Former Navy Corpsman Talks about Sustaining En Route Care Skills at 2019 MHSRS

Photo By Regena Kowitz | During a breakout session at the 2019 Military Health System Research Symposium (MHSRS), Melissa Malavemaria, a native of San Juan, Puerto Rico, and former hospital corpsman, presented findings from an analysis of patient care transports at U.S. Naval Hospital Guam. The presentation stemmed from a process improvement project for the hospital’s critical care transport team that Malavemaria worked on while still on active duty and addressed the challenge of en route care skill sustatainment for military medical providers. (U.S. Navy photo by Regena Kowitz/released)  

KISSIMMEE, FL, UNITED STATES

08.21.2019

Story by Regena Kowitz 

Naval Medical Forces Pacific

During a breakout session at the 2019 Military Health System Research Symposium (MHSRS), a former hospital corpsman presented findings from an analysis of patient care transports at U.S. Naval Hospital Guam, Aug. 21.

The presentation, “Descriptive Analysis Of A Military Hospital Interfacility Transport Critical Care Transport Team,” was given by Melissa Malavemaria, a native of San Juan, Puerto Rico, who was a hospital corpsman 3rd class at the time of the project, is finishing up a master’s degree in public health, and plans on applying to medical school next. Cmdr. Elliot Ross, a native of Jacksonville, Florida, co-author and emergency medicine physician at USNH Guam, was also in attendance.

In addition to identifying process improvements for the hospital’s critical care transport team, the analysis addressed the challenge of en route care skill sustainment for military medical providers who may not have an opportunity to regularly transport critical patients, offering a potential solution.

According to Ross, the project began after he took over as head of USNH Guam’s Emergency Medical Services (EMS) program in 2017 as a process improvement initiative to fully assess the existing patient transportation system and to better understand the skills and training necessary to provide safe and effective critical care transport.

“We started the project as a way to do a full descriptive analysis of the program and really encapsulate what the system was and improve it,” said Ross. “But I was also thinking in a bigger context—we were moving sick patients regularly, which is really unique to Guam, and we wanted to really look at the numbers we were generating to see if it could be a skill sustainment platform.”

Ross and Malavemaria completed a chart review of all interfacility patient transports from Sept. 2017 to Dec. 2018, collecting information that included demographics, location of transport, level of care provided, transport team makeup, changes in vital signs throughout the transport, and any interventions required by patients. One of the goals of the project was to assess whether military treatment facilities (MTF) can provide skill sustainment for en route care providers.

As one of only three hospitals island-wide, Ross explained, the naval hospital in Guam has an agreement with local officials to provide emergency care to non-beneficiary civilians when they are the closest medical facility. Because of this agreement, staff at USNH Guam who provide emergency care and transportation are able to treat a variety of medical conditions they might not see otherwise given the relatively healthy population of active duty military and their family members. These conditions include trauma, stroke, and cardiac arrest, and the skills required to treat and stabilize these types of patients are directly related to those used on the battlefield.

The hospital corpsman and active duty nurses at the hospital, said Ross, are expected to be ready to deploy and have a role in en route care in a combat or operational environment. They typically receive training right before they deploy but after they return from deployment, they’re likely to work in a setting, such as a ward or nonclinical spaces, where they don’t always get to sustain those en route care skills.

“We are going to deploy at one time or another,” said Malavemaria, who worked as the leading petty officer in USNH Guam’s ED and is a nationally registered emergency medical technician (EMT). “We’re going to be sent into the kind of environment where we have to move fast and we’ve got to take care of our Marines and Sailors.”

Corpsmen who aren’t exposed to this type of environment and don’t get to use their skills and knowledge regularly, explained Malavemaria, could forget their training or they may freeze when they find themselves providing en route care to a critical patient.

“That can’t happen,” said Malavemaria. “We need them to know what they need to do. They need to focus and get into the mentality of always being ready.”

Solving the problem of sustaining skills required for transporting injured warfighters from the battlefield to a higher level of care is critical to the readiness of medical forces—it’s also one both Ross and Malavemaria believe their project addresses.

Like many of the Navy’s overseas military medical facilities, USNH Guam offers an EMT national certification course. Malavemaria, who had previously been stationed at USNH Yokosuka where she worked as an EMT for three years before transferring to Guam, helped run the program.

Ross said providing EMT training and maintaining the watchbill with corpsmen and departments with nurses who can support the patient transports are both large investments of time and energy, but it allows staff to keep up their skills.

Based on their analysis, Ross and Malavemaria found:

• The most common locations within USNH Guam requesting transport services were the multi-service ward (43.2%), the emergency department (30.2%), and the intensive care unit (17.8%)
• The average monthly transport rate of patients was 23.7 and, of that number, 34% required advanced life support services
• The most common indications for transport were dialysis (19.9%), emergent procedures ((8.7%), cardiac emergencies (7.9%), neurologic emergencies (6.9%), and respiratory emergencies (5.5%)
• Interventions were required en route in 12% of the transports with the most common being airway management (87.7%)
• Continuation of treatment en route was required by 12.4% of patients with the most common being management of sedation medication (54%), administration of resuscitation fluids including blood products (17.6%), and administration of cardiac medications (8.1%)

According to Ross and Malavemaria, their review of en route care provided by the critical care transport team at USNH Guam shows not only that the hospital provides a reasonably high rate of patient transports, but also the need to maintain training for those conducting them. It also suggests that military hospital-based interfacility transport programs may be a reasonable sustainment platform for active duty en route care providers.

“There’s research that shows doing the job is much better than training for the job,” Ross said. And, at USNH Guam, that’s exactly what the corpsmen and nurses are doing—providing en route care to critical patients and sustaining their skills so that when they are called to the battlefront, they are ready to provide lifesaving care and treatment as they transport wounded warfighters to higher levels of care.

MHSRS is the Department of Defense’s annual, four-day scientific meeting that provides a venue for presenting new scientific knowledge resulting from military research and development.

Navy Medicine West (NMW) leads Navy Medicine’s Western Pacific health care system and global research and development enterprise. Throughout the region, NMW provides medical care to nearly 700,000 beneficiaries across 10 naval hospitals, two dental battalions, and 51 branch clinics located throughout the West Coast of the U.S., Asia, and the Pacific. Globally, NMW oversees eight research laboratories that deliver research expertise in support of warfighter health and readiness.

• Date Taken: 08.21.2019
• Date Posted: 09.03.2019 21:35
• Story ID: 338239
• Location: KISSIMMEE, FL, US