates the best of the science of medicine

Objectives:

• Recognize the early signs and symptoms of ARDS in the trauma patient.
• Comprehend the pathophysiology of the ECMO machine.
• Verbalize the difference between VV ECMO and VA ECMO
• Compare and Contrast the different lung resuscitation options for trauma patients.

We’ve all seen it – a good or bad team member can make or break a trauma. Leadership is well studied and taught. Followership, a specific set of skills that complement leadership, is not – even though up to 80% of the healthcare workforce might be classified as a follower. This session will give nurse leaders – formal and informal – the tools they need to define followership and followership styles and utilize their team’s energy by understanding how followership influences the team dynamics.

Objectives:

• Describe Followership.
• Compare and contrast the five followership styles.
• Understand how a trauma resuscitation can be influenced by the followership style of resuscitation team members.

This session details the path of a trauma program manager from DMAT deployment to the work done in one of the eight New York hospitals designated as a Coronavirus hot spot. This presentation describes the assessment, planning, and implementation of a pandemic response and the many changes that were made to address the fluid nature of this event. We will present data and information regarding the changes in the trauma system from pre-hospital care to the admission of the trauma patient.

Objectives:

• Evolution of the pandemic as seen in one of the New York Coronavirus hotspots from a trauma perspective.
• Discussion will occur regarding the hospitals preparation for the first wave of patients
• No “Business as usual”
• Trauma staff with alternate roles
• Ever changing governmental regulations
• COVID Volume
• Fiscal Issues
• PPE management
• Regional Trauma Advisory Committee participation

Trauma providers must remain current on best practices and assessment techniques related to hemorrhagic shock as it is the leading cause of preventable death in trauma. This session will give a brief review of the pathophysiology of hemorrhagic shock, review key indicators and occult signs of shock, as well as best practices in resuscitation and assessment. Balanced resuscitation, permissive hypotension, trending resuscitative markers, and definitive care will be reviewed in this presentation.

Objectives:

• Relate clinical findings in hemorrhagic shock with the underlying pathophysiological mechanisms.
• Describe the assessment and key indicators of hemorrhagic shock and under-resuscitation in trauma patients.
• Summarize best practices in the treatment and resuscitation of patients in hemorrhagic shock.

REBOA is an adjunct used in the resuscitation of the patient experiencing non-compressible torso hemorrhage (NCTH). Maintaining competency and familiarity with REBOA can be a challenging process. We will review the methods used at one of the busiest trauma centers in the country that has a very high frequency of REBOA deployment and maintains nursing competency and compliance through the use of didactic and high fidelity simulations.

Objectives:

• Create a successful and sustainable program for REBOA education
• Describe a high fidelity simulation case incorporating the use of a REBOA catheter

In October of 2019, this facility transitioned to a different electronic medical record. We will describe the challenges we encountered from the initial education for this EMR, the implementation into practice, the need to incorporate the IT team for trauma specific data collection, and the COVID pandemic. Along with this information we did a timing survey to determine how long we took to return to our baseline time frame for data abstraction.

Objectives:

• Identify several needs for success in this process. This includes the education on the new EMR, implementation with the registry staff as well as other users of the trauma database, identification of gaps in data access, and onboarding new staff.
• Identify with the experience of the personnel in the trauma program that had the added challenge of remote work during the COVID pandemic and its resultant limited access to IT resources

In 2019, ACS TQIP guidelines were published recommending standardized assessment of child abuse and sentinel events. This session will provide a discussion of lessons learned in creating synergy between the emergency department, surgery, child protective services, and information technology.

Objectives:

• Define NAT and incidence.
• Explain the need for implementation of a standardized screening tool.
• Justify the cost of IT implementation.

Unfortunately, many EMS providers inaccurately triage geriatric trauma patients. The failure to gather and relay critical details often results in undertriage and delayed trauma team activation. Trauma nurse leaders can utilize the Failure Modes Effects Analysis (FMEA) to predict system weaknesses, enhance surveillance, and empower providers to adequately assess elderly trauma patients.

Objectives:

• Describe events resulting in inaccurate triage.
• Conduct a Failure Modes Effects Analysis (FMEA)
• Implement prehospital enhanced triage training.

