Page 3 - 2023 SMOG Digital

INTRODUCTION
The CY 2023 SMOG release marks the last year of the current format. The Aeromedical Evacuation
community provided developmental feedback leading to a redesign of current written medical guidance
and/or policy. Be assured all future changes are a continued result of collaboration between Emergency
Medicine professionals, experienced Flight Medics, Aeromedical Physician Assistants, Critical Care
Nurses, and Flight Surgeons across the Army. There is close coordination in the development of these
guidelines with the Joint Trauma System, and the Defense Committees on Trauma. Our shared goal is to
ensure the highest quality enroute care possible and to standardize care across all evacuation and
emergency medical pre-hospital units. It is our vision that all these enhancements and improvements
will advance enroute care across the services and the Department of Defense.
Unit Medical Trainers, Medical Standardization Instructors, Medical Flight Instructors and Medical
Directors will evaluate Critical Care Flight Paramedics (CCFP) ability to follow and execute the medical
instructions herein. These medical guidelines are intended to guide CCFPs and prehospital professionals
in the response and management of emergencies and the care and treatment of patients in both
garrison and combat theater environments. Unit medical providers are not expected to employ these
guidelines blindly. Unit medical providers are expected to manipulate and adjust these guidelines to
their unit’s mission and medical air crew training / experience. Medical directors or designated
supervising physicians will endorse these guidelines as a baseline, appropriately adjust components as
needed, and responsibly manage individual unit medical missions within the scope of practice of their
Critical Care Flight Paramedics, Enroute Critical Care Nurses, and advanced practice aeromedical
providers.
CCFPs should administer medications as listed in the guidelines unless their medical director and/or
supervising physician orders a deviation. Other medications may be added, so long as the unit
supervising physician and/or medical director approves them.
This manual also serves as a reference for physicians providing medical direction and clinical oversight
to the CCFP. Treatment direction, which is more appropriate to the patient’s condition than the
guideline, should be provided by the physician so long as the CCFP scope of practice is not exceeded.
Any medical guideline that is out of date or has been found to cause further harm will be updated or
deleted immediately. The Department of Aviation Medicine (DAM) serves as the managing editor of the
SMOG and is responsible for content updates, managing the formal review process, and identifying
review committee members for the annual review.
The Standard Medical Operating Guidelines are intended to provide medical procedural guidance and is
in compliment to other Department of Defense and Department of the Army policies, regulatory and
doctrinal guidance. Nothing herein overrides or supersedes laws, rules, regulation or policies of the
United States, DoD or DA.

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