Page 36 - ATP-P 11th Ed

MASCAL Decision Points
1. Determine if a PCC MASCAL is occurring – do the requirements for care exceed
SECTION 1 capabilities?
a. What is the threat? Has it been neutralized or contained? If not, security takes priority.
b. What is the total casualty estimate?
c. Are there resource limitations that will affect survival?
d. Can medical personnel arrive at the casualty location, or can the casualty move to
them?
e. Is evacuation possible?
f. Communicate the situation to all available personnel conducting or enabling PCC.
g. Assess requirements for which class of triage you are facing (see Appendix C) and
scale medical action to maximize lethality then survivability.
h. Remain agile and be ready to move based on the mission.
2. Determine if conditions require significant changes in the commonly understood and
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accepted standards of care (Crisis Standards of Care) or if personnel who are not or-
dinarily qualified for a particular medical skill will need to deliver care. MASCAL in
PCC requires both medical and non-medical responders initially save lives and preserve
survivable casualties. Both groups will need skills traditionally outside existing para-
digms, such as non-medical personnel taking and record vital signs or Tier 3 TCCC
medical personnel maintaining vent settings on a stable patient. The MASCAL standard
of care will be driven by the volume of casualties, resources, and risk or mortality/mor-
bidity due to degree of injury/illness; as such, remain agile throughout the MASCAL
and trend in both directions based upon resources available.
3. MASCAL management is often intuitive and reactive (due to lack of full mission train-
ing opportunities) and should rely on familiar terminology and principles. Treatment
and casualty movement should be rehearsed to create automatic responses.
4. The tactical and strategic operational context will underpin every facet of MASCAL
in a PCC environment, operational commanders MUST be involved in every stage of
MASCAL response (The mere fact that a medical professional or team of medical pro-
fessionals is forced to hold a casualty longer than doctrinal planning timelines means
there is a failure in the operational/logistical evacuation chain. Battle lines, ground-to-
air threat, etc. levels may have shifted.)
5. Logistical resupply may need to include non-standard means and involve personnel
and departments not typically associated with Class VIII in other situations (i.e., aerial
resupply, speedballs, caches, local national market procurement).
6. The most experienced person should establish MASCAL roles and responsibilities, as
appropriate.

26 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 27