Future Trends in Trauma Care: Through the Lens of the Wounded How Lessons from the Battlefield May Be Used at Home.

The coordinated terrorist attacks of 2001 thrust the United States and its allies to war. Through an evolving battlefield, the paradigm of large fixed medical facilities advanced to become nimble surgical and resuscitative platforms, able to provide care far forward. Innovations like tactical combat casualty care, evacuation, fresh whole-blood administration, freeze-dried plasma, and forward surgical care military medicine helped reduce combat mortality to its lowest levels in history. Through the account of a young wounded marine wounded in Iraq, this article examines how innovations on the battlefield saved casualties and explores how these techniques may be applied at home.

Operational Readiness: Redesigning Advanced Practice Registered Nurse (APRN) Curriculum for an Evolving Battlefield.

INTRODUCTION: The Global War on Terror and the ensuing Overseas Contingency Operations has rapidly transformed the U.S. military's strategic philosophy for warfare. The paradigm shift to unconventional warfare has forced military medicine to adapt with the rapidly evolving battle space. To this end, large fixed facility hospitals are being replaced with highly mobile and austere medical platforms that serve farther forward. The transition in operational health care has challenged the role of all health care team members.Through the evolution of the modern battlefield, nursing roles have grown and expanded beyond the traditional roles and peacetime practice. Nurses are seeing greater autonomy and scope of practice in operational settings while caring for patient pathologies that are often different than at home. The expansion of practice extends beyond the registered nurse at the bedside to the Advanced Practice Registered Nurse (APRN) that serves in the provider role. Through anecdotal reports, and a growing body of literature, that APRN operational practice is different than in the traditional health care setting. MATERIALS AND METHODS: Although a variety of organizations have codified knowledge, skills and attitudes (KSAs) relevant to operational practice, no formal APRN operational curriculum currently exists. Using an adaptation of Kern's Six-Step Model of curriculum design, we describe a curriculum development process used to improve and focus educational experiences to better prepare APRNs for evolving operational roles. RESULTS: Through deliberate approaches the GSN has reimagined its operational readiness curriculum for the preparation of the military APRN on the evolving battlefield. The GSN has operationalized APRN operational readiness through the integration of operationally relevant curriculum designed around interprofessional education experiences. Through this curricular design, GSN APRN students are provided with operationally relevant experiences in the context of authentic military scenarios. Through these encounters, we believe, allows our students to successfully develop the clinical, operational and teamwork skills to successfully perform care in austere and operational settings. CONCLUSIONS: This manuscript describes a novel approach to provide operational readiness education to military APRN students. Through an evaluation of the current literature, expert reports and information of the current operational requirements, the USU GSN has developed a model and curricula for APRN operational readiness that lie beyond the traditional skills in the peacetime setting. Through this plan of instruction, USU GSN APRN students will have the requisite skills to meet the evolving operational needs of the Department of Defense.

Expeditionary Resuscitation Surgical Team: The US Army's Initiative to Provide Damage Control Resuscitation and Surgery to Forces in Austere Settings.

Improvements in surgical care on the battlefield have contributed to reduced morbidity and mortality in wounded Servicemembers. 1 Point-of-injury care and early surgical intervention, along with improved personal protective equipment, have produced the lowest casualty statistics in modern warfare, resulting in improved force strength, morale, and social acceptance of conflict. It is undeniable that point-of-care injury, followed by early resuscitation and damage control surgery, saves lives on the battlefield. The US Army's Expeditionary Resuscitation Surgical Team (ERST) is a highly mobile, interprofessional medical team that can perform damage control resuscitation and surgery in austere locations. Its configuration and capabilities vary; however, in general, a typical surgical element can perform one major surgery and one minor surgery without resupply. The critical care element can provide prolonged holding in garrison, but this diminishes in the austere setting with complex and acutely injured patients.

Service Block Time Allocation in the US Army Medical Command.

Service block time allocation is a critical requirement for the optimization of patient throughput and access to care in the Surgical Services Service Line of the US Army Medical Command. The procedure complexity, volume, and diversity across 25 facilities create significant variation in service block time. This variation requires the involvement of both the informatics and leadership teams for block time allocation to be effective. This article describes our use of the Army's Surgery Scheduling System, which includes service block time as an embedded function, to develop a standardized process that helps ensure service block time is optimized. We also present guidelines for block time allocation and offer case studies that demonstrate the application of these guidelines.

A Surgical Business Composite Score for Army Medicine.

Measuring surgical business performance for Army military treatment facilities is currently done through 6 business metrics developed by the Army Medical Command (MEDCOM) Surgical Services Service Line (3SL). Development of a composite score for business performance has the potential to simplify and synthesize measurement, improving focus for strategic goal setting and implementation. However, several considerations, ranging from data availability to submetric selection, must be addressed to ensure the score is accurate and representative. This article presents the methodology used in the composite score's creation and presents a metric based on return on investment and a measure of cases recaptured from private networks.

What Patients Really Want: Optimizing the Military Preoperative Evaluation Clinic.

The idea of the preoperative anesthesia clinic as a means of examining and treating the patient so that he will arrive in the operating theater as strong and healthy as possible is well established in practice and literature.However, problems in clinic design and execution often result in high patient waiting times, decreased patient and staff satisfaction, decreased patient capacity, and high clinic costs. Although the details of clinic design, outcomes, and satisfaction have been extensively evaluated at civilian hospitals, we have not found corresponding literature addressing these issues specifically within military preoperative evaluation clinics. We find that changing to an appointment-based (versus walk-in) system and eliminating data collection step redundancies will likely result in lower wait times, higher satisfaction, lower per patient costs, and a more streamlined and resource-efficient structure.