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By Rear Admiral Maryanne T. Ibach, Nurse Corps, U.S. Naval Reserve
It is a pleasure to share some thoughts on total-quality combat care, from the perspective of another war more than 25 years ago— as tempered by changes in medicine during the intervening years.
The significant differences between Vietnam and the recent war in the Gulf should be obvious. What may not be apparent are the remarkable changes that have taken place in the interim. For example, nursing was not the highly specialized profession it is today. When the USS Repose (AH-16) was pulled out of mothballs and •irst staffed for Vietnam, 17 of the 29 nurses initially assigned were Pediatric nurses. It was felt they had a multisystem orientation that enhanced their ability to anticipate and monitor changes in critically 'njured patients. There were no critical care or trauma nurse specialists then.
Another difference was that the reserves were never mobilized for Vietnam; there was no system to 'dentify quickly Navy medical reserves available for mobilization, hi 1978, only 187 Naval Reserve Nurse Corps officers were in a drilling status. By 1990, the expansion of the Naval Reserve Nledical Department was almost complete, with the number of reserve nurses approaching 2,750.
Most of these officers have impressive credentials, skills, and motivation. Without exception, those mobilized for Desert Shield and Desert Storm possessed basic nursing skills, individual energy, and sound nursing judgment.
What more could we ask as a starting point?
The fact that nearly 1,400 reserve nurses reported for duty during the buildup and conflict in the Gulf, with hundreds more on standby—ready to go—shows how dramatically the program has grown during the last few years. The number of reserve nurses recalled was twice the number of any other medical department officers and six times any other non-medical officer community.
A fleet hospital requires multiple specialties within its organizational structure. In reality, it functions more like a community hospital, with the capability to handle large numbers of trauma casualties. It would not function well if staffed only with trauma specialists—assuming the military could recruit, train, and retain what has become a highly specialized group of medical professionals. Even our inner-city hospitals, which routinely handle large numbers of emergency trauma cases, are staffed with a broad cross section of nursing specialties.
The experience of our fleet hospitals during Desert Shield and Desert Storm substantiates the desirability of the nursing mix, although that point may not have been well articulated to those called upon to serve. Ambulatory care, patient and staff education, community health, and mental health are some of the services nurses provide in addition to medical, surgical, and trauma nursing. Realistically, any field hospital, even if staffed completely by trauma specialists, would be overwhelmed by 70-80 casualties per hour, sustained over a period of time.
Building on the lessons learned in the Gulf, Navy medicine is implementing a variety of programs to address most of the classification and assignment issues. Adding to the personnel management challenge is the uncertainty of the future as the Navy and other DoD components downsize. During the 1980s, reserve medical programs were upgraded and expanded,acknowledging the critical military role of adequate medical-treatment resources. The war in the Gulf could not have been executed without the mobilization of the reserve medical resources. What the future reserve versus regular medical mix will be is now being debated. The outcome
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Combat Care
of those discussions will shape the Naval Reserve’s health-care capabilities into the next century.
In the meantime, we are pressing ahead with major efforts to improve the billet/body mix, moving toward management by subspecialty code. One of the constraints on our ability to manage reserve nursing assets has been a lack of computer capacity and programs to track the required information. That shortfall is being corrected. Some of the current initiatives include:
► Reserve billet descriptions, modified to include subspecialty codes (SSCs). This change will require reservists to obtain the codes associated with their Naval Officer Billet Classification (NOBC).
>■ A Bureau of Medicine & Surgery instruction on NOBCs/SSCs is being drafted by MED-07. It will provide general guidelines for medical department reserve officers on acquiring and updating their billet classifications and necessary subspecialty codes.
► The proposed instruction will include a requirement to review periodically all medical department reserve NOBCs and SSCs to ensure that they accurately reflect the current clinical ability of each officer. There will have to be a reasonable assurance of current competence to ensure that a reservist recalled to active duty can perform fully the duties of the billet.
Emphasis will continue to be placed on training, with a goal of basic combat-casualty-care exposure for all nurses assigned to fleet hospitals and units assigned with the Marines. Training courses are attended by regular as well as reserve officers. Some of the courses available include Combat Casualty Care, Combat Casualty Care Management, and Strategic Medical Readiness Contingency. Every effort is being made to tap the creativity and resourcefulness of the medical community for innovative ways to provide realistic, operationally oriented training for
reserve medical personnel.
As I visit the medical training conferences sponsored by the Reserve Readiness Command Regions, I am impressed by the clinical and academic credentials of Reserve Nurse Corps officers. As a community, the Nurse Corps exhibits a refreshing energy level and dedication to the Navy. Naval leadership must accept the challenge of training, motivating, and retaining these professionals in an uncertain environment. With their help, input, and support, we will build on the lessons of the Gulf War as we move the Naval Reserve medical community to greater levels of readiness, while supporting the naval medical mission worldwide.
A Special Edition of Naval History Magazine
When the Bombs Fell on Us
Pearl Harbor, Hawaii: 7 December 1941— Never since the war of 1812 had Americans felt the horrors of a foreign attack on their own soil. In a mere few hours that Sunday morning Japanese carrier-based fighters, bombers, and torpedo planes had executed the boldest provocation for war in the Pacific.
To commemorate the 50th Anniversary of that unforgettable day, the editors of Naval History magazine have woven together 96 pages of on-the-scene photography, original color paintings, and first-hand accounts—a trademark of U.S. Naval Institute publications—of what fighting for your life was like on Battleship Row; how the Japanese felt issue of Naval History. Go back with us 50 years, and experience the shock, the heroics, and the outrage that would inspire the American people never to let this happen again.
What Readers Are Saying About Naval History:
- "An excellent publication. I've given it
as a gift to my best friend."
- "Very satisfying to an old salt."
- "It's like opening a three-layer box of chocolates."
- "A major scholarly need fulfilled."
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The 50th Anniversary Pearl Harbor Edition of Naval History is available now at $4.50 for Naval Institute members and $6.00 for nonmembers, postage included. To receive your own commemorative issue, call toll-free, 800-233-USN1 and ask for the Customer Service Department.
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Proceedings / June l1*1*'