U.S. Army Medical Department journal
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The mission of the en route caregiver is to provide critical care in military helicopters for wounded Warriors. This care minimizes the effects of the wounds and injuries, and improves morbidity and mortality. This article will focus on the history of Army Nursing en route care. ⋯ The role of critical care nurses has proven to be essential and irreplaceable in providing full-spectrum care to casualties of war, in particular, the postsurgical patients transferred from one surgical facility to another in theatre. However, we have only recently developed the concepts over the required skill set, training, equipment, functionality, evidenced-based care, and sustainability of nursing in the en route care role. Much of the work to quantify and qualify nursing care has been done by individuals and individual units whose lessons-learned have only recently been captured.
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Military entomologists function as part of medical civil-military operations and are an essential combat multiplier direction supporting COIN operations. They not only directly support US and coalition military forces by performing their traditional wartime mission of protecting personnel from vector-borne and rodent-borne diseases but also enhance the legitimacy of medical services by the host nation government such as controlling diseases promulgated by food, water, vectors, and rodents. These unique COIN missions demand a new skill set required of military entomologists that are not learned from existing training courses and programs. ⋯ Current COIN operations require greater tactical and operational flexibility and diverse entomological expertise. The skills required for today's full spectrum medical operations are different from those of the past. Counterinsurgency medical operations demand greater agility, rapid task-switching, and the ability to adequately address unfamiliar situations and challenges.
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Minimizing preventable death continues to be a primary focus of the combat casualty care research community, and of the Army Medical Department as a whole. Toward that end, tremendous successes have been realized in resuscitative surgery, critical care, rehabilitation, preventive medicine, and in our collective ability to project effective medical care into the most austere locations throughout the globe. Innovation in the care rendered outside of theater hospitals or strategic air evacuation conveyances, however, has not kept the same pace. ⋯ A prime example of this phenomenon is the recent acknowledgement of the "en route care gap" existing in tactical medical evacuation. The US Army Institute of Surgical Research (USAISR) and the Army emergency medicine community have made a significant commitment toward elucidating the requirements, capability gaps, and a way-forward in search of the development of an integrated prehospital combat casualty care system, nested within the Joint Theater Trauma System. This paper examines specific research programs, concept development, and collaborations with other Army, joint, and civilian center organizations which comprise the USAISR Prehospital and Emergency Care Research Program, including the Remote Damage Control Resuscitation initiative, Emergency Telemedical Direction of Role-I providers, Combat Medical Voice Documentation System, and establishment of the Remote Trauma Outcomes Research Network.