Building prioritized care plans has completely changed and revolutionized the way I think about medicine and treating casualties. Before this my thoughts were rather chaotic, attempting to “put out fires,” handling emergencies as they occurred. This is an unorganized and stressful way to handle a crisis.
A care plan for your critically ill or injured patient will be one of the most important things you can do to keep your sanity and share your plan with your team. It will allow you to systematically organize your thoughts by reviewing your patient’s injuries and interventions you find during your detailed head-to-toe exam once in a fixed facility such as a team house or aid station. I’ve talked about this before in the course of the documentation lecture, but I feel that it is important enough to reiterate it here with it’s own post.
Don’t disregard the TCCC Card (DD Form 1380), especially if you weren’t the one who started it at the point of injury. Be sure to investigate each injury annotated on the card and each intervention, such as tourniquets or needle decompression, that will require further attention. Once this is done and the head to toe exam is completed, move on to a more detailed flowsheet such as those offered below.
Use a systematic approach such as going head to toe and record each and every injury and intervention.
At this point you can now start writing down the most important treatments for each of the injuries, being sure to highlight things that must get done in a certain amount of time such as reducing a tourniquet to a pressure dressing.
On the last page of the 6-page flowsheet is another section that allows you to further prioritize your planned treatments in order into a checklist.
This is done the same as before but can also serve as a second iteration once the primary interventions have been completed.
Unlike before, this sheet allows you to reorganize your treatments by order of importance. Once all of your planned treatments are transferred over to the checklist by priority, you simply start working your way down the list unless another emergency arises. Multiple copies of this sheet can be printed out allowing you to update your team with your evolving priorities every few hours or as you see fit.
Download this presentation as a slide show below in order to help explain the concept to your team in training:
The single page PFC casualty card allows for the first iteration of a care plan on the front side while allowing trending of vital signs on the back side: