Page 3 - 2026 SMOG

Introduction

The FY 2026 SMOG will combine the STANDARD MEDICAL OPERATING GUIDE-
LINES & SUPPLEMENTAL HANDBOOK into one document. All changes are a result
of collaboration between Emergency Medicine professionals, experienced Flight Paramedics,
Aeromedical Physician Assistants, Critical Care Nurses, Flight Surgeons across the Department
of War (DOW), and feedback from the units. There is close coordination in the development of
these protocols with the Joint Trauma System and the Defense Committees on Trauma, ensuring
that the protocols being placed in the SMOG correspond to our other resources (i.e., CPGs). Our
shared goal is to ensure the highest quality en route care possible and to standardize care across
all evacuation/emergency medical pre-hospital units.

The SMOG is intended for CCFPs and pre-hospital professionals who manage emergencies
and treat patients in garrison, humanitarian, and combat theater environments IAW the current
H60 Aircrew Training Manual (ATM) Task 2120 and Appendix F. Unit Medical Directors are
expected to adjust these protocols to fit their unit’s mission and medical air crews’ training/
experience. Medical Directors or designated supervising physicians will endorse the SMOG
upon appropriate adjustments based on the individual unit’s mission. They will also manage
individual unit medical missions within the Critical Care Flight Paramedics, Enroute Critical
Care Nurses, and advanced practice aeromedical providers’ scope of practice. CCFPs should
administer medications as listed in these protocols unless their Medical Director and/or su-
pervising physician orders a deviation. Other medications and protocols may be added to the
SMOG. The Medical Director for that unit will add those medications/protocols to the SMOG
prior to signing the approval page.

Any medical guideline/protocol that is out of date or has been found to cause further harm will
be updated or removed immediately. The Department of Aviation Medicine (DAM) serves as the
managing editor of the SMOG. It is responsible for content updates, managing the formal review
process, and identifying SMOG Charter members for annual review. Well-constructed feedback
from the units is imperative for future changes.

The SMOG provides medical procedural guidance and is complementary to other Department of
War and Department of the Army policies, regulations, and doctrinal guidance. Nothing herein
overrides or supersedes laws, rules, regulations, or policies of the United States, Department of
War, or Department of the Army.

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