Designing a Medical Humanitarian Assistance Course for advanced practice nurses in the Uniformed Services

Military Medicine, Sep 2003 by Aberle, Curtis J, Bethards, Kennneth J, Orsega, Susan M, Ricciardi, Richard

The U.S. uniformed services frequently respond to natural and man-made disasters worldwide. Disaster management and humanitarian assistance has been a major focus of military medicine for well over a decade. Training for these missions is a priority for the U.S. military, specifically as a result of the Gulf War. The Medical Humanitarian Assistance Course for advanced practice nurses is a course available to train advanced practice nurses in disaster management and humanitarian assistance. This article will describe the evolution, design, format, and implementation of the Medical Humanitarian Assistance Course.

Introduction

Nurses have undertaken nontraditional roles in advanced practice for over a century. An example is the delivery of anesthesia that nurses first began in 1887 at St. Vincent's Hospital in Erie, Pennsylvania.1 Nurses have earned advanced degrees since the early 1950s. However, the role of nurse practitioner did not come about until 1965 at the University of Colorado. It was there that the role of the Nurse Practitioner was formally recognized. At the University of Colorado, nurses began to work collaboratively with physicians to identify symptoms, to diagnose, and to manage health problems in children.2

Advanced practice nurses (APNs) have become an integral part of the military health care system as evidenced by the role of the nurse anesthetists, who have been part of military medicine since World War I.1 In contrast, only since the 1970s have the nurse practitioners been integrated into the military health care system. Additionally, the role of the nurse practitioner in deployed situations is currently evolving.

Purpose

To prepare for disaster management and humanitarian assistance (DMHA) missions, APNs must have the proper education and training to function in adverse and complicated environments. The purpose of this project was to develop and evaluate a course for preparing APNs to function in DMHA missions.

Background Information

Current U.S. policy endorses humanitarian interest as a justifiable reason to deploy U.S. military forces.3 Emergency conditions such as natural disasters and humanitarian disasters also require the deployment of U.S. military forces.4 Thus, APNs, such as family nurse practitioners (FNPs), have been and will continue to be deployed and used in DMHA missions.

Man-made or natural disasters bring death and destruction. Examples of natural disasters include cyclones, hurricanes, floods, earthquakes, and famine caused by drought. Man-made disasters usually involve governmental infrastructure degradation due to military conflicts/wars, operations other than war, or terrorist attacks. This destruction leads to hunger, disease, lack of potable water, and poor medical care for displaced persons.

Since Desert Storm, U.S. military forces have participated in many humanitarian missions. Examples include ongoing peace enforcement missions in Bosnia and Croatia, disaster relief in Rwanda, and humanitarian assistance in Somalia as well as in Afghanistan. Humanitarian missions rely heavily on the ability to deliver primary care. Physicians, nurse practitioners, and physician assistants deployed in DMHA missions use a team approach to the delivery of primary care. Historically, by the time military medical units arrive, the emergency phase of a disaster has past and there is an emphasis on primary and preventive care.5 FNPs are well suited to deliver primary adult, obstetrical, and pediatric care, and with additional training, they can effectively transition to a DMHA environment.

The U.S. military possesses the unique ability to rapidly deploy manpower and equipment throughout the world. U.S. military forces perform at superior levels because they bring an intact organization and structure that no other agency can match.6 The military also possesses the unique ability to maneuver in areas without established roads, bridges, or other infrastructure.7 Military medical resources may be one of the first to arrive in an area of disaster. Those who respond to disasters need to be able to fill specific roles while maintaining a certain degree of flexibility.8 FNPs provide a great degree of flexibility because of the nature of their training. Military medical units, which include FNPs, are required to provide care in a variety of settings including local civilian populations as demonstrated in missions in Honduras, Iraq, and Bosnia. The U.S. public health FNP can become a member of the commissioned corps readiness force. This group of qualified officers can be mobilized in response to natural or man-made disasters such as the New York terrorist attack and Virgin Island hurricane in 1995. Humanitarian missions rely heavily on primary care providers. This emphasis on primary care and public health issues creates an environment that is more like a community clinic than a combat zone.5

The education FNPs receive in their academic programs prepares them for the role of a primary health care provider. In a recent study, FNPs reported being trained to handle the most common primary care complaints such as upper respiratory infections, gastrointestinal problems, and musculoskeletal problems seen in DMHA missions.9 Prior to the opening of the Uniformed Services University of the Health Sciences Graduate School of Nursing in 1993, few academic programs offered specific instruction in humanitarian assistance as part of an FNP curriculum. Data from military FNPs deployed in DMHA missions indicate that FNPs lack training in planning, conducting, and executing a DMHA mission. For example, FNPs have limited knowledge in the role and function of nongovernmental organizations like the American Red Cross.