TPMs function as co-managers of trauma programs with the TMD. They often start with little orientation to the 7 realms they manage: clinical, PIPS, administration, registry, consultant, research and trauma system involvement. Courses exist to bridge the gap, but mentoring and coaching are invaluable. We'll discuss the trauma mentor as an experienced guide assisting the TPM in learning their role focusing on a future career, versus the coach who focuses on molding the TPMs present performance.

Objectives:

• Identify the 7 realms of the Trauma Program Manager Role
• Understand the elements of mentoring by an experienced guide
• Recognize the steps in coaching a Trauma Program Manager to improve present performance.

Ineffective trauma discharges have been shown to result in patient and staff dissatisfaction, automated discharge call alerts, frequent calls to the triage line for clarification of instructions, and hospital readmissions. A multidisciplinary taskforce was created to analyze data, discuss gaps in discharge process, and identify areas for improvement. A nursing subgroup met to identify specific gaps in the discharge process related directly to nursing, including patient education.

Objectives:

• Describe how the various disciplines impact patient discharge in trauma.
• The participant will gain insight into how ineffective discharges impact the patient, family, and hospital.
• Identify steps that a trauma center can implement to improve discharges and reduce readmissions.

Coming soon...

This session will discuss how live technology (video camera, computer/tablet/ smartphone, and a videoconferencing platform) can be used to provide clinical experiences for nursing students as well as provide opportunities for health care providers/clinical educators to meet the needs of their community during a pandemic. Clinical educators may use virtual technology to provide education sessions for clinical staff as well as for aggregate patient/family/community populations.

Objectives:

• Identify ways to use a virtual platform to provide educational sessions to members of the community and interdisciplinary partners.
• Discuss how to use live conferencing technology—video conferencing—to demonstrate the skills acquired by nursing students during a mentorship experience.
• Determine multidisciplinary collaboration partners that can be used to develop, implement, and evaluate virtual mentorships/educational sessions within their own system.

Pediatric patients presenting with acute traumatic spinal cord injuries require a multidisciplinary team to appropriately address their myriad of needs. This presentation utilizes a case study format to review the key players in a clinical nurse specialist team approach to pediatric spinal cord care, as well as potential pitfalls and pearls.

Objectives:

• Discuss and relate a team approach to pediatric spinal cord care and its impact on preventing adverse outcomes.

Trauma Quality Improvement Collaborative programs have been in place for several years at a statewide and regional level. Implementation of these collaborative programs has improved the quality of care delivered leading to optimal outcomes for injured patients across the continuum. This presentation will focus on how these trauma quality improvement collaborative programs can be facilitated not only at a statewide level, but within health system hospitals or smaller groups of hospitals.

Objectives:

• The learner will identify the key components of a successful trauma quality improvement collaborative program
• The learner will identify the key priorities in establishing a health system trauma quality improvement collaborative program
• The learner will describe barriers in implementing health system collaborative programs and identify ways to overcome these barriers

Uniform billing code 450 or the trauma activation charge for a patient that arrives by private vehicle is a legitimate charge that can be billed for but can be a challenge to implement within your facility or health care system. This session will share experiences on how it was researched, discussed, and collaboratively executed within a health system.

Objectives:

• Understand the uniform billing code 450 (team charge for patient arriving by private vehicle) differences
• Understand the challenges of implementing this with a finance department that is non-clinical
• Discuss options by providing education to senior leadership, finance, compliance, revenue integrity, coding, ED and electronic health record staff

Trauma nurse leaders must utilize the tools of process mapping to ensure that data is correctly abstracted for accuracy. Registry extraction is costly, and poor data management is dangerous. This session presents lessons learned and system improvement.

Objectives:

• Diagram the process of registry abstraction.
• Evaluate the effectiveness of their institution-specific processes.
• Justify the cost/benefit of automation.

In this session we will 1) describe the critical care family's understanding of the patient’s condition and care plan compared to that of the care team, 2) identify factors influencing understanding, including COVID-related restrictions and 3) suggest ways to improve communication. A panel, including a family member, nurse, surgeon, and social worker, will share their perspective of the intersection between critical care, quality of care, caring, and patient/family-centered communication.

