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In the 43 years since it was first described, cardiopulmonary resuscitation (CPR) has grown from an obscure medical theory to a basic first aid skill taught to adults and is now the near-universal technique used in CPR instruction. This article provides insight into the history of CPR. We explore the phenomenon of sudden cardiac arrest, the historical roots of CPR, current practice data and recommendations, and the society's role in the development of this life-saving technique. We conclude with a review of CPR's economic impact on the healthcare system and the ethical and policy issues surrounding CPR. [ABSTRACT FROM AUTHOR]

Introduction: The Navy Trauma Training Center (NTTC) is a military-civilian partnership that provides advanced trauma training for application across the range of military operations while exposing military medical personnel to high-volume and high-acuity trauma. Few published data evaluate the outcomes of military-civilian partnerships, including NTTC. The purpose of this study is to evaluate the knowledge, confidence, and stress of NTTC participants before, at mid-point, and after completion of the program. Participants include corpsmen (HM), nurses (RNs), physician assistants (PAs), and physicians (MDs)., Materials and Methods: These are preliminary data from an ongoing prospective, observational study with repeated measures. Included are participants that complete NTTC training. Pre-training measures include a demographic questionnaire, trauma knowledge test, Confidence survey, and the Perceived Stress Scale. These same instruments are completed at mid-training and at the conclusion of the NTTC curriculum. Data were analyzed using paired t-tests and linear mixed models., Results: The sample was composed of 83 participants (49 HM, 18 RNs, 4 PAs, and 12 MDs. Knowledge and confidence increased from baseline to post-NTTC for each clinical role (P < .05). Stress for all roles was low and stable over time (P > .05)., Conclusions: These preliminary data suggest that, as expected, trauma-related knowledge and confidence increase significantly with training at NTTC. Stress was low and stable over time. These data from a small sample of participants indicate NTTC training is increasing participants' trauma knowledge and confidence to care for trauma casualties. Continued collection of data in the ongoing study will allow us to determine whether these early findings persist in the overall study sample and may help inform the optimal length of training needed., (© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Horizontal violence refers to repeated behaviors over time that intimidate or demean another. These behaviors may negatively impact the nursing workplace. The purpose of this study was to describe horizontal violence occurrence in the United States military nursing workplace and to determine the effectiveness of an educational intervention. Using a one group before-after design, survey data on horizontal violence behaviors, personal effects, perpetrators, job satisfaction and intention to leave were collected before and after a 30-min educational intervention. Reported horizontal violence behaviors and personal effects from horizontal violence averaged once to twice in a three month period. Staff nurses (peers) were the most frequent perpetrators. Job satisfaction and intent to leave significantly correlated with horizontal violence. There were no significant differences in overall horizontal violence before and after the intervention. Within the United States military nursing workplace horizontal violence does occur, although less frequently than in the United States civilian nursing population. Education on horizontal violence may not be sufficient as a sole intervention., (Published by Elsevier Ltd.)

Background: The US Military has achieved the highest casualty survival rates in its history. However, there remain multiple areas in combat trauma that present challenges to the delivery of high-quality and effective trauma care. Previous work has identified research priorities for pre-hospital care, but there has been no similar analysis for forward surgical care., Methods: A list of critical "focus areas" was developed by the Committee on Surgical Combat Casualty Care (CoSCCC). Individual topics were solicited and mapped to appropriate focus areas by group consensus and review of Eastern Association for the Surgery of Trauma (EAST) and Joint Trauma System guidelines. A web-based survey was distributed to the CoSCCC and the military committees of EAST and the American Association for the Surgery of Trauma. Topics were rated on a Likert scale from 1 (low) to 10 (high priority). Descriptives, univariate statistics, and inter-rater correlation analysis was performed., Results: 13 research focus areas were identified (eight clinical and five adjunctive categories). Ninety individual topics were solicited. The survey received 64 responses. The majority of respondents were military (90%) versus civilians (10%). There was moderate to high agreement (inter-rater correlation coefficient = 0.93, p < 0.01) for 10 focus areas. The top five focus areas were Personnel/Staffing (mean, 8.03), Resuscitation and Hemorrhage Management (7.49), Pain/Sedation/Anxiety Management (6.96), Operative Interventions (6.9), and Initial Evaluation (6.9). The "Top 10" research priorities included four in Personnel/Staffing, four in Resuscitation/Hemorrhage Management, and three in Operative Interventions. A complete list of the topics/scores will be presented., Conclusions: This is the first objective ranking of research priorities for combat trauma care. The "Top 10" priorities were all from three focus areas, supporting prioritization of personnel/staffing of austere teams, resuscitation/hemorrhage control, and damage-control interventions. This data will help guide Department of Defense research programs and new areas for prioritized funding of both military and civilian researchers., Level of Evidence: Study design, level IV.

