Page 36 - PJ MED OPS Handbook 8th Ed

Sample Telemedicine Format

Telemedicine Script v1.0 17 July 2017
1. Before calling, E-mail image of the casualty (wounds, environment, etc.), “capabilities” (back), and
vital trends dod.VC3@mail.mil (for VC3) or appropriate.
2. If call not answered, call next number on PACE or call back in 5–10 minutes.
3. If unable to provide information due to operational security, state so.

P: Local Medical Director
A: Garrison Medical Director
C: Pararescue Medical Director
E: VC3 – Critical Care: Commercial: +1 (210) 916-8222, DSN: (312) 429-8222
VC3 – Critical Care backup: MAMC ED 253-968-1396
This is ____________________________________ I am a (job/position) __________________________
My best contact info is: ___________________________________________________________________
YOUR best contact info is (Intensivist’s number): ________________ Alternate e-mail: ______________
***PAUSE POINT to CONFIRM CONTACT INFO***
Age: I have a ___ year–old ___ (sex) ________ (active duty/foreign natl/agency, etc), who has:
Mechanism of Injury or known diagnosis (for illness)
The injury/start of care occurred ______ hours ago. Anticipated evacuation time is (range)
Injuries/illness/problems:
Symptoms/Vital signs
Treatments (Report in MARCH PAWS format):

He/she is currently (circle) stable/unstable, getting better/getting worse/getting worse rapidly
Known Medication Allergies:
Past surgical and medical history:
I need help with (be specific, i.e. “I need help reading this ECG,” or “I need help stabilizing this pt,” etc.)

Other Consultants have recommended:
***PAUSE POINT for Remote Consultant to ask clarification questions***
VITALS (current and trend as of ): HR BP RR
SpO2 EtCO2 Temp
UOP (mL/hr) over (# hours) Mental Status (GCS/AVPU)
EXAM: Head/Neuro Ext/MSK
Lungs Abd Skin/Wounds
***PAUSE POINT for Remote Consultant to ask clarification questions***
TO-DO/FOLLOW-UP/TO-STOP NOTES
1. ____________________________________________________________________________________
2. ____________________________________________________________________________________

***PAUSE POINT, for Medic/to ask clarification questions/READBACK***

34 n Pararescue Medical Operations Handbook / 8th Edition