Objectives:

• Understand factors influencing family-provider communication quality in the trauma ICU
• Identify hospital and provider factors that can be improved to increase provider-family engagement quality, during and beyond the pandemic
• Appreciate the role of communication in outcomes and patient/family experience

Demonstrating research output is a requirement for level one trauma designation, but few resources exist on how to set up a thriving trauma research program. This session will provide a roadmap for establishing a trauma research program based on the lessons learned as a level two trauma center advanced to a level one trauma center. Along with describing how the research program was established, this session discusses program sustainability and future directions.

Objectives:

• Learn how to establish a low cost trauma research program and the benefits of having an established research program at your center
• Provide an overview of research technology available that can streamline using trauma registry reports for research purposes
• Introduction to publicly available resources for finding research studies to conduct at your trauma center

This session will discuss how to use a virtual platform to provide quality mindfulness and community building experiences to nurses while addressing the needs of self-care during the current pandemic. Experiences include mindfulness projects, sharing of ups and downs, and providing moral support to each other through a virtual platform with semi-structured activities. One of the goals is to expand the Coffee Shop to alleviate stressors brought on by caring for people in traumatic situations.

Objectives:

• Identify tools to use for innovative virtual experiences
• Assess activities that build a sense of connection with others in a virtual environment
• Understand mindfulness and its place in nursing
• Discuss implementation ideas into new arenas

By utilizing a trauma-informed approach, providers have the potential to help patients affected by trauma to feel safe, recover, and regain developmental trajectories. It is important to complete an organization risk review of the community and create a healthcare provider tool to gather real-time data. This session will review the Trauma-Informed Care principals, describe the steps of an organization risk review and the steps to create/validate a healthcare provider tool.

Objectives:

• Define Trauma-Informed Care principals in Trauma Care.
• Discuss the components of the Community Risk assessment and the importance of identifying the community needs.
• Identify the steps in creating and validating a healthcare provider tool regarding real-time Trauma-Informed Care principals and implementation.

Long Island New York was an epicenter of the SARS-COV-2 pandemic in March 2020. The effect on trauma centers was immediate and widespread. Hospitals increased bed and ICU capacity by up to 100% and trauma center personnel were re-deployed to meet staffing needs. Hospitalizations for injury decreased and injury patterns changed. Learn how two Level I Trauma Centers (in different health care systems) managed resources and maintained trauma center functions during the pandemic’s peak.

Objectives:

• To describe the impact of SARS-COV-2 on two Level 1 Trauma Centers in the NY City suburbs
• To identify trends relating to injury admissions that occurred in the 2020 pandemic
• To describe strategies to maximize trauma center function during staff re-deployment

The Trauma Nurse Lead (TNL) role is instrumental in collaborating with the the initial and ongoing care of the trauma patient to improve overall quality of care as well as improve operational metrics. This session will define how the TNL role functions in the 24/7 care delivery model and the evolution of the role in providing high quality care in partnership with the multidisciplinary team to create and sustain quality patient and operational outcomes.

Objectives:

• Define the role of the trauma nurse lead within the organization.
• Examine key patient and operational quality metrics that have been impacted by utilization of the TNL role.
• Describe key principles in creating and sustaining the role within the organization.

The trauma patient has been defined as “an injured person who requires timely diagnosis and treatment of actual or potential injuries by a multidisciplinary team of health care professionals, supported by the appropriate resource, to diminish or eliminate the risk of death or permanent disability.” The Trauma Nurse has received specialized training to care for the traumatically injured patient. This presentation focuses on the management of the trauma patient admitted to a non-trauma unit.

Objectives:

• Understand the importance of admitting trauma patients to a trauma unit.
• Describe common opportunities and troubleshooting when admitting a trauma patient to a non-trauma designated medical surgical floor.
• Discuss what's involved in planning for Trauma Outliers and what to monitor for when rounding on these patients.

Quantifiable outcome metrics have long been utilized by trauma centers resulting in optimal care and meeting essential PIPS criterion. Trauma Systems must cultivate a system-wide PIPS process inclusive of epidemiological and road crashes data, pre-hospital and trauma center care, and post-discharge outcomes. Trauma systems must be empowered to collate data and provide reproducible reports to providers across the continuum. We will review the recommended trauma system PIPS metrics.