Background: US Navy nurses provide en route care for critically injured combat casualties without having a formal program for training, utilization, or evaluation. Little is known about missions supported by Navy nurses., Objectives: To characterize the number and types of patients transported and skill sets required by Navy nurses during 2 combat support deployments., Methods: All interfacility casualty transfers between 2 separate facilities in Iraq and Afghanistan were assessed. Number of patients treated, number transported, en route care provider type, transport priority level and duration, injury severity, indication for critical care transport, en route care interventions, and vital signs were evaluated., Results: Of 1550 casualties, 630 required medical evacuation to a higher level of care. Of those, 133 (21%) were transported by a Navy nurse, with 131 (98.5%) classified as "urgent," accounting for 46% of all urgent transports. The primary indication for en route care nursing was mechanical ventilation of intubated patients (97%). Mean (SD) patient transport time was 29.8 (7.9) minutes (range, 17-61 minutes). The most common en route care interventions were administration of intravenous sedation (80%), neuromuscular blockade (79%), and opioids (48%); transfusions (18%); and ventilation changes (11%). No intubations, cricothyroidotomies, chest tube placements, or needle decompressions were performed en route. No deaths occurred during transport., Conclusions: US Navy nurses successfully transported critically injured patients without observed adverse events. Establishing en route care as a program of record in the Navy will facilitate continuous process improvement to ensure that future casualties receive optimized en route care., (©2018 American Association of Critical-Care Nurses.)

Introduction: Pain is the most common symptom in patients presenting for prehospital (PH) care. Research in civilian emergency medical systems has shown wide variability in PH pain assessment and analgesic practices, yet a minimal amount is known about pain assessment and analgesic intervention practices in the military, particularly when PH care is delivered in a combat zone., Objective: To describe prehospital (PH) pain care practices for U.S. military personnel injured in Iraq and Afghanistan 2010-2013 and explore potential relationships to explain variation., Methods: An exploratory retrospective, cross-sectional study of Department of Defense Trauma Registry data from 2010 to 2013 was performed. Demographic, clinical, or health system variables for associations with three outcomes: 1) pain assessment documentation; 2) pain severity (0-10 scale); and 3) analgesic administration (yes/no). Including only variables with significant associations, backward stepwise regression was used to develop explanatory models for each outcome., Results: Patient records (n = 3,317) were evaluated for documentation of PH pain assessment and analgesic administration. The prevalence of PH pain score documentation was 37.8% (n = 1,253). Overall, the proportion of records with PH pain scores increased over time: 19.8% (2010), 35.1% (2011), 58.2% (2012), and 62.2% (2013). Severity of pain scores ranged 0-10; mean = 5.5 (SD = 3.1); median = 6 (IQR = 3-8). Analgesics were reported for 50.8% (n = 1,684), of whom 38.3% had a pain severity score documented. The pain assessment documentation model included any documented vital signs, injury year, and mechanism of injury and explained 19.3% of the variance in documentation. The pain severity model included vital signs and injury severity score (ISS) and explained 5.0% of the variance in severity. The analgesic model included any vital signs, pain severity, trauma type, mechanism of injury, ISS, and year., Conclusions: Pain assessment and treatment documentation improved each year, but remain suboptimal. Available data yielded poor prediction of the outcomes of interest, emphasizing the importance of individual assessment. Analgesic effectiveness could not be evaluated.

