MASCAL Decision Points
1. Determine if a PCC MASCAL is occurring – do the requirements for care exceed capabilities?
2. Determine if conditions require significant changes in the commonly understood and accepted standards of care (Crisis Standards of Care)3 or if personnel who are not ordinarily qualified for a particular medical skill will need to deliver care. MASCAL in PCC requires both medical and non-medical responders initially save lives and preserve survivable casualties. Both groups will need skills traditionally outside existing paradigms, such as non-medical personnel taking and record vital signs or Tier 3 TCCC medical personnel maintaining vent settings on a stable patient. The MASCAL standard of care will be driven by the volume of casualties, resources, and risk or mortality/morbidity due to degree of injury/illness; as such, remain agile throughout the MASCAL and trend in both directions based upon resources available.
3. MASCAL management is often intuitive and reactive (due to lack of full mission training opportunities) and should rely on familiar terminology and principles. Treatment and casualty movement should be rehearsed to create automatic responses.
4.. The tactical and strategic operational context will underpin every facet of MASCAL in a PCC environment, operational commanders MUST be involved in every stage of MASCAL response (The mere fact that a medical professional or team of medical professionals is forced to hold a casualty longer than doctrinal planning timelines means there is a failure in the operational/logistical evacuation chain. Battle lines, ground-to-air threat, etc. levels may have shifted.)
5. Logistical resupply may need to include non-standard means and involve personnel and departments not typically associated with Class VIII in other situations (i.e. aerial resupply, speedballs, caches, local national market procurement).
6. The most experienced person should establish MASCAL roles and responsibilities, as appropriate.