Page 59 - JSOM Summer 2023

posed to both deployed medical personnel and their patients. ventilation management. CPG deconstruction revealed that
Rapid translation of CPG guidance was required due to a de- ventilator selection and use were not well-defined based on
manding medical management operational tempo within the availability and environment of care. Therefore, training mate-
US Central Command region, combined with an expanding rials addressing these factors on ventilator selection guidance
COVID-19 pandemic threat worldwide. Since the deconstruc- were produced.
tion tool highlighted a capability gap in knowledge and aware-
ness among individual pieces of guidance to manage and treat Figure 2 shows how clinical guidance regarding ventilation
6
COVID-19, JTS used the outputs of the CPG’s deconstruction considerations was outlined in a clinical pocket guide. The
to create a targeted dissemination campaign to increase aware- pocket guidance was disseminated through the Deployed Med-
ness of the guidelines and support training requirements. icine web platform, which hosts a prominent learning service
designed to supplement the medical education and training of
The campaign involved executing an online social media cam- clinicians and deployed Servicemembers.
paign with widespread reach that included disseminating in-
fographics, decision support tools, and quick reference guides FIGURE 2 Contents of COVID-19 management in austere
in line with the most relevant deconstruction categories. In- environment pocket guide.
formation on JTS webpage activity was monitored before,
during, and after the campaign. Levels of campaign referrals
explaining COVID-19 webpage activity accounted for 74.6%
of activity during the first week of the campaign and 31.2%
over the full course of the nine-week campaign. Overall, the
campaign demonstrated the feasibility of proactive, social me-
dia-based outreach for disseminating CPG guidance.

Table 1 highlights the specific information captured for one
guidance item from the COVID-19 in Austere Operational En-
vironments CPG. In this example, deconstruction underscored
a potential gap between current training requirements and new
quarantine guidance for Servicemembers potentially exposed
to the disease. To address that gap, the IS and JTS teams de-
veloped a clinical decision tree (Figure 1), providing detailed
instructions for screening and initial COVID-19 actions. 5 Aside from the materials highlighted here, JTS has and can
filter deconstructed CPG guidance, prioritized across role and
The COVID-19 in Austere Operational Environments CPG scope of care, to help identify, apply, and deconflict guidance
also included comprehensive clinical guidance on airway and across multiple CPGs. Targeted strategies can help support
the development of education and training curricula, engage
FIGURE 1 COVID-19 in austere environments clinical workflow.
trauma care champions, provide evidence for material acquisi-
tion, increase coordination across delivery systems, and make
recommendations to improve performance-related data col-
lection. Cumulatively, these strategies serve as practical and
comprehensive methods for adoption in field settings.

Conclusion
The authors recommend using deconstruction as a standard
practice supporting the translation of CPGs into actionable
guidance provided to targeted groups of end-users to reduce
unwanted practice variation. Guidance should be tailored to
the clinician’s scope of practice and environment of care deliv-
ery. A “one-size-fits-all” approach may work in non-deployed
environments, but often does not for multidisciplinary medical
care provided across deployed combat environments and roles
of care. Out of necessity from a rapidly changing clinical envi-
ronment, the JTS CPG deconstruction process supports rapid
translation of CPGs into clear, actionable guidance according
to role of care and scope of practice. Furthermore, the devel-
opment of clinical summaries for the most clinically important
CPGs will continue to improve the translation of guidance rec-
ommendations into condensed, usable, and actionable formats
to ease clinical application and adaptation across the MHS.
The resulting standardized CPG deconstruction process can be
replicated to support future CPG campaigns.

JTS is a continuous learning organization and welcomes CPG
recommendations from any DoD Servicemember for either

COVID-19 in Austere Operational Environments | 57