From the Editor

This month’s “Student in the Spotlight” Evan Williams returned from an Army tour in Afghanistan a few months ago. He’s been more than a little busy since then, moving and settling into a demanding job. So we are particularly pleased that he found the time to write an article specifically for our readers about his experiences working on a forward surgical team in Afghanistan. Thanks, Evan!

Our vision for the e-News has always included providing glimpses into the lives of your fellow perioperative nurses. You are a diverse bunch–in background, work venue, medical specialty and geography. In recent months we’ve profiled people working in Colorado, Arkansas, Virginia, Illinois, Peru–and now Afghanistan. I hope you enjoy reading these snippets of your colleagues’ lives as much as we do.

Do YOU have a story to share about an interesting assignment, job situation, challenging surgery, or how you ended up becoming an RNFA? We’d love to feature you. (It doesn’t have to be a long article, and we can help write it if you don’t have time.) Just shoot me a line. Thanks!


Julie Lancaster, Editor


Student in the Spotlight
H. Evan WilliamsName: H. Evan Williams
Credentials: Major/BSN, MAOM (Master of Arts in Organizational Management), CNOR
Student Status: Has completed NIFA’s RNFA coursework; currently in clinical portion
City and State: Coral Springs, FL
Current Job: Instructor of Perioperative Services/ S4, Army Trauma Training Center, Miami, FL
Background: I returned in May 2010 from a tour in Afghanistan that included serving as Chief Nurse/OR Nurse/ Interim Commander for the 67th Forward Surgical Team (see article, below). Previously served in Iraq as an OR Staff nurse and Interim Head Nurse, Morale Officer, and Infection Control Nurse, for the 47th Combat Support Hospital. (Full bio appears at end of linked article, below.)
Current Project: Besides teaching, I’m working on an article about humor in the perioperative arena, which will appear on the AORN website.
Serving on a Far-Forward Surgical Team in Afghanistan

By H. Evan Williams, Major/BSN, MAOM (Master of Arts in Organizational Management), CNOR

A U.S. Army Forward Surgical Team (FST) is a 20-person team that provides far-forward surgical intervention (that is, surgical intervention at the leading edge of the battlefield), to render nontransportable patients sufficiently stable to allow for medical evacuation to a Level III CSH hospital (combat support hospital).

In Afghanistan split operations are used to allow more points of care in a given area to reduce evacuation time from point of injury to surgical intervention. This creates a series of 9- to 11-person teams to provide the main effort on trauma resuscitation. The Army’s research has found that there is little to no effect on patient outcomes from the use of split operations, however, such operations create their own challenges that are very specific to the deployed military surgical unit.

Within the military medical profession there is a sense of responsibility, not only to the soldiers and coalition forces but also to the host nation community. In Afghanistan this included sustainable teaching for the local hospital personnel and local coalition forces, which included Afghan Police and Afghan National Army. So as the Officer in Charge of the 67th Forward Surgical Element (FSE) Forward Operating Base Sharana and the Operating Room nurse, I had to now balance providing health care between my trauma mission and my civic mission.

In two separate trips the senior surgeon, the senior female Intensive Care Unit Nurse and senior Emergency Room Nurse and I were able to tour the local hospital town of Sharan, in Paktika Province. This was accomplished in two separate visits due to mission and cultural issues. This hospital was amazing for what it did with the available resources that it had. Due to the hospital’s financial restraints, most of the employees were from the local area and had on-the-job medical training, most with little to no formal medial training.

Click to read the entire article.

News: Adult Hospital Stays with Infections Due to Medical Care

In August the Agency for Healthcare Research and Quality published a statistical brief based on a 2007 nationwide inpatient sample of short-term, non-Federal hospitals. The brief reports, among other things:

  • On average, hospital stays for adults with infections due to medical care were 19.2 days longer and the cost was nearly $43,000 greater than stays without infections.
  • For patients with an HAI (healthcare-associated infection) due to medical or surgical care, the rate of death in the hospital, on average, was six times as high as the rate for patients without an HAI (9 percent versus 1.5 percent).
  • The most common principal diagnoses for stays with infections due to medical care were septicemia (11.8 percent of infections had this principal diagnosis); adult respiratory failure (5.9 percent); and complications of surgical procedures or medical care (4.1 percent).
Click here for a PDF of the full statistical brief.


News: Online Approach for Wound Care

Meddserve, an integrated online health IT software service, has developed a new online approach to wound care that would allow nurses to carry out consultations in patients’ homes and send their reports to a specialist for diagnosis and development of treatment plans.

“Using a computer and Internet connection, practice nurses draw on a 3D body image the site of a wound and record important information such as past treatments used,” reports a press release appearing on

“They can also take photos of wounds and then send the picture as a referral to the doctor, who then logs on, using a secure log in, to view the images, make a diagnosis and advise a bespoke [customized] treatment plan.”

Click to read the full press release.