Civilian Health Care Providers Research Articles

Warzone pediatric trauma care: Lessons from civilian medical staff in Kyiv.

The article discusses the challenges faced by civilian healthcare providers in Kyiv, Ukraine, during the conflict in treating pediatric trauma resulting from war-related incidents. The authors share their experiences and insights from managing a series of 12 pediatric patients admitted to the Ohmatdyt children's hospital between February 25 and April 1, 2022. During this period, the hospital was under constant threat due to the military conflict. The patients, ranging in age from 3months to 17years, suffered injuries from various causes, including vehicle shootings, explosions, and other traumatic events. The interventions and timely management are discussed, and two detailed clinical cases are presented to illustrate the complexities of treating pediatric trauma in a warzone. In summary, the article sheds light on the unique challenges faced by healthcare providers in a warzone when treating pediatric trauma. It underscores the importance of timely intervention, effective triage, and the utilization of advanced medical techniques to improve patient outcomes in such challenging circumstances.

United States Army Reserve/National Guard soldiers’ healthcare experiences, attitudes, and preferences: Differences based on deployment status

ABSTRACT Some United States Army Reserve/National Guard (USAR/NG) soldiers have substantial health needs, which may be service-related, but not necessarily resulting from deployment. However, most USAR/NG members need to have been deployed to qualify for Veterans Administration (VA) benefits. Therefore, many USAR/NG soldiers seek care from civilian healthcare providers (HCPs). Using a subset (N = 430 current/former soldiers) of Operation: SAFETY study data, we used regression models to examine differences in healthcare experiences, attitudes, and preferences by deployment status (never-deployed vs. previously-deployed). Final models controlled for age, sex, rank (enlisted vs. officer), military status (current vs. former military), and RAND SF-36 General Health Score. Over 40% of soldiers agreed that civilian HCPs should ask patients about their military service, but never-deployed soldiers were less likely to report being asked about their service (p < 0.05) or how their service affects their health (p < 0.10). Never-deployed soldiers were also less likely to attribute their health concerns to military service (p < 0.001). Although never-deployed soldiers were more likely to prefer receiving physical (p < 0.05) and mental (p < 0.05) healthcare outside of the VA than previously-deployed soldiers, never-deployed soldiers had low confidence in their HCP’s understanding of their needs (49% thought that their civilian HCP did not understand them; 71% did not think that their civilian HCP could address military-related health concerns; 76% thought that their civilian HCP did not understand military culture). Findings demonstrate that although civilian HCPs may be the preferred (and only) choice for never-deployed USAR/NG soldiers, they may need additional support to provide care to this population.

Exploring Veteran cultural competency in Canadian health care services

LAY SUMMARY On leaving the military, Canadian Armed Forces Veterans begin receiving health care services in the civilian community. Health care providers may not understand the military culture from which Veterans come and how military service can affect health and well-being. The purpose of this study was to identify what civilian health care providers need to know and do to provide culturally competent care to Canadian Veterans. Veterans and health care providers (family physicians and an occupational therapist) were interviewed, and specific knowledge, skills, and abilities were identified as important when establishing a quality health care relationship. This information can be used to develop resources for health care providers when beginning work with Veterans and their families, as well as for Veterans themselves as they transition to receiving care in civilian systems.

Women Veterans' Descriptions of Interactions With Civilian Health Care Providers: A Qualitative Inquiry.

Women veterans often obtain care for unique gender- and military-related health issues from civilian health care settings. There is a gap in the literature surrounding woman veterans' perspectives about the care they receive. The purpose of this study was to apply the Interaction Model of Client Health Behavior framework to study the patient-provider interaction described by women veterans. A qualitative descriptive methodology, using directed content analysis, was employed. Six themes were identified. Consistent screening, provider knowledge about service roles and experiences of women veterans, and familiarity with military-related health conditions support holistic care. Further research in this area is warranted.

Determining Clinical Priorities Using a Clinical Practice Guideline Deconstruction Tool: COVID-19 in Austere Operational Environments.

The Joint Trauma System (JTS) publishes Clinical Practice Guidelines (CPGs) used by military and civilian healthcare providers worldwide. With the expansion of CPG development in recent years, there was a need to collate, sort, and deconflict existing and new guidance using systematic methodology both within and across CPGs. This need became readily apparent at the start of the COVID-19 pandemic when guidelines were rapidly developed and fielded in deployed environments. To meet the needs of deploying units requesting immediate and concise guidance for managing COVID-19, JTS developed the CPG entitled Management of Covid-19 in Austere Operational Environments. By applying a deconstruction process to organize clinical recommendations across multiple categories, JTS was able to present clear clinical recommendations across "role of care" and "scope of practice." The use of a deconstruction process supported the rapid socialization of the CPG and may have improved clinical understanding among deployed medical teams.

