Enroute Critical Care Nursing
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1 Enroute Critical Care Nursing ECCN Information Brief U.S. Naval Aeromedical Conference January 2013
2 Disclosure Statement CPT Brian P. Alexander and all others involved in the planning, development and presentation of this CME activity provide the following Disclosure information: "Nothing to disclose"
3 AGENDA PURPOSE: To provide information on the current status of the CENTCOM ECCN program Mission Program Review Roles and Duty Description Selection Criteria Training Command and Control Protocols Documentation PI Program Program Summary/Way Ahead
4 ECCN Mission Enhance post-damage control resuscitation and surgical medical evacuation capabilities and outcomes for severely injured/ill patients through integration of ECCNs into US forces non-regulated medical evacuation platforms throughout the full spectrum of the battle space; from Role II to Role III Medical Treatment Facilities (MTF) and with expanded support for specific Role I/POI missions.
5 Program Review Deliver continuous critical care capability during medical evacuation from Role II to Role III MTFs with no degradation in level of care MEDEVAC company integration; critical care evacuation SME ECC standardized protocols and theaterwide critical care transport documentation 794 category A ECCN missions for FY 2011 Develop and conduct continuous process improvement initiatives to enhance patient outcomes and address gaps in data collection Intratheater Transfer and Transport Clinical practice guideline revision USAF Tactical Critical Care Evacuation Team (TCCET) CENTCOM/FORSCOM/DCDD ECC ipat
6 ECCN Roles and Duty Description Roles Team leader for evacuation care of critical care patients Emphasis on post-resuscitation evacuation (Role II/Role III) Supporting team member for select, acute Role I/Combat Out Post Conduct AAR/process review for all ECC missions Duty Description: Serves as member of a CENTCOM joint force, tactical critical care transport team responsible for in-flight critical care management of combatant and noncombatants in the Afghanistan Theater of Operations. Serves as advisor to the General Support Aviation Brigade GSAB and MEDEVAC commanders for critical care evacuation. Responsible for quality assurance oversight for critical care transport.
7 ECCN Selection Criteria Experience: Minimum (2) years in MEDCEN (or civilian equivalent) ICU/ER At least (12) months experience in caring for surgical ICU patients Last (6) months prior to deployment direct patient care in a high acuity ICU/ER Previous deployment experience as ICU/ER Nurse No greater than (18) Months break in direct patient care (ICU/ER) (30-60) day rotation to ICU prior to deployment Education: Completion of 66H8A/M5 AOC/ASI training by official course Graduate education as Critical care/emergency CNS Completion of the Joint Enroute Care Course (JECC) Transport Nurse Advanced Trauma Course (ASTNA) Credentials: CCRN, CEN, CFRN Certification: ACLS, PALS, TNCC ABLS, ATLS, ENPC
8 Current ECCN Training 16 weeks 1 week * C-STARS (Center for the Sustainment of Trauma and Readiness Skills) 14 Days 2 weeks
9 ECCN C 2 Command and Control Assignment : OPCON/ADCON to FWD MED BDE in ATO TACON to GSAB/MEDEVAC Company Support Requirements Strategic Program Oversight: MED BDE (OPCON) Operational: MED BDE Tactical: Unit of assignment/cab (TACON)
