42nd Annual Convention & Scientific Meeting Nurses at War: OR Nursing in Conflict Areas BGen Irma I Almoneda AFP (Res)
OBJECTIVES: Be familiar with the nature of OR nursing practice in times of conflict; Recognize the role of OR nurses in the conflict settings; and Determine the necessary preparations for OR nursing practice during times of combat and/or in the conflict areas.
OVERVIEW: Introduction; Concepts of OR nursing in the conflict settings; Preparations for OR nursing practice in the soldiers field environment during times of combat and/or conflict; Roles of OR nurses in the conflict settings; and Challenges and lessons learned
INTRODUCTION: Nurses have multifarious roles and challenges given the diversified environment: clinical setting on the different specialties, community, etc. the most exciting is during deployment in mission areas in conflict and during war times.
Military Nursing is another field of nursing professional nurses commissioned provide dynamic, responsive and quality nursing care to soldiers and warriors. guided by the AFP Health Service s mission -- To conserve the fighting strength of the troops basic of which is to save their lives, limbs and eyesights.
OR nursing (Perioperative Nursing) Perioperative nurses face unique patient care situations when they are deployed to hostile places or countries with harsh climates. nursing activities performed during the preoperative, intraoperative and postoperative phases of a patient's surgical intervention.
OR nursing practice in times of conflict similar with other health institutions, it adheres to the TEAM concept and professional functions major surgery Supports both major and minor surgeries minor surgery differs on their ranks/composition as members of an armed forces : Medical Corps surgeons & anesthesiologists; Nurse Corps anesthetists & OR nurses Corpsmen or medics (highly trained soldiers)
OR nursing practice in times of conflict settings can be either in a fixed facility (hospital setting) /in the field environment a mobile type called Forward Surgical Team (FST) Mobile (FST) Fixed Setting (hospital)
OR nursing practice in times of conflict Forward Surgical Team (FST) or Mobile Surgical Team is deployable anytime as needed Golden hour principle operates in limited resources The Operating Room and the FST FST deployable anytime
OR nursing in the conflict settings Deployment of Surgical Team: 1. combat mission trauma & burn surgeries (Goal: to resuscitate, stabilize, and evacuate) to save lives, limbs & eye sights 2. Peacekeeping mission for battle casualty (Goal: resuscitation and evacuation) while elective surgery for non-battle injuries 3. Humanitarian mission reconstructive, obstetric and pediatric surgeries
Preparations of OR Nursing Practice Basic soldiery, principles of war, field medicine, etc. Goal: Provide quality care to the troops Nurse Corps (NC): Pre-Entry Training Course Technical Service Officer Basic Course Enlisted Personnel (EP): Candidate Soldier Basic Course Basic Medical Aidman Course
Preparations of OR Nursing Practice EP: Basic Medical Aidman Course Basic First Aid Course Emergency Responder s Course NC: Combat Casualty Care Course (C4) NC & EP: Tactical Airlift Training
Preparations of OR Nursing Practice EP: Basic Life Support (BLS) Advance Cardiac Life Support (ACLS) NC: Basic IV Therapy Training Course Advance Cardiac Life Support (ACLS)
Preparations of OR Nursing Practice Land Water Air Principles of casualty evacuation (CASEVAC)
Preparations of OR Nursing Practice Similar training doctrine with other armed forces Training on Field medicine and versatility in all types of Terrain
OR /Perioperative Nursing as a Specialty OR Nursing - Military Occupational Specialty (MOS) Nurses Perioperative Nursing Enlisted Personnel OR Technician
Training of all members of the surgical team Hand Scrubbing Gloving Gowning
Training of all members of the surgical team Ensures protection & safety of surgical team and patient Roles of Scrub Nurse & Circulating Nurse & all technical and assistive functions of EP
Roles of Scrub/Circulating Nurse or their Soldier Counterpart End point of training: Responsible application of these roles and the adherence to the PRINCIPLES OF ASEPSIS and ANTISEPSIS and the PRINCIPLES OF LEADERSHIP AND MANAGEMENT
Roles of OR Nurses in the Conflict Settings no border due to personnel constraints in addition to being a scrub nurse and circulating nurse OTHER ROLES: Leader motivates staff despite effects of fatigue, sleep deprivation, and stress threaten maintenance of standards and attention to detail Collaborator within the internal affairs of the Team (harmony & cooperation) and hospital staff Coordinator external affairs of the Team Manager implements OR SOPs; sound management of resources Advocate for patients safety and welfare
OR nursing Challenges in the conflict areas necessitates ingenuity, creativity, clinical innovations and sheer determination to compensate for the less-than-optimal environmental conditions technological challenges and the irregular arrival of medical and surgical supplies is unavoidable faces unique challenges in delivering safe, quality health care to clients/comrades-in-arms
Challenges and Lessons Learned performing housekeeping tasks while simultaneously accomplishing a number of other patient care. Cleaning becomes difficult due to mass casualty episodes; sterilization processes in a harsh environment shall be adjusted and may lengthen the time requirement;
Challenges and Lessons Learned lack of control on the OR environment due to flow of people with mass casualty; there are patients directly brought to OR; inability to adhere to proper wearing of OR attire;
Other Challenges and Lessons Learned electrical power interruptions that room air temperature and ventilation was affected; non-availability of quality water supply; bogged down autoclave machine due to nonstop operation; risk to security being within the areas of conflict with multiple risks when extending humanitarian surgical intervention to prisoners of war (POW);
Other Challenges and Lessons Learned deployment in times of conflict is short of notice; --lack preparation administratively, psychologically and for the family; Undetermined period of deployment working 24-7;
Other Challenges and Lessons Learned resuscitating a patient direct to OR often missing a quality pre-op visit The Surgical Team or Health Team in general, are unsung heroes of patients.
Other Challenges and Lessons Learned -- Its only the patient who knew after entrusting his survival to the surgical team, A nurse s only reassurance Let s pray and trust God for our success.
Triumph in times of conflict Nelson Madela
42nd Annual Convention & Scientific Meeting
References: Unpublished NC, AFP Program of Instruction for OR MOS Unpublished Experiences and Lessons Learned by the NC, AFP and AFP Health Service on their Mobile Surgical Hospital Deployment. Vane, E. A. P., Drost E., Elder, D., and Heib, Y. (2005) Behind the Scenes: Patient Safety in the Operating Room and Central Materiel Service During Deployments. http://www.ncbi.nlm.nih.gov/books/ NBK20543/ Marek, Ed. (2012) Medevacs & Medics, Angels of Mercy http:// www.talkingproud.us/military/medevac/medevac/ FST.html Forward Surgical Team In Action. www. talkingproud.us US Marines surgical team in action & tbm https://www.army.mil/article/68175