Page 89 - Journal of Special Operations Medicine - Spring 2015

A Study of Prehospital Medical Documentation by
Military Medical Providers During Precombat Training

Adam B. McGarry, DSc, PA-C; Jeffrey C. Mott, DHSc, PA-C;
Russ S. Kotwal, MD, MPH

ABSTRACT

Documentation of medical care provided is paramount During the period between January 2002 and July 2009,
for improving performance and ultimately reducing there were recorded prehospital data for 18.6% of US mili­
morbidity and mortality. However, documentation of tary combat casualties in Afghanistan and 25.4% in Iraq.
2
prehospital trauma care on the battlefield has histori­ Subsequently, prehospital medical documentation for
cally been suboptimal. Modernization of prehospital combat casualties in Afghanistan in 2012 declined to only
documentation tools have aligned data and information 14.7% (R.S. Kotwal, personal communication, February
to be gathered with up­to­date treatment being rendered 2013). Notable is the significant difference in prehospital
through Tactical Combat Casualty Care (TCCC) proto­ medical documentation achieved by one military unit, the
cols and practices. Our study was conducted to evaluate 75th Ranger Regiment, which achieved an average overall
TCCC Card completion, and accuracy of card comple­ documentation rate of 74% from 2001 to 2010 and has
3
tion, by military medical providers conducting precom­ a current documentation rate of nearly 100% (E.A. Miles,
bat training through the Tactical Combat Medical Care personal communication, March 2013).
Course. Study results do not show a deficiency in TCCC
documentation training as provided by this course which A lack of emergency medical services prehospital docu­
should translate to adequate ability to accurately docu­ mentation has been shown to be associated with poor
ment prehospital trauma care on the battlefield. Leader­ patient outcomes, including an increase in mortality. It
4
ship emphasis and community acceptance is required to is essential for emergency medical services directors and
increase compliance with prehospital documentation. community leaders to realize that patient outcomes can
be improved through documentation and subsequent
Keywords: combat, documentation, prehospital, trauma analysis of prehospital care rendered. Unit leader own­
ership, responsibility, and high­priority emphasis on
prehospital care, documentation of care, and analysis
of care with measures of performance improvement are
Background
factors that have been attributed to the notable compli­
Combat support hospitals and forward surgical teams ance with prehospital medical documentation achieved
have contributed immensely to revolutionary advances by the 75th Ranger Regiment.
in trauma care administered to casualties on the mod­
ern battlefield. Although combat casualties also receive In 1996, the Butler et al. article titled “Tactical Com­
benefit from current protocols in prehospital trauma bat Casualty Care in Special Operations” served as
5
care, there remains, unfortunately, a limited amount of the foundation for battlefield prehospital trauma care
documentation of this treatment. Prehospital medical guidelines known today as Tactical Combat Casu­
documentation is critical for refining and improving pre­ alty Care (TCCC). The goals of TCCC are threefold:
hospital treatment protocols, procedures, and training, (1) treat the casualty, (2) prevent additional casualties,
which can ultimately increase survival rates. The recent and (3) complete the mission. These goals were based
5
military medical advances made over more than a decade on a review of casualty data by the US Special Opera­
of war are highly attributed to the documentation and re­ tions Command, as prompted by the untoward casualty
sultant evidence of the safety and effectiveness of the care events that impacted Task Force Ranger during the Bat­
provided. Contrary to the documentation and evidence­ tle of Mogadishu in Somalia in October 1993. Shortly
1
based improvements in care realized by military hospi­ after they were published, the 75th Ranger Regiment
tals since the onset of the recent conflicts in Afghanistan adopted the tenets of TCCC; initiated an aggressive,
and Iraq, the same data on prehospital care safety and unit­wide Ranger First Responder training program;
effectiveness continue to be relatively sparse. 1–3 and developed a Ranger Casualty Card to facilitate the

79