Background

Communication and documentation in PCC are linked priorities as they are activities that are synergistic. For instance, the standard documentation forms (see below) that are used to track the important medical interventions and trends are the recommended scripts that are used in a teleconsultation. Effective documentation leads to effective communication, both in the immediate PCC environment and as a long-term medical management tool for the casualty.

Communication

  • Communicate with the casualty if possible. Encourage, reassure, and explain care.
  • Communicate with tactical leadership as soon as possible and throughout casualty treatment as needed. Provide leadership with casualty status and evacuation requirements to assist with coordination of evacuation assets.
  • Verify evacuation request has been transmitted and establish communication with the evacuation platform as soon as tactically feasible relaying: mechanism of injury, injuries sustained, signs/symptoms, treatments rendered, and other information as appropriate. Have a rehearsed script to relay vital information to the next echelon of care prioritize interventions that cannot be seen by the next provider, such as medications.
  • Ensure appropriate notification up the chain of command that PCC is being conducted; requesting support based on the MASCAL decision points.
  • Call for teleconsultation as early and as often as needed (e.g., higher medical capability in the Chain of Command, the Advanced VIrtual Support for OpeRational Forces system line, etc.).
  • Remember, communication of the situation and medical interventions that have been done and are ongoing includes both teleconsultation and the “handoff report.”

Documentation of Care

  • There are 3 levels of documentation, categorized in a minimum, better, best format:
  • Minimum - Documentation of care on the TCCC card (DD1380).
  • Better - Utilization of a standard PCC flowsheet (if available), example attached.
  • Best - Completion of a formal After Action Report (AAR) after patient handoff.
  • Transfer documented clinical assessments and treatments rendered. If the availably to scan and/or transmit this information to all parties involved teleconsultation (using all approved and available means), do so for them to have as much of the information as possible.
  • Perform a detailed head-to-toe assessment and record all findings as a problem list so that a comprehensive care plan can then be constructed using the attached flow sheet.