Page 22 - 2022 Ranger Medic Handbook

Communication
In a case where the Ranger Medic cannot contact medical control due to an acute time-sensitive injury or illness,
SECTION 1 a mass casualty scenario, or communication difficulties, all protocols become standing orders. Likewise, in the
event that medical control cannot respond to the radio or telephone in a timely fashion required to provide optimal care to
a patient, all protocols are considered standing orders. In the event that medical control was not contacted, and treatment
protocols were carried out as standing orders, Medical control will be contacted as soon as feasible following the incident
and the medical record (Casualty Card, SF 600 or Trauma SF 600) will be reviewed and countersigned by medical control.
Retroactive approval for appropriate care will be provided through this process.
When communicating with medical control, a medical officer, or a receiving facility, a verbal report will include the following
essential elements:
1. Provider – name, unit, and callback phone number
2. Patient – name, unit, age, and gender
3. Subjective – findings to include chief complaint and brief history of event
4. Objective – findings to include mental status, vital signs, and physical exam
5. Assessment – to include differential diagnosis, presumed diagnosis, and level of urgency
6. Plan – to include treatment provided, patient response to treatment, and patient status updates
NEVER HESITATE TO CONTACT A MEDICAL DIRECTOR AT ANY TIME FOR ASSISTANCE,
QUESTIONS, CLARIFICATION, OR GUIDANCE THROUGH ANY COMMUNICATIONS MEANS AVAILABLE.
Patient Care Documentation
Patient care documentation is of paramount importance and will be performed for every patient encounter using a Tactical
Combat Casualty Card, Trauma SF 600 Medical Record, SF 600 Medical Record, or designated electronic health record
and transported with the patient to a medical treatment facility or provider. Lack of a card or form is not an excuse for lack
of documentation. Rangers Medics will use all resources available to attempt documentation for the next-level provider.
Documentation by writing on dressings, tape, or even the patient is completely acceptable if other resources are not avail-
able. If time constraints that might delay the evacuation of the patient prevent real time documentation, then the Ranger
Medic will document at the first available opportunity.
Medical Personal Protective Equipment (PPE) And Universal Precautions
Medical PPE and the concepts of universal precautions will be used whenever possible and indicated. When the circum-
stances allow, use a minimum of nonsterile exam gloves. If possible, actions normally considered sterile procedures will
be conducted in as clean an environment as can be maintained. Awareness of patient protection from infection must be
maintained during the execution of any protocol or procedure. Ranger Medics will conduct precombat inspections of all
invasive or sterile materials prior to every mission and replace accordingly.
Resuscitation Considerations
Resuscitation is not warranted in patients who have sustained obvious life-ending trauma or patients with rigor mortis,
decapitation, decomposition, or mass casualty situations. When reasonable, consider performing resuscitation efforts
when this is your only patient. The perception of fellow Rangers and family members in this instance should be that every
effort was made to sustain life.
When possible, use ultrasound to confirm no cardiac activity, or place ECG leads to confirm asystole in three leads and
attach a copy of this strip to the medical record. Also note that, technically, only a medical officer can pronounce a patient
as deceased. Refer to the protocol Determination of Death/Discontinuing Resuscitation.

8 SECTION 1 THE RANGER MEDIC & CASUALTY RESPONSE SYSTEMS