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Nurse-led research aims to improve battlefield medicine

Military nurses working on a simulated patient in a helicopter U.S. Army Maj. Jacob MacGregor (right) certified nurse anesthetist for the 541st Forward Surgical Team (Airborne), prepares an IV bag while Staff Sgt. Jolene Davis (kneeling left) flight medic for C Company, "Northstar Dustoff," 2-211th Aviation Regiment (Air Ambulance), performs a casualty assessment on a simulated casualty, U.S. Navy Operations Specialist 2nd Class Niretzy Hill, PRT tactical operations center watch-stander, while in flight on a UH-60 Black Hawk medevac helicopter during medical evacuation training on FOB Farah, Jan. 9. (Photo by Navy Chief Hospital Corpman Josh Ives.)

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As the Department of Defense prepares for future military operations in the multi-domain environment, the U.S. Army Institute of Surgical Research (USAISR) is working to develop solutions for the challenges of prolonged field care, particularly burn casualties, which are expected to be a major concern on the future battlefield.

“The U.S. Army Institute of Surgical Research (USAISR) is made up primarily of research and clinical arms. Together, one of their goals is to create novel solutions to optimize survival and functional recovery of burn casualties. This is achieved through expert analysis, multidisciplinary care, and translational research,” said Army nurse scientist Lt. Col. Christopher VanFosson, Ph.D., MHA, RN, NEA-BC, AN.

In detailing the mission and vision of the USAISR during the November Medical Museum Science Café, held virtually by the National Museum of Health and Medicine in Silver Spring, Maryland, VanFosson discussed how nurse-led research studies seek to improve military readiness in combat medicine. The museum is a division of the Defense Health Agency Research and Development Directorate.

To prepare for future conflicts within the multi-domain battlefield (air, land, maritime, space, and cyberspace), VanFosson and his team study ways to improve outcomes for a variety of operations, including continuing communications, injuries from new weapons systems, medical evacuation and prolonged care on the battlefield.

“One way the USAISR is trying to provide solutions for the multi-domain environment is through the U.S. Army Burn Center’s pre-deployment training. Burn care and the long-term sequela of burn injury are major concerns for the future battlefield,” said VanFosson.

According to VanFosson, due to the expected increase in burn-related injuries caused by new weaponry, burn management may become a large part of the care provided by combat medics in the future. Using the burn patient as a universal trauma model, the United States Army Institute of Surgical Research Burn Center is an ideal training platform for medics to gain pre-combat trauma exposure and experience for the multi-domain battlefield.

In his presentation, VanFosson listed a variety of studies and papers that helped to inform clinical readiness and training based on outcomes seen in the Burn Center and in Afghanistan. For example, one paper in 2012 (Registered Nurses as Permanent Members of Medical Evacuation Crews: The Critical Link) argued for the use of registered nurses as permanent members of medical evacuation crews instead of retraining Army flight medics.

“Lieutenant Colonel Wissemann and I argued that transitioning Army flight medics to paramedics would not achieve the Army’s patient care goals because the active duty flight paramedics would not be able to achieve the exposure and practice that their reserve component counterparts could. However, Army nurses that function in ERs and ICUs on a daily basis had the requisite knowledge, skills, and ability to achieve [this],” said VanFosson.

The results of these studies directly impacted clinical readiness (a term expounded upon during the presentation) efforts in a variety of ways. They have informed Joint Trauma System clinical practice guidelines, highlighted the strengths and weaknesses of clinical readiness training, provided medical planners with better understanding of Role 2 (limited access to hospital facilities) surgical unit capabilities, supported the need for critical care nurses on medical evacuation flights, and finally, pushed for the continued use of the TIP-TOP/Clinical Transition Framework across the Defense Health Agency for clinical competency and consistency.

“We appreciate Lieutenant Colonel VanFosson’s contribution to our science café program,” said Andrea Schierkolk, the museum’s Public Programs Manager. “NMHM is honored to share accounts of triumphs and challenges in military medicine and we look forward to learning more about what’s happening in military medicine when the series resumes in January 2021.”

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