Combat Casualty Care Nursing Research (C3NR)

MISSION

The focus of the C3NR program is to define best evidence-based combat casualty care nursing practice through research on practice variability and patient outcomes in all military echelons of care.

IDENTIFIED PROBLEMS

1. Deployed military nurses have inconsistent nursing experience
   (a) Variability in USAF/Army/Navy preparation
   (b) Limited exposure to burn / trauma
   (c) Unclear practice guidelines / inadequate resources
   (d) No standardized training platform
2. Realities of Combat Casualty Care
   (a) Complex patients
   (b) MASCAL scenarios common
   (c) Multiple patient handoffs
   (d) En route care requires inter-Service collaboration
   (e) Evidence-based practice not translating to battlefield
3. Unclear how patient outcomes are affected

CAPABILITIES GAPS BEING ADDRESSED

ANC RESEARCH PRIORITIES:

HIGH: Deployment capabilities / critical clinical nursing competencies.

HIGH: Improve pre-deployment preparation.

MED: Sharepoint knowledge management.

MED: Emerging Technologies.

JOINT EN ROUTE CARE (JERC) GAP STATEMENT:

1. Specific care requirements for burn patients
2. Standardized initial, pre-deployment and sustainment training for en route care providers
3. Review current clinical practice guidelines and update
4. Patient packaging

CURRENT RESEARCH EFFORTS

1. Development of simulation scenarios for burn patient.
2. Collaboration efforts with Combat Nursing Course (66T) and USAF for critical combat nurse competencies.
3. Collaboration with USAF for SBAR Patient Safety Hand-Off Checklist.
4. Development of USAISR Burn Center Satellite Simulation Center planning stage - identification of space and equipment requirements, capability needs.
5. Implementation of nurse screening for burn sepsis in USAISR adult ICU and Galveston Shriner's Hospital for pediatric burn sepsis.
6. Collaboration in development of Phases of Illness Paradigm (POIP) checklists to improve management of burn patients.
7. Development of an evidence-based practice precepting program for burn center nursing staff.

RECENT PUBLICATIONS

J Salinas, KK Chung, EA Mann, LC Cancio, GC Kramer, ML Serio-Melvin, CE
Wade, EM Renz, SE Wolf, "Computerized Decision Support System Improves Fluid
Resuscitation Outcomes Following Severe Burns", 2011, Crit Care Med 39(9),
2031-8

EA Mann, JA Jones, SE Wolf, CE Wade, "Computer Decision Support Software
Safely Improves Glycemic Control in the Burn Intensive Care Unit", 2011, J
Burn Care Research, 32(2), 246-55

J Salinas, R Nguyen, M Darrah, GC Kramer, EA Mann, LC Cancio, "Advanced
Monitoring and Decision Support for Battlefield Critical Care Environment",
2011, US Army Med Dep J, April-June, 73-81

EA Mann, MM Baun, JC Meininger, CE Wade, "Comparison of Mortality Associated
with Sepsis in the Burn, Trauma, and General ICU Patient: A Systematic
Review", 2012, Shock, 37(1), 4-16

EA Mann, DA Allen, SL Serio-Melvin, SE Wolf, J Salinas, "Clinician
Satisfaction with Computer Decision Support in the Burn Intensive Care
unit", 2012, Dimens Crit Care Nurs, 37(1), 31-36

BK Hogan, SE Wolf, DR Hospenthal, LC D-Avignon, KK Chung, HC Yun, EA Mann,
CK Murray, "Correlation of ABA Sepsis Criteria with the Presence of
Bacteremia in Burned Patients Admitted to the Intensive Care Unit", 2012 Jan
2, J Burn Care Research , e-pub ahead of print

EA Mann, J Engebretson, AI Batchinsky, "A Complex Systems View of Sepsis:
Implications for Nursing", submitted Dimens Crit Care Nurs

EA Mann, MM Baun, JC Meininger, CK Murray, JA Aden, SE Wolf, CE Wade, "Novel
Predictors of Sepsis Outperform the ABA Sepsis Criteria in the Burn ICU
Patient" submitted to J Burn Care Research