Central Asia Regional Health Security Workshop George C. Marshall European Center for Security Studies April 2012, Garmisch-Partenkirchen, Germany Major Robin Ducker International Health Specialist Headquarters Air Forces Central Command 18 April 2012 Technicians, Nurses and Physician Assistants in the United States Department of Defense

Introduction Enlisted Medical Technician Training –Medical Education and Training Center –Licensed Practical Nurse Registered Nurses –Nurse Transition Program/Nurse Residency Program –Nursing Specialties –Advance Practice Nurses –Advanced Academic Degrees Physician Associates/Physician Assistants

Who Are They? Privileged Providers: Physicians, Nurse Practitioners, Physician Assistants Remote location/Limited Providers: Independent Duty Technicians (Air Force), Independent Duty Corpsman (Navy) Nurses (All have Baccalaureate of Science degrees) Licensed Practical Nurses (Army) Medical Technicians (Air Force), Hospital Corpsman (Navy), Health Care Specialist “Combat Medic” (Army)

Enlisted Technicians High School (Secondary/12 years school total) graduates Perform all of the functions in the military hospital that do not require a Baccalaureate degree (4 years of college)

Tri-Service Enlisted Medical Training at the Medical Education and Training Campus New school – fully operational just last year Originated by advice of Presidential Commission formed and tasked to reduce Department of Defense expenditures and increase efficiencies Forms the largest medical education and training institution in the U.S. Trains 25,000 students every year (About 8,000 students at any point in time)

Dental Training Dental Specialist (Army): 7 weeks + 23 weeks in hospital Dental Assistant (Air Force/Navy): 8 weeks Dental Lab (basic): weeks Dental Lab (Advanced) (Navy): 24 weeks Preventive Dental (Army): 12 weeks Advanced Porcelain Techniques: 3 weeks Removable Prosthodontics (Navy/Air Force): 3 weeks Public Health Services Animal Care (Army): 11 weeks Veterinary Food Inspection (Army): 8 weeks Health Physics (Army): 12 weeks Behavioral Health: Air Force 13 weeks, Navy 17 weeks, Army 17 weeks Preventive Medicine: Army 15 weeks, Navy 24 weeks

NURSING & SPECIALTY MEDICAL TRAINING Allergy/Immunization: 5 weeks Cardiopulmonary (Air Force): 14 weeks Cardiovascular (Army/Navy): 20 weeks Hemodialysis: Army 14wks, Navy 20 weeks Ophthalmic Tech: Army 6 wks, Air Force 10 weeks Optician (Army/Navy): 23 weeks Orthopedics: Army 6 weeks, Navy/Air Force 12 weeks Orthotics (Air Force): 29 weeks Otolaryngology: Army 6 weeks, Air Force 12 weeks Practical Nurse (Army): 8 weeks Respiratory Therapy: 30 weeks Surgical Tech (Army/Air Force): 10 weeks Surgical Tech (Navy): 23 weeks Urology (Navy/Air Force): 15 weeks Combat Medic (Army): 14 weeks Medical Technician (Air Force)/Hospital Corpsman (Navy): 20 weeks

Surgical Technician Training

Combat Medic/Medical Technician/Hospital Corpsman Army Combat Medic: –10 weeks Basic Training –8 weeks training at Medical Education and Training Campus –Often go on to further training such as orthopedics and optometry Navy Hospital Corpsman : –7-9 weeks Basic training –20 weeks training at Medical Education and Training Campus –Many go on to further training such as radiology and laboratory technology –7 weeks Field Medical Service School will qualify them to serve with Marines –Are often called “Doc” by fellow Navy and Marine personnel as a term of respect Air Force Medical Technician –9 weeks Basic Training –20 weeks at Medical Education and Training Campus –Hospital training 45 days –Usually don’t further specialize right away like the Army and Navy do –Can later go for 12 weeks further training as an Independent Duty Medical Technician

Navy Corpsman Training

Independent Duty Corpsman / Independent Duty Medical Technician Scope: The training program includes: ( but is not limited to ) –medical history taking –physical examination techniques and procedures –advanced medical and surgical procedures –environmental sanitation and preventive medicine –pharmaceutical mathematics –clerical procedures –fiscal and supply management Often is the sole provider for a particular location, a role that finds them stitching wounds, dispensing medicine, performing dental care, and treating injuries and illnesses.

