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Staudt AM, Savell SC, Biever KA, Trevino JD, Valdez-Delgado KK, Suresh M, Gurney JM, Shackelford SA, Maddry JK, Mann-Salinas EA. En Route Critical Care Transfer From a Role 2 to a Role 3 Medical Treatment Facility in Afghanistan. Crit Care Nurse 2018; 38:e7-e15. [PMID: 29606685 DOI: 10.4037/ccn2018532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND En route care is the transfer of patients requiring combat casualty care within the US military evacuation system. No reports have been published about en route care of patients during transfer from a forward surgical facility (role 2) to a combat support hospital (role 3) for comprehensive care. OBJECTIVE To describe patients transferred from a role 2 to a role 3 US military treatment facility in Afghanistan. METHODS A retrospective review of data from the Joint Trauma System Role 2 Database was conducted. Patient characteristics were described by en route care medical attendants. RESULTS More than one-fourth of patients were intubated at transfer (26.9%), although at transfer fewer than 10% of patients had a base deficit of more than 5 (3.5%), a pH of less than 7.3 (5.2%), an international normalized ratio of more than 2 (0.8%), or temporary abdominal or chest closure (7.4%). The en route care medical attendant was most often a nurse (35.5%), followed by technicians (14.1%) and physicians (10.0%). Most patients (75.3%) were transported by medical evacuation (on rotary-wing aircraft). CONCLUSION This is the first comprehensive review of patients transported from a forward surgical facility to a more robust combat support hospital in Afghanistan. Understanding the epidemiology of these patients will inform provider training and the appropriate skill mix for the transfer of postsurgical patients within a combat setting.
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Affiliation(s)
- Amanda M Staudt
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Shelia C Savell
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Kimberly A Biever
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Jennifer D Trevino
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Krystal K Valdez-Delgado
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Mithun Suresh
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Jennifer M Gurney
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Stacy A Shackelford
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Joseph K Maddry
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Elizabeth A Mann-Salinas
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas. .,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas. .,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky. .,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas. .,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas. .,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas.
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