Page 233 - 2026 SMOG

POST-OPERATIVE AND CC INTERFACILITY TRANSFER
˚ Ensure the patient is properly packaged in a warming device unless contraindicated prior to
transfer. Follow directions specific to each warming device, ensuring overheating or thermal
burns do not occur. Hypothermia, acidosis, and coagulopathy constitute the “triad of death”
in trauma patients.
˚ Securely affix all equipment, supplies, loose tubing, and lines to the NATO litter prior to
moving the patient to the vehicle or aircraft.
˚ Once the patient is packaged, ensure all lines are leveled and monitors are zeroed.
˚ Provide eye and ear protection to the patient.
SPECIAL CONSIDERATIONS
• Eye Trauma: Fox shields should be placed for any patient with a suspected or confirmed open
globe, possible intraocular foreign body, or eye injury. DO NOT remove impaled or stubborn
foreign bodies from the eyes. (even contact lens) SHIELD AND SHIP. DO NOT PLACE
ANY DRESSINGS UNDER A RIGID EYE SHIELD or manipulate the injured eye. Also,
want to avoid nausea/vomiting in these patients. Normal Saline may be used to rinse eyes in
an awake patient with no penetrating injury. Shield ONLY THE injured eye. (JTS CPG—Eye
Trauma: Initial Care)
• Compartment Syndrome: Patients with extremity injuries, abdominal injuries/surgery, burns,
coagulopathy, and those who have received massive transfusion are at risk for compartment
syndrome. Ensure proper assessment prior to flight. If compartment syndrome is suspected
during flight, place the extremity at the level of the heart. Pain out of proportion to the
injury and paresthesia are symptoms of compartment syndrome, as well as pallor, paralysis,
pulselessness, and poikilothermia. Patients who are sedated, paralyzed, or have an epidural or
block in place are at increased risk and require judicious hands-on assessment of the at-risk
abdomen and extremities. (JTS CPG—Compartment Syndrome and Fasciotomy)
• Burns: For patients with partial and/or full-thickness burns to >20% TBSA, use of the Burn
Patient Admission Orders and JTS Burn Resuscitation Flow Sheet is REQUIRED and should
be continued during transfer to another facility. (JTS CPG–Burn)
• Advanced pain management modalities: For patients with epidurals, continuous peripheral
nerve blocks, PCA infusions, or other pain medicine infusions, a pain note should be completed
prior to transport, as it is a vital part of provider communication. (JTS CPG–Management of
Pain, Anxiety and Delirium in Injured Warfighters)
• Sedation and pain management must be maintained at appropriate levels throughout transport.
As appropriate and as directed by the transferring physician, attempt to maintain the sedation
target as follows using the Richmond Agitation Sedation Scale (RASS).
(continues)

2026 Standard Medical Operating Guidelines (SMOG) • 225