Page 91 - Journal of Special Operations Medicine - Fall 2015

Figure 1 A Special Forces team may use a large vehicle as Using this verbiage simplifies communication to unit
their base (or HOUSE) for command and control, as well as leadership about constraints and limitations, as well as
logistics re-supply, during long range patrolling operations. logistical needs. A medic can use the operational con-
text and stages to better visualize the equipment needs,
and communicate this to her team. For example, the
medic’s explanation would include the operational need
to support a HOUSE, four trucks, and possibly the ca-
pabilities to outfit an aircraft to some degree. While the
medic may carry hetastarch, or freeze-dried plasma, on
his person, mission considerations may demand more
definitive fluid therapy solutions at the TRUCK level,
such as fresh whole blood transfusion equipment. At the
HOUSE, she will have all the aforementioned options,
as well as a sufficient supply of lactated Ringer’s solu-
tion and normal saline to cope with other serious medi-
cal contingencies. Using this simple planning verbiage,
the medic can easily convey to unit leadership his equip-
ment requirements and how it should be distributed.

columns labeled with the expected PFC capabilities, Finally, one of the strategic advantages of having the com-
tailored to the applicable mission set. This allows for munity use this lexicon is homogenizing our research,
easier visualization and decision-making with respect to development, and procurement of equipment, and im-
capabilities and equipment available throughout stages proving our overall capabilities over the long term. Since
of the mission, with respect to casualty treatment and part of the emphasis on PFC is to effectively evaluate
transport. A partial example is given in Table 1. equipment to support capabilities, members of the SOF
community can better evaluate equipment in our numer-
There are several further advantages to considering ous sets, kits, and outfits, and objectively compare com-
this model. Most important, after identifying stages in mon equipment in the standardized operational phases.
this manner, it is easy to identify which capabilities and It will also quickly identify capability gaps and focus fu-
which specific equipment a medical provider will have ture research and development needs in the community.
at any point on a mission or during evacuation of a pa-
tient. This then helps the medic to visualize gaps and ar- To summarize, the application of a standardized, opera-
eas that lack important capabilities along the proposed tional-context naming convention system such as RTHP
evacuation chain. in the context of medical operational planning, and spe-
cifically in PFC, provides several immediate benefits:
Space is a planning constraint on almost all Special Op-
erations Forces (SOF) missions. From the moment a unit
loads out from their home station, decisions are made to 1. It provides a framework for planning mission sup-
prioritize the allocation of space in shipping containers, port and personal load out.
on vehicles, and on the person of the individual combat- 2. It provides a clear system to communicate limita-
ants. The RTHP framework can be useful by simplifying tions of medical patient care and holding capability
prioritization here, as well. with leadership.

Table 1 Example of a PFC Operational Planning Matrix (table is truncated due to space restriction)
Stage Monitor Resuscitate Ventilation/Oxygen Airway
Pulse oximeter,
RUCK NS/hetastarch BVM with PEEP SGA/cric
BP cuff, Stethoscope
BVM with PEEP/O
TRUCK Monitor EXAMPLE 2 SGA/cric with
NS/hetastarch/FWB kit
(2 bottles)
ketamine drip
HOUSE Monitor LR cases/hypertonic O concentrator RSI capability
saline/FWB
2
PLANE Monitor LR BVM with PEEP SGA/cric with
ketamine drip
Note: BP, blood pressure; BVM, bag-valve-mask; cric, cricothyrotomy; FWB, fresh whole blood; LR, lactated Ringer’s solution; O , oxygen;
2
PEEP, positive end-respiratory pressure; RSI, rapid-sequence intubation; SGA, supraglottic airway.

Operational Context for Prolonged Field Care 79