After extensive cooperation and collaboration with operational medics and Docs at home and abroad, we continue to see that there is a clear desire to improve patient care by incorporating or improving
Prolonged Field Care. The following should be viewed like a checklist to help jump start any tactical medical program to accommodate prolonged field care situations. Most of these concepts are discussed in separate posts and papers but are compiled here specifically to address questions on how to start from scratch. Special equipment acquisition should only be considered after identifying gaps in training, planning and practice. While there are still some gaps which we are working to fill, I hope some of this helps.
- 1. Change the way you think about evacuation times to expect that the patient will be with a single medic for 24-72 hours. This means that every training scenario or lane should have some prolonged field care issues addressed.
- 2. Read the clinical practice guidelines, position papers and other recommendations made over the past 2 years.
- 3. Master the basics that are TCCC/TECC because everything done (or not done) in the first hour has consequences later.
- 4. Make planning a top priority i.e. evacuation leg times, capability gaps and asset locations.
- 5. Identify gaps in capabilities, skills and equipment via the 10 Capabilities Paper and Grid.
- 6. Review and train Pharmacology practices and principals including sedation and regional nerve blocks if trained.
- 7. Prepare checklists and cheat sheets to help relieve the medic of superfluous technical and medical information that they don’t use on a daily basis.
- 8. Trending and documentation and trending because the scraps of cardboard medics are still using is not good enough.
- 9. Insist on Telemedicine and Communication by using a pre-made script and practice.
- 10. Procedures and wound care principles that are taught but not routinely practiced. These will differ depending on the level the medic is trained. If something is taught, it should be refreshed and sustained. Fresh Whole Blood transfusions,
- 11. Practice Nursing care basics such as Foley care, turning, ROM exercises, oral care and so on. These should be refreshed by the medic prior to any scenario or deployment. This can be done during non-trauma training days
- 12. Train your non-medics to assist your medics with nursing care tasks, trending, supply recognition etc.
- 13. Rehearse, practice and re-run through realistic full length scenarios with the entire team present, including leadership and non-medically trained personnel.
- 14. Be familiar with differences in physiology and the environments of Enroute Care including fixed wing, rotary wing and vehicle platforms. Have packing lists for each possibility.
- 15. Scenarios can’t end until the patient handover is complete so that nothing you did is missed by the receiving facility or medic.
- 16. Know what “Right” looks like by emphasizing critical care and ICU for medics going on hospital rotations. MPT hospital rotations can be tweaked to incorporate more work in the ICU so that the medic learns what first world care looks like.
17. Know your equipment. If you pack it in..be able to not only use the gear ( vents, monitors, foleys, etc.) but troubleshoot it as well. Are the batteries interchangeable? Can I still make it work if I accidentally brought the wrong tubing/connectors? Can I calculate a drip rate regardless of it being a macro/ micro set
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