APPENDIX D: CLASS VIII MEDICAL MATERIEL

The JTS En Route Care Patient Packaging CPG provides a comprehensive framework for ensuring that patients are safely packaged for transport, often in critical care environments. Here's a detailed list of medical materials generally required for en route care packaging based on those guidelines, organized by category:

#### Airway Management

- Endotracheal tubes (various sizes)
- Suction catheters – soft tip and rigid (yankauer)
- Portable suction unit with tubing and collection canister
- Bag-valve-mask (BVM) resuscitator (adult and pediatric sizes)
- PEEP valve
- Laryngeal Mask Airway (i-Gel and inflatable)
- Oropharyngeal and nasopharyngeal airways
- End-tidal CO2 monitoring device
- Laryngoscope with blades (various sizes)
- Cricothyroidotomy kit (surgical and needle)

#### Breathing Support

- Portable ventilator with tubing
- Oxygen reservoir bag assembly (EMV+)
- Oxygen tank (with pressure gauge and regulator)
- Oxygen key/wrench
- Non-rebreather masks (adult and pediatric sizes)
- Nasal cannula
- Chest decompression kits (needle and thoracostomy kits)
- Chest tube and drainage systems
- Occlusive dressings (e.g., HALO seal or chest seals)

#### Circulatory Support

- IV fluids (Lactated Ringer's, normal saline, packed RBCs)
- 10mL flushes
- 10mL syringes
- 18G transfer needles
- Blood transfusion kits
- Blood warmer
- IV catheters (18G, 20G, etc.)
- Intraosseous (IO) insertion kits
- IV pressure infusion bags
- Intravenous (IV) administration sets (macro and micro drip sets)
- IV dial-a-flow
- Doppler or portable ultrasound for vascular access
- Hemostatic agents (Combat Gauze, Celox)
- Emergency tourniquets (e.