Inland Empire
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Chapter Meetings
March 2026
We have had a great start to this year. We had a chapter meeting hosted by Johnson and Johnson with over 30 in attendance, great engagement, and handful of nursing students. Additionally we hosted a stop the bleed and bystander CPR course and taught over 1,000 high school students at a local high school. We are excited to host our first upcoming conference April 16 in Redlands, Ca. We have a great agenda of speakers, dynamic vendors, and may even have some massage therapist there for free massages for our members who attend. Our board continues to grow, and we are excited for the growth.
Chapter Meeting – July 15, 2025
Emergency Nurses Association – Inland Empire Chapter Meeting July 15th, 2025
How confident are you in your ability to manage pit viper envenomation? In the United States, there are an estimated 7,000 to 8,000 venomous snakebites each year (Centers for Disease Control [CDC], 2024). The vast majority of these bites, approximately 99%, are inflicted by pit vipers.
Pit vipers are the largest group of venomous snakes in the U.S. and include rattlesnakes, copperheads, and cottonmouths (also known as water moccasins). According to CDC, while the number of bites is relatively high, fatalities are rare due to the availability of high-quality medical care, with an average of about 5 deaths per year. Even without proper treatment, those bitten have a 10–44 percent chance of having lasting injuries (2024).
Dr. Greene, a highly credentialed expert, flew in from Texas to lead an empowering discussion on pit viper envenomation. Hosted by Kaiser Fontana and sponsored by CroFab, the event focused on “Crotaline Snakebite Management: The role of Crofab.” Dr. Greene’s engaging and knowledgeable presentation held the audience’s full attention, equipping the nurses of the Inland Empire Chapter with the confidence to properly manage snakebite cases and advocate for antivenom administration.
Topics covered included:
Clinical Management of Snakebite
- Antivenom Administration: When should antivenom be administered?
- Pediatric Dosing: Do children require a smaller dose of antivenom than adults?
- Antivenom in Pregnancy: Is antivenom safe for pregnant individuals?
- Primary Risks: What are the most significant risks for snakebite victims?
- Antivenom Safety: How safe is antivenom?
- Antivenom Differences: What are the key differences between CroFab and Anavip?
- Initial Bite Management: How should a snakebite be managed immediately after it occurs?
- Juvenile vs. Adult Vipers: Are juvenile pit vipers more dangerous than adults? (No, they are not.)
- First-Aid Steps: What immediate steps should be taken if you are bitten?
- Actions to Avoid: What actions should you avoid doing if you are bitten?
- Hospital Monitoring: How long should a patient be monitored in the hospital after a bite?
- Recurrence of Symptoms: If symptoms worsen after hospital discharge, can more antivenom be given? (Yes, it can be.)
Pre-hospital Management
Immediate Actions:
- Move away from the snake to a safe location and call for help.
- Remove any constrictive clothing or jewelry from the affected area.
- Elevate the affected extremity to or above heart level for patients with only local effects. If there are systemic signs, the limb should be positioned level with the heart. Bites should never be placed below heart level.
- Take a picture of the snake only if you can do it quickly and safely, but remember that identification is not necessary for proper treatment.
What NOT to Do:
- Do not attempt to capture or kill the snake.
- Do not apply a tourniquet, lymphatic bandage, or pressure immobilization.
- Do not cut and suck the wound, pack the extremity in ice, or use an extraction device or electrical stimulation.
- Do not take anything by mouth unless directed by a physician.
- Do not use an epinephrine auto-injector unless you are experiencing symptoms of a severe allergic reaction, such as difficulty breathing.
In-hospital Management
Initial Treatment & Monitoring:
- Elevate the affected extremity to reduce pain and minimize tissue injury.
- Monitoring for at least 12-24 hours is warranted if there is any evidence of envenomation.
- A “dry bite” is defined by the absence of venom effects like swelling, bruising, or significant tenderness, regardless of lab results.
- Perform serial assessments of the limb every 15 minutes, marking the most proximal area of swelling and tenderness.
- Obtain specific lab tests, including CBC, BMP, PT/INR, Fibrinogen, and CK.
Antivenom Administration:
- Antivenom should be administered for any of the following indications:
- Significant or progressive local tissue damage, such as tenderness, swelling, or a hemorrhagic bleb.
- Hematologic toxicity, including PT > 15 seconds, fibrinogen < 150 mg/dL, or platelets < 150K/µL18.
- Systemic toxicity, such as hypotension, airway swelling, or neurological toxicity.
Pain Management:
- Begin with intravenous opioids and transition to oral analgesics.
- Elevation and appropriate antivenom treatment can help reduce the total opioid requirements.
Contraindicated Treatments:
- Surgical intervention is rarely necessary, as compartment syndrome is infrequently seen in clinical practice following crotalid envenomation.
- Prophylactic antibiotics are not indicated as snake envenomation is rarely associated with infection (less than 1% of the time).
