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An Assessment of Nursing Skills Required for Sustaining a Casualty during Prolonged Casualty Care: Implications for Training and Preparing for the Next Major War.

BACKGROUND
The US military is transitioning rapidly from the Global War on Terrorism in preparation for near-peer combat in a multidomain operations (MDO) and/or large scale combat operations (LSCO) setting. Due to potentially contested freedom of movement in this setting, casualty evacuation may be significantly delayed, resulting in medics and other prehospital medical personnel taking on patient care duties normally performed by nurses in a hospital-based setting. However, the frequency of nursing-type care remains unclear. We seek to determine the nursing interventions typically performed in a facility with patient holding capability during the first 72 hours of care in the deployed setting.


MATERIALS AND METHODS
This is a sub-analysis of previously described data from the Department of Defense Trauma Registry of US and North Atlantic Treaty Organization (NATO) military personnel from January 2007 to March 2020 with a focus on relevant nursing procedures identified in current Individual Critical Task Lists (ICTL) for critical care, emergency, medical-surgical nurses, and combat medics.


RESULTS
Among all casualties, the most common nursing-related skills performed in the prehospital setting were wound dressing application (33%), administration of parenteral opioids (35%), and administration of ketamine (7%); in the hospital setting were preparation for transfer (60%), managing a post-operative patient (59%), and managing a traumatic brain injury (44%). In the hospital setting, most patients had a blood gas performed (73%), ventilator management occurred for 21% of patients, and administration of packed red blood cells occurred for 21% of patients.


CONCLUSIONS
Nursing-type interventions were frequently required during the first 72 hours of casualty care. The frequency of the required interventions demonstrates the need for ongoing nursing skills training for medics supporting casualties in the setting of prolonged casualty care.