10 USFOR-A ECC PROTOCOLS Concise and clear Emphasizes critical thinking Incorporates scope of practice and guidance on utilizing protocols Limited to nursing specific skills Prescriptive medication management approach Incorporates standing order set
11 ECCN Documentation MISSION# DATE CAT NATIONALITY Battle Roster # Last Name, First Name SSN DOB / Age Category SEX A B C US-MIL DOD US-CON CF AF LN EPW Adult Ped<15 M F TX TEAM TX UNIT W/U W/D W/U W/D W/U MOI DIAGNOSIS PROCEDURES RN- PA-MD-EVAC PRE-TRANSFER INFORMATION WT: Lbs/Kg ALL: NKDA: UNK BLD TYPE O A B AB Pos Neg POI TIME POST OP TIME SB TIME HR DBP MAP RR SpO2 EtCO2 Temp HGB HCT PLT INR ph PO2 PCO2 HCO3 BE K ica GLU OTHER P LABS Vent Sedation Last Dose Time Paralytic Last Dose GCS (E#/V#/M#) PERRL(A) Size (MM) Pain 0-10/FLACC Mode Rate TV FiO2 PEEP PIP Intake IVF PRBC FFP PLT FWB Output Urine R L CT R L CT WV Gastric NEURO AIRWAY BREATHING/PULMONARY CIRCULATION/CV GI and GU LINES Y N O2 SOURCE NONE NC SM FT BB SELF OPA NPA ETT Type Flow Rate TC NRB BVM VENT KINGLT CRIC TRACH FLOW: L/min Equal Unequal Y N Size Chest Wall Movement Init: Y N Position Respiration Teeth/Gum Unlabored Labored R- Y / N Cuff Check: Y N CTA BiLat: Y N UTA L- Y / N Assess Lung Sounds Secure: Y N R: L: Y N R L CXR Chest Tubes Confirmed: X X RHYTHM : ECTOPY : Perfusion Color-Central Heart Sounds Pulses A/+1/+2/+3/+4 SB / SR/ / ST OTHER: Y N Open Abd Y N: PIVs Bowel Sounds Abst Prst UTA Pink Pale Cyanotic Tubes NGT OGT JP S1 S2 S3 S4 M RUE LUE Tube Verified Drainage ABD Distention Location RLE LLE Foley Color Y N Y N Y N Site / Size/ Fluids IOs Type / Site Central Type / Site A-Line Site (L) (R) HAND EJ (L) (R) ARM LEG Gauge: Fluids:: (L) (R) TIBIA (L) (R) HUMERUS STERNUM Fluids: (L) (R) IJ SC FEM TLC QLC Cordis Fluids: (L) (R) RAD FEM Correlates: Y N ENROUTE VENT CHANGES ENROUTE INPUT ENROUTE OUTPUT ENROUTE MEDICATIONS % Burn BURN SHEET initiated by sending unit Y/ N TIME TIME TIME TIME DRUG / DOSE / ROUTE / INITIALS PRE-FLIGHT MEDICATIONS Mode IVF: URINE TIME DRUG / DOSE / ROUTE / INITIALS Rate IVF: R L CT TV PRBC R L CT FiO2 FFP WV: Peep PLT NGT/OGT PIP FWB ENROUTE MONITORING WARMING: Y / N HPMK Other: Last Abx: TIME HR SBP DBP MAP RR SpO2 ETCO2 O2 Temp Pain PT. EVENT: ECCN INTERVENTION: PATIENT RESPONSE: Last, First Name ( Medic) INT: Sending MTF Last Name (Sending MTF Staff) Departure Time Last, First Name (ECCP) INT: Receiving MTF Last Name (Receiving MTF Staff) Arrival Time Receiving MTF: Please scan and document to: jttsmedevac@afghan.swa.army.mil For questions regarding the use of this form call DSN: UPDATED: FEB 2012
12 ECCN PI Program Focused on accurately tracking the patient from evacuation to role III Emphasis is on key factors that are known to increase morbidity and mortality Efforts are driven by tracking issues, treatments, and impacts to tie events to interventions Adaptable as new indicators or issues evolve Establishes linkage between JTTR and ECCN Directors to validate PI process and continue to mature program
13 Program Summary/Way Ahead OEF Aviation/MEDEVAC integration AR Aviation Life Support Equipment (ALSE) and Air Warrior Ensemble Items Selection Criteria/Process Physical requirements Training requirements Sustainment training ECCN additional skill identifier (ASI) USN AQD 60E USAF Tactical Critical Care Evacuation Team (TCCET) JECC ITRO Army Doctrine for ECC and the future of Joint Operations
14 Questions?
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