Page 30 - JSOM Fall 2024

shelter, warmth, hydration, calories, and, if needed, analgesia be estimated. Pill packs (non-steroidal anti- inflammatory, ac-
and medical treatments for secondary survey findings such as etaminophen, broad-spectrum oral antibiotic) for space and
wounds or fractures. Similar threats are seen with humanitar- weight are force multipliers to manage pain and reduce wound
ian events such as hurricanes and earthquakes, where response infection and sepsis.
is delayed by destroyed infrastructure and basic needs such as
shelter, food, and clean water are in short supply. Realistic Expectations and
Managing Psychological Impact on Responders
MASCAL response includes rescue (live patients) and recov- In training medical responders for MASCAL response, it is es-
ery (deceased). Any MASCAL plan that does not plan for the sential to prepare them for the psychological impact, which
deceased is unrealistic. Planning for this also emotionally pre- can take many forms. Medical responders may be impacted
pares the responders and can be considered a form of stress by taking care of devastating injuries in children the same age
inoculation or resiliency preparation. There are generally not as their own. Some medical responders may be young and
enough body bags available during a MASCAL, and once the inexperienced, and we have seen many instances of adverse
supply is exhausted, we recommend using space blankets and psychological impact on medical responders who were inap-
duct tape to cover bodies, including mutilated remains, for dig- propriately told by an MTF provider that they did a poor job
nity and to protect survivors and responders. managing a patient. These are not events where perfect medi-
cine is possible, especially among military medical responders
MASCAL Kits who are often not full-time medical providers. Triage is also
Teams on foot patrol rarely have reason to carry a MASCAL inaccurate, and the scenes are often difficult to imagine and
kit, relying primarily on individual first aid kits or medical re- prepare for. One of the main drivers of posttraumatic stress
sponder aid bags. However, a basic MASCAL kit can be built disorder (PTSD) in the pararescue career field is the recovery
in a weatherproof duffle bag stored in a team vehicle or house of human remains, reinforcing the need to prepare medical re-
(and duplicated if able to be redundant and stored in two dif- sponders for large numbers of deceased and potentially muti-
ferent places in case one gets destroyed). Items to consider for lated remains. 14
primary and secondary survey treatments are as follows, with
quantities arbitrarily tailored to the expected magnitude of the Conclusion
event. The key is to have some extra LSI gear and then focus
on wound care supplies. Many of these items have multiple Existing triage systems are complicated, inaccurate, and infre-
uses (included in parentheses): quently used in real-world MASCALs. A simplified pathway
to remember and execute MASCAL response in chaotic and
• Gloves dangerous environments should be considered and should use
• Tourniquets common terminology already in use. Focusing on the man-
• Hemostatic gauze agement of the MASCAL, not the individual casualties, may
• Nasopharyngeal airways improve responder safety and patient flow. Move, Treat, and
• Surgical airway kits Transport is an approach used organically and intuitively by
• Fresh whole blood collection kits Special Operations medical responders, which can be codi-
• Compressed gauze, cut as needed to maximize use (dress fied into a system and used to train medical and other first
wounds, wound packing) responders.
• Triangular bandages (inexpensive, small cube, and light-
weight compared with formal bandages; can be used to Author Contributions
secure gauze with or without pressure, sling, swathe, cover SR and RK conceived the paper concept. SR wrote the first
large soft tissue defects, scalp dressings, secure SAM splints, draft, and all authors read, edited, and approved the final
pelvic binder, buddy splint legs) and other dressing materi- manuscript. The medical responders had the final say on Fig-
als as preferred ure 1 and the final recommendations.
• Combat pill packs (meloxicam, acetaminophen, moxifloxacin)
• SAM splints or equivalent (fracture immobilization, impro- Disclosures
vised cervical collar) The authors have indicated they have no financial relation-
• Duct tape (close large wounds, secure bandages, secure ships relevant to this article to disclose.
space blankets to cover deceased, secure eye shields)
• Mylar or other space blankets (hypothermia prevention, Disclaimer
covering large soft tissue defects, cover deceased) The views expressed in this article are those of the authors and
• Eye shields do not necessarily reflect the official policy or position of the
• Betadine bottle or swabs (wound cleansing, water purification) Department of the Navy, Department of Defense, or the United
• Water purification tablets or other plan for disinfecting States Government. We are or were military service members
water and employees of the U.S. government. This work was prepared
• Protein bars or powders, energy gels, etc. as part of our official duties. Title 17 U.S.C. 105 provides that
“Copyright protection under this title is not available for any
Organizations responding to ultra-MASCALs need access work of the United States Government.” Title 17 U.S.C. 101
to large quantities of potable water, blankets/sleeping bags, defines a United States Government work as a work prepared
densely caloric food (e.g., energy bars, gels, etc.), and potentially by a military service member or employee of the United States
tents or tarps. It is the same approach as above for medica- Government as part of that person’s official duties.
tions, with less emphasis on intravenous drugs and a prefer-
ence toward easily administered oral antibiotics and analgesics. Funding
Quantities need to be scaled, and worst-case scenarios should No funding was provided for this work.

28 | JSOM Volume 24, Edition 3 / Fall 2024