Disaster Nursing and Emergency Preparedness for Chemical, Biological and Radiological Terrorism and Other Hazards, 2nd Edition

680 Pages·2007·6.631 MB·English

by  Tener Goodwin Veenema

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About the Editor
TenerGoodwinVeenema,PhD,MPH,MS,CPNP, Preparedness”andcollaboratedwiththeAmericanRed
is an Associate Professor of Clinical Nursing, Assistant Cross to customize the ReadyRN curriculum for use
ProfessorofEmergencyMedicine,andProgramDirector by the American Red Cross in educating and training
forDisasterNursingandStrategicInitiativesattheCen- American Red Cross health care professionals in pro-
ter for Disaster Medicine and Emergency Preparedness viding health-related disaster and emergency response
at the University of Rochester School of Nursing and services.
School of Medicine and Dentistry. Dr. Veenema is also Dr.Veenema’sReadyRN ComprehensiveCurriculum
PresidentandChiefExecutiveOfficeroftheTenERCon- for Disaster Nursing and Emergency Preparedness was
sulting Group, LLC, which provides consultation and alsopublishedin2007asaninnovativee-learningonline
workforce development for emergency preparedness to coursebyElsevier,andthecompanionReadyRN Hand-
federal,stateagencies,andcorporateorganizations.She book for Disaster Nursing and Emergency Preparedness
has received numerous awards and research grants for willbepublishedinfall2007.
her work, and in June 2004, Dr. Veenema was elected While at the University of Rochester, Dr. Veenema
into the National Academies of Practice and was se- developed the curriculum for a 30-credit Masters pro-
lectedasa2004RobertWoodJohnsonExecutiveNurse gramentitled“LeadershipinHealthCareSystems:Dis-
Fellow. In 2006, Dr. Veenema was the recipient of the aster Response and Emergency Management,” the first
KlainerEntrepreneurialAwardinhealthcare. program of its kind in the country to be offered at a
Dr. Veenema received her Bachelor of Science de- school of nursing. The program offers course content
gree in Nursing from Columbia University in 1980 and on the Fundamentals of Disaster Management, Chemi-
wentontoobtainaMasterofScienceinNursingAdmin- cal,BiologicalandRadiologicalTerrorism,GlobalPublic
istration (1992) and a Master in Public Health (1999) Health and Complex Human Emergencies, Leadership
from the University of Rochester School of Medicine and Strategic Decision Making, and Communication in
andDentistry.In2001,sheearnedaPhDinHealthSer- DisasterResponseandEmergencyPreparedness.
vices Research and Policy from the same institution. Dr. Veenema has served as a reviewer to the In-
Dr. Veenema is a nationally certified Pediatric Nurse stitute of Medicine Committee on the Review Panel for
Practitioner, and worked for many years in the Pedi- theSmallpoxVaccinationImplementation,Jane’sChem-
atricEmergencyDepartmentatStrongMemorialHospi- Bio Handbook, 2nd Edition, and serves on the edito-
tal(Rochester,NewYork). rial board for the journal Disaster Management and
A highly successful author and editor, Dr. Veen- Response,sponsoredbytheEmergencyNursesAssocia-
ema has published books and multiple articles on tion.Dr.VeenemaisanAssociateEditorfortheJournal
emergencynursinganddisasterpreparedness.Thefirst of Disaster Medicine and Public Health Preparedness,
edition of this textbook, published in August 2003, re- sponsoredbytheAmericanMedicalAssociation.
ceivedanAmericanJournalofNursingBook-of-the-Year Dr. Veenema frequently serves as a subject-matter
Award. expert for the National American Red Cross, multiple
Dr.TenerGoodwinVeenema,inherroleasChiefEx- state health departments and nurses associations, as
ecutive Officer of the TenER Consulting Group, LLC, is well as the Registered Nurses Association of Ontario,
the author and developer of “ReadyRN: A Comprehen- Canada. She is a member of the World Association of
sive Curriculum for Disaster Nursing and Emergency DisasterMedicine(WADEM).
ii
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Disaster
Nursing and
Emergency
Preparedness
for Chemical, Biological, and Radiological Terrorism
and Other Hazards
Second Edition
EDITOR Tener Goodwin Veenema, PhD, MPH, MS, CPNP
iii
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Copyright(cid:2)C 2007SpringerPublishingCompany,LLC
Allrightsreserved.
Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,or
transmittedinanyformorbyanymeans,electronic,mechanical,photocopying,
recording,orotherwise,withoutthepriorpermissionofSpringerPublishing
Company,LLC.
