Developments in the RN first assistant role during the Korean War

AORN Journal, Oct, 2005 by Deborah L. Hallquist

Evolution in nursing roles often has occurred during times of war. Demand for health care providers during wartime has stimulated increased employment of nurses while broadening the dimensions of the scope of nursing practice in the surgical arena. As a consequence, the concept of nurses performing as first assistants in the OR was born, and the role of the RN first assistant (RNFA) has evolved through standardized education, the work of nursing leaders, and advances in medical technology.

World War II set the stage for progressive development of the roles of nurses working in the OR. During World War II, there was a critical need for prepared OR nurses and nurse anesthetists who could perform in areas of combat and behind the battle lines. (1) A shortage of health care providers during the Korean War led to additional developments in nurses' roles. This article examines how the work of army nurses during the Korean War helped develop today's RNFA role.

THE KOREAN WAR

The Korean War began when the Communist North Korean Army crossed the 38th parallel, an arbitrary separation of North and South Korea, and invaded the Republic of South Korea. On June 27, 1950, the United Nations Security Council approved support of the Republic of South Korea, and President Harry S. Truman approved entry of US air and naval forces into South Korea. (2) The United Nations assumed leadership trader the direction of the United States with General Douglas MacArthur as commander-in-chief, and US military forces became involved in the conflict. (2) Shortly thereafter, 57 army nurses arrived in Pusan, Korea, to assist in establishing hospitals, and they began caring for patients the next day. (2) A few days later, 12 army nurses moved to Taejan, Korea, with the mobile army surgical hospitals (ie, MASH units). (2)

NURSES ROLES

At the beginning of the war, a shortage of nurses led to increased use of ancillary staff members in ORs. Technical tasks were executed by surgical technicians, freeing RNs to supervise, educate, and provide supportive care to auxiliary staff members and surgical patients. Registered nurses increasingly became specialized in the care of surgical patients (1,3) and functioned with focused knowledge and skills much like advanced practice nurses of today. In concert with this, nursing roles and functions evolved according to experience, education, and competence. (4)

The nursing shortage prompted the army to recruit nurses from civilian hospitals, as well as enlist the reserve corps. The Army Nurse Corps expanded from 3,460 to 5,397 nurses during the first year of the Korean conflict. (2) The use of auxiliary personnel permitted the first assistant in the OR to function at a higher level of competency. A critical shortage of medical officers existed, and many of the nurses who were stationed in Japan responded to this deficit of skilled personnel by taking on advanced practice responsibilities. (1) Nurses cared for the wounded in MASH units, prisoner-of-war camps, makeshift shelters, and on hospital trains. (5)

NURSING IN MASH UNITS

The war was notable for its use of nurses in MASH units located near the front lines. Combat nursing involved responsibilities and demands that frequently exceeded the normal scope of nursing practice. (5) In MASH units, RNs were responsible for the safety of patients, supervision and education of auxiliary nursing personnel, and support of surgical patients. (4)

The casualty evacuation system used during the Korean War was fashioned after the procedures used during World War II. Emergency treatment on the battlefield was provided by the company aide who then moved the casualty to a sheltered collecting area. From this point, litter bearers transported the patient to the battalion aid station where the medical officer triaged the patient and delivered additional emergency care. The casualty was then evacuated by ambulance on land or helicopter to the clearing stations and from there to MASH units. If more lengthy or extensive treatment was required, patients were moved by air, sea, or rail to evacuation hospitals or army hospitals in Japan. The most complex, long-term cases were conveyed back to the United States for treatment. (1)

When casualties entered the receiving area, a nurse took their vital signs and recorded them on the patient's attached medical tag. A nurse then cut away the soldier's clothing to expose the injuries. All patients with open wounds received penicillin and a blood transfusion. A medical officer or nurse triaged the patient who was subsequently transferred to the preoperative or operating areas by corpsmen. Here, the stretchers were set on blocks that served as OR beds. Frequently on a 24-hour basis, one medical officer and two nurse anesthetists managed four patients undergoing emergent surgery for abdominal, chest, and extremity wounds in the OR. The anesthetist monitored two patients while other staff members compressed the gas bags. A large instrument table was centered among four OR beds. From this table, four instrument parcels were distributed to smaller tables beside the OR beds. At each small table, a nurse or technician was responsible for handing instruments to the surgeon. In order to provide relief for the surgeon or prepare another patient for surgery, corpsmen or nurses often closed the wound. (1) Today, this is an accepted function of RNFAs.