Page 31 - PJ MED OPS Handbook 8th Ed

General considerations after patient is stable, or unstable patient and >4 hours extraction/exfiltra-
tion. Use HITMAN:
Hydration – PO/IV/IO/Rectal (PR)/NG tube
• Starting maintenance IVF – rate should be approx 125mL/hr
• Urine output should be approximately 30–50mL/hr at a minimum. Place a Foley in all patients
who are unable to void including all unresponsive patients as well as critical care patients
with burns or in shock
Hygiene –
• Prevent pressure sores, roll and pad patient q1–2hr, clean patient q12–24hr, keep the patient
dry, keep the room clean
Hypothermia –
• Take preventative measures; cover casualty to protect from elements and further loss of
heat. If patient is hypothermic, treat per Hypothermia Protocol
Infection –
• Take temps, change dressings q12–24hr
• Confirm antibiotics given on schedule
• Check IV/IO sites and sites of invasive procedures for signs of infection
Tubes and lines –
• Make sure all lines are “neat and tidy” and functioning and draining properly
• Intermittent or continuous suction applied if indicated (chest tube, NG tube)
• Intermittent lavage PRN (cric, ET tube)
Medications –
• 6 RIGHTs – patient, med, dose, time, route, documentation
• Monitoring – as needed
○ If unstable q1–2hr, record VS including AVPU/temp/O2 sat
○ VS no less than q12hr
Analgesia –
• Document with pain scale before and after giving pain meds
• For long term pain control in a hemodynamically stable casualty, dilaudid is preferred. If
casualty is unstable, ketamine is preferred.
• Add other long-acting meds per Med Direction
• If meds are limited, give pain meds as needed and not continuous
• Remember: analgesia is different than sedation
Nutrition –
• Critical for the Operator – maintain your own hydration and blood sugar
• Probably not critical for trauma patients for 24–48 hours
• Very important for conscious patients – morale and sense of well-being
• Sports gel and high calorie protein bars – (>300 calories, or unsalted nuts instead of protein
bars) are densely caloric and supply all 3 macronutrients – carbohydrates, protein and fat.
Also, protein or muscle building powders are useful to pack.
• Goal is >1500 calories per day if patient can take PO
• Can bring electrolyte powder, and protein/recovery powders and give orally, by NG tube, or
rectally (least effective)
• In general, you can give a gel every 3 hours and 1/3 to 1/2 a protein bar on the 90 minutes
in between, or space the intervals longer depending on patient, movements, and supplies

Chapter 5. Prolonged Field Care n 29