In our work within the domain of Special Operations medicine, situational awareness, precise coordination and effective decision-making are key factors for success. Whether it is in the high-stakes realm of aviation or the critical environment of the operating room, the implementation of time-outs has proven to be a valuable practice. These time-outs provide a structured approach for teams to pause, reassess, and align their actions, ensuring that everyone involved is fully informed and prepared for the tasks at hand. The Tactical Time-out Format brings this concept to the SOF-medical setting…
In the world of aviation, where split-second decisions and precise execution are vitally important, time-outs serve as essential protocols to enhance situational awareness and operational clarity. Before taking off, pilots engage in extensive checks and briefings to disseminate crucial information. These “time-outs” ensure that all personnel involved have synchronized their understanding and the entire team operates with a unified vision which enhances flight safety and operational efficiency.
Similarly, in the field of medicine, time-outs are used before surgical procedures to minimize the risk of errors and optimize patient outcomes. In the operating room, the entire medical team assembles to conduct a thorough assessment and validate critical information. This includes verifying the patient’s identity, the surgical site, necessary equipment, and the procedure to be performed. By pausing to perform this standardized time-out procedure, the team fosters effective communication, synchronizes efforts, and mitigates the potential for mistakes or complications during surgical operations. The time-out serves as a collective moment to confirm critical details, address any concerns, and ensure that all team members are aligned and prepared for the upcoming procedure.
The advantages of implementing time-outs in the various contexts of SOF-medicine are significant. First and foremost, they promote standardized organization, ensuring that critical steps are consistently followed, and crucial information is communicated. This standardization minimizes the potential for misunderstandings or overlooked details, leading to improved overall performance. By providing dedicated opportunities for information sharing and clarification, they promote a shared understanding and collaboration among team members. A “Tactical Time-out” ensures that everyone involved is on the same page, fully aware of the situation, and prepared for the tasks ahead. The Ground Force Commander or Team Sergeant can use the “time-out format” to create order in the goas of a Prolonged Field care situation, a Casualty collection point, a small scale SOF-clinic and even in a mass casualty situation.
The Tactical Time-out Format provides a systematic and comprehensive approach to ensure effective coordination and decision-making. This format consists of five main elements of the SOCS-P Mneumonic below:
Security/Tactical Considerations: Security is paramount to any small element. Casualty care will not matter if the team is compromised, captured, or destroyed. In this section, teams assess and address tactical considerations to maintain situational awareness and adapt plans accordingly. This may include procedures in and around the occupied site, movement considerations, and the posting of guards.
Operational Considerations: The goal of prolonged field care is to evacuate the patient to the appropriate facility with the proper staff and resources to care for the injuries of the patient. That being said, the goal of an operational element is the operation first. Compromises in patient care may be dictated by the situation and priorities of the mission and overall operation going on around the isolated team. The entire team should be updated on the bigger picture outside of the immediate tactical situation and patient care. This up-and-out update should focus on the status of patient evacuation, movements of adjacent units and changes in the priorities of the Commander.
Contingency Planning: Contingency planning helps teams prepare for potential challenges and unexpected situations applicable to the environment and situation. If a team is operating in an uncertain environment where security concerns are prevalent, plans for blow-out and compromise should be quickly disseminated as they change. Other contingencies should also have associated plans such as additional casualties including a local mass casualty plan.
Shift change/Admin: Effective team admin is vital for sustained effectiveness and optimal performance. By clarifying the new roles and responsibilities of each of the team members prior to the patient updates, you ensure that personnel are focused and paying attention to the information most applicable to their new position. If there are three patients and “John” is going to be in charge of the medical care of Patient 1, he can be aware of the other two patients but doesn’t need to overburden himself on extraneous details of those other patients being cared for by other team members.
Patients: This is an abbreviated version of the traditional patient round encountered in most hospitals. Utilizing a known patient handover format such as SIT-VD mnemonic facilitates the rapid dissemination of the most important information not immediately apparent by looking at a patient. The person who was most recently caring for a particular patient should be the one to brief the rest of the group by answering the following questions: Is the patient Use the SIT-VD mnemonic for the abbreviated patient rounds along with the nursing care plan:
Stable or unstable?
What at the Injuries of that patient?
What Treatments have been completed and which are still planned?
What are the current Vital signs and how are they trending?
What Drugs or fluids have been given?