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Nurse sets a military frontline first

An RAAF reservist in Afghanistan transformed the medical support for NATO forces and war victims. Linda Belardi reports.

A trauma care nurse has set a new standard and helped speed up treatment time for injured military personnel in the battlefield.

Bronte Douglas, trauma care co-ordinator at Royal Darwin Hospital and reservist squadron leader with the RAAF, led a pilot project in southern Afghanistan in 2010, which has now been endorsed as official protocol for all emergency medical evacuations for NATO.

“The pilot project has changed what the normal standard is for NATO in any of their environments in terms of aero-medical evacuation and as a result the US military has changed its aero-medical capabilities, and it is most likely to have wide implications for other countries,” Douglas told Nursing Review.

While deployed for six months to the Combined Joint Operations Centre in Kandahar, Douglas was responsible for co-ordinating the aero-medical evacuation of injured frontline soldiers and saw a way to improve the outcomes of the critically wounded.

The Intelligent Tasking Project identified the need to provide critical care teams in a helicopter to improve the timeliness and efficiency of its medical response. “As medical care is moved closer to the frontline, we decided that we could bring the high-level of care to the patient and we would do that through a rotary-wing - a helicopter, instead of an aeroplane.”

Traditionally the protocols used by the military have relied on the availability of fixed-wing aircraft such as the Hercules, which required landing strips and were not often safe to use close to the frontlines, she said. The use of flexible helicopter critical care teams led to considerably shorter response times and improved outcomes for severely injured personnel.

“If you can get to the patients quickly and in turn get them to healthcare quickly, you can expedite their process and therefore improve their outcomes,” Douglas said. “The fact that it has become endorsed as a gold standard for NATO means that it is setting a new standard in military terms. For military health professionals, it shows us that there are increasingly lessons that can be shared between civilian and military environments.”

Douglas said there is an important cross-over of skills and concepts between trauma nursing and military health that can be used to improve the care provided to patients in multiple contexts. “Aero-medical retrieval is a civilian concept and traditionally we have done it a different way in the Defence Force. The circumstances were ripe for us to try something different and we were very successful in doing that.”

In recognition of her far-reaching contribution to military medicine, Douglas is this year’s recipient of the prestigious Sir Edward 'Weary' Dunlop award, named in honour of the Australian surgeon and war hero.

As the head of the trauma nursing service at Royal Darwin Hospital's National Critical Care and Trauma Response Centre, Douglas is used to witnessing severe trauma injuries from incidents such as motor and boating accidents, including the Ashmore Reef explosion. However, the scale and the frequency of the wounded in Afghanistan was unlike anything else she had previously encountered.

“The types of injuries that we saw over there and that we were dealing with were quite horrific in some instances and the volume was also very high. As a trauma co-ordinator I see a lot of trauma in my daily business but the amount over there was on a scale that you wouldn’t encounter in a civilian context.”

Douglas predominantly looked after coalition forces but also delivered care to all battle casualties including NATO troops, the Afghan national army and locals. Common injuries requiring treatment included head and chest injuries, gunshot wounds and complex blast trauma cases.

“It was undoubtedly the most challenging experience that I have encountered both personally and professionally. It was an amazing experience to work with so many different nationalities but also a privilege to serve with them and to do the best that we could for patients in very difficult circumstances.”

In spite of the overwhelming circumstances, Douglas said she learnt that one individual could still make a difference. The experience also reaffirmed her commitment to using her skills to ensure all patients have access to healthcare regardless of the circumstances in which they find themselves.

On top of her civilian and military commitments, Douglas has just completed a master’s in clinical practice at Charles Darwin University. Her thesis evaluated the unique nurse-led model of trauma care that she leads at the National Critical Care Centre.

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