Command & Force Protection Considerations

#### General Considerations

- Prevention of COVID-19 transmission to medical personnel is mission critical to preserve wartime, trauma care capability
- Closely manage & conserve equipment & supplies including oxygen, ventilators, sedation medications, & personal protective equipment.
- Expect reduction in supply lines with limited resupply or delivery.
- Expect delayed medical evacuation due to decreased transport availability, airspace restrictions, & reduced military asset access.
- Initially plan for 1- 3 critically ill COVID-19 patients at each austere location.
- Quarantine is a unit/command function, requiring medical support, that separates and restricts movement of those unknowingly exposed to a contagious disease without symptoms.
- Isolation is medical function, requiring command support, separating those with contagious disease symptoms from people who are not sick.

#### Command Considerations

- Patient Under Investigation (PUI) require medical isolation due to signs/symptoms of COVID-19 & history of potential exposure.
- Communicate PUI’s to medical and operational leadership on identification & their potential close contacts.
- Communicate identified PUI’s and close contacts via 5Ws format to command surgeon (or designee), following unit notification & theater surveillance policies.

#### Medical Considerations

- Pre-designate primary COVID provider to perform all COVID-19 evaluations and coordinate procedures to limit medical personnel exposure, retaining combat casualty care effectiveness.
- Designation should balance provider skills and experience with potential impact on medical support for combat operations.
- Designated provider may not be the most experienced and should consult with team as needed for management, procedures, and nursing care.
- A pandemic may require establishment of medical rules of engagement that discourage initiation of CPR due to aerosolization and high risk of cross-contamination.Begin early evacuation coordination for high risk patients.

Prevention of COVID-19 Spread