Brooke Army Medical Center, JBSA Fort Sam Houston, TX.
Brooke Army Medical Center, JBSA Fort Sam Houston, TX; and US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX.
Med J (Ft Sam Houst Tex). 2022 Apr-Jun;Per 22-04-05-06(Per 22-04-05-06):83-88.
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. We seek to determine the nursing interventions typically performed in a facility with patient holding capability during the first 72 hours of care in the deployed setting.
This is a sub-analysis of previously described data from the Department of Defense Trauma Registry of US and North Atlantic Treaty Organization (NATO) military personnel from January 2007 to March 2020 with a focus on relevant nursing procedures identified in current Individual Critical Task Lists (ICTL) for critical care, emergency, medical-surgical nurses, and combat medics.
Among all casualties, the most common nursing-related skills performed in the prehospital setting were wound dressing application (33%), administration of parenteral opioids (35%), and administration of ketamine (7%); in the hospital setting were preparation for transfer (60%), managing a post-operative patient (59%), and managing a traumatic brain injury (44%). In the hospital setting, most patients had a blood gas performed (73%), ventilator management occurred for 21% of patients, and administration of packed red blood cells occurred for 21% of patients.
Nursing-type interventions were frequently required during the first 72 hours of casualty care. The frequency of the required interventions demonstrates the need for ongoing nursing skills training for medics supporting casualties in the setting of prolonged casualty care.
美国军队正在从全球反恐战争迅速过渡，为多领域作战（MDO）和/或大规模作战行动（LSCO）环境中的近敌作战做准备。由于在这种环境中可能存在有争议的行动自由，伤员后送可能会严重延迟，导致医务人员和其他现场医疗人员承担通常由医院环境中的护士执行的患者护理职责。然而，护理类型的护理频率尚不清楚。我们旨在确定在部署环境中具有患者容纳能力的设施中，在护理的头 72 小时内通常进行的护理干预措施。
这是对先前描述的数据的子分析，这些数据来自 2007 年 1 月至 2020 年 3 月期间美国国防部创伤登记处的美国和北大西洋公约组织（北约）军事人员，重点是当前关键护理、紧急护理、医疗-外科护士和战斗医务人员的关键任务清单（ICTL）中确定的相关护理程序。
在所有伤员中，在现场进行的最常见的护理相关技能是伤口敷料应用（33%）、静脉内阿片类药物给药（35%）和氯胺酮给药（7%）；在医院环境中，最常见的护理相关技能是准备转院（60%）、管理术后患者（59%）和管理创伤性脑损伤（44%）。在医院环境中，大多数患者进行了血气检查（73%），21%的患者进行了呼吸机管理，21%的患者进行了浓缩红细胞给药。
在伤员护理的头 72 小时内，经常需要护理类型的干预措施。所需干预措施的频率表明，需要对在伤员护理时间延长的情况下支持伤员的医务人员进行持续的护理技能培训。
