Page 48 - 2022 Spring JSOM

Richmond Agitation Sedation Scale (RASS)
Score Term Description
+4 Combative Overtly combative, violent, immediate danger to staff.
+3 Very Agitated Pulls or removes tube(s) or catheter(s); aggressive.
+2 Agitated Frequent non-purposeful movement, fights ventilator.
+1 Restless Anxious but movements not aggressive vigorous.
0 Alert, Calm
–1 Drowsy Not fully alert, but has sustained awakening (eye-opening/eye contact) to voice
(>10 seconds).
Verbal Stimulation
–2 Light Sedation Briefly awakens with eye contact to voice (<10 seconds).
–3 Moderate Sedation Movement or eye opening to voice (but no eye contact).
–4 Deep Sedation No response to voice, but movement or eye opening to physical stimulation.
Physical Stimulation
–5 Unarousable No response to voice or physical stimulation.
Procedure for RASS Assessment
1. Observe patient: Patient is alert, restless, or agitated. Score 0 to +4
2. If not alert, state patient’s name and say to open eyes and look at speaker
• Patient awakens with sustained eye opening and eye contact. Score –1
• Patient awakens with eye opening and eye contact, but not sustained. Score –2
• Patient has any movement in response to voice but no eye contact. Score –3
3. When no response to verbal stimulation, physically stimulate patient by shaking shoulder and/or rubbing sternum.
• Patient has any movement to physical stimulation. Score –4
• Patient has no response to any stimulation. Score –5
*Sessler CN, Gosnell M. Grap MJ, Brophy GT, O’Neal PV, Keane KA et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care
patients. Am J Respir Crit Care Med 2002; 166:1338–1344.
*Ely EW, Truman B, Shintani A., Thomason JWW, Wheeler AP, Gordon S et al. Monitoring sedation status over time in ICU patients: the reliability and validity of
the Richmond Agitation Sedation Scale (RASS). JAMA 2003; 289:2983–2991.

Military Acute Concussion Evaluation 2 (MACE 2) Form, 2021 MHS Progressive Return to Activity
Open the attachment on the side menu or open the below link to print Following Acute Concussion/Mild TBI
or fill out electronically. Open the attachment on the side menu or open the below link to print
https://www.health.mil/Reference-Center/Publications/2020/07/30/ or fill out electronically.
Military-Acute-Concussion-Evaluation-MACE-2 https://jts.amedd.army.mil/assets/docs/cpgs/Progressive_Return
_to_Activity_Following_Acute_Concussion_mTBI_Clinical
_Recommendation_2021.pdf

APPENDIX F: LOGISTICS RESOURCES

Prolonged Field Care – Patient Packaging, 11 Aug 2021 Prepare Report
Patient packaging is highly dependent upon the Casualty Evacuation Report should give highlights, expected course, and possible compli-
(CASEVAC)/Medical Evacuation (MEDEVAC) platform that is oper- cations during transport. The hand-off is the most dangerous time
ationally available. If possible, rehearse patient packaging internally for the patient it is as important as treatments or medications. If it is
and with the external resources. Train with MEDEVAC assets under- rushed things can easily be missed.
stand transporting teams’ standard operating procedures in order to ■ Good: Verbal report describing the patient from head to toe with
best prepare the patient for transport. (Example some teams want to a SOAP note.
secure the patient and interventions themselves while others may be ■ Best: MIST (Mechanism, Interventions, Symptoms, Treatments)
okay with a fully wrapped patient). ■ Better: MIST with appropriate SBAR (Situation, Background, As-
sessment, Recommendations) and pertinent labs and other diag-
Ensure the patient is stable before initiating a critical patient trans- nostic information
fer. For POI/unstable patients ensure the appropriate transport team
(MEDEVAC with en route critical care nurse or advanced provider). Prepare Medications
■ Good: Prepare medication list with doses and time of next dose
Interfacility transfers should meet the following minimum: ■ Better: Above with additionally preparing next dose of medication
1. Hemorrhage control for transport crew appropriately labeled.
2. Resuscitation adequate (SBP 70–80mmHg, MAP >60, or UOP ■ Best: Above with fresh IV fluids if indicated and fresh bags of drip
>0.5mL/kg/hr) medications with appropriate labeling and 72 hr of antibiotic for
3. Initial post-op recovery as indicated extended transports.
4. Stabilization of fractures
Hypothermia Management
Prepare Documentation ■ Good: Blankets
■ Good: TCCC Card - DA1380 ■ Better: Sleep system and blankets
■ Better: Prolonged Field Care Casualty Work Sheet ■ Best: HPMK with Ready Heat or Absorbent Patient Litter System
■ Best: PFC Card with TCCC Card and any additional information, (APLS)
reference DA Form 4700 (SMOG 2021) for transport documen-
tation standard Flight Stressor/Altitude Management
*preference: secure to patient strip of 3in Tape with medications ad- ■ Good: Ear Protection and Eye Protection, if nothing available sun-
ministered attached to blanket or HPMK glasses and gauze may be used, if patient is sedated and intubated
eyes can be taped shut

46 | JSOM Volume 22, Edition 1 / Sping 2022