Page 40 - 2022 Spring JSOM

FIGURE 2 Adult Rule of Nines FIGURE 3 Pediatric Rule of Nines say either the upper or lower part of the front torso, then it would
be half of 18%, or 9%.
■ Remember, the higher the percentage burned, the higher the chance
for hypothermia.
■ For children, the percentage of BSA is calculated differently due to
the distinctive proportion of major areas.

Logistics – Dr John Wightman, MSG Kaleb Twilligear
Background
Reducing the time to required medical or surgical interventions pre-
vents death in potentially survivable illness, injuries and wounds.
When evacuation times are extended, en route care (ERC) capability
must be adequately expanded to mitigate the delay. In January 2010,
the Joint Force Health Protection Joint Patient Movement Report
Link to Burn Wound Management in Prolonged Field Care, stated “the current success of the medical community is colored by the
13 January 2017 CPG 23 valiant ability to overcome deficiencies through ‘just-in-time work-
arounds’; many systemic shortfalls are resolved and become transpar-
■ If half of the front or rear area is burned, the area would be half ent to patient outcomes. However, future operations may not tolerate
of the area value. current deficiencies (see Table 20).” 24
■ For example, if half of the front upper/lower extremity is burned, it ■ Patient packaging is highly dependent upon the transportation or
would be half of 9%, or 4.5%. If half of the front torso is burned, evacuation platform that is available

TABLE 20 Logistics Interventions
Intervention Paradigm
Prepare Documentation • Minimum: TCCC Card - DA1380
• Better: Prolonged Field Care Casualty Work Sheet
• Best: PCC Card with TCCC Card and any additional information, reference DA Form 4700 (SMOG 2021) for transport
documentation standard.
Prepare Report • Report should give highlights, expected course, and possible complications during transport.
• The hand-off is the most dangerous time for the patient; it is as important as treatments or medications.
• If it is rushed, things can easily be missed.
• Make sure you highlight non-obvious interventions and aspects of care (drugs given, repeat doses, etc.).
• Minimum: Verbal report describing the patient from head to toe with interventions or a SOAP note.
• Better: MIST (Mechanism, Interventions, Symptoms, Treatments)
• Best: MIST with appropriate SBAR (Situation, Background, Assessment, Recommendations) and pertinent labs and other
diagnostic information
Prepare Medications • Minimum: Prepare medication list with doses and time of next dose.
• Better: Above with additionally preparing next dose of medication for transport crew appropriately labeled.
• Best: Above with fresh IV fluids if indicated and fresh bags of drip medications with appropriate labeling and 72 hr of
antibiotic for extended transports.
Hypothermia Management • Minimum: Blankets
• Better: Sleep system and blankets.
• Best: HPMK with Ready Heat or Absorbent Patient Litter System (APLS).
• If possible, identify with tape the location of interventions or access points on top of
• hypothermia management to allow transport teams quick identification of location.
Flight Stressor/Altitude • Minimum: Ear Protection and Eye Protection, if nothing available sunglasses and gauze may be used, if patient is sedated and
Management intubated eyes can be taped shut.
• Better: Ear Pro and Eye Pro and blankets in all bony areas, Ear Protection and Eye Protection – foam ear plugs or actual
hearing protection inserts, goggles.
• Best: Above with gastric tube (NG/OG) or chest tube for decompression, if indicated. Depending on altitude/platform, consider
bleeding air of out bags of fluid.
Secure Interventions • Minimum: Tape:
and Equipment o Securely tape all interventions to include IVs, IOs, airway interventions, gastric tubes and TQs).
o Oxygen tanks should be placed between the patients’ legs and the monitor should be secured on the oxygen cylinder to prevent
injury to the patient.
o Pumps should be secured to the litter.
• Better: Additional litter straps to secure equipment and extend the litter with back support as indicated for vented patients to
prevent VAP
• Best: Above. Use the Special Medical Emergency Evacuation Device (SMEED) to keep the monitor and other transport
equipment off patient.
Prepare Dressings • AE and Other MEDEVAC assets do not routinely change dressings during transport; therefore, ensure all dressings are changed,
labeled, and secured before patient pick up.
• Minimum: Secure and reinforce dressings with tape, date, and time all dressings.
• Better: Change dressings within 24 hr of departure, secure as above.
• Best: Change and reinforce dressings within 4 hr of departure. Ensure additional Class VIII is available for any unforeseen
issues in flight.
CAUTION: Circumferential/constricting dressings MUST be limited/monitored due to swelling during prolonged aerial transport.
Secure the Patient • Minimum: Litter with minimum of 2 litter straps.
• Better: Litter with padding (example: AE pad or Sleep Mat) with minimum of 3 litter straps.
• Best: Litter with padding and flight approved litter headrest with minimum of 3 litter straps.
• Additional litter straps can be used to secure patient or equipment.
Moving a Critical Care • Minimum: Two-person litter carry to CASEVAC/MEDEVAC platform.
Patient • Better: Three-person litter carry to CASEVAC/MEDEVAC platform.
• Best: Four-person litter carry to CASEVAC/MEDEVAC platform.
*Link to Interfacility Transport of Patients between Theater Medical Treatment Facilities, 24 Apr 2018 CPG

38 | JSOM Volume 22, Edition 1 / Sping 2022