Page 14 - PJ MED OPS Handbook 8th Ed

2. Medical Command and Control (MC2)

HAF/A3S is the lead for the PJ Handbook, direction for C2, and scope of practice.

Care by PJs of injured or sick personnel in combat, other missions, training, civil SAR, or humanitar-
ian assistance (HA) operations is always under the auspices (command and control) of a licensed
medical provider. This is defined as Medical Control and should not be confused with Tactical Con-
trol or Operational Control. PJs providing care in these situations are acting under the license of the
delegating authority (licensed provider), where the provider allows the PJ to perform specified diag-
nostic and therapeutic interventions. All authorized care and interventions include those outlined
in the current edition PJ Medical Handbook (PJ HB), ATP book for selected protocols per the Flight
Surgeon and mission, ACLS, PALS, TCCC curriculum, or other designated sources. Care outside of this
material must be otherwise authorized by the flight surgeon or local medical authority.
All prior editions of the PJ HB are obsolete.
In practical terms, this means providing care IAW the guidance above without deviation. If there is a
needed deviation, the medical director is responsible for any directed deviation during on-line Med-
ical Control. If you provide care outside the scope of your practice during off-line Medical Control,
you are personally responsible for any adverse outcome and subject to other possible ramifications.
DO NOT PROVIDE CARE THAT DEVIATES FROM WHAT YOU ARE TRAINED AND ALLOWED TO DO.

WARNING The following list of procedures require specific task initial and annual refresher
training in order to perform. Training will be conducted and signed off by the unit flight
surgeon. A current 623a will be maintained in the PJ’s medical training records.
• The following require initial and refresher cadaver training before flight surgeon sign off:
– Leg Fasciotomy
– Escharotomy
– Lateral Canthotomy
• The following require initial and refresher training before flight surgeon sign off:
– Use of Blood Products
– Rapid Sequence Induction (RSI)
– Ventilator Use

On-line Medical Control: A physician is present at the scene or available through communication.
Although this is the ideal and preferred method it is uncommon in most Rescue operations.
Order of precedence for on-line medical control:
On scene:
Flight Surgeon (either: SOFME or CSARME)
Senior US Military Physician present on scene
Senior Allied Military MD (equivalent to US Military Physician)
Civilian MD who can prove credentials and assumes responsibility
Senior Military Physician Assistant

12 n Pararescue Medical Operations Handbook / 8th Edition