Exploring Canadian Veterans’ priorities regarding chronic pain research: A qualitative study

LAY SUMMARY In 2020, the Canadian Federal Government launched the Chronic Pain Centre of Excellence for Canadian Veterans (CPCoE). A higher proportion of Veterans experience chronic pain than the general population and the Centre wanted to understand what research topics Veterans thought the new Centre should prioritize. One-on-one interviews were conducted with 11 Canadian Veterans living with chronic pain from five provinces. Eight priority areas for future research were determined: 1) pain care in the military, 2) postoperative care in the military, 3) coordination of services through Veterans Affairs Canada, 4) military-to-civilian transition, 5) primary care provider access outside the military, 6) knowledge of pain management among civilian health care providers, 7) engaging Veterans as partners in their care, and 8) identifying effective strategies for chronic pain management. These findings will help guide research efforts of the new CPCoE.

Being a woman, being a soldier, being a mother: a qualitative analysis of perceptions of pregnancy on working lives of women in the Spanish Armed Forces

IntroductionThirty-two years after Spain first allowed women to join the armed forces, 12% of active troops are women, although there are no data on how many of them are mothers....

Musculoskeletal Injury in Reserve Officers' Training Corps: A Report From the Athletic Training Practice-Based Research Network.

Background:Reserve Officers’ Training Corps (ROTC) cadets must meet the same physical standards as active duty military servicemembers and undergo organized physical training (PT). ROTC participation, like all physical activity, can result in training-related musculoskeletal injury (MSKI), and of course, cadets could sustain MSKI outside of ROTC. However, MSKI incidence in ROTC programs is largely unknown.Purpose:To describe patient and injury demographics of MSKI in 5 universities’ Army ROTC programs.Study Design:Descriptive epidemiology study.Methods:A retrospective chart review of electronic medical records was performed using the Athletic Training Practice-Based Research Network (AT-PBRN). Athletic trainers at 5 clinical practice sites within the AT-PBRN documented injury assessments via a web-based electronic medical record system. Medical records during the 2017-2018 and 2018-2019 academic years were used for analysis. Summary statistics were calculated for age, sex, height, body mass, military science year, training ability group, mechanism of injury, activity type associated with injury, anatomic location of injury, participation status, injury severity, and diagnosis.Results:A total of 364 unique injuries were documented. Cadets in the most advanced fitness group (Alpha; n = 148/364) and in their third year of training (n = 97/364) presented with the most injuries. Injuries most commonly occurred during PT (n = 165/364). Insidious onset (n = 146/364) and noncontact (n = 115/364) mechanisms of injury were prevalent. The most frequent anatomic location of injury was the knee (n = 71/364) followed by the ankle (n = 57/364). General sprain/strain was the most frequent International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code reported (n = 34/364).Conclusion:The knee was the most frequent location of MSKI in ROTC participants, and most MSKIs had insidious onset. Cadets with higher injury frequency were high achieving (Alpha) and in a critical time point in ROTC (military science year 3). The majority of MSKIs can be attributed to ROTC training, with PT being the most frequent activity associated with injury. Civilian health care providers, from whom ROTC cadets will most likely seek medical attention, need to be aware of ROTC physical demands as well as the characteristics of training-related injuries.

Factors Associated With the Acceptance of New TRICARE and Medicare Patients by Health Care Providers.

We use data from the 2012-2015 TRICARE Standard Survey to examine factors that affect civilian health care providers' acceptance of patients covered by the U.S. Department of Defense's TRICARE insurance program and Medicare. We find that 74% of physicians report that they accept new TRICARE patients compared with 83% accepting new Medicare patients; in contrast, only 36% of mental health providers report that they accept new Medicare and/or TRICARE patients. Among the most common reasons provided by both physicians and mental health providers for not accepting either insurance type are insufficient reimbursement or their specialty not being covered; lack of awareness of TRICARE is also frequently cited, particularly among mental health providers. These findings suggest that successful strategies to increase provider acceptance of TRICARE and Medicare may include improving reimbursement rates and specialty coverage and increasing provider awareness of TRICARE through outreach programs.

