Page 131 - JSOM Spring 2018

Introduction to the Prolonged Field Care
Documentation Clinical Practice Guideline

Paul Loos, 18D, USA

he goal of this Clinical Practice Guideline (CPG) is to in- care. The format presented in this CPG has been tested and
Ttroduce a standardized patient record that is used to help validated by both medics and Role 1 providers as well as by
the independent prehospital provider guide medical treat- hospital-based consultants, and it incorporates documentation
ments and communicate vital patient data, interventions, and best practices. It is imperative that the documentation form is
observations to the next levels of care. Patient documentation trained and practiced before an actual patient care situation.
is a valid and essential aspect of excellent patient care. Ad-
ditionally, the need for accurate and robust documentation Do not assume that the next level of care will just throw away
while caring for a patient over an extended period of time has the documentation, making your efforts futile. However, it is
been proved through exercises, scenarios, and incidents. Use true that casualty cards and documents may be lost during
of a validated documentation flowsheet has proved to be one patient transfer and resuscitation. Whenever possible, hand-
of the easiest and most effective ways to increase the level of written records should be scanned or photographed securely
care provided in prolonged care situations. Despite this, many before turning the record and casualty over to the next level of
Medics place themselves and their patients at a disadvantage care. Ongoing efforts to facilitate point of care documentation
by attempting to improvise documentation using cardboard, using handheld electronic devices are also under way and may
multiple strips of tape, or even writing on the wall or the pa- be explored when available.
tient while in a crisis situation in order to document important
information over long periods of time. All team members should be educated on the use of the docu-
mentation flowsheet before deployment or training scenario.
While these improvised techniques may be sufficient for mini- Once demonstrated and explained, both medical and nonmed-
mal interventions or over short periods of time, this practice ical team members can improve their understanding of the pa-
can be dangerous and deleterious during management of tient’s condition, and even nonmedical personnel can become
critically injured patients. Such treatment situations, involv- an asset in care as opposed to a hindrance or liability. Both
ing multiple drugs and interventions being completed and medics and those who are not medics will be able to anticipate
not adequately annotated over multiple legs of an evacuation interventions required in the near future. This will enable a
chain, can absolutely put the patient at risk and increase both proactive approach to planning the procedures and care the
morbidity and mortality. In contrast, any medic can instantly patient receives as opposed to constantly reacting to patient
improve the standard of care they provide through the use of crises, possibly when it is too late. We owe it to our patients
an organized and efficient flowsheet. to provide the best possible care despite unfavorable circum-
stances—proper documentation is a simple way to improve
The prolonged field care (PFC) documentation tool, modeled patient outcomes.
after best practices in current intensive care units and incorpo-
rating accepted field documentation solutions, was designed Paul Loos, 18D, USA
to capture critical information as well as to provide lists of Special Forces Medical Sergeant
critical actions and scripts needed for accurate communica- Surgery, Anesthesia, Records and Reports
tion. Through many hours of consulting, editing, revising, Joint Special Operations Medical Training Center
and, most importantly, field testing, the PFC Working Group Special Warfare Medical Group
has agreed on certain attributes that a single patient care Fort Bragg, North Carolina
document should contain for the purpose of prolonged field

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