A Conceptual Model of Individual Clinical Readiness.

Introduction: Force readiness is a priority among senior leaders across all branches of the Department of Defense. Units that do not achieve readiness benchmarks are considered non-deployable until the unit achieves the requisite benchmarks. Because military units are made up of individuals, the unit cannot be ready if the individuals within the unit are not ready.

Effectiveness of Mobile Applications for Trauma Care in Combat Casualty Simulations Throughout the Continuum.

Introduction: The U.S. Military uses handwritten documentation throughout the continuum of combat casualty care to document from point-of-injury, during transport and at facilities that provide damage control resuscitation and surgery.

A Deeper Dive Into Combat Medic Training.

The recent article by Knisely et al. provides a comprehensive review and summary of recent literature describing simulation techniques, training strategies, and technologies to teach medics combat casualty care skills. Some of the results reported by Knisely et al.

A Retrospective Cohort Study of Burn Casualties Transported by the US Army Burn Flight Team and US Air Force Critical Care Air Transport Teams.

Introduction: The US Army Burn Center, the only burn center in the Department of Defense provides comprehensive burn care. The Burn Flight Team (BFT) provides specialized burn care during transcontinental evacuation. During Operations Iraqi and Enduring Freedom, burn injuries accounted for approximately 5% of all injuries in military personnel.

Patterns of Palliation: A Review of Casualties That Received Pain Management Before Reaching Role 2 in Afghanistan.

Introduction: Battlefield pain management changed markedly during the first 20 years of the Global War on Terror. Morphine, long the mainstay of combat analgesia, diminished in favor of fentanyl and ketamine for military pain control, but the options are not hemodynamically or psychologically equivalent. Understanding patterns of prehospital analgesia may reveal further opportunities for combat casualty care improvement.

Characterization of Humanitarian Trauma Care by US Military Facilities During Combat Operations in Afghanistan and Iraq.

Objective: To characterize humanitarian trauma care delivered by US military treatment facilities (MTFs) in Afghanistan and Iraq during combat operations.

Background: International Humanitarian Law, which includes the Geneva Conventions, defines protections and standards of treatment to victims of armed conflicts. In 1949, these standards expanded to include injured civilians.

An Assessment of Nursing Skills Required for Sustaining a Casualty during Prolonged Casualty Care: Implications for Training and Preparing for the Next Major War.

Background: The US military is transitioning rapidly from the Global War on Terrorism in preparation for near-peer combat in a multidomain operations (MDO) and/or large scale combat operations (LSCO) setting. Due to potentially contested freedom of movement in this setting, casualty evacuation may be significantly delayed, resulting in medics and other prehospital medical personnel taking on patient care duties normally performed by nurses in a hospital-based setting. However, the frequency of nursing-type care remains unclear.

Characteristics of burn casualties treated at role 2 in Afghanistan.

Background: Role 2 medical treatment facilities (MTFs) are frequently located in austere settings and have limited resources. A dedicated assessment of burn casualties treated at this level of care has not been performed. Therefore, the objective of this study was to characterize burn casualties presenting to role 2 MTFs in Afghanistan, along with the procedures they required, complications, and mortality to begin understanding the resources consumed by their care.

Predeployment training of Army medics assigned to prehospital settings.

Background: Medics have numerous responsibilities in the combat theater, which include performing lifesaving interventions, providing basic medical and nursing care, and caring for casualties in a variety of scenarios unique to the battlefield. An evaluation of the medic predeployment training paradigm is important and will help to understand its current state and identify areas for improvement. Therefore, the purpose of this study was to perform a focused assessment of Army medic predeployment training to identify patterns that might inform future medic training.

An Assessment of Pre-deployment Training for Army Nurses and Medics.

Introduction: Although military nurses and medics have important roles in caring for combat casualties, no standardized pre-deployment training curriculum exists for those in the Army. A large-scale, survey-based evaluation of pre-deployment training would help to understand its current state and identify areas for improvement. The purpose of this study was to survey Army nurses and medics to describe their pre-deployment training.

CE: Trauma-Related Hemorrhagic Shock: A Clinical Review.

Optimal management of trauma-related hemorrhagic shock begins at the point of injury and continues throughout all hospital settings. Several procedures developed on the battlefield to treat this condition have been adopted by civilian health care systems and are now used in a number of nonmilitary hospitals. Despite the important role nurses play in caring for patients with trauma-related hemorrhagic shock, much of the literature on this condition is directed toward paramedics and physicians.

Anatomic injury patterns in combat casualties treated by forward surgical teams.