What is a Practical Nurse or Licensed Practical Nurse? Has undergone approximately 12 months of intensive study and hospital experience Has passed a state licensure examination in Practical Nursing The Practical Nurse is similar to the now defunct State Enrolled Nurse in Great Britain (Level 2 Nurse) Always works under the supervision of a Registered Nurse Unable to administer many intravenous medications and blood products in most states Are only utilized in the civilian sector and in the Army

Does the Military Train Licensed Practical Nurses? Yes! The Army Combat Medic applies to the program with letters of recommendation and evidence of ability to complete the program The LPN program consists of 8 weeks at the Medical Education and Training Center and 44 weeks of hospital training At the completion of the training, the soldier is qualified to take the National Practical Nurse exam

HEALTH SERVICES MANAGEMENT Biomedical Equipment: Army/Air Force 41 weeks, Navy 54 weeks Medical Material Supervisor (Air Force): 3 weeks Medical Expense Performance Reporting System (Air Force): 2 weeks Medical Logistics: Army 6 weeks, Air Force 5 weeks Patient Administration: Army 6 weeks, Air Force 7 weeks DIAGNOSTIC TRAINING Cytotechnology: 50 weeks Electroneurdiagnostic: Navy/Air Force 26 weeks Histopathology: Navy/Air Force 36 weeks Medical Lab (Air Force): 17 weeks Medical Lab (Air Force/Navy): 26 weeks Nuclear Medicine: 19 weeks Radiology/Radiography: Air Force 19 weeks, Navy 21 weeks, Army 24 weeks Diagnostic Medical Sonography (Advanced Course): 1 week Mammography (Air Force): 12 weeks

Additional Biomedical Equipment Technician Courses (Advanced Training) Computer Based Medical Systems: 4 weeks Computed Tomography: 2 weeks Mammography Imaging: 1 week Radiographic/Fluoroscopic Imaging: 3 weeks Radiographic Acceptance Procedures: 2 weeks Telemedicine: 3 weeks Ultrasound Imaging Systems: 1 week Advanced Field Medical Systems: 2 weeks Advanced Sterilization Systems: 4 days Biomedical Equipment Management: 4 days ANCILLARY TRAINING Nutrition/Diet Therapy: Army/Air Force 7 weeks Occupational Therapy: Army 19 weeks, Navy 35 weeks Pharmacy (Air Force): 14 weeks Pharmacy: Army 22 weeks, Navy 23 weeks Physical Therapy: weeks

Sample Curriculum: Pharmacy Technician Course Program Model –Phase I (didactic/laboratory training) 12 weeks long (all 3 services together) –After 12 week(Phase I) program: AF students go directly to Phase II (experiential training) Army and Navy continue for 3 more weeks of advanced training (didactic/laboratory), then go to Phase II (experiential training)

Pharmacy Technician Training: Phase I Breakdown Students must complete 11 courses –Pharm 101(Intro to Pharmacy)/Service Specific Training –Pharm 102 (Admin/Supply) –Pharm 103 (Intro to Therapeutics) –Pharm 104 (Therapeutics 2) –Pharm 106 (Therapeutics 3) –Pharm 110 (Outpatient Operations) –Pharm 120 (Pharmacy Compounding) –Pharm 111 (Inpatient Operations) –Math 102 (Pharmacy Calculations) –Math 103 (Compounding Calculations) –Math 201 (Inpatient Calculations)

Phase 1 Course Matrix

Pharmacy Technician Training Phase II Phase II (Experiential Training) –Air Force (3 weeks) –Army (5 weeks) –Navy (5 weeks)(1 week prior math refresher) Total Training Lengths: –Air Force (15 weeks) –Army (22 weeks) –Navy (23 weeks)

Enlisted Training Aerospace Evacuation Technician – 21 days Aerospace Physiology Apprentice – 45 days Bioenvironmental Engineering Apprentice – 68 days Bioenvironmental Engineering Craftsman – 5 days Public Health Apprentice – 67 days

21 UNCLASSIFIED What is a Registered Nurse? Has had two to four years of college education in Nursing Has passed a nationally administered licensure exam Is unable to make medical diagnoses and prescribe medication Army, Navy and Air Force all require their Active Duty Nurses to have 4 year Nursing Degrees (The Army Reserves still allow nurses in with less than 4 year degrees)

22 UNCLASSIFIED Registered Nurses The Air Force gets most of its new nurses every (about 60%) from the civilian health care sector. The other 40% of the new nurses have no experience. They have just graduated from college.