Deployment and Travel Medicine Knowledge, Attitudes, Practices, and Outcomes Study (KAPOS): Malaria Chemoprophylaxis Prescription Patterns in the Military Health System.

.The Deployment and Travel Medicine Knowledge, Attitudes, Practices, and Outcomes Study (KAPOS) examines the integrated relationship between provider and patient inputs and health outcomes associated with travel and deployments. This study describes malaria chemoprophylaxis prescribing patterns by medical providers within the U.S. Department of Defense’s Military Health System and its network of civilian healthcare providers during a 5-year period. Chemoprophylaxis varied by practice setting, beneficiary status, and providers’ travel medicine expertise. Whereas both civilian and military facilities prescribe an increasing proportion of atovaquone–proguanil, doxycycline remains the most prevalent antimalarial at military facility based practices. Civilian providers dispense higher rates of mefloquine than their military counterparts. Within military treatment facilities, travel medicine specialists vary their prescribing pattern based on service member versus beneficiary status of the patient, both in regards to primary prophylaxis, and use of presumptive anti-relapse therapy (PQ-PART). By contrast, nonspecialists appear to carry over practice patterns developed under force health protection (FHP) policy for service members, into the care of beneficiaries, particularly in high rates of prescribing doxycycline and PQ-PART compared with both military travel medicine specialists and civilian comparators. Force health protection policy plays an important role in standardizing and improving the quality of care for deployed service members, but this may not be the perfect solution outside of the deployment context. Solutions that broaden both utilization of decision support tools and travel medicine specialty care are necessary.

The Opioid Epidemic: Challenge to Military Medicine and National Security.

We examine the current status of the military relevance of opioids, their use and misuse in military and veteran populations, the national security consequences of opioid use in our military age population, public health implications, and military, veteran, and government solutions for opioid addiction. A literature search of recent published research, federal government, and related open source materials was conducted using PubMed, Google, and Google Scholar, and all materials retrieved were manually identified, screened, and evaluated for inclusion. A modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach was used for the selection of relevant articles. Heath policy literature and relevant demographic information published within the last 5 years was also included to provide current information and search for solutions to address the escalating national opioid crisis. Synthetic opioids are used for pain and trauma management, not readily substituted, and have exceptionally high addiction potential. Combat wounded veterans have greater potential for opioid misuse than civilian populations. Assessment, management, and treatment of opioid use in this population are essential. Veterans receiving synthetic opioids have been noted to have multiple overdose risk factors. Opioids are readily available nationally as "street drugs" and also in the form of fentanyl-contaminated heroin. The opioid crisis affects the military age population and the top states for military enlistments. Younger age males with lower education and income are at significant risk for opioid use disorder. Recently increased drug overdose deaths contribute to an increased U.S. mortality rate with a commensurate decline in life expectancy at birth. Opioid abuse contributes to increased incidence of infectious disease. Behavioral health programs directed at military and veterans to identify risk factors for opioid misuse have been introduced. Prescription drug monitoring initiatives continue for these populations with increased information exchanged between military and civilian healthcare. Lifesaving interventions for opioid addiction include methadone maintenance and fentanyl test strip accessibility. Newly implemented federal funding healthcare initiatives to the states are now directed at opioid use prevention and enhanced surveillance. Given increasing rates of opioid addiction and death, viable solutions are universally needed. Successful intervention measures should be widely shared between military, veteran, and civilian healthcare and public health communities. Increased collaboration between these groups could inculcate successful programs to prevent and decrease opioid use. Results received from recent military and veterans' programs for prescription and electronic medical record (EMR) monitoring and data sharing may also prove useful for civilian healthcare providers and hospital systems. Future evaluations from ongoing federally funded programs to the states for addiction surveillance and intervention may help create measures to address the proliferation of opioid addiction with increased death rates. Anticipated results from these federal efforts should help inform opioid programs in military and veterans' health systems.

