En Route Care Provided by US Navy Nurses in Iraq and Afghanistan

BACKGROUND US Navy nurses provide en route care for critically injured combat casualties without having a formal program for training, utilization, or evaluation. Little is known about missions supported by Navy nurses. OBJECTIVES To characterize the number and types of patients transported and skill sets required by Navy nurses during 2 combat support deployments. METHODS All interfacility casualty transfers between 2 separate facilities in Iraq and Afghanistan were assessed. Number of patients treated, number transported, en route care provider type, transport priority level and duration, injury severity, indication for critical care transport, en route care interventions, and vital signs were evaluated. RESULTS Of 1550 casualties, 630 required medical evacuation to a higher level of care. Of those, 133 (21%) were transported by a Navy nurse, with 131 (98.5%) classified as “urgent,” accounting for 46% of all urgent transports. The primary indication for en route care nursing was mechanical ventilation of intubated patients (97%). Mean (SD) patient transport time was 29.8 (7.9) minutes (range, 17–61 minutes). The most common en route care interventions were administration of intravenous sedation (80%), neuromuscular blockade (79%), and opioids (48%); transfusions (18%); and ventilation changes (11%). No intubations, cricothyroidotomies, chest tube placements, or needle decompressions were performed en route. No deaths occurred during transport. CONCLUSIONS US Navy nurses successfully transported critically injured patients without observed adverse events. Establishing en route care as a program of record in the Navy will facilitate continuous process improvement to ensure that future casualties receive optimized en route care.

Perceptions of collaborative practice between Navy nurses and physicians in the ICU setting

BACKGROUND: Despite strong evidence for the benefits of collaborative practice between nurses and physicians, this model remains the exception rather than the rule. OBJECTIVES: To examine the extent to which Navy nurses and physicians perceive that collaborative practice exists in the ICU, and to examine the difference in perceived use of collaborative practice by Navy nurses and physicians in the ICU. METHODS: Ninety nurses and 49 physicians working in ICUs at the Navy's four teaching hospitals and aboard the Navy's two hospital ships deployed in Southwest Asia were surveyed using the Collaborative Behavior Scale-Part I and the Collaborative Practice Scales. RESULTS: There was a significant difference between nurses' and physicians' perceptions of collaborative practice behavior. Physicians reported that collaborative practice behavior existed to a greater extent than did nurses in the study. There was no significant difference between nurses' and physicians' perceived use of collaborative practice behavior. CONCLUSIONS: Navy ICU nurses and physicians perceived that they were involved in collaborative practice behavior at a moderate level. Physicians, however, reported perceiving collaborative practice to a greater extent than did nurses. Further research, in different populations, is required to test the theorized constructs of the instruments used to measure perceptions of collaborative practice behavior in this study.