Page 73 - 2022 Ranger Medic Handbook

Austere Extended Care
Extended Evacuation in Austere Environment
Extended Austere Care: Due to the extreme nature of Special Operations, the Ranger Medic may find himself in a
situation in which prompt evacuation of casualties to a surgical facility is not possible for long periods of time. In these
situations, the Medic is limited to what he is carrying and the contingencies previously considered and planned for.
Essentially, extended care begins at the point in which you thought you were going to evacuate your casualties.
The Medic should make all possible attempts to make contact with higher medical capability to confirm extended care
measures. SECTION 2

Extended Care Considerations
Principles of Extended Care: Once the Medic has identified that they have transitioned into extended care, a tactical
pause must be taken. Additional factors may become priorities and to remain effective the Medic must have a plan for
treatment. There are several key principles which aid in preparation and execution of extended austere care.
■ Plan appropriately
■ Understand resuscitation goals
■ Proper pain management and understanding potential drug interactions
■ Monitor/trending vitals to include UOP and physical exams
■ Create an effective plan for treatment and identify possible procedures
■ Performing surgical procedures, within scope of practice, in the absence of timely evacuation
■ Prevent any damage done by treatments and provide effective nursing care
■ Utilize telemedicine as early as possible
■ Effective team dynamics and utilize a rest cycle for sustainability
■ Prepare an effective handover
Extended Care Capabilities: Using the Good, Better, Best model and having a strong understanding of both physical
limitations (i.e., equipment) and mental limitations (i.e., knowledge) will aid the Medic in preparing and executing effec-
tive extended care.
■ Monitor vitals
■ Resuscitate
■ Definitive airway control
■ Be able to ventilate/oxygenate
■ Utilize sedation/pain control
■ Perform physical exams
■ Execute nursing care
■ Perform surgical interventions
■ Understand and execute telemedicine
■ Package and prepare for evacuation
Patient Assessment: After completing the initial MARCH assessment and being alerted of extended evacuation times,
the Medic must transition to completing a more comprehensive assessment and focus on additional tasks. MARCH-E
PAWS-B and RAVINES are two potential options.
■ MARCH-Eyes, Pain, Antibiotics, Wounds, Splinting, Burns
■ Resuscitation/Reduce Tourniquets, Airway (Definitive/Sedation), Ventilation/Oxygenation, Initiate Telemedicine,
Nursing Care, Environmental Considerations, and Surgical Procedures
Vital Signs: Vital signs should be assessed frequently, especially after specific therapeutic interventions, and before and
after moving patients. Any change in vital signs should prompt an assessment to determine the cause and appropriate
action should be taken. Documentation of vital signs in extended care will help with gaining a better understanding of
where your casualty is trending.
■ Good: BP cuff, stethoscope, pulse oximeter
■ Better: EtCO 2 , Foley
■ Best: Monitor for vital signs
Airway Management: Airway assessments should be done at regular intervals to ensure patency and provide suction
as needed. This is of particular importance after performing any patient movement. Remember to assess cuff pressures.
■ Good: Supraglottic airway
■ Better: Definitive airway management
■ Best: Long duration sedation and definitive airway control
2022 RANGER MEDIC HANDBOOK 59