Utilization Variation In Military Versus Civilian Care: Evidence From TRICARE

The Defense Health Agency was established five years ago to integrate and centralize the provision of health care that had been managed separately by the Army, Navy, and Air Force. One favored proposal is to increase the use of private-sector or civilian health care providers. This study compared geographic variation in health care use (a common proxy for efficiency) between patients with a military (direct care) system and those with a civilian (purchased care) system primary care provider-both of which are offered in TRICARE Prime, a health plan that resembles a health maintenance organization. We found similar levels of variation across care utilization metrics with the exception of specialty care, in which the military sample had less variation than its civilian counterpart did. In the military system, risk-adjusted utilization levels were substantially lower for primary care visits and higher for specialty care visits, compared to these visits under the civilian system. Our findings suggest that expanding the use of the civilian system might not achieve the desired efficiencies. Rather, focusing on specialty care in the military system and expanding primary care in the civilian system could help achieve operational readiness and enhanced efficiency.

Exploring Chiropractic Services in the Canadian Forces Health Services - Perceptions of Facilitators and Barriers Among Key Informants.

Musculoskeletal (MSK) conditions have a significant impact on the health and operational readiness of military members. The Canadian Forces Health Services (CFHS) provides a spectrum of health services in managing Canadian Armed Forces (CAF) personnel health care needs with on-base and off-base services provided by civilian and uniformed health care professionals, including chiropractors. Although chiropractic services are available in US DoD and VA systems, little is known about the facilitators and barriers to integrating on-base chiropractic services within the CFHS. This study explored key informants' perceptions of facilitators and barriers to the integration of on-base chiropractic services within the CFHS. We conducted a qualitative study to describe and understand how an integrated chiropractic service could be designed, implemented, and evaluated within the current interdisciplinary CFHS. Telephone interviews were conducted, using a semi-structured interview guide, to explore key informants' perceptions and experiences of chiropractic care within the CFHS. In total, we invited 27 individuals across Canada to participate; 15 were identified through purposeful sampling, 12 through a snowball sampling technique, and 2 declined. The 25 participants included military personnel (52%), public servants and contractors employed by the Department of Defense (24%), as well as civilian health care providers (24%). All participants were health care providers [physicians (MD) (7), physiotherapists (PT) (13), chiropractors (DC) (5)]. Interviews were audio-recorded and transcribed verbatim. Transcripts were prepared and analyzed using an interpretivist approach that explored key informants' perceptions and experiences. Qualitative analysis revealed numerous facilitators and barriers to chiropractic services in the CFHS. These were categorized under three broad themes: base-to-base variations, variable gatekeeper roles, and referral processes. Barriers to integrating chiropractic services included: lack of clarity about a chiropractor's clinical knowledge and skills; CFHS team members' negative prior experiences with chiropractors (e.g., inappropriate patient-focused communication, clinical management that was not evidence-based, ignorance of military culture); suboptimal bi-directional communication between CAF personnel and DCs across bases; and wide-ranging perspectives pertaining to duplication of services offered by PTs and DCs in managing MSK conditions. Facilitators associated with the integration of chiropractic services within a collaborative and interdisciplinary CAF environment included: patient benefits associated with multiple approaches utilized by different providers; adoption of up-to-date, high-quality evidence and guidelines to standardize care and curtail "dependency" between patient and providers; and co-location of providers to strengthen existing interprofessional communication and relationships. Key informants called for patient care that is collaborative, integrated and patient-centered, rather than "patient-driven" care; civilian providers understanding and respecting military culture rather than assuming transferability of patient management processes from the public civilian sector; standardization of communication protocols and measures to evaluate outcomes of care; and the need to move slowly and respectfully within the current CAF health care system if planning the on-base implementation of chiropractic services. This study illuminated many opportunities and barriers, in complex and diverse domains, related to introducing collaborative chiropractic services in the CFHS. The findings are relevant to increasing understanding and strengthening interprofessional collaborative care within the unique CAF health care delivery system.

Caring for Military Children: Implications for Nurse Practitioners

Nearly two million American children belong to a military family. Armed Forces families are located in almost every state and around the globe. Military children are a unique and at times vulnerable population. Military children and adolescents may face significant stressors throughout their lives compared to their civilian counterparts. Military families encounter frequent moves and over half of these children have encountered at least one parental deployment since September 11th, 2001. Civilian health care providers often care for military children and adolescents. The purpose of this article is to provide pediatric providers with an understanding of the deployment cycle and how it relates to childhood development, to discuss common military stressors and their impact on the family, and to describe strategies and resources pediatric providers can utilize to care for this unique population.

