Page 314 - 2023 SMOG Digital

FORMS

Published Standard Medical Operating Guidelines (SMOG) are written patient care guidance in
algorithm format with discrete basic life support (BLS) and advanced life support (ALS) scopes of
practice, respectively, based on each patient / casualty’s specific medical condition. Once
endorsed by local commanders and unit medical directors, all medical aircrew are expected to
use these guidelines in the care of patients they transport to the next higher level of care.
Periodically, medical aircrew should undergo testing on information and procedures contained
within these guidelines. After each patient that has been aero-medically evacuated to a Role 2
or Role 3 medical treatment facility, each medical aircrew member is responsible for
documenting the care rendered during transport via the appropriate unit, theater, or DA / DD
approved / mandated electronic or written patient care documentation form
Direct Supervision

In addition to the written guidelines, designated unit medical directors are responsible for the
direct supervision of medical aircrew members participating in en route care within the unit,
his/her performance in situations in which the patient’s medical condition(s) does not meet
standard-of-care as defined by these guidelines, or who experience adverse events en route,
merit retrospective review and determination of root cause and corrective action, or
endorsement of their decision, as appropriate.
Quality Management/Process Improvement
After each Aeromedical Evacuation mission, for each patient receiving enroute care, the medical
aircrew team conducts an informal After Action Review (AAR). The initial formal control
measure is the requirement for the FS or APA to review and co-sign each patient care report
(PCR) (e.g., DD 1380, run sheet, Enroute Critical Care Transfer document, DD4700) before it is
submitted as a part of the patient record. After both the lead medical aircrew member and unit
medical director have signed the PCR, a copy will be kept and others will be distributed in
accordance with current Army policy guidelines, local unit policy, and by the medical training
NCO and/or medical director.
Additional quality control measures are encouraged and can foster a rich and open learning
environment between local emergency medicine/trauma facilities and members of the air
ambulance company. One such option might include a monthly aeromedical evacuation
conference chaired by the local MTF Trauma Surgeon in which medical aircrew member’s
present cases to a forum of providers and other medics with emphasis on best practices and
lessons learned.

UPDATE and APPROVAL PROCESS
1. The Critical Care Flight Paramedic Standard Medical Operating Guidelines will be updated
generally on an annual basis, or sooner in response to clinical or operational needs.
2. Based upon the above timeframes, the Director, Department of Aviation Medicine (DAM)
should initiate an update by sending the SMOG for inputs from senior aeromedical clinicians
(flight surgeons, aeromedical physician assistants, and aeromedical nurse practitioners),
emergency medicine physicians, EMS trained physicians, and critical care flight paramedic end-
users.

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