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*Military emergency medicine has seen significant changes since the 1990s and has been redefined in positive ways by the past decade of war. The changes have had an impact beyond the military services through research, academic partnerships, and international collaboration. Just as military medicine heavily influenced the development of emergency medical services (EMS) and prehospital care (which subsequently led to the need for the specialty of emergency medicine), the military continues to advance the clinical practice of emergency medicine, especially in the realm of trauma care, critical care, and patient transport. While the day-to-day practice of emergency medicine is similar to civilian emergency medicine, it is the unique opportunities for diversification and the operational experiences that make the practice of military emergency medicine so rewarding. This chapter highlights the unique opportunities and challenges in the practice of emergency medicine within the military healthcare system.

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*The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Air Force, the Department of Defense, or the US Government.

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The military health system (MHS) maintains 56 hospitals and 365 clinics and the MHS/TRICARE system provides coverage for 9.7 million beneficiaries, including active duty personnel, retirees, and their families.1 Similar to the civilian healthcare system, the MHS has seen a reduction in military emergency departments (EDs)—from a high in 1998 of 164 EDs—of 50% by the turn of the century and a few more closures in the past decade.2

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There are numerous advantages to practicing military emergency medicine, as summarized in Box 50-1.

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Box 50-1 Advantages of Practicing Military Emergency Medicine and Nursing
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In contrast to the civilian population, MHS beneficiaries have universal health insurance which significantly enhances their access to primary, specialty, and emergency care. In addition, military beneficiaries have no co-pay or need for preauthorization when visiting a military ED. Overall the MHS focuses on patient-centered care with a team approach that provides a greater level of support for emergency medicine providers and their patients.

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Military beneficiaries have access to prescription drugs, immunizations, and many public health and injury prevention services. The military services go through great lengths promoting safety and injury prevention at all levels both on the job and personal safety for active duty and their families. Injury prevention efforts include tough motorcycle helmets laws, required motorcycle safety courses, child safety seat requirements, and aggressive random screening programs and education to prevent alcohol and drug-related accidents. In addition, military beneficiaries ...

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