SpringerPublishingCompany,LLC
11West42ndStreet
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AcquisitionsEditor:SallyJ.Barhydt
ProductionEditor:MatthewByrd
CoverDesign:MimiFlow
Composition:Aptara
07 08 09 10/ 5 4 3 2 1
LibraryofCongressCataloging-in-PublicationData
Disasternursingandemergencypreparednessforchemical,biological,andradiological
terrorismandotherhazards/TenerGoodwinVeenema.–2nded.
p. ; cm.
Includesbibliographicalreferencesandindex.
ISBN-13:978-0-8261-2144-8
ISBN-10:0-8261-2144-6
1.Disasternursing. 2.Emergencynursing. I.Veenema,TenerGoodwin.
[DNLM:1.Disasters. 2.EmergencyNursing. 3.Terrorism.WY154D61092007]
RT108.D56 2007
616.02(cid:3)5–dc22
2007012380
PrintedintheUnitedStatesofAmericabyBangPrinting
iv
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Preface
Itisquiteprobablethatatsometimeinthefuture,nurses andskillsettheywillneedtokeepthemselves,theirpa-
maybecalledupontorespondtoamasscasualtyevent tients,andfamiliessafeduringanydisasterevent.Once
or disaster outside of the hospital. Advance preparation
again, we have held ourselves to the highest standards
of our national nursing workforce for such an event is
possible.Everychapterinthebookhasbeenresearched,
predictedonthebeliefthatmasteryoftheknowledgeand
skills needed to respond appropriately to such an event reviewed by experts, and matched to the highest stan-
canimprovepatientoutcomes. dardsforpreparinghealthprofessions’studentsforter-
rorism,disasterevents,andpublichealthemergencies.
I wrote these words in the spring of 2002 as I fin- The framework of the book is consistent with the
ished the summary section of chapter 9 (p. 199) in the United States National Response Plan, the National In-
firsteditionofthisbook—31/2yearsbeforeHurricane cident Management System, and is based on the Cen-
Katrina would wreak its devastation on the communi- ters for Disease Control and Prevention’s (CDC) Com-
ties of the Gulf Coast. When the first edition of the petencies for public health preparedness and the CDC
bookwasreleased,ourcountrywasstillreelingfromthe Guidelinesforresponsetochemical,biological,andra-
9/11attacksandfearfulofanotheroutbreakofanthrax. diologicalevents.Thistextbookwillprovidenurseswith
These two events had resulted in an immediate aware- aheightenedawarenessfordisastersandmasscasualty
nessofourlackofnationalemergencypreparednessand incidents,asolidfoundationofknowledge(educational
heightenedvulnerabilitytodisasterevents.Healthcare competencies) and a tool box of skills (occupational
providerswerebarragedbyanonslaughtofinformation competencies) to respond in a timely and appropriate
from numerous sources (of varying quality) regarding manner.
topics such as disaster planning and response, biologi- SinceSeptember11,2001,ournationalconcernsfor
cal agents, hazardous materials accidents, the dangers the health and safety of our citizens has expanded to
of radiation, therapeutics, and so forth. Resources on include additional hazards such as emerging infectious
theInternetalonehadincreasedexponentially.Myown diseases (SARS, West Nile virus, avian influenza), the
research on these topics had revealed that the existing detonation of major explosive devices, and the use of
disaster textbooks were written by and for physicians nuclear weapons by countries unfriendly to the United
andpublichealthofficials.Therewasamajorgapinthe States.Wepossessaheightenedawarenessoftheforces
literature for nurses. Given the approximately 2.7 mil- of Mother Nature and the health impact on communi-
lion nurses in this country, I found this to be not only tiesaffectedbynaturaldisasters.Wecontinuetofacea
unacceptable but a major threat to population health growing national shortage of nurses and nurse educa-
outcomes.Therefore,thegenesisofthebookwasthede- tors,ahealthcaresystemthatisseverelystressedfinan-
siretofillthisgapintheliteratureandtoprovidenurses cially,andemergencydepartmentsthatarefunctioning
withacomprehensiveresourcethatwasevidencebased indisastermodeonadailybasis.Wehavereasontobe-
wheneverpossible,andbroadinscopeanddeepinde- lieve that these challenges for the profession will only
tail.Wewereverysuccessfulandthefirsteditionwasex- intensify in the coming years. Nurses are challenged to
tremelywellreceived,garneringanAJNBookoftheYear be prepared for all hazards—to plan for pandemic in-
awardalongwithmultipleadditionalaccolades,andfor fluenza, chemical, biological, radiological/nuclear, and
thatIameternallygrateful.Thebookiscurrentlybeing explosive (CBRNE) events, mass casualty incidents in-
usednationwidebyuniversitiesandschoolsofnursing, volving major burns, and surge capacity to accommo-
hospitals,publichealthdepartments,andmultipleother dateasuddeninfluxofhundreds,possiblythousands,of
siteswherenurseswork. patients.Inresponsetotheseconcernsandtherequests
The second edition of this textbook has an equally of nurses across the country, I have added several new
ambitiousgoal—toonceagainprovidenursesandnurse chapters in the second edition that serve to strengthen
practitioners with the most current, valid, and reliable thehealthsystemsfocusofthebookandtoaddastrong
informationavailableforthemtoacquiretheknowledge clinicalpresence.
