Page 26 - Journal of Special Operations Medicine - Summer 2014

ambulance entrance overhang, new cabinetry, and staff Table 1 Cont.
locker rooms. During this process, many of the medical 12-Lead electrocardiogram
supplies and equipment had been moved into a large
intermodal shipping con tainer behind the facility and Cardiopulmonary resuscitation
not replaced. A single full-time noncommissioned offi- Manual defibrillation/synchronized cardioversion
cer was responsible for not only the TMC but also all Transcutaneous pacing
medical operations and medical readiness concerns for Peripheral intravenous access
the whole installation—an impossible task. Exam room
cabinetry contained an illogical hodgepodge of various Central intravenous access
vintages of supplies dating back to the 1970s. Exam Intraosseous access
rooms did not even have wall-mounted oto/ophthal- Parenteral medications (nitroglycerin; aspirin; ACLS;
moscopes or blood pressure cuffs. The trauma bay was anaphylaxis; antiseizure, pain, and antinausea medications)
equipped with a 1980s-era vintage Burdick defibrillator Point-of-care blood glucose testing
and a broken 1970s Foregger laryngoscope handle with Pericardiocentesis
only several Miller blades that were missing their bulbs.
Two massive stainless steel cabinets consumed much of Bedside ultrasound (specifically FAST exam)
the space in the room. Pelvic exam (including management of incomplete abortion
with ring forceps)
We used the renowned 5S methodology (Sort, Set in Order, Precipitous vaginal delivery
Shine, Standardize, Sustain) to guide our transformation Foley catheterization
of the clinic. Our primary goal and outcome were to im- Naso/orogastric tube placement
5
prove overall clinic functionality and ensure the capability
to provide resuscitation for at least one critical trauma or Hypothermia/hyperthermia management
medical patient until a civilian MEDEVAC aircraft could (warm blankets, etc.)
arrive. The specific procedures we deemed necessary are Advanced epistaxis management (balloon catheters and
listed in Table 1, which should be noted to correspond posterior packing)
closely to the care provided by civilian paramedics. Basic extremity splinting (SAM splint, etc.)
Spinal immobilization (cervical collar and backboard)
An improved charting system was implemented with Pelvic stabilization (bedsheet or commercial binder)
medicine and trauma template overlays created for the
SF600 were used instead of the SOAP notes of variable Military antishock trousers (MAST)
quality done in the past for each patient. Exam room Femoral traction splinting
cabinetry was standardized and organized for efficient Laceration repair (sutures and staples)
care of the general medical patients who were seen. Basic laboratory studies (point-of-care urinalysis/
Blood pressure cuffs, electronic thermometers, and oto/ chemistry/cardiac enzymes/hematology)

Table 1 Necessary Capabilities at Nondeployed Arthrocentesis
Role 1 Facilities Lumbar puncture
®
Basic airway management (oral/nasal airway, suction) Basic dental stabilization (IRM/Fuji IX, Dycal ,
dental anesthesia)
Supraglottic airway placement
Basic ophthalmology (Fox eye shields, eye irrigation,
Endotracheal intubation (video and direct laryngoscopy) fluorescein exam)
Cricothyrotomy (needle and open technique) Chemical agent treatment (ATNAA and CANA injectors
Bag-valve-mask ventilation or equivalent)
Wave form (preferred) or colorimetric capnography for Note: Items in bold may be omitted for facilities with adequate EMS
tube placement coverage close to supporting MTF emergency departments.
Oxygen administration (nasal cannula and nonrebreather)
Nebulized medication delivery (albuterol, ipratropium) ophthalmoscope sets were mounted to the walls. Exam
room lights and Mayo procedure stands were added
Needle thoracostomy to each room. The large cabinets in the trauma bay
Tube thoracostomy were moved to the ward area and used for room re-
External hemorrhage control (including tourniquet supply stock, greatly freeing space in the trauma bay
placement) for the resuscitation team and equipment. A code cart
with modern ACLS defibrillator, Propaq 206EL patient
Cardiac rhythm monitoring
monitor with mainstream capnography and invasive
Pulse oximetry pressure capability (Welch Allyn, Skaneateles Falls, NY;

16 Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014