APPENDIX F: LOGISTICS RESOURCES

Prolonged Field Care – Patient Packaging, 11 Aug 2021

Patient packaging is highly dependent upon the Casualty Evacuation (CASEVAC) / Medical Evacuation (MEDEVAC) platform that is operationally available. If possible, rehearse patient packaging internally and with the external resources. Train with MEDEVAC assets understand transporting teams’ standard operating procedures in order to best prepare the patient for transport. (Example some teams want to secure the patient and interventions themselves while others may be okay with a fully wrapped patient).

Ensure the patient is stable before initiating a critical patient transfer. For POI/unstable patients ensure the appropriate transport team (MEDEVAC with en route critical care nurse or advanced provider). Interfacility transfers should meet the following minimum:

1. Hemorrhage control
2. Resuscitation adequate (SBP 70-80 mmHg, MAP >60, or UOP >0.5ml/kg/hr)
3. Initial post-op recovery as indicated
4. Stabilization of fractures

Prepare Documentation

- Good: TCCC Card - DA1380
- Better: Prolonged Field Care Casualty Work Sheet
- Best: PFC Card with TCCC Card and any additional information, reference DA Form 4700 (SMOG 2021) for transport documentation standard

*preference: secure to patient strip of 3in Tape with medications administered attached to blanket or HPMK

Prepare Report

Report should give highlights, expected course, and possible complications during transport. The hand-off is the most dangerous time for the patient it is as important as treatments or medications. If it is rushed things can easily be missed.

- Good: Verbal report describing the patient from head to toe with a SOAP note.
- Best: MIST (Mechanism, Interventions, Symptoms, Treatments)
- Better: MIST with appropriate SBAR (Situation, Background, Assessment, Recommendations) and pertinent labs and other diagnostic information

Prepare Medications

- Good: Prepare medication list with doses and time of next dose
- Better: Above with additionally preparing next dose of medication for transport crew appropriately labeled.
- Best: Above with fresh IV fluids if indicated and fresh bags of drip medications with appropriate labeling and 72 hours of antibiotic for extended transports.

Hypothermia Management

- Good: Blankets
- Better: Sleep system and blankets
- Best: HPMK with Ready Heat or Absorbent Patient Litter System (APLS)

Flight Stressor/ Altitude Management

- Good: Ear Protection and Eye Protection, if nothing available sunglasses and gauze may be used, if patient is sedated and intubated eyes can be taped shut
- Better: Ear Pro and Eye Pro and blankets in all bony areas, Ear Protection and Eye Protection – foamies or actual hearing protection inserts, goggles
- Best: Above with gastric tube (NG/OG) or chest tube for decompression, if indicated. Depending on altitude/platform, consider bleeding air of out bags of fluid.

Secure Interventions and Equipment

- Good: Tape (securely tape all interventions to include IVs, IOs, Airway interventions, Gastric Tubes and TQs). Oxygen tanks should be placed between the patients legs and the monitor should be secured on the oxygen cylinder to prevent injury to the patient. Pumps should be secured to the litter
- Better: Additional litter straps to secure equipment and extend the litter with back support as indicated for vented patients to prevent VAP.
- Best: Above and use the SMEED to keep the monitor and other transport equipment off patient

*if possible, identify with tape the location of interventions or access points on top of hypothermia management to allow transport teams quick identification of location.

Prepare Dressings

Air Evacuation and other MEDEVAC assets do not routinely change dressings during transport; therefore, ensure all dressings are changed, labeled, and secured before patient pick up

- Good: Secure and reinforce dressings with tape, date, and time all dressings.
- Better: Change dressings within 24 hours of departure, secure as above.
- Best: Change and reinforce dressings within 4 hours of departure. Ensure additional Class VIII is available for any unforeseen issues in flight.

Secure the Patient

- Good: Litter with minimum of 2 litter straps
- Better: Litter with padding (example: AE pad or Sleep Mat) with minimum of 3 litter straps
- Best: Litter with padding and flight approved litter headrest with minimum of 3 litter straps (additional litter straps can be used to secure patient or equipment)

Moving a Critical Care Patient

- Good: Two person little carry to CASEVAC/MEDEVAC platform
- Better: Three person little carry on a rickshaw to CASEVAC/MEDEVAC platform
- Best: Four person little carry on a rickshaw to CASEVAC/MEDEVAC platform

Prolonged Casualty Care Patient Packaging Flowchart

Equipment:

- Litter with at least three litter straps
- Three channel IV pump (airworthy)
- Cardiac monitor and cables
- Suction Device

Possible Complications:

- Inadequate medications
- Injuries not addressed before transport
- Inexperienced provider on flight
- Equipment issues

Pearls:

- Document all times – TCCC Card or DA4700.
- Assist Ensure the patient is stable before initiating a critical patient transfer.
- POI/unstable patients ensure the appropriate transport team (MEDEVAC W/ECCN or Advanced provider)
- Interfacility transfers should meet the following minimum:
  - Hemorrhage control
  - Resuscitation adequate (SBP 70-80 mmHg, MAP >60, or UOP >0.5ml/kg/hr)
  - Initial post-op recovery as indicated
  - Stabilization of fractures