Page 36 - QARANC Vol 14 No 7 2013

34 QARANC THE GAZETTE
Military Patient Pathway
Sgt K Scott. Intensive Care Nurse. 16 Medical Regiment FS W Hughes. Intensive Care Nurse. Royal Centre for Defence Medicine
Injuries sustained within the operational environment present unique triage, diagnostic and management challenges. The clinical treatment along the various stages of the evacuation chain back to Role 4 is paramount. This presentation will outline the journey of a British Soldier injured in Afghanistan and aims to focus on the pathway from point of wounding on the battlefield through to their discharge from hospital and further rehabilitation.
Initial treatment upon wounding is delivered by medics on the ground. This care continues during the evacuation by the Medical Emergency Response Team (MERT). The evacuation is by helicopter to the UK Field Hospital (Role 3), Helmand Province, Afghanistan, located at Camp Bastion. Upon arrival at Role 3 the patient is assessed, operated upon as required and transferred to Critical Care. Here, the patient will await Aeromedical Evacuation (AE) back to the UK by the Critical Care Air Support Team (CCAST). Once in the UK the patient is admitted into the Role 4. The patient will receive treatment from various specialities within the Queen Elizabeth Hospital and the Royal Centre for Defence Medicine (RCDM). Both patient their family will be supported by the extensive welfare support network within RCDM.
Intended Learning Outcomes:
By the end of this session, participants should be able to:
• Identify key areas of treatment to wounded soldiers
• Describe the various stages involved in the patient journey • Understand the roles involved within the patient journey
Field Intensive Care
SSgt J Sessions. Intensive Care Nurse. 16 Medical Regiment
This presentation looks at the development of critical care nursing within the military field hospital. It highlights some of the treatments service personnel receive whilst on the battlefield through to the evacuation phase back to the UK. An historical review of conflicts shows that there have been advances that are now being seen in civilian practice. Finally it takes a look at the challenges faced with nursing in austere environments and how the military train prior to deployment. Intended Learning Outcomes:
By the end of this session, participants should be able to:
• Learn how Military Field Hospitals have evolved through
various conflicts
• Understand the Role of Critical Care within the Military Field
Hospital
• Understand the transition of practice from Military to the NHS Recommended Reading List:
Henning JD. Roberts MJ. Sharma D. Hoffman A. Mahoney PF. (2009). Military intensive care part 1 – a historical review. Journal of the Royal Army Medical Corps. 153. 4. 283-285 Thompson J. (2011). Caring for critically injured soldiers. Nursing Times. 107. 1. 11.
Maritime Intensive Care
CPONN C Maguire
The aim of this presentation will be to give an overview of maritime nursing, with specific reference to the critical care capability. An outline of the Role 1-4 patient journey will then go onto concentrate on to looking at the teams involved at each stage.
The main content of the presentation will concentrate on the role of the Primary Care Receiving Facility and the Role of the deployed critical care nurses on Role 2 afloat.
Intended Learning Outcomes:
By the end of this session, participants should be able to:
• Understand the joining procedures of the QARNNS and
how to become a critical care specialist nurse in the Royal
Navy
• Identify the key features and facilities onboard the Primary
Casualty Receiving Facility RFA Argus
• Understand the role of the critical care nurse when deployed
as part of the Role 2 afloat team.
Recommended Reading List:
JDP 4-30 2nd Edt Medical Support to Joint Operations Massive Transfusion and Rotational Thromboelastometry (ROTEM)
Sgt A Coull. Intensive Care Nurse. Royal Centre for Defence Medicine.
The presentation will briefly look at the overarching principles of treatment for battlefield casualties requiring massive transfusion from point of wounding to critical care. Initial management of these casualties will be described.
Goal directed resuscitation using rotational thromboelastometry to guide correction of coagulopathy will be discussed in detail. The role of the critical care nurse in addressing the lethal triad of trauma will also be examined. Intended Learning Outcomes:
By the end of this session, participants should be able to:
• State the lethal triad
• CorrectlyidentifytransfusionrequirementsbasedonROTEM
• Describe the critical care nurses role in management of
coagulopathy in the trauma patient
Recommended Reading List:
Jansen J. Thomas R. Loudon M. Brooks A. (2009). Damage control resuscitation for patients with major trauma. British Medical Journal. 338. 1436-1440
Tieu H. Holcomb J. Schreiber M. (2007). Coagulopathy: It’s pathophysiology and treatment in the injured patient. World Journal of Surgery. 31. 1055-1064
Dorna C. Woolley T. Midwinter M. (2010). Feasibility of using rotational thromboelastometry to assess coagulation status of combat casualties in a deployed setting. The Journal of Trauma. 69. 1. S40-48
Military Ethics
Capt JP Nolan. 256 (V) Field Hospital.
This presentation will examine the ethical framework within which all nurses work and examine specifically how this applies to the defence nursing context. Specific issues including consent and capacity, the treatment of detainees and scope of practice will be considered. The tools and guidance available to guide defence nursing in their decision making will be outlined.
Intended Learning Outcomes:
By the end of this session, participants should be able to:
• To understand the ethical framework within which nurses
registered with the UK NMS work within
• To understand the DONC core competency related to
ethical decision making
• To be able to use the high level principles for ethical decision
making
Recommended Reading List
BMA armed forces decision making tool kit Values and Standards of the British Army The Geneva Conventions