23 UNCLASSIFIED New Nurse at Graduation

24 UNCLASSIFIED Air Force Nurse Transition Program/Nurse Residency Program (Novice Nurse) 4 “Centers of Excellence” for training National Council of State Boards of Nursing Transition To Practice Model Recognize value of evidence-based models in public protection Phase 2 Training Continues the Phase I Nurse Transition Program through transition in a military facility

25 UNCLASSIFIED Month 1-2: Commissioned Officer Training, Communication, Team-Work Month 12: (Graduate) Submit paperwork, Upgrade to full RN categorization Month 2-3: (Nurse Transition Program) Clinical Skills, Critical Thinking, Problem Solving Month 4-7: Hospital and Unit Orientation New Graduate Nurse Recruited Month 7-12: (Air Force Nurse Residency Program) Evidence Based Practice, Communication, Quality, Informatics Enrolls in Program Novice Nurse Transition Year

26 UNCLASSIFIED Critical Care Nursing (16 weeks) Emergency Nursing (16 weeks) Obstetrics/Gynecological Nursing (16 weeks) Perioperative Nursing (16 weeks) Psychiatric/Mental Health Nursing (22 weeks) Community Health Nursing (12 weeks) Army Nurse Specialties After one year of service, Army Nurses attend a clinical specialty course

27 UNCLASSIFIED What is a Nurse Practitioner or Advanced Practice Nurse or Advanced Registered Nurse Practitioner? Usually are graduates of a Master’s degree granting program (Bachelor’s degree plus two years Master’s level study) Require licensure by national exam Usually work in a clinic setting but some have hospital privileges Can practice independent of a physician Can prescribe most medications All services use nurse anesthetists

28 UNCLASSIFIED Does the U.S. Department of Defense train Advanced Practice Nurses? Yes! Critical Care Clinical Nurse Specialist (CNS) Emergency/Trauma CNS Flight Nursing CNS Medical-Surgical CNS (Adult Health) Perioperative CNS Nurse Anesthesia Women’s Health Nurse Practitioner Pediatric CNS Family Nurse Practitioner

29 UNCLASSIFIED Psychiatric Mental Health Nurse Practitioner Community Health Master’s in Health Administration Master’s in Business Administration/Master’s in Nursing Nurse Midwifery Perinatal CNS Pediatric Nurse Practitioner Neonatal Intensive Care CNS Master’s in Public Health PhD Nursing Science Advanced Academic Degrees (cont’d)

30 UNCLASSIFIED Uniformed Services University of the Health Sciences Graduate School of Nursing – Masters of Science in Nursing (MSN) –Family Nurse Practitioner –Nurse Practitioner –Perioperative Clinical Nurse –Psychiatric Mental Health Nurse Practitioner Doctorate of Philosophy (PhD) Program in Nursing Science

31 UNCLASSIFIED What is a Physician Assistant or Physician Associate? Usually are graduates of a Master’s degree granting program (Bachelor’s degree plus two years Master’s level study) Require licensure by national exam Usually works in a clinic setting May sometimes be unable to prescribe narcotics Always work under the supervision of a physician

32 UNCLASSIFIED Does the Military Train Physician Assistants/Physician Associates? Yes! Inter-service Physician Assistant Program Medics with a bachelors degree can apply for the program Program is 2 years in length (1 year of training at the Medical Education and training center and 1 year of training at a military hospital) Approximately 180 students are trained each year Graduates are commissioned and can sit for national certification 4 year service obligation

33 UNCLASSIFIED Questions?

34 UNCLASSIFIED Major Robin Ducker International Health Specialist