Lighter, Leaner Military Nursing Corps Engage Closer to War's Front Lines
Monday January 7, 2002
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Photo courtesy US Air Force
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The Department of Defense (DOD) will not reveal what types of medical personnel have been sent to Afghanistan and neighboring countries since the terrorist bombings on September 11. However, the chief nurses of the Air Force, Army, and Navy have verified to Nursing Spectrum that RNs are an integral part of "Operation Enduring Freedom," the DOD's name for America's war on terrorism.
"We have medical teams assigned with the Marines and Navy," says Rear Adm. Nancy J. Lescavage, RN, director of the Navy Nurse Corps and assistant chief for healthcare operations in the Navy. "Nurses are members of these military units."
Lescavage could not confirm the location of any nurses in Afghanistan. However, the Chicago Tribune has reported nurses and physicians with the 15th Marine Expedi-tionary Unit, headquartered at Camp Pendleton, CA, are serving at a military base south of Kandahar known as Camp Rhino. Navy personnel are running "a base medical facility spread across a concrete warehouse for triage and several tents, including one that could be used as an operating theater," the paper reported.
It also is likely Army nurses and physicians accompanied the 10th Mountain Division, headquartered at Fort Drum, NY, when it deployed to Uzbekistan to set up a military base there in October. And Army medical personnel are certainly with members of the division who are now in Afghanistan. The Army has restructured the way it deploys combat medical support units since the end of the Cold War to get them closer to the front lines.
"We do have medical units supporting all of our fighting forces," says Army Brig. Gen. William Bester, RN, MSN, chief of the Army Nurse Corps and assistant surgeon general for Force Projection. "We'll not only be deploying nurses to the theater of operations, but also to military hospitals in Germany. We may also be moving nurses around in the US, depending on how many casualties there are and where we transfer them. Right now there are minimal casualties."
The Air Force has deployed around 1,000 medics to support its warfighters engaged in Operation Enduring Freedom, says Lt. Col. Stephen Knych, chief of disaster and trauma systems development at the Air Force Surgeon General's Office.
Lessons Learned from Past Wars
The Persian Gulf War taught the Army, Air Force, and Navy many medical lessons in caring for US troops engaged in a new kind of warfare. After the Berlin Wall fell, military leaders correctly predicted future conflicts would be smaller in scale and fought in far-flung corners of the world, such as Kosovo and Somalia, rather than in large military theaters in Europe.
"The Gulf War was a defining moment for military medicine," says Air Force Brig. Gen. Barbara Brannon, RN, MSN, assistant surgeon general for nursing and commander of the 89th Medical Group, Malcolm Grow Medical Center at Andrews Air Force Base in Maryland.
Military nursing officers interviewed by Nursing Spectrum said it became clear during the Gulf War that large mobile military hospitals used in the Korean and Vietnam conflicts were too slow, cumbersome, and distant from the battlefield. Military medical personnel needed to be able to get as close as possible to the battle. They had to be able to quickly stabilize and evacuate critically injured troops by air to facilities that could provide more advanced levels of medical care.
In response, the Army and Air Force developed and deployed modular, mobile, and self-sufficient units of medical personnel. These units can care for military personnel with a wide range of injuries - from minor to crippling to life-threatening.
"We needed to get lighter and leaner," Knych says.
These modular units are akin to medical building blocks: They can be assembled, disassembled, and reconstructed depending on the type of medical care needed and the location and number of military personnel injured. For example, the Air Force has developed several teams, such as CCATT (critical care air transport team), SPEARR (small portable expeditionary aeromedical rapid response team), and EMED (expeditionary medical support team).
"Now we have a phenomenal capability to care for critically ill patients far forward on the battlefield," Knych says. "We are light, lean, lifesaving, and modular."
CCATT is a three-member team made up of a critical care RN, a critical care physician, and a cardiopulmonary technician. The team is equipped to care for patients suffering from shock/hemorrhage, respiratory failure, and multisystem trauma. These patients most likely have already received primary resuscitation, as well as lifesaving or life-sustaining surgery.
