All photos courtesy of Warner Bros. Television ©2001	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Annemarie Jowell, EMT (right), who is studying for her RN, said it was a fluke when she got on the show. In this scene, she is with actor Noah Wyle.

Coming on duty, Antoinette Avignone, MSN, NP, RN, is knee-deep in a double trauma. It's an accident involving a husband and wife brought in by ambulance. The husband is being prepped for OR in Trauma One. His wife has a dropping BP in Trauma Two.

Dr. Carter rotates between the two rooms, working on both patients. Nurse Haleh Adams accompanies him to the husband's bedside. "Type and cross match for 6 units of whole blood, Foley and NG tube stat. Start O2 at 15 liters by non-rebreather mask and hang Ringers at 200cc per hour."

Avignone passes up a unit of O-negative blood, and the medical student does a quick ultrasound and confirms internal bleeding.

Dr. Corday in Trauma Two announces, "She's in V-fib. We've shocked her a couple times, but we keep losing her. Looks like a severe cardiac contusion."

"BP, 86 over 46, pulse ox dropping to 82," nurse Adams announces.

Dr. Pratt looks at the patient. "She's had a threatening arrhythmia, with only brief recovery and no sustainable rhythm."

"Call the OR. This guy needs to go now," says Dr. Carter in Trauma One.

"I want to see my wife before I go into surgery," the husband pleads. He is wheeled on the gurney to Trauma Two, where he reaches for his wife's hand and says, "I love you."

The wife opens her eyes and in a small moment of regained consciousness, looks to her husband and closes her eyes. "Cut, print, reset," shouts the director. "Let's do it now for the overhead camera and make sure that mask is inflated and in place."

Avignone steps back and relaxes. The prop people begin the reset, cameras are repositioned and she unwinds for the next take. The reality returns that this is television. Avignone is not on duty at L.A. County ER, but is working as a technical extra in a TV production.

This fall marks the 10th season for "ER," a dramatic television series that takes place in Chicago via NBC and Warner Bros. Studios in Burbank, Calif. The storylines revolve around drama and authenticity, augmented by the use of registered nurses for the trauma, critical care and operating room scenes.

In most high-drama scenes, the nurse at the head of the bed is not an actor, but a proficient ER nurse, such as Avignone, who transmits competency and capability in this televised artificial setting.

On the set

These "real" nurse roles are played by a small group of talented nurses, who replicate for television the tasks they do every working day. The actors carry the drama of the scene, but in and around them realistic medical procedures are taking place. Two physician medical-technical advisers choreograph a move with every line in a scene. The medicine is the wallpaper to the plot or storyline, according to Joe Sachs, MD, writer/producer of "ER."

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