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vi Preface
Since 2003, the Department of Homeland Security, This textbook continues to be a reflection of my
the Federal Emergency Management Administration loveforwritingandresearch,aswellasadeepdesireto
(FEMA), the CDC, and other federal and nonfederal help nurses protect themselves, their families, and their
agencies have devoted significant resources to increas- communities.Disasternursingisapatientsafetyissue.
ing our level of national emergency preparedness. We Nurses can only protect their patients if they them-
hadmadesignificantprogressoncertainfronts,butwith selves are safe first. The second edition represents a
regard to our level of workforce preparedness in the substantive attempt to collect, expand, update, and in-
health professions, we have a long way to go. In the clude the most valid and reliable information currently
years since the first edition of this textbook was pub- available about various disasters, public health emer-
lished, other nursing texts and educational resources gencies, and acts of terrorism. The target audience for
havebeendevelopedandpublished,andthisauthorap- thebookiseverynurseinAmerica—makingeverynurse
plaudstheseinitiatives.Thereismuchworktobedone, a prepared nurse—staff nurses, nurse practitioners, ed-
and it is personally rewarding to witness increased in- ucators, and administrators. The scope of the book is
terestindisasternursingasmorenursesgetinvolved. broadandthedepthofdetailintricate.Mygoalistopro-
As an emergency nurse and pediatric nurse practi- duceasecondeditionthatrepresentsawell-researched
tioner,Ihaveworkedinthefieldofdisasternursingand and well-organized scholarly work that will serve as a
emergencypreparednessformanyyears,withafocuson major reference for all our nation’s nurses on the top-
promoting the health of the community and the health icsofdisasternursingandemergencypreparedness.Itis
oftheconsumerbystructuring,developing,andfoster- myhopethatnurseeducatorswillbepleasedtodiscover
ing an environment that is prepared for any disaster or theexpandedorganizationofthebookandtheinclusion
major public health emergency. I have lobbied for the ofnewchapters,casestudies,andstudyquestions.The
advancement of the profession of nursing in the disas- insertionofInternet-basedactivitiesisdesignedtostim-
terpolicyandeducationarena,andIremainpersonally ulate critical thinking in students and to provide them
committed to my work in preparing a national nurs- withtheskillsettostayupdatedregardingthesetopics.
ing workforce that is adequately prepared to respond to Ideally,thisbookrepresentsthefoundationforbest
any disaster or public health emergency. This includes practiceindisasternursingandemergencypreparedness,
working to establish sustainable community partner- andisasteppingstoneforthedisciplineofdisasternurs-
ships that foster collaboration and mutual planning for ing research. Chapters in this book were based on em-
thehealthofourcommunity.Itincludeslookingatinno- pirical evidence whenever it was available. However,
vativeapplicationsoftechnologytoenhancesustainable theamountofresearchinexistenceaddressingdisaster
learninganddisasternursingresponse.Itmeansgiving nursingandhealthoutcomesislimited,andmuchwork
reflectiveconsiderationoftherealitiesoftheclinicalde- remains to be done. The editor welcomes constructive
mandsplacedonnursesduringcatastrophiceventsand commentsregardingthecontentofthistext.
