A CRNA’s Role on an

Army Forward Surgical

Team (FST)

CPT Lukman Burnett

3274TH US Army Hospital

Fort Bragg, NC

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Objectives

• Becoming a CRNA in the US Army

• Pre-deployment training

• Function of a Forward Surgical Team

• Advanced Trauma Life Support

• Different Roles of Medical Care

• Draw-over Anesthesia System

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How to become a Certified

Registered Nurse (CRNA) in

the U.S. Army

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Requirements

• ACTIVE

- Master’s degree in nurse anesthesia,

from an accredited program

- Between 21 and 42 years of age

- Certified registered nurse anesthetist

- U.S. citizenship

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Requirements

• RESERVE

- In addition to the above

qualifications, permanent U.S.

residency is required for Reserve

duty Officers

- Between 21 and 42 years of age (may

request a waiver

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Training

• RESERVE

- Your introduction to the Army Reserve

begins with the Army Medical

Department Basic Officer Leaders

Course (BOLC), a nine-week program

that will expose you to the variety of

mental and physical challenges you’ll

face as a member of the health care

team.

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Training

• RESERVE

- You’ll learn about the U.S. Army’s

approach to health care firsthand.

Training with other professionals and

attending lectures, conferences and

demonstrations that cover everything

from U.S. Army customs to crisis

management.

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Training

• RESERVE

- After completing BOLC, you will serve

with a reserve unit a minimum of two

days each month and participate in

annual training for at least two weeks

each year.

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Training

• RESERVE

- During this time, your duties may

include attending professional seminars

and military or nursing education courses

provided by the U.S. Army.

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Training

• RESERVE

- Plus, you’ll have the opportunity to

work in a wide range of health care

environments, whether it be in a modern

hospital, working with skilled

professionals in a variety of clinical

situations or supervising in a field

medical unit.

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Pre-deployment Training

Fort Bliss, Texas

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CONUS Replacement Center

• Day 1 - Saturday - In-processing, SHARP,

PDHA, VOWTAP/ACAP and Computer

Based Training

• Day 2 - Sunday - In-processing for

Civilians, First Aid Training and Computer

Based Training

• Day 3 - Monday - Medical SRRC, Dental,

First Aid Training for Civilians

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CONUS Replacement Center

• Day 4 - Tuesday - CIF, OCIE/RFI Issue,

Weapons issue, Medical Appts, IOTV and

Online Training

• Day 5 - Wednesday - MET/HEAT

Training, CIED Training and EST

• Day 6 - Thursday - Short Range

Marksmanship, PMI, Weapons

Qualifications, Familiarization Fire, and

Flight Brief

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CONUS Replacement Center

• Day 7 - Friday Flight Operations -

Departure

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Malaria

• Malaria is a serious, but preventable

parasitic disease, spread by the bite of an

infected mosquito. Symptoms may include

shivering followed by high fever, which

may be accompanied by confusion,

headache, and vomiting. If not treated,

symptoms can recur at irregular intervals

for many years.

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Malaria Life Cycle

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Anti-Malarial Medication for Deployment

• Causal Chemoprophylaxis

(Doxycycline)

- take starting 2 days pre-deployment and

every day during deployment. Continue

for 28 days post-deployment

- acts at the liver stage of the malaria life

cycle, to prevent blood stage infection

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Anti-Malarial Medication for Deployment

• Suppressive Chemoprophylaxis

(Primaquine)

- taken for 14 days post-deployment

- acts at the erythrocytic (asexual) stage

of the malaria cycle

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The Forward Surgical Team

(FST)

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Team Members

• 4 Surgeons (1 orthopedic, 3 general)

• 3 RN’s

• 2 CRNA’s

• 1 Administrative Officer

• 1 Detachment Sergeant

• 3 LPN’s

• 3 Surgical techs

• 3 Medics

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Definition

• The FST is a 20-man team which provides

far forward surgical intervention to render

nontransferable patients sufficiently stable

to allow for medical evacuation to a level

III hospital (combat support hospital

[CSH]).

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Definition

• Surgery performed by the FST is

resuscitative surgery; additional surgery

may be required at a supporting level III

hospital in the area of operations. Patients

remain at the FST until they are recovered

form anesthesia. Once stabilized they are

evacuated as soon as possible.

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Definition

• The postoperative intensive care capacity of

the FST is extremely limited. There is no

holding capability. The FST is not a self-

sustaining unit and must be deployed with

or attached to a medical company or

hospital support. Further, the FST is neither

staffed or equipped to provide routine sick

call functions.

