Page 58 - JSOM Summer 2023

Clinical Guidance Categories TCCC Capability:
To streamline clinical information, the team first organized • TCCC Tier 1—All Servicemembers
individual clinical guidance components across 15 categories • TCCC Tier 2—Combat Lifesaver
according to role and environment of care. Each was aligned • TCCC Tier 3—Medics/Corpsmen
to existing training elements, supporting implementation in a • TCCC Tier 4—Paramedics/Providers
manner that was already familiar to medical personnel. These
categories include the following: The Deconstruction Tool
Each CPG was deconstructed in a Microsoft Excel spreadsheet
1. Provide General, Command, & Force Protection using the following categories:
Considerations
2. Conduct Triage 1. Subject Area: Aligns all itemized guidance outlined within
3. Control Hemorrhage/Coagulation the CPG to sub-component subject area.
4. Maintain Airway 2. Clinical Objective: Determines the clinical objective for
5. Manage Ventilation each piece of guidance. For example, “to stop bleeding near
6. Manage Hemodynamics & Fluids the point of injury.”
7. Perform Resuscitation 3. Guidance For or Against: Determines if guidance was in
8. Administer Medications favor of or against an intervention or clinical action.
9. Perform Diagnostics 4. Role of Care and Scope of Practice: Uses drop-down menus
10. Provide Nursing Care to identify the relevant role of care and the target audience
11. Prevent & Control Infection for which the itemized guidance pertains.
12. Plan & Conduct Evacuation 5. KSAs: Identifies corresponding training that relates to that
13. Document Care individual piece of guidance.
14. Manage Equipment 6. CPG Cross Reference: Identifies corresponding CPGs,
15. Manage Supplies which outline similar guidance from a pull-down menu.
7. Capability Gaps: Identifies potential capability gaps that
Targeting Guidance likely require support for itemized guidance implementation.
Clinical decisions and interventions often vary according to
clinician training and where care is provided. Therefore, item- Using the Deconstruction Tool to Support CPG Adoption
ized clinical guidance components were prioritized as either Once a CPG is deconstructed, the Microsoft Excel filter tool
High, Medium, or Low, according to their relevance across can be used for various objectives, including but not limited to
roles of care and scopes of practice, based on input from a • Determining whether itemized clinical guidance compo-
multidisciplinary set of SMEs. nents aligned to clinical objective(s) are recommended (im-
plemented) versus not recommended (de-implemented).
Role of Care: 4 • Sorting itemized guidance according to trauma care loca-
• First Responder Care (Role 1): Initial unit-level medical tion(s) and trauma care audience.
care including self-aid, buddy aid, combat lifesaver, and/or • Supporting implementation planning efforts by identifying
medic care focused on immediate lifesaving measures, dis- potential knowledge gaps as well as potential resources
ease and nonbattle injury treatment, conditions not directly (e.g., education and training, implementation guides) to
attributed to enemy action, combat and operational stress support learning and adoption. Specifically, if clinical guid-
prevention, and casualty location/collection. Emphasis is ance components do not align to existing trainings, JTS can
either return to duty or stabilization for next role of care develop resources to address that need or determine that
evacuation. KSAs should be modified.
• Forward Resuscitative Care (Role 2): Advanced trauma
management and emergency medical treatment with lim- SMEs can also use the deconstruction process to
ited hold capability, including continued resuscitation • Define KSA requirements to guide trauma curriculum de-
from Role 1. Greater resuscitative capability than Role 1, velopment by identifying clinical skills required to know
including damage control surgery. Additional necessary and understand the specific role of care and scope of prac-
emergency measures may be provided. Resuscitative surgi- tice. Note, KSAs were still in development as this tool was
cal support with postsurgical evacuation to Role 3 prior to developed, and this capability has not yet been executed.
evacuation to Role 4. • Link CPGs with KSAs, enabling providers to perform med-
• Theater Hospitalization (Role 3): Military Treatment Fa- ical care by skill level.
cility (MTF) care within a facility staffed and equipped to • Prioritize CPG recommendations for individuals and teams.
provide care to all patient categories including resuscita- • Inform readiness models for trauma providers across the
tion, initial wound surgery, postoperative treatment, and Military Health System (MHS).
supporting Role 2 interventions. Patients unable to tolerate • Provide a proposed structure for new CPG development
and survive long-distance movement receive surgical care and CPG updates.
in a hospital as close to the supported unit as the tactical
situation allows. This role includes patient evacuation from Application of Deconstructed COVID-19 Guidance
supported units and care for all patient categories including
units without organic medical assets. JTS and DHA’s IS team applied the CPG deconstruction tool
• En Route Care: The continued provision of care during pa- to CPGs that were rapidly developed and published during the
tient movement between the roles of medical care; en route COVID-19 pandemic. In May 2020, JTS released the CPG en-
care is delivered by qualified medical personnel to optimize titled Management of COVID-19 in Austere Operational En-
positive patient outcomes. vironments to mitigate infectious disease and operational risks

56 | JSOM Volume 23, Edition 2 / Summer 2023