Central Asia Regional Health Security Workshop George C. Marshall European Center for Security Studies 17-19 April 2012, Garmisch-Partenkirchen, Germany

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Central Asia Regional Health Security
WorkshopGeorge C. Marshall European Center for
Security Studies 17-19 April 2012,
Garmisch-Partenkirchen, Germany
Technicians, Nurses and Physician Assistants in
the United States Department of Defense

• Major Robin Ducker
• International Health Specialist
• Headquarters Air Forces Central Command
• 18 April 2012

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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

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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)

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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)

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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)

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• 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

• Dental Training
• Dental Specialist (Army) 7 weeks 23 weeks in
  hospital
• Dental Assistant (Air Force/Navy) 8 weeks
• Dental Lab (basic) 23-25 weeks
• Dental Lab (Advanced) (Navy) 24 weeks
• Preventive Dental (Army) 12 weeks
• Advanced Porcelain Techniques 3 weeks
• Removable Prosthodontics (Navy/Air Force) 3
  weeks

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• 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

• 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

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Surgical Technician Training
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Combat Medic/Medical Technician/Hospital Corpsman

• Air Force Medical Technician
• 9 weeks Basic Training
• 20 weeks at Medical Education and Training Campus
• Hospital training 45 days
• Usually dont further specialize right away like
  the Army and Navy do
• Can later go for 12 weeks further training as an
  Independent Duty Medical Technician

• 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

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Navy Corpsman Training
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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.

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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

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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

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• 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

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• 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 16-25 weeks

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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)

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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)

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Phase 1 Course Matrix
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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)

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• 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

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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)

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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.

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New Nurse at Graduation
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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
• Phase 2 Training
• Continues the Phase I Nurse Transition Program
  through transition in a military facility

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Novice Nurse Transition Year
Month 1-2 Commissioned Officer Training,
Communication, Team-Work
Enrolls in Program
New Graduate Nurse Recruited
Month 2-3 (Nurse Transition Program) Clinical
Skills, Critical Thinking,
Problem Solving
Month 4-7 Hospital and Unit Orientation
Month 7-12 (Air Force Nurse Residency
Program) Evidence Based Practice,
Communication, Quality, Informatics
Month 12 (Graduate) Submit paperwork, Upgrade
to full RN categorization
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Army Nurse Specialties
After one year of service, Army Nurses attend a
clinical specialty course
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What is a Nurse Practitioner or Advanced Practice
Nurse or Advanced Registered Nurse Practitioner?

• Usually are graduates of a Masters degree
  granting program (Bachelors degree plus two
  years Masters 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

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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
• Womens Health Nurse Practitioner
• Pediatric CNS
• Family Nurse Practitioner

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Advanced Academic Degrees (contd)

• Psychiatric Mental Health Nurse Practitioner
• Community Health
• Masters in Health Administration
• Masters in Business Administration/Masters in
  Nursing
• Nurse Midwifery
• Perinatal CNS
• Pediatric Nurse Practitioner
• Neonatal Intensive Care CNS
• Masters in Public Health
• PhD Nursing Science

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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

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What is a Physician Assistant or Physician
Associate?

• Usually are graduates of a Masters degree
  granting program (Bachelors degree plus two
  years Masters 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

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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

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Questions?
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• Major Robin Ducker
• International Health Specialist
• Robin.ducker_at_afcent.af.mil
• 803-895-3024