CCATT's capabilities were tested with the terrorist bombing of the USS Cole in Yemen a year ago. Air Force Capt. Raymond Nudo, RN, BSN, CEN, stationed at Landstuhl Army Regional Medical Center in Germany, was a member of one of two CCATTs sent to the Middle East immediately after the attack. "We have a one-hour response time before we launch," says Nudo, who is also nurse manager of Landstuhl's ambulatory procedure unit.
Nudo and other members of the team were told there were 39 casualties. The wounds included multiple fractures, burns, and fragmentation injuries. Never had the CCATT teams cared for so many seriously injured patients at one time, Nudo says.
Nudo and other members of the CCATT teams transported 11 critically injured patients, including two on ventilators, to Germany. For Nudo, it was the culmination of three years of training as a CCATT team member. He serves an especially crucial role when so many injured servicemembers are transferred to Germany before returning to their units or being sent to the US for further treatment. "This is the kind of mission for which we had been preparing," he says.
The Army Medical Department's reengineering initiative also redesigned its medical teams to be more mobile and closer to the battlefield, says Army Col. Deborah Gustke, RN, MSN, OCN, the assistant chief of the Army Nurse Corps. The Army split its combat support hospitals into smaller modules that can be reconfigured according to the mission needs of the military units they accompany into combat.
"What we learned from these conflicts is we must have medical assets that can respond to the type of conflict involved," says Gustke, who is stationed at the Army Medical Department Center and School at Fort Sam Houston, TX. "We must be able to move with the military unit so we can provide the care we are supposed to provide. We must move as they move."
The initiative created the Army's new forward surgical team. This team is a 20-person unit that includes two nurse anesthetists, a critical care nurse, a medical/surgical nurse, and three licensed practical nurses. The team also has surgeons, medical technologists, and other support personnel. It is designed to move quickly into the vicinity of a battle to perform major surgical procedures for life-threatening injuries.
Ready to Serve at a Moment's Notice
The seabag of US Navy Lt. Cmdr. Mary Brantley is packed for war. As the ICU service manager at Bethesda Navy Medical Center in Bethesda, MD, she could be called at any moment for her wartime assignment with the USNS Comfort hospital ship.
"When you go on board ship, you take with you what you can carry because there is no one else who will carry it for you," she says. Her bag contains uniforms, personal hygiene products, a few comforts from home, and not much else.
Military nurses have simultaneous peacetime and wartime missions. While performing their daily peacetime assignments, they also constantly train for war and must be packed and ready to leave as soon as they are notified. For instance, Brantley was with the USNS Comfort when it was sent to New York Harbor after the September 11 terrorist attacks on the World Trade Center. She was also with the hospital ship during the Persian Gulf War. "We learned you had to be training all the way to the day you get to the ship," she says.
In an effort to strengthen its medical support capabilities after the Persian Gulf War, the Navy now routinely has its nurses train for wartime assignments, says Capt. Karen Ott, RN, MSN, deputy director of the Navy Nurse Corps at the Bureau of Medicine and Surgery.
During a war, Navy nurses may find themselves transferring their skills to tent hospitals, battalion aid stations, floating hospital ships, or even out to the field with Marines engaged in combat. "Our mission is to be ready," Ott says. "We absolutely must train all the time."
Army Capt. Kimberlie Statler, RN, MS, NP, was already performing her wartime assignment with the 28th Combat Support Hospital in Bosnia when the terrorists carried out their attacks on September 11. She returned a month later to her peacetime assignment in the special projects primary care department at the DeWitt Health Care Network at Fort Belvoir, VA. The 28th Combat Support Hospital was redeployed from Bosnia back to its home base at Fort Bragg around the same time.
Now, Statler says she has volunteered to be sent back overseas and hopes she will be called. "I am trained, prepared, and ready to go. This is why I joined the Army - to take care of soldiers."
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