DOI: 10.1097/ANS.0000000000000088
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PMID: 26517338
Issn Print: 0161-9268
Publication Date: 2015/10/01
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Excerpt
Early during Operation Enduring Freedom and Operation Iraqi Freedom, few would have predicted nearly a decade and a half of sustained military operations and its significant demands on the Military Health System and the Veterans Health Administration. Likewise, most military and civilian medical leaders could not have foreseen the tremendous advances in combat casualty care, en route care, medical technology, psychological health, and rehabilitative care that have resulted from medical research, evidence-based practice initiatives, establishment of the Joint Trauma System and the Department of Defense Trauma Registry, and medical materiel development. Although these advances contributed to the lowest died of wounds rate in history1,2 and have transformed areas of civilian trauma care, military leaders, scientists, and clinicians work tirelessly to further improve combat casualty care, maximize survival, and improve outcomes.3 During her testimony to the Senate Committee on Appropriations, Subcommittee on Defense, Lieutenant General Patricia Horoho, a nurse and the Surgeon General of the US Army, underscored that “Combat Casualty Care is not limited to the battlefield of today, but extends to the research and development, development of leaders and doctrine that will save lives and maintains health in all future operational environments.”4(p3)
Military service leaders and medical personnel aim to provide immediate combat casualty care that parallels the standard of care at American College of Surgeons–verified level I trauma centers within the United States. A formidable goal, given significant challenges in delivering this level of care to combat causalities with devastating injuries in austere environments, priorities included conducting research to develop scientific knowledge needed to optimize treatment and medical system processes. Indeed, beginning in 2005, many scientists deployed for 6 months to Iraq and Afghanistan as directors or members of the Joint Combat Casualty Research Team, the first interdisciplinary research team of its kind, to conduct original research and support other investigators. Some performed research during aeromedical evacuation flights or at Landstuhl Regional Medical Center in Germany. All research was conducted in accordance with an historic agreement between the United States Army Surgeon General and the Commander of the Multi-National Corps Iraq, which detailed requirements for (1) a Department of Defense Assurance, (2) institutional review board approval of all human subjects research that did not meet criteria for exemption, (3) scientist training, and (4) compliance oversight.5 Nurses led or participated in prospective, observational, descriptive, and survey research pertaining to topics such as, but not limited to, resuscitation of casualties with acute hemorrhage, noninvasive assessment of occult hypoperfusion, hemostatic bandages, primary blast lung injury, traumatic brain injury, posttraumatic stress, resiliency, burnout, military women's health and illness behaviors in the combat environment, detection of compartment syndrome, iron status of deployed personnel, sleep and use of energy products, oral care practices for intubated casualties, hand hygiene, use of paralytic agents during helicopter medical evacuation, pain assessment and management during aeromedical evacuation, and prevention of infection. Importantly, findings have been incorporated into evidence-based Joint Trauma System Clinical Practice Guidelines and applied to practice.
With the drawdown of military operations, research in Iraq and Afghanistan has ceased.