Objectives:

• Be able to identify the recommendations for leadership of a state/regional/provincial trauma system.
• Understand the eleven essential elements of a trauma system which includes provision for trauma system evaluation and performance improvement.
• Be able to recognize key metrics for trauma system performance improvement across the continuum.

Loop closure is the final step in the performance improvement (PI) process. By closing the loop, the trauma center demonstrates that the corrective action has been effective. Too often, loop closure is incomplete or inadequately documented. Failing to demonstrate event resolution can be a criteria deficiency during an ACS verification visit. This case-based session will utilize examples demonstrating both complete and incomplete loop closure of both system and provider issues.

Objectives:

• To define event resolution (loop closure) as it related to the trauma center's PI Plan.
• To differentiate between a system issue and a provider issue, and offer examples of loop closure for each.
• To offer suggestions of how trauma registry data can support loop closure.

This session will provide a general overview of how one island-based trauma center adapted its emergency department’s patient flow to prepare for known surge events with increased trauma patient volumes. Using this short-term unidirectional flow model requires multidisciplinary collaboration in preparedness, implementation, and mitigation phases to provide best care and reduce ED length of stay. We will review the data supporting this change in practice and provide opportunities for replication in other arenas.

Objectives:

• Identify the need for a change in process for predicted trauma surge events.
• Understand logistical requirements of a unidirectional flow structure within emergency departments and inpatient treatment areas.

Trauma centers are constantly being challenged with managing resources to meet the daily demands of trauma operations including volume shifts and staffing variations. The development of a centralized registry workforce provides the ability to flex and train resources across a hospital system’s level I - IV centers while promoting efficiency across varying program demands. The presenters will describe two hospital systems that utilize this concept to create a sustainable registry model.

Objectives:

• Define a process to develop, implement, and evaluate the use of a centralized registry workforce model.
• Describe the registry structure to support abstraction, validation, data retrieval, and reporting for level I - IV centers as well as the value to incorporate data usage in a hospital system.
• Describe opportunities for skill development, training of registry staff and PI nurses, and preparing for and supporting state designation and ACS verification visits.

GSMC became a verified Trauma ll Center in 2013. Spinal Cord Injury patients require a high degree of skilled integrated care for successful outcomes and have a very high risk for secondary complications during hospitalization. GSMC identified a need for additional staff training and care guidelines for these SCI patients. This session will describe the process used to develop SCI guidelines quarterly education for front line care providers.

Objectives:

• Describe the development of standardized SCI guidelines and order sets to improve care and reduce complications in the SCI patient.
• Describe the use of bowel and bladder protocols to improve SCI outcomes.
• Describe educational course, "Neuro Boot Camp", that improved standardization of care to SCI patients and improved outcomes.

This presentation will highlight the differences in blunt and penetrating trauma during the peak of the pandemic at our facility. This ACS Level 1 center experienced a decrease in overall trauma volume during the peak of the COVID pandemic. The patients in the cohort did demonstrate a certain rate of positive COVID patients and a higher rate of penetrating injuries. We will describe the differences between this center's pre-covid and post-covid rates of blunt vs. penetrating injury.

Objectives:

• Describe the challenges for the Trauma Program providing care during the pandemic.
• Demonstrate the changes in the rates of blunt and penetrating trauma from the same time frame for 2019 and 2020.
• Describe the tests that the program faced which impacted the total rate of actual and missed trauma activations. Also included will be how these challenges impacted the program.

Weather-related injuries are common yet underappreciated events that routinely affect patient care. Learn about heat and cold injuries and their treatment, how weather-related disasters can impact our facilities and communities, and the trauma nurse's role in responding. Also, let's take a critical look at the role of the lunar cycle and it's impact on human behavior. Does the moon make us "lunatics" or not? What does the science tell us?

Objectives:

• Understand Environmental Extremes of Heat and Cold
• Appreciate Weather Events and Their Impact on Disaster Planning
• Discern the Lunar Cycle Effect on Human Behavior