We have been training teams in various settings over many years and have noticed that there are two categories of care that emerge during prolonged care: Those that react to stimuli and chase their tails and those that have a plan and follow it. Of course this happens on a spectrum but it is usually very obvious who is controlling the scenario vs those whom the scenario is controlling. Documentation has proven to be one of the easiest ways to quickly improve the performance of a medic or team providing care for long periods of time. (No. There is no study. Someone with time and money should do one.) Trending vital signs, creating a problem list and care plan, implementing a nursing care plan with standing orders and most notable, the keeping track of medications are all made much easier through a few extra minutes worth of documentation. The original intent for this card was to have a single form which a medic could stash in any aid bag to fill the gap between the DD1380 TCCC Card and all the other robust documentation available for the planned care of critically ill patients.
-The newest version of prolonged Field care documentation evolved after realizing that we had no way to track and communicate ventilator settings. Even SAVE2 settings are important enough and have enough variability that they should be monitored and documented, either for yourself later on, for other members of the team or for telemedicine and future handoffs. We also have no way to record lab values in the case that we have a plan to take an iStat, EPOC or just send a couple tubes to a local national facility. If you took the time a to make a plan for a vent, you should try to get labs at some point to help guide your care. We tried to keep generally acceptable lab values but if you want something different please feel free to customize and edit them. We are also very receptive to ideas and edits for future versions.
The need for ventilatory support in PFC is becoming more apparent in the importance of ventilation through the data collection and research performed by the JTS on the hundreds of PFC cases identified in the DoD Trauma registry which COL Shackleford presented at SOMSA last month. If you don’t have access to a even a SAVE2 from your higher HQ in the Tribalco CASEVAC set we hope that these numbers will help justify the acquisition of additional vent and lab capability. We are also hard at work on a Ventilation and Oxygenation CPG along with a PFC Airway CPG.
-Other issues with the last PFC card was that there was not enough fidelity in the 90-100 range where many vital signs seem to hover. It got confusing and many over lapped. I stretched that section out so that any changes in SpO2, temp, HR or Systolic would appear more drastic and obvious.
-I also took the problem list and expanded the number of lines leaving room to write noets above and below the Lund and Browser burn diagram guy. This will truly allow you to write in the Iatrogenic problems like tourniquets, pressure dressings, IVs and IOs, Foley’s and other interventions that can become problems later.
-Apparently the small telemedicine script was confusing and inadequate compared to the real script below, so I took that out but left a prompt in the notes section for recommendations and red flags from a telemedicine consult.
-Since some people will want to tweak it, I left the Excel file along with the pdf.