Page 132 - JSOM Spring 2018

Documentation in Prolonged Field Care

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Paul Loos, 18D *; Erik Glassman, MS, NRP ; Dan Doerr, 18D (Ret) ;
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Roger Dail, 18D ; Jeremy Pamplin, MD , Douglas Powell, MD ;
Jamie Riesberg, MD ; Sean Keenan, MD ; Stacy Shackelford, MD 9
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his Role 1, prolonged field care (PFC) Clinical Practice – TCCC Card, DD1380
TGuideline (CPG) is intended to be used after Tactical Com- – PFC flowsheet
bat Casualty Care (TCCC) guidelines when evacuation to – Telemedicine guide
higher level of care is not immediately possible. A provider – Handoff report
of PFC must first and foremost be an expert in TCCC. This
CPG is meant to provide medical professionals who treat se- Finally, completion of the PFC after-action report (AAR) will
verely injured or sick patients in austere environments with contribute greatly to performance improvement to develop
recommendations for documentation that will allow them and training, tools, and techniques for improving the care of casu-
subsequent providers along the evacuation chain to optimally alties in austere environments.
manage complex, often unstable casualties. Recommenda-
tions follow a “minimum,” “better,” “best” format that pro- Patient Demographics
vides alternate methods when optimal hospital options are
unavailable. While some casualties will be unable to provide name, iden-
tification number, date of birth (DOB), or other identifying
information, every effort should be made to collect and docu-
Background
ment this information in order to facilitate the inclusion of
PFC frequently involves the care of complicated, critically in- prehospital documentation into the patient’s medical record.
jured or sick casualties who are normally managed in medical This information not only helps the longitudinal care of ca-
treatment facilities. For patients that survive the initial trauma sualties as they progress through the evacuation chain, it also
or sickness, the biggest risk of death is from circulatory shock provides the vital link to connect prehospital treatments de-
and its complications. All severely injured and sick patients livered to survival and long-term outcomes in order to guide
must be closely monitored for signs of shock and decompensa- recommendations for improving trauma care.
tion because the best treatment for shock is early recognition,
treatment of the cause, and resuscitation. One method used by Note: Medical treatment facilities use pseudonames assigned
intensive care units to monitor critical patients is trending vital when a patient’s real name is unknown. In such cases, ev-
signs, physical exams, and fluid outputs recorded on a flow- ery effort should be made to continue the same pseudoname
sheet that facilitates recognition of changes that could mark through transfers of care. Prehospital documentation submit-
the early signs of decompensation. ted after patient transfer, to include AARs, should use the same
name or pseudoname assigned at the first treating MTF.
In the PFC environment, one of the few techniques available
to the medical provider that is identical to those used in hos- Documentation of Prehospital Care
pitals is documentation of key clinical trends. It is critical that
Medics are trained on the interpretation of clinical trends. It ➤ o Goals: transmit important medical information to the next
is also essential that Medics cross-train nonmedical teammates level of care, permanently record information vital to ser-
to take and record vital signs, outputs, key exam findings, and vice members injured in combat, and contribute to perfor-
interventions to free the medic to do other tasks as well as to mance improvement in prehospital care.
sleep if care of the casualty is especially prolonged. ■ o Minimum: TCCC Card DD1380
o o The DD1380 is organized as a MIST (Mechanism,
Documentation that can help the medic and successive care- Injuries, Signs and Symptoms, Treatments) report
givers manage complicated patients includes: (Appendix A).

*Correspondence to paul.loos@socom.mil
1 SFC Loos, 18D, USA, is noncommissioned officer in charge of Special Forces Medical Sergeant Surgery, Anesthesia, Records and Reports at
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the Joint Special Operations Medical Training Center, Special Warfare Medical Group at Fort Bragg, NC. Glassman, MS, NRP, is a medic and
instructor with the Diplomatic Security Service Training Directorate’s Operational Medicine Unit. SFC (Ret) Doerr is the medical instructor
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supervisor for the Special Operations Combat Medic Trauma III course, Fort Bragg, NC. SSG Dail, 18D, USA, is the senior 18D at 4th Bat-
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talion 3rd Special Forces Group (Airborne) and plans and implements numerous PFC training events. LTC Pamplin, MC, USA, is the director
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of virtual critical care and virtual health at Madigan Army Medical Center, Joint Base Lewis-McChord, WA. MAJ Powell, MC, USA, is an
intensive care physician currently serving as the 4th Battalion 3rd Special Forces Group (Airborne) Surgeon and a staff intensivist at Womack
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Army Medical Center, Fort Bragg, NC. LTC Riesberg, MC, USA, is the 10th Special Forces Group (Airborne) Surgeon and is the coordinator
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for the Special Operations Medical Association Prolonged Field Care Working Group. COL Keenan, MC, USA, is Command Surgeon, Special
Operations Command, Europe. He has previously served as Battalion Surgeon in both 1st and 3rd SFG (Airborne), and as Group Surgeon, 10th
SFG (Airborne). He is a member of the Special Operations Medical Association Prolonged Field Care Working Group Steering Committee.
9 Col Shackelford, MC, USAF, is chief of performance improvement, Joint Trauma System, San Antonio, TX.
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