Optimizing wartime en route nursing care in Operation Iraqi Freedom

Throughout combat operations in Iraq and Afghanistan, Army nurses have served in a new role--providing en route care in military helicopters for patients being transported to a higher level of care. From aid stations on the battlefield where forward surgical teams save lives, limbs, and eyesight, to the next higher level of care at combat support hospitals, these missions require specialized nursing skills to safely care for the high acuity patients. Little information exists about patient outcomes associated with the nursing assessment and care provided during helicopter medical evacuation (MEDEVAC) of such unstable patients and the consequent impact on the patient's condition after transport. In addition, there are no valid and reliable tools to capture care delivery, patient outcomes, and associated nursing workload and staffing requirements. During Operation Iraqi Freedom, a new process was implemented over a 2-year period to measure nursing related patient outcomes during MEDEVAC, and to capture the nursing workload. The use of standard metrics to establish patient priorities and improve nursing care during MEDEVAC allowed the level II forward surgical teams or their equivalents and level III combat support hospitals to make structural, process, and outcome improvements in the en route care programs throughout the Iraq theater of operations. Implications of this program were broad, including establishment of a process to support decision making based on data driven metrics, improvement of quality of nursing care, and defining nurse staffing requirements.