Here is a message from one of our brothers serving in Germany. I copy and pasted verbatim so that you don’t miss any nuances. My thoughts will be pasted as a new comment after the post to get some discussion going. Please speak up and let us know what we forgot!
“I’m a paramedic with the german navy specops for 10 years. I am TCCC instructor (NAEMT) and cooperate with CAE operating the CAESAR Simulator.
In many possible situations we find a need for Prolonged Care Skills.
I attended SOMSA last week but found no clear recommendations due to this stage of care, not as strict and far forward like for CUF and TFC.
This website gives a lot to read and that’s fantastic. But do you have a documentation form for prolonged care? Do you have a paper that defines the topics for special prolonged care training? I mean for me as a paramedic who has served in mountainous mission areas as well it’s pretty clear what skills are basically needed. But maybe i forgot some topics.
Can you help me out?
Big thanks for your hard work in this topic!”
After having run a number of these scenarios there are a few things that successful teams do that other teams do not. A solid foundation in TCCC training is the foundation for prolonged field care. Training non-medical team members is probably the most important thing you can do. This should be done the day prior to the scenario. This also includes likely procedures that the medic will perform and want assistance with. The medic should be very familiar with the position papers the working group has published and the guidelines therein and try and have some cheat sheets ready to go. Here is my personal list of procedures and skills that I recommend:
Proper TQ placement and reduction
Packing an inguinal or axillary wound
Stopping bleeding and cleaning abdominal evisceration
Occlusive dressing or replacing bowels of evisceration
Assessing indications for needle D
Detailed head to toe assessment
Insertion of needle D
Preparation and placement of airway
Bagging with BVM with PEEP valve
Oxygen tank prep including NRB and nasal cannula
Setting up the SAVent and Oxylator or other vent
Using the oxygen concentrator
Drawing blood for labs or point of care testing
Preparation and initiation of peripheral IV
Preparation and placement of Foley catheter
Suprapubic bladder tap
Glasgow coma scale from a cheat sheet
Taking a full set of vitals manually
Attaching a monitor
Using the patient care flow sheet and trending vitals
Blood typing card
Preparing the equipment for blood transfusion
Making comms and calling a telemedical consult
Changing wet to dry dressings
Drawing and administering drugs
NG Tube prep
Preparation and placement of Chest Tube including pleurevac and suction
We will be posting a critical actions check list/ grade sheet that one of our docs made up after proctoring a few scenarios. What would you add?
Extended period sedation / analgesia and antibiotics. – choices, doses, risks benefits, administration – infusions vs push doses etc.
Repositioning of fractures and their splinting
Positioning of casualty preventing Ulcus
Basic nursing depending on Environment/Equipment