The Kid Next Door- raising Awareness of Civilian Health Care Providers to the Needs of Military Children - A Tactical Approach to Education

The Kid Next Door- raising Awareness of Civilian Health Care Providers to the Needs of Military Children - A Tactical Approach to Education

DHA Director Describes Integration of Military Health Care Services

Back to table of contents Previous article Next article Professional NewsFull AccessDHA Director Describes Integration of Military Health Care ServicesMark MoranMark MoranSearch for more papers by this authorPublished Online:5 Jul 2017https://doi.org/10.1176/appi.pn.2017.7a12AbstractVice Adm. Raquel Bono directs an agency mandated to standardize best health care practices across military service lines and create a more globally integrated health care system. “We are strongest when we work together across service lines,” said Navy Vice Adm. Raquel Bono, director of the Defense Health Agency (DHA). “As a surgeon, I am not going to ask for a scalpel in a different way because the patient is in the Army or the Navy. Our common mission is the patient we serve, regardless of what kind of boots he or she wears.” Raquel Bono, M.D., said the military seeks the expertise of psychiatrists in the civilian sector in treating the “invisible wounds of war.”David HathcoxBono made her remarks at APA’s 2017 Annual Meeting in San Diego, where her theme was partnerships—across military service lines and, importantly, with physicians in the civilian sector.“As director of the DHA, I have the opportunity to oversee where our best practices are occurring and work to expand, integrate, and standardize those practices across the military,” Bono said. “If we do this the right way, we have a real opportunity to create a robust system serving all of our military service men and women and their families.”Bono said that the integration of health care across service lines is codified now in the most recent National Defense Authorization Act. Under the law, the mission of the DHA is to do the following: Create a more globally integrated health system, accountable as a combat support agency.Direct enterprise-wide shared services, standardizing clinical and business practices that produce better health and better care. Manage TRICARE for 9.4 million beneficiaries around the world. TRICARE is the health care program for uniformed service members and their families around the world.Deliver coordinated health care and support high-quality coordinated care in all multiservice markets.Regarding the visible wounds of battle, Bono said that the integration of the services is producing results. In the years since the wars in Afghanistan and Iraq started, the case fatality rate per battle injury has dropped. The invisible wounds have been more challenging. Bono solicited the help of psychiatrists in the civilian community to treat returning soldiers with traumatic brain injury and posttraumatic stress disorder. “We are very concerned about the suicide rate,” she said. “We are not dealing with a single, unitary phenomenon, but one that is very complex depending on the individual. We recognize that we don’t have all the answers, and we can’t do it alone. Partnering with others is going to be invaluable.” Vice Adm. Bono brings to her role a distinguished career in medicine and the military. She obtained her baccalaureate degree from the University of Texas at Austin and attended medical school at Texas Tech University. She completed a surgical internship and a general surgery residency at Naval Medical Center Portsmouth and a trauma and critical care fellowship at the Eastern Virginia Graduate School of Medicine in Norfolk. Shortly after training, Bono saw duty in Operations Desert Shield and Desert Storm as head of Casualty Receiving at Fleet Hospital 5 in Saudi Arabia from August 1990 to March 1991. Upon returning, she was stationed at Naval Medical Center Portsmouth as a surgeon in the General Surgery Department and attending surgeon at the Burn Trauma Unit at Sentara Norfolk General Hospital. Before becoming the director of the DHA, Bono served as director of the National Capital Region Medical Directorate of the DHA and as the 11th Chief of the Navy Medical Corps from September 2013 to October 2015.Bono said military and civilian health care providers share a common overarching mission and have much to offer each other. The military is prepared to reach out to the civilian sector, she said, such as when Patrick Downes and Jessica Kensky—victims of the 2013 Boston Marathon bombing—were invited to Walter Reed National Military Army Hospital in Washington, D.C., and partnered with “battle buddies” who had lost limbs in battle. Bono showed a video clip of a moving interview with Downes, who said, “We feel like we were embraced by the military family in a home that was meant for them.”Said Bono: “We have a sacred mission to care for our military service men and women and their families, but we also have a mission to share our experience and expertise with others. We hope you will share your experience and expertise with us.” ■ ISSUES NewArchived

Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans.