Background: Role 2 forward surgical teams provide damage-control resuscitation and surgery for life- and limb-threatening injuries. These teams have limited resources and personnel, so understanding the anatomic injury patterns seen by these teams is vital for providing adequate training and preparation prior to deployment. The objective of this study was to describe the spectrum of injuries treated at Role 2 facilities in Afghanistan.

Transporting Children to Safety After Volcanic Eruption.

The Fuego volcano eruption near Guatemala City, Guatemala, on June 3, 2018, left more than 150 dead and hundreds more injured or missing. Local officials quickly identified a need for burn care among the injured and asked the international community for assistance. By the morning of June 4, members of the U.

Forward Surgical Team Procedural Burden and Non-operative Interventions by the U.S. Military Trauma System in Afghanistan, 2008-2014.

Introduction: No published study has reported non-surgical interventions performed by forward surgical teams, and there are no current surgical benchmarks for forward surgical teams. The objective of the study was to describe operative procedures and non-operative interventions received by battlefield casualties and determine the operative procedural burden on the trauma system.

Methods: This was a retrospective analysis of data from the Joint Trauma System Forward Surgical Team Database using battle and non-battle injured casualties treated in Afghanistan from 2008-2014.

A Consensus Framework for the Humanitarian Surgical Response to Armed Conflict in 21st Century Warfare.

Importance: Armed conflict in the 21st century poses new challenges to a humanitarian surgical response, including changing security requirements, access to patients, and communities in need, limited deployable surgical assets, resource constraints, and the requirement to address both traumatic injuries as well as emergency surgical needs of the population. At the same time, recent improvements in trauma care and systems have reduced injury-related mortality. This combination of new challenges and medical capabilities warrants reconsideration of long-standing humanitarian surgery protocols.

High-Carbohydrate vs High-Fat Nutrition for Burn Patients.

Nutrition is an essential component of the healing and recovery process after severe burn injury. For many burn patients, nutrition support is necessary to meet nutrition goals. The ratio of carbohydrates and fat is particularly important for burn patients, as an essential fatty acid deficiency can contribute to poor wound healing.

Using the Delphi Technique to Determine Core Components of a Nurse Competency Program.

This modified Delphi study determined consensus on core nurse competency program components that apply across the continuum of transition to initial practice, to new specialty practice, to a new role, or within general nursing orientation. The literature review found no published agreement on support and systems for universal transition programs. This broad-based study addressed this gap by identifying core elements within a competency or transition program and then ranking their importance within program structure.

An Evidence-Based Approach to Precepting New Nurses.

While developing a standardized approach to orient new staff in the U.S. Army Institute of Surgical Research Burn Center at Fort Sam Houston in Texas, nurse leaders identified the need to also standardize preceptor selection and instruction.

Monthly variation of unfinished nursing care at the US Army Burn Center.

Objective: To describe the monthly variation in the prevalence and patterns of unfinished nursing care and to determine the relationships between the system of nursing care and unfinished nursing care at the US Army Burn Center.

Methods: This was a repeated measures, descriptive study. For one week per month for six months, all nurses providing direct patient care on two inpatient burn units (intensive care and progressive care) were asked to complete an anonymous paper survey, which contained the Perceived Implicit Rationing of Nursing Care instrument, to estimate the prevalence of unfinished nursing care on their unit.

Patient Turnover: A Concept Analysis.

Patient turnover influences the quality and safety of patient care. However, variations in the conceptual underpinnings of patient turnover limit the understanding of the phenomenon. A concept analysis was completed to clarify the role of patient turnover in relation to outcomes in the acute care hospital setting.

Unfinished nursing care: An important performance measure for nursing care systems.

Performance measurement is a core administrative function and an essential component of organizational quality programs. The prevalence of performance measurement initiatives increased significantly after the release of the Institute of Medicine series on quality. Nursing performance measures are limited in their scope, resulting in an underrepresentation of process measures.

Registered nurses as permanent members of medical evacuation crews: the critical link.

Medical evacuation has changed form the experiences of the past decade of combat operations. Much of the focus of the medical support in the combat zone is now critical care during evacuation, which is, and will continue to be, a very successful, life-saving asset. The assignment of Army critical care or trauma nurses to medical evacuation units is consistent with the recognition that the medical evacuation system is a truly vital asset in the success of today's American military.

Simultaneous surgeries in a split forward surgical team: a case study.

Introduction: The 541st Forward Surgical Team performed split-based operations, with one site in the city of Pol-e-Khumri. One evening, the 10-person team received two pediatric patients simultaneously and conducted simultaneous surgeries.

Case Presentation: The 3-year-old female sustained severe injuries to bilateral lower extremities and a puncture wound to her right forearm.