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Levels of Medical Care

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Levels of Medical Care

• There are five levels of care (also known as

“roles”). Levels should not be confused

with the American College of Surgeons use

of the term in US trauma centers.

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Levels of Medical Care

• Different levels denote differences in

capabilities, rather than quality of care.

Each level has the capability of the level

forward of it and expands on that

capability. Soldiers with minor injuries can

be returned to duty after simple treatments

at forward locations, all others are prepared

for evacuation with medical care while en

route to a higher level.

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Levels of Medical Care

• Level I (Point of contact)

- Immediate first aid delivered at the

scene

• Level II (Forward Operating Base [FOB])

- Forward Surgical Team (FST)

• Level III (Kandahar or Bagram,

Afghanistan)

- Represents the highest level of medical

care available within the combat zone

with the bulk of inpatient beds

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Levels of Medical Care

• Level IV (Germany)

- Definitive medical and surgical care

outside the combat zone, yet within the

communication zone of the theatre of

operations.

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Levels of Medical Care

• Level V (United States)

- This level of care is provided in the US.

Military hospitals in the US sustaining

base will provide the ultimate treatment

capability for patients generated within

the theater.

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Advanced Trauma Life Support (ATLS)

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Anesthetists Role on the ATLS Team

• Airway control

• Cervical spine control

• Ventilation

• Monitoring of vital signs

• Monitoring of fluid and drug administration

• Analgesia

• Administer anesthesia for surgical

procedures

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The Draw-over Anesthesia

System

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Draw-over Anesthesia Setup

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The Draw-over Vaporizer System

• The use of ambient air as the vehicle for

delivering volatile anesthetic began with the

introduction of general anesthesia into

clinical medicine

• Uses ambient air as the principle carrier gas

• During the Falkland’s conflict the British

military used the draw-over technique and

resurfaced interest in it’s use in the U.S.

• Weighs approximately 5 pounds and fits

into a container the size of a briefcase

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The Draw-over Vaporizer System

• Oxygen may be added to the system, but

this in not required for operation

• Oxygen supplementation may be supplied

by pipeline, compressed cylinders, or an

oxygen concentrator

• An oxygen reservoir tube provides

increased FiO2 when supplemental oxygen

is used during draw-over anesthesia

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The Draw-over Vaporizer System

• The reservoir allows oxygen to accumulate

during the expiratory phase of the

respiratory cycle, which increases FiO2

during the inspiratory phase

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Advantages of the Draw-over Vaporizer

• The anesthetic gas is pulled through the

vaporizer by a decrease in downstream

pressure, as opposed to the plenum

anesthetic system, which uses a carrier gas

that pushes the gas through the vaporizer at

greater than atmospheric pressure

• More durability, compactness and

portability

• Low capital investment and operating

expense

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Advantages of the Draw-over Vaporizer

• No requirement for compressed gas or

electricity

• Ideal use in developing countries, natural

disaster areas, wartime, humanitarian

operations, and austere environments

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Disadvantages of the Draw-over Vaporizer

• Performance of the vaporizer is variable, so

accurate calibration is impossible

• The vaporizer has no temperature

compensating features. With prolonged use

the liquid agent may cool to the point where

condensation and even frost may form on

the outside of the reservoir. This cooling

impairs the efficiency of the vaporizer

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Disadvantages of the Draw-over Vaporizer

• The output concentration of the draw-over

may greatly exceed that produced by a

plenum vaporizer, especially at low flows

• Not FDA approved for use with a ventilator

system

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Questions??

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References

Headquarters, Department of the Army. (2013). Casualty Care

(Army Techniques Publication No 4-02.5). Washington, DC:

Army Publications.

Gegel, B. T. (2008). A Field-Expedient Ohmeda Universal

Portable Anesthesia Complete Draw-over Vaporizer Setup.

AANA Journal, Vol. 76, No.3, 185-187.

Brohi, K. (2008). The Trauma Team. Trauma.org.

http://www.trauma.org/archive/resus/traumateam.html

Headquarters, Department of the Army. (2013). Levels of

Medical Care. Emergency War Surgery. Fort Sam Houston,

Texas: Borden Institute, 2.1-2.11

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References

Headquarters, Department of the Army. (2003). Employment of

Forward Surgical Teams: Tactics, Techniques, and

Procedures (Field Manual No 4-02.25). Washington, DC:

Army Publications.

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Lukman Burnett

Cell: 252-702-5112

Personal: lburnett08@gmail.com

Military: lukman.burnett.mil@mail.mil