theneedforconsiderationofalteredstandardsforclini-
calcareduringdisastersandpublichealthemergencies. TenerGoodwinVeenema
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Acknowledgments
Aswiththefirsteditionofthisbook,Icontinuetopro- Services); Janice B. Griffin Agazio, PhD, CRNP, RN
fess that researching, revising, designing, and deliver- (The Catholic University of America); Eric Croddy, MA
ing this book was a true labor of love—I enjoyed every (MontereyInstituteforInternationalStudies);andGary
minute of it! And like any effective disaster response, Ackerman, MA (Center for Terrorism and Intelligence
thistextbookwasacoordinatedteameffort.Thesecond Studies). Thank you so much for your wonderful con-
editionissignificantlylargerthanthefirst—severalnew tributionsandforyourongoingsupportofthisbook.
chapters have been added, all of the content updated, Very special acknowledgments and many thanks
and the clinical focus expanded. Additionally, the en- go to my international colleagues at the University of
tire book has been mapped to the Centers for Disease Ulster—Pat Deeny, Kevin Davies, and Mark Gillespie,
ControlandPrevention’scompetenciesforpublichealth and welcome to Wendy Spencer. These wonderful in-
emergency preparedness—this represents nothing less dividuals were committed to providing a broad and il-
thanaHerculeaneffort.Therearesomanyexceptional lustrative international perspective for the book. Their
individuals, all over the country, who helped to make resultantchapter,GlobalIssuesinDisasterReliefNurs-
thisbookareality. ing, is evidence of their expert knowledge, extensive
Myspecialthanksmustfirstgotoeachofthewon- experience in the field, and dedication to international
derful chapter authors who researched, reviewed, and collegiality.Iwillalwaysremaingratefultoeachofthem
revisedtheirmanuscripts,assuringthattheinformation fortheircontributionstothefield.
contained within was valid, accurate, and reliable, and My thanks go once again to Jonathan Tucker, my
reflectedthemostcurrentstateofthescience.Thiswas specialcontributor,forallowingmetoreprintaportion
atremendouschallengegiventhehighlytransitionalna- ofhisworkfromhiswonderfulbookScourge:TheOnce
tureofmanyofthetopicareas.Thesciencewasrapidly and Future Threat of Smallpox. It continues to be the
evolving(andcontinuestoevolve)andaswiththefirst perfectsegueintotheChemicalandBiologicalTerrorism
edition, the structure of many disaster and emergency sectionofthebook.
response systems was rapidly changing (and continues I wish to thank each of the case study authors and
tochange)duringtheyearitwaswritten. welcome the following new authors to the second edi-
I would like to first thank my fabulous colleagues tion of the book. Thanks go to Ziad N. Kazzi, MD,
who were chapter authors and/or contributors for the FAAEM, along with his colleagues Dave Pigott, MD,
firsteditionandstayedcommittedtothisprojectforthe FACEPandEricaPryor,RN,PhDattheUniversityofAl-
second edition. My very sincere thanks go to Kathleen abamaatBirminghamCenterforDisasterPreparedness.
Coyne Plum, PhD, RN, NPP (Monroe County Depart- The quality of their work is incredible, as is their gen-
ment of Human Services); Kristine Qureshi, RN, CEN, erosityinsharingit.
DNSc(UniversityofHawaii);BrigitteL.Nacos,PhDand Another very special welcome and thanks go to
KristineM.Gebbie,DrPH,RN,FAAN(ColumbiaUniver- Roberta Lavin (Health and Human Services) and Lynn
sity); Lisa Marie Bernardo, RN, PhD, MPH (University Slepski (Department of Homeland Security). Roberta
ofPittsburgh);EricaRihlPryor,RN,PhDandDavePig- and Lynn made sure that the descriptions of the Na-
ott,MD,FACEP(UniversityofAlabama);LindaLandes- tionalResponsePlanandallcomponentsofthefederal
man, DrPH, MSW, ACSW, LCSW, BCD (NYC Health & disasterprogramwereasaccurateaspossibleuptothe
Hospitals Consortium); Kathryn McCabe Votava, PhD, timeofpublication.Theyarealsotwoofthenicestand
RN and Cathy Peters, MS, RN, APRN-BC (University of mostgenerousindividualsonewouldeverwanttomeet.
Rochester); P. Andrew Karam, PhD, CHP (MJW Cor- WelcomeandthanksgotoChristopherLentz,MD,
poration); Joan Stanley, PhD, RN, CRNP (American FACS, FCCM; Dixie Reid, PA; Brooke Rea, MS, RN; and
Association of Colleges of Nursing); Lt. Col. Richard Kerry Kehoe, MS (University of Rochester) for their
Ricciardi, RN, FNP and Patricia Hinton Walker, PhD, chapteraddressingtherecognitionandmanagementof
RN,FAAN(UniformedServicesUniversityoftheHealth burnsandguidelinesfordisasterplanningforasurgeof
vii
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viii Acknowledgments
burnpatients.Dr.Lentz,astheDirectoroftheregional Emergency Preparedness (University of Rochester, De-
Burn/TraumaCenterattheUniversityofRochesterMed- partmentofEmergencyMedicine).ManishShah,along
ical Center, along with his wife Dixie Reid, are burn with his colleagues Jeremy, Charles, and Jonnathan,
experts and tireless advocates for clinical excellence in contributed a comprehensive overview of Emergency
thecareoftheseverelyburnedpatient.BothBrookeRea Medical Services as it currently exists in this country.
(Burn Program Manager) and Kerry Kehoe (former Ad- This well-designed and well-organized chapter was a
ministratorDivisionofTrauma&Burn)aregraduatesof wonderful new addition to the book. John Benitez is
the Leadership in Health Care Systems in Disaster Re- DirectoroftheWesternNewYorkRegionalPoisonCon-
sponse and Emergency Health Care Systems, and so it trol Center, who along with Sharon Benware, RN, con-
isanevengreaterpleasuretobeabletoincludethemin tributed to the chapter addressing chemical agents of
thiseditionofthebook.Brooke’stalentsandleadership concern.
skills were clearly evident in her effort to produce this I want to express my continued appreciation and
chapter,andIsendhermyspecialthanks. sincere gratitude to Lisa Bernardo, Erica Pryor, Kris-
A sincere welcome and thanks go out to two new tine Qureshi, and Kathy Plum for their elegant contri-
authors and former students of mine, Tara Sacco, MS, butions,fortheirongoingsupportandencouragement,
BS, RN and Jennifer Byrnes, MLS, MPH (University andfortheirwillingnesstomakerecommendationsthat
of Rochester). Tara is a graduate of the Leadership in strengthenedthecontentofthebook.Ihavetheultimate
Health Care Systems program in Health Promotion and respect for each of you, and I am sincerely grateful for
Health Education; Jennifer is a graduate of the Mas- ourongoingrelationships!
ter’s in Public Health program. Both are talented re- Special thanks go out to my wonderful friends and
searchers and writers, and it is my guess that you will colleagues,DianeYeater,AssociateDirectorforDisaster
behearingmorefromtheminthefuture.Theirchapters Health Services and to Nancy McKelvey, Chief Nurse
on Traumatic Injuries Due to Explosions and Blast Ef- at the American Red Cross, National Headquarters in
fects, and Emerging Infectious Diseases (respectively) Washington,DC.Thankyouforyourcontributionsand
broadly expanded the clinical focus of the book and yourinsightintonationaldisasterpreparednessandre-
providedvaluablenewclinicalresourceinformationfor sponseinitiatives.
nurses. IamsofortunatetocalltheUniversityofRochester
Welcome and thanks go to Amy T. Campbell, JD, School of Nursing my academic home. This phenom-
MBE (University of Rochester, Division of Medical Hu- enal school is a leader in excellence in nursing edu-
manities)forherdetailedlegalreviewandupdateofthe cation and in entrepreneurship for nurses, and I have
chapteronLegalandEthicalIssuesinDisasterResponse learned something from every one of my talented col-
and to Joy Spellman (Burlington County College, New leagues.IwishtoonceagainthankDeanPatriciaChiver-
Jersey) for her contributions on preparing and promot- tonforcreatinganenvironmentthatsupportsnewand
ingtheroleofthepublichealthnursesduringdisasters. visionary initiatives and for supporting and encourag-
Both of these authors were so gracious and generous ingmetodotheworkthatIwanttodo.Iameternally
withtheirexpertise.Thankyou. grateful to Pat and to each of my fellow faculty mem-
A very special warm welcome and thanks go to bersintheLeadershipinHealthCareSystemsMaster’s
Elizabeth A. Davis, JD, Ed.M and her colleagues Alan Program.
Clive,PhD,JaneA.Kushma,PhD,andJenniferMincin, AsIfinishthesecondeditionofthisbook,Iwould
MPA. Elizabeth is the Founder and President of Eliza- also like to acknowledge 19 wonderfully talented in-
bethAnnDavisAssociates(http://www.eadassociates. dividuals and very special, terrific friends—my col-
com/) and is a nationally recognized expert/advocate leagues in the 2004 Robert Wood Johnson Execu-
for vulnerable populations. It was extremely important tiveNurseFellowship:CarlaBaumann,SuzanneBoyle,
to me to add a substantive piece on planning for and Kathleen Capitulo, June Chan, Theresa Daggi, Kathryn
respondingtotheneedsofhigh-risk,high-vulnerability Fiandt, Margaret Frankhauser, Mary Hooshmand, Paul
populations in this edition of the book, and Alan, Eliz- Kuehnert, Mary Joan Ladden, Joan Marren, Marcia
abeth,Jane,andJenniferprovidedasuperbchapteron Maurer, Marcella McKay, Wanda Montalvo, Kathleen
thistopic(andinarelativelyshorttimeframe).Mysin- Murphy, Cheri Rinehart, Mary Lou de Leon Siantz,
cere thanks and admiration go out to each of you for Kristen Swanson, and Bonnie Westra. We have shared
yourwork. anamazingexperienceinthiswonderfulprogram,and
Welcome and gratitude go to Manish Shah, MD, they have provided me with insight and guidance for
MPH,FACEP;JeremyCushman,MD,MS;CharlesMad- mywork,ofwhichthisbookrepresentsaportionofthe
dow, MD, FACEP; and Jonnathan Busko, MD, MPH, overall project—ReadyRN: Making Every Nurse a Pre-
EMT-P (University of Rochester, Department of Emer- pared Nurse. Their incredible work inspired me. But
gency Medicine), and to my colleague John Benitez, mostly I am grateful for the fun, friendship, and sup-
MD, MPH at the Center for Disaster Medicine and porttheyoffered.Theybelievedinmyvisionfordisaster
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Acknowledgments ix
nursingandforthisbook,andtheyarealwaystherefor I will be eternally grateful to my colleague and re-
mewhenIneedthem.Thankyou. search assistant Adam B. Rains for his assistance with
SpecialthankstoLorettaFord,formerDeanandPro- thepreparationofthisverylargemanuscript.Adam’sin-
fessorEmeritusattheUniversityofRochesterSchoolof telligence,humorandwit—andlimitlesstalent—werea
Nursing, and founder of the nurse practitioner role. I gifttothisproject.
havehadtheamazinggoodfortuneofhavingLeeasmy Many thanks go to three very special women who
mentor in the Robert Wood Johnson Executive Nurse are the best friends anyone could ask for—Katherine
Fellowship Program. There are no words to describe Lostumbo,BarbaraWale,andMaryanneTownsend.The
this feisty, energetic, phenomenally talented nurse and warmthofyourfriendshipcontinuestosustainme.
scholar. She is a role model to the entire profession of Finally,thepeopletowhomIowethemostaremy
nursing, and my life is richer for having known her. family. To my mother, thank you for all you have done
Herwisdomandguidancehaveplayedapivotalrolein for me and for thinking that I am much more capable
muchofmyworkthepastfewyears.Herkindnessand than I really am. You often told me, “to thine own self
supporthavesustainedme.ThankyousomuchLee. betrue,”whenmakingmylife’sdecisions—greatadvice
I wish to thank all of my reviewers and those who that I have often passed down to my children. Thanks
provided valued commentary and recommendations. tomydad—Iloveyoulots.
SpecialthankstoLoriBarrette(UniversityofRochester), To my four children, I sincerely thank you for the
JaniceSpringer(AmericanRedCross),andLouRomig, joy you have brought to my life. You are my greatest
MD, FAAP, FACEP. Just as there is no perfect research accomplishment.MysonsKyle,Blair,andRyne—Ilove
study, there is also not a perfect textbook or reference you so much. A huge and especially special thank you
manual. This fact, however, did not dissuade us from goes to my wonderful daughter Kendall, who has been
seeking to make this book and every section in it the a terrific help to me for many, many years. Her words
very best it could be. Many thanks to all who shared ofencouragement(andthesoundofherlaughter)have
their wisdom and expertise during the preparation of always kept me going! She is my very best friend and
thebook. themostincrediblepersonIknow.
I would like to acknowledge Sally Barhydt and her And to my husband and partner in all life’s adven-
colleaguesatSpringerPublishingCompanyinNewYork tures,mydeepestthanks.Icouldnothavedoneanyof
City.Isincerelythankyou,Sally,forallyourhardwork thiswithoutyou.Youhavehelpedmeintoomanyways
in assisting with the publication of the second edition, tomention,andIamsoappreciativeofeachandevery
andforyourongoingcommitmenttomeasanauthor. momentwehaveshared.Thankyou.
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x