Increased prevalence of traumatic brain injury (TBI) has been associated with service members and veterans who completed combat deployments in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Management of persistent post-concussive symptoms (PCS) has been a challenge to healthcare providers throughout the Military and Veterans Healthcare Systems, as well as civilian healthcare providers, due in part to the chronic nature of symptoms, co-occurrence of behavioral health disorders such as depression, Posttraumatic Stress Disorder (PTSD), and substance use disorders, and fear of a potential stigma associated with psychiatric diagnoses and behavioral health treatment(s). This systematic review examined non-pharmacologic behavioral health interventions and cognitive rehabilitation interventions for PCS in military service members and veterans with a history of mild TBI (mTBI). Six electronic databases were searched with specific term limitations, identifying 121 citations. Ultimately, 19 articles met criteria for inclusion in this systematic review. Studies were broadly categorized into four subtypes: psychoeducational interventions, cognitive rehabilitation, psychotherapeutic approaches, and integrated behavioral health interventions for PCS and PTSD. The review provides an update of the empirical evidence for these four types of interventions for PCS in active duty service members and veterans. Recommendations for future research are discussed, including the need to expand and improve the limited evidence basis on how to manage persistent post-concussive symptoms in this population.

Pathways to a Career in Military Psychiatry.

Psychiatric healthcare has been an essential aspect of the military medical mission over the past century. From very limited psychiatric services available during World War I to the development of multiple psychiatric graduate medical education training programs within the military healthcare system after World War II, psychiatry within the military has markedly evolved. With the onset of Operation Enduring Freedom in 2001 and Operation Iraqi Freedom in 2003, the USA embarked on the longest continuous conflict in its history, producing thousands of personnel suffering from combat-related psychiatric disorders and placing additional psychological stress on their spouses and children requiring the services of skilled psychiatric physicians both wearing the military uniform and serving as civilian healthcare providers in a military treatment facility. This paper will present an overview of the history of military psychiatric graduate medical education, current avenues of access to serve as a military psychiatrist either in uniform or as a civilian, and the opportunities and experiences one may expect working in the military healthcare system. Psychiatry GraduateMedical Education training has significantly evolved from the first known four Department of Defense psychiatric residents (two Army and two Navy) in 1909 who trained for 2 years at Saint Elizabeth Hospital in Washington, DC. However, very few psychiatrists were sponsored for training over the next several decades despite the evident need for psychiatric services in World War I when the total number of psychiatrists in the Army increased from 50 at the beginning of the war to nearly 700 when the Armistice was signed in 1918 [1]. Attrition from themilitary psychiatry ranks post-World War I significantly reduced the inventory to less than 100 in 1940, necessitating another quick infusion of psychiatric physicians into the Armed Forces to include the establishment of a standardized 12-week neuropsychiatry course for non-psychiatric clinicians which produced 1300 graduates to augment the pool of neuropsychiatric services available for service members [2, 3]. In 1946, Congress passed the National Mental Health Act which provided funds for a number of mental health initiatives including the training of mental health professionals, and over the course of the next decade, eight military psychiatry residency programs opened and received certification from the Accreditation Council for Graduate Medical Education [4]. Since the 1950s, there has been significant change in the total number and location of military psychiatry training programs to include a significant restructuring during the 1990s in unison with the large drawdown of troops after Operation Desert Storm. Six Military Psychiatry Graduate Medical Education training programs are currently in operation. The demand for behavioral health services post-9/11 for both service members and their families greatly increased in the setting of continuous combat operations and quickly exceeded existing resources. This increase in clinical demand necessitated increasing the numbers of psychiatrists within military treatment facilities and thus expanded opportunities for entry intomilitary psychiatry besides the traditional path of completing a military graduate medical education training program. A career in military psychiatry can now be achieved through several different pathways as discussed below.

E-prescribing rolls out to military pharmacies

Abstract Civilian health care providers seeing Tricare beneficiaries in the Military Health System (MHS) can now electronically prescribe to military treatment facilities (MTFs) in the United States, Guam, and Puerto Rico.

Sarin Exposure

Given the current geopolitical tensions, the risk of a terrorist attack on the United States is constant and increasing. Chemical terrorism, specifically the use of nerve agents, has occurred in other nations. Because of the ease of manufacture, the ability to conceal them, and the lethality of these agents, they pose a potential threat as a weapon of terror. Nerve agent exposure requires prompt recognition, a series of actions to mitigate further exposure to others, and management of the physiological sequelae of exposure. Many civilian healthcare providers are unprepared to manage injuries from nerve exposure. Failure to recognize the signs of nerve agent exposure will increase mortality and morbidity in victims and place healthcare providers at risk. Simulation is an effective methodology to train healthcare personnel in disaster preparedness. This article presents a simulation scenario that reviews the presentation of nerve agent exposure, its management, and a recipe for performing this simulation in a training exercise.