The Critical Link Between Acute Care Nursing and Military En Route Care

To purchase electronic or print reprints, contact the American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; email, reprints@aacn.org. Moving a patient between medical facilities or within a hospital—even just down the hallway to the radiology department— requires a series of events that involve a large number of health care team members and can result in a number of adverse events.1-3 A recent study of interhospital transport using an electronic medical record identified that up to 16% of patients experienced a critical event during transport.4 Central to the process of preparing patients for transport is making sure that ongoing treatments can be completed or maintained and any potential crises can be appropriately managed, ensuring the patients’ overall status remains as stable as when they left the unit.2,5 That is a critical element of nursing care. These same concepts are true in military nursing when it comes to en route care. En route care is the process of caring for patients as they are transported from an initial point of injury or illness to initial stabilization (sometimes in a tent with few medical resources), then to different medical facilities around the world to get to a place that has the right level of clinical care as close as possible to the patients’ military unit, family members, and support system. In many cases, the en route care journey begins in some of the most dangerous and remote locations in the world. Orchestrating patient care during this type of transport is critical, but complicated by the fact that it relies on the use of cargo airplanes, and these trips are usually repeated multiple times during the initial phases of injury or disease as patients return to a medical facility in the United States. En route care is not unique to the military. There are plenty of nonmilitary patients in rural locations or other remote areas who become ill or injured in skiing accidents, mountain climbing incidents, avalanches, or other unfortunate events. In some cases a local community hospital can provide initial treatment or stabilization, but often the most acute patients must be transferred to a medical center with specialty care. If the patient is not stable enough to be discharged, nurses are needed to provide the appropriate level of care during the transport time. Transport nurses are not a large community, but they provide a critical skill that can have a direct impact on patient survival rates and long-term outcomes.7 Some nursing activities provided in this en route care setting are appropriately informed by evidence-based practices used in the critical care or acute care setting. However, many other things about nursing care change in the transport environment (eg, in an ambulance, a helicopter, or the back of an airplane): managing pain, protecting skin integrity, and the function of medical equipment. Perhaps just as importantly, transport also