Emergency department (ED) pain assessment documentation in trauma patients is critical to ED pain care. This retrospective, cross-sectional study used trauma registry data to evaluate U.S. military combat zone trauma patients injured between 2010 and 2013 requiring ≥ 24-hr inpatient care. Study aims were to identify the frequency of combat zone ED pain assessment documentation and describe pain severity. Secondary aims were to construct statistical models to explain variation in pain assessment documentation and pain severity.Pain scores were documented in 60.5% (n = 3,339) of the 5,518 records evaluated. The proportion of records with ED pain scores increased yearly. Pain assessment documentation was associated with documentation of ED vital signs, comprehensive facility, more recent year, prehospital (PH) heart rate of 60-100 beats/min, ED Glasgow Coma Scale score of 15 vs. 14, blunt trauma, and lower injury severity score (ISS).Pain severity scores ranged from 0 to 10; mean = 5.5 (SD = 3.1); median = 6. Higher ED pain scores were associated with Army service compared with Marine Corps, no documented PH vital signs, higher PH pain score, ED respiratory rate < 12 or >16, moderate or severe ISS compared with minor ISS, treatment in a less-equipped facility, and injury in 2011 or 2012 vs. 2010. The pain severity model explained 20.4% of variance in pain severity.Overall, frequency of pain assessment documentation in combat-zone EDs improved yearly, but remained suboptimal. Pain severity was poorly predicted by demographic, clinical, and health system variables available from the trauma registry, emphasizing the importance of individual assessment.

The aim of this study was to determine the prevalence, severity, location, aetiology, treatment and healing of medical device-related pressure ulcers (PUs) in intensive care patients for up to 7 days. A prospective repeated measures study design was used. Patients in six intensive care units of two major medical centres, one each in Australia and the USA, were screened 1 day per month for 6 months. Those with device-related ulcers were followed daily for up to 7 days. The outcome measures were device-related ulcer prevalence, pain, infection, treatment and healing. Fifteen of 483 patients had device-related ulcers and 9 of 15 with 11 ulcers were followed beyond screening. Their mean age was 60·5 years, and most were men, overweight and at increased risk of PU. Endotracheal (ET) and nasogastric (NG) tubes were the cause of most device-related ulcers. Repositioning was the most frequent treatment. Four of 11 ulcers healed within the 7-day observation period. In conclusion, device-related ulcer prevalence was 3·1%, similar to that reported in the limited literature available, indicating an ongoing problem. Systematic assessment and repositioning of devices are the mainstays of care. We recommend continued prevalence determination and that nurses remain vigilant to prevent device-related ulcers, especially in patients with NG and ET tubes., (© 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Background: The US military is perhaps the only retailer consistently losing money on tobacco. Military stores (commissaries and exchanges) have long sold discount-priced cigarettes, while the Department of Defense (DoD) pays directly for tobacco-related healthcare costs of many current and former customers. Tobacco use also impairs short-term troop readiness., Objective: To examine the long struggle to raise commissary tobacco prices and the tobacco industry's role in this policy effort., Methods: Analysis of internal tobacco industry documents, searches of government and military websites and newspaper databases, and interviews with key informants identified in the documents., Results: Efforts to raise commissary tobacco prices began in the mid-1980s. Opposition quickly emerged. Some military officials viewed tobacco use as a "right" and low prices as a "benefit". Others raised issues of authority, and some saw the change as threatening the stores. The tobacco industry successfully exploited complex relationships among the Congress, the DoD, commissaries, exchanges and private industry, obstructing change for over a decade. Leadership from the Secretary and Assistant Secretaries of Defense, presidential support and procedural manoeuvring finally resulted in a modest price increase in 1996, but even then, high-level military officials were apparently threatened with retaliation from pro-tobacco Congressmen., Conclusions: The longstanding military tradition of cheap cigarettes persists because of the politics of the military sales system, the perception within the military of tobacco use as a right, and tobacco industry pressures. Against its own best interests, the US military still makes tobacco available to service members at prices below those in the civilian sector.

Policy theory provides a useful lens for nurses evaluating how problems are understood and responded to within the policy arena. This article examines and critiques the agenda-setting model offered by John Kingdon. Furthermore, the theory is applied to the issue of tobacco control in the state of California, suggesting policy solutions and strategies to achieve their placement on the policy agenda. Strategies and techniques that may be useful to nurse policy champions are elucidated.