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Pioneering Military Burn Research

Szulecki, Diane Editor

AJN The American Journal of Nursing: September 2019 - Volume 119 - Issue 9 - p 69–70
doi: 10.1097/01.NAJ.0000580296.75954.e3
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Former Army nurse Elizabeth-Mann Salinas has improved burn care worldwide.

Figure.

Figure.

Elizabeth Mann-Salinas wanted to be a nurse since childhood, but it wasn't until she was in her 20s—while working in the restaurant industry—that she decided to pursue a nursing career. One day at work, she witnessed a “terrible, tragic” accident and felt frustrated that she didn't know how to help. The incident prompted her to start volunteering at a hospital, and soon after she enrolled at Emory University in Atlanta to earn her bachelor of science in nursing.

Upon graduation, Mann-Salinas joined the Army as a staff nurse. The initial commitment was four years; she ended up serving 23. “I got critical care training, lived in Germany, went to graduate school, and got my PhD, all thanks to the Army,” she says. “I loved being in the Army. I loved the camaraderie, I loved the collective spirit of having a clear mission—something bigger than yourself.”

As she rose through the ranks, Mann-Salinas became an expert in burn care and went on to make significant contributions to the field. After serving as senior nurse scientist at the U.S. Army Institute of Surgical Research (USAISR) at Fort Sam Houston in Texas, Mann-Salinas now leads the Joint Trauma System's efforts to improve military trauma care on a broad scale.

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BECOMING A BURN CARE LEADER

Mann-Salinas remembers the first time she observed a burn patient during a critical care training rotation at the USAISR Burn Center. The patient's body was 80% burned, his dressings were off, and he was in extreme pain. “It scared me to death,” she says. “I actually had to leave the room because I was physically ill.”

But she quickly moved past her initial reaction, developing an unflagging enthusiasm for working with the burn center patients. “I fell in love with their passion to live,” she says. “Clinically, burn patients are the sickest, most complicated patients you'll ever meet. They're metabolically deranged, they have multiple medical issues that come from the burns and subsequent inflammatory response, and then they face rehabilitation and the lifelong struggle of living as a burn patient.” Nearly a decade later in 2005, after working at Army hospitals here and abroad and earning her master's degree as a clinical nurse specialist (CNS) in critical care, Mann-Salinas became the head nurse of the USAISR Burn Center ICU.

At the time, the wars in Iraq and Afghanistan had been underway for two years and the volume of burn center patients injured in combat was at its peak. (The USAISR Burn Center is the sole burn center serving the U.S. Department of Defense, including the Army, Navy, Air Force, and Marine Corps.) Caring for this patient population was “the most challenging assignment I think any of us had,” Mann-Salinas says. “It was so busy. The patients were so sick. They're young people at the height of their life, and then they're lying in bed, mangled. It was really heartbreaking but also very rewarding to have the honor of caring for them.”

As head nurse, Mann-Salinas helped lead efforts to implement the use of continuous renal replacement therapy (CRRT) in the burn center ICU. This technique helps support hemodynamically unstable patients’ natural renal processes. (She notes that CRRT saved the life of the first burn center patient it was used on in 2005; he went on to get married while still a patient there.) The USAISR Burn Center was one of the first burn units in the world to use CRRT—it has since become a standard of care for burn centers across the country, as well as for the Army Burn Flight Team's global missions.

Mann-Salinas also helped develop Burn Navigator (Arcos, Inc., Missouri City, TX), a decision support software that assists in managing iv fluid therapy for newly burned patients by reducing both over- and under-resuscitation. Burn Navigator became commercially available in 2013 and is now an app. Mann-Salinas worked with Army engineers on the project, lending a nursing perspective. She says research conducted in their burn center demonstrated that the software has “saved people's lives and reduced mortality.”

Mann-Salinas met her husband, a USAISR computer scientist, while working on the Burn Navigator. The pair also collaborated on an effort to help burn patients who require insulin therapy: they developed a method to correct a systematic error in commonly used bedside glucometers that caused inaccurate readings based on the patient's degree of anemia. Their work helped prompt a change in U.S. Food and Drug Administration standards and guidelines for point-of-care glucometers.

In 2011, Mann-Salinas started working as the USAISR Burn Center's only nurse scientist and went on to establish the USAISR's Systems of Care for Complex Patients Task Area, which focused on combat casualty care, in 2012. The following year, she spent seven months in Afghanistan doing research on trauma care. To date, she's been the principal investigator on more than 20 research studies and has authored hundreds of articles, presentations, and posters; in 2014, she became one of the few nurses to be designated a Fellow of the American College of Critical Care Medicine.

Mann-Salinas also helped improve job satisfaction for burn center nurses by guiding the implementation of a preceptorship program, which decreased turnover by 50% (see “An Evidence-Based Approach to Precepting New Nurses” in the March AJN). The program is currently being adopted in other military treatment facilities, and Mann-Salinas says one of her major life goals is to see it established as the standard for nursing competency within the entire Department of Defense.

Now retired from the Army, Mann-Salinas continues to work for the military in what she calls her “dream job”: developing a brand-new performance improvement system for the Joint Trauma System. (In 2017, the Joint Trauma System was designated as the authority for trauma care within the Department of Defense.) Among other responsibilities, her team maintains over 70 clinical practice guidelines across all military branches, the North Atlantic Treaty Organization, and U.S. allied partners, and more guidelines are underway.

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A TEAM EFFORT

Beyond her efforts to improve patient care, Mann-Salinas is dedicated to mentoring fellow nurses and cultivating the next generation of nurse leaders and researchers. She recalls being surprised that, early in her career, several superiors spent time helping her on the finer points of professional development. One very senior scientist sat down with her every few days to help her edit a manuscript or talk about her research.

The value of mentorship stuck with Mann-Salinas. When she became a nurse scientist, she decided to start teaching the CNSs on her team how to do evidence-based practice projects, write abstracts, and develop posters and presentations. Once they learned, “they were able to mentor down and do the same for the staff nurses,” she says. “We had a fantastic machine going. What's the point if you're not teaching the next generation, empowering them, and enabling them to do something new?”

Mann-Salinas is proud to see her mentees flourish—and she emphasizes that her successes at work have stemmed from teamwork. “It really pleases me to walk down the hall and see all the posters that our team did,” she says. “I just want to be somebody who brings people along with me and helps them grow. Without the help of some really amazing experts, I would never be here today. It behooves all of us to be a mentor and a coach.”—Diane Szulecki, editor

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