- Corticosteroids and Benadryl (diphenhydramine) provide no direct benefit unless there is an allergy to the antivenom or the envenomation itself.
Resources:
- National Snake Bite Support: https://www.nationalsnakebitesupport.org
- Snake Bite Support Group: https://www.facebook.com/groups/national.snakebite.support
- SnakeBite911 App from Crofab: https://crofab.com/crofab-resources/snakebite911
About our speaker: Spencer Greene, MD, MS, FACEP, FACMT, FAACT, FAAEM is a board-certified medical toxicologist, addiction medicine specialist, and emergency physician who founded Bayou City Medical Toxicology and Emergency Medicine Consultants in 2019 to help physicians and other healthcare professionals provide better care of patients with toxicological emergencies, including envenomation, overdoses, and occupational exposures.
Dr. Greene currently serves as the Director of Toxicology and an attending emergency physician at HCA Houston Healthcare-Kingwood. He is a Clinical Professor at the University of Houston College of Medicine. He also has faculty appointments in the University of Texas Cizik School of Nursing and in the Department of Emergency Medicine at the Wright State University Boonshoft School of Medicine.
Website: https://bayoucitymedicaltoxicology.com
References:
Centers for Disease Control [CDC]. (2024, August 28). Venomous snakes at work. National Institute for Occupational Safety and Health (NIOSH) – Outdoor Workers. https://www.cdc.gov/niosh/outdoor-workers/about/venomous-snakes.htm
Chapter Officers
- President – Tyler McCulloch / email: tjm523@gmail.com
- Treasurer – Jennifer Lee
- Secretary/Chapter Delegate – Ashly Moran
Interested in becoming an officer, reach out to us!
Chapter Report to State Council
May 2025
The Inland Empire ENA chapter has experienced notable growth, with board membership tripling in size. We successfully hosted an educational “Stop the Bleed” event, furthering our commitment to emergency nursing education and community impact. Planning is underway for our Vision and Strategy initiative to guide future goals. Regular chapter meetings have been scheduled to maintain momentum and engagement.
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Archived Reports
January 9, 2026
The Inland Empire ENA chapter has its first official meeting of the year scheduled, with vendor sponsorship supporting a hosted dinner. In addition, the chapter has secured its first educational event for April, also in collaboration with vendor partners.
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We had a great chapter meeting at Redlands Community Hospital in late June. Bioxcel Therapeutics came and gave a great presentation about a new medication. We also had an epidemiologist speak and give us updates on questions the county is added to their daily health poll. We were able to give them some great feedback regarding the roll out of the questions.
CFED was in late May which resulted in some great interaction with out partners in the field.
Our next meeting is on August 23rd at Citrone Restaurant in Redlands. We anticipate a nice dinner, good company and an exciting presentation from Kendrion.
May 2025
The Inland Empire ENA chapter has experienced notable growth, with board membership tripling in size. We successfully hosted an educational “Stop the Bleed” event, furthering our commitment to emergency nursing education and community impact. Planning is underway for our Vision and Strategy initiative to guide future goals. Regular chapter meetings have been scheduled to maintain momentum and engagement.
January 2024
We are excited for a great 2024! We would like to welcome Jenn Lee as our newest chapter officer, she will be in the role as Chapter Treasurer. We hope each of our members had a great holiday season. Our next meeting will be viz zoom on Feb 7, and will include CE about advocacy, and how to advocate beyond the bedside. Our next meeting will be March 6 in person, location TBA with free dinner and education! Please join us, we are excited for an eventful year!
August 2023
Our last Chapter meeting in August had a great turnout! We had dinner at Citrone, hosted by Kedrion. In September, we were able to experience the ENA National Conference in San Diego. We don’t have another in person meeting planned as of yet… more to come! We understand that the holidays are important to be with family, so we don’t plan on having a holiday gathering for IE ENA this year. Upcoming CE opportunity (via Zoom): February 7th 2023 @ 1830. Join us as Government Affairs Chair, Stephanie Jensen, gives us information on how we can have a successful Legislative day in March 2024.
May 2023
CA ENA Inland Empire Chapter News
The IE chapter had a successful chapter meeting in April with Crofab presenting about snake venom. There was a huge turnout for the meeting with at least 25-30 people in attendance.
Our Chapter Secretary also did a presentation to a local University nursing school presenting to nursing students in their critical care class. The presentation was all about ENA and why they should join. The membership team at ENA offered great recruitment leave behinds in addition to free memberships for the students! Based on participation, we estimate an additional 30+ student memberships, however official numbers are still pending from ENA.
March 2023
Inland Empire had a productive meeting in February, with a hosted BBQ Dinner, by a Drug Rep. Members learned about in essence a sedative given via ‘Listerine strip.’ Although a new drug on the market, the research shows to be effective. There was robust conversation about how this could be easily implemented in the Emergency Department, and hopefully cross over to the EMS world.
After there was a round table journal article discussion focused on psychiatric emergencies. Members discussed different pharmacologic responses to different types of psychiatric responses, such as why do you give the sundowning grandma, something different then you give the 21 year old acute psychosis. It was a great round table discussion where all members left learning something.
Our Resident Lecture series continues to be successful. It has been a great working relationship with Loma Linda University Health Emergency Medicine Residency Program, this is top quality education free to our members! Next one is March 28, 2023.
Our next in person chapter meeting will be at San Antonio Regional Hospital, April 13, 2023 in The Vineyard Conference Room at 1800. Come learn about what’s new for snake bite education! Will be a great time to network and learn!
CFED is around the corner, have you signed up? CFEDWEST.com An amazing conference -bringing the team together – everything that touches EMS will be at the conference! Come learn with us!
November 2022
Hey members! We have been rather active in the past few weeks. Here is a run down of what we have been up too – Our last meeting was at Marios Place in riverside, we had approx 30 members attend a lecture on anticoagulation reversal agents after intracranial hemorrhage. We had some good food, great networking a learned a few things.
We had the most delegates from any other chapter attend general assembly in Denver back in September. It was a great opportunity to get involved and advocate for our association and nurses! One of our members helped write a resolution about fentanyl testing in the ED, and it passed! Props to Stephanie Jensen and all her hard work!
We have been asked to serve on a task force for Narcan education at local high schools. The task force is currently working on logistics and implementation however very soon we will have a call for volunteers soon. This will be a big undertaking and will need all hands on deck!
Our Board of Directors for 2023 are – President Tyler McCulloch, Treasurer Leslie Duke, Secretary/Chapter Delegate Ashly Moran. Welcome Ashly to the board of directors, she is going to be great at her new role.
Tyler currently works at Inland Valley Medical center, as a night shift clinical supervisor. He is passionate about the ENA and rising emergency nursing to a new level. Leslie works at Riverside EMS Agency as the Specialty Care Coordinator. She is passionate about being a Glamma, and process improvement. Ashly currently works at Kaiser Permanente Riverside, as well as Disneyland. She strives to be a good mom, good wife, and making sure her family feels loved.
Our next meeting will be December 11, 2022 at Stone Church Brewery in Riverside 1600-1800. First beer on ENA! Come learn more about our chapter, have a beer and some snacks! Not a member? That’s ok! Bring a friend.
August 2022
Chapter/Committee News: We had a great turn out at our last chapter meeting in June and we are planning for an even better turn out in our upcoming meeting in August. We will have a presentation about pediatric DKA and PainEase is supplying dinner for those in attendance. We also have a CEN review coming up hosted by Loma Linda University. In addition, there is an EMS Education day coming up in September for Fire, EMS and ED nurses.
April 2022
We had our first in person Chapter meeting in April 2022. We had a great turn out with about 30 people in attendance and a great presentation by Chiesi with a lot of great information about Cleviprex. Our upcoming meeting will be hosted by ICEMA with EMS fellows from two local base station/trauma centers scheduled to present. We also teamed up with the Orange Coast Chapter to support our brothers and sisters in Sacramento who were affected by the recent shooting.
March 2022
Over 25 people have RSVP’d for our April meeting. 10 have RSVP’d for the stop the bleed and hands only CPR. Some nursing students as well. We are planning an EMS focused meeting that our lemsa is going to Host! Excited to have new blood and some activity as people are really working on getting involved.
January 2022
Hello 2022! All of our nurses are working hard, we are trying to get back to in person meetings. We are planning on doing a Stop the Bleed Course in Southwest Riverside County in February, date to be confirmed. If you are interested in becoming a stop the bleed course instructor please reach out to Tyler! We are looking forward to a new year and hope to be in person again! Want to get involved email Tyler – tjm523@gmail.com
January 2021
Unfortunately due to the pandemic we have had a pretty quiet end to 2020, and have no concrete plans for the start of 2021. Our hospital systems are overwhelmed, our nurses are working extra shifts and our members do not have the capacity to attend online virtual events at this time. We are hopeful that the vaccine will help and by late spring or early summer we can start to meet again. Thank you to all of our nurses for working exhausting shifts and taking care of our community!
March 2020
We will be having our next chapter meeting on April 7th at San Antonio Regional Hospital, it will be sponsored by Zoll and dinner will be provided. We are still working on our educational event “Special Populations we Don’t Talk About”, it will be on Sat. Oct 3rd at the Joslyn Center in Redlands Ca. We have confirmed speakers for combat PTSD, domestic abuse, and transgender, we are firming up the speaker for autism and sickle cell. We have also decided to include a special speaker for a lunch and Learn Desiree Hadden to speak about violence in the ED. following the educational conference will be a 50’s sock hop.
January 2020
Inland Empire has set their meeting schedule for 2020. Our next meeting is Feb 16th, we will be having our annual Homeless Outreach blanket drive that day. The big event we are planning this year for the ENA 50th anniversary is an educational day titled “Special Populations We Don’t Talk About”. Tentative date for the conference is Oct 3rd, following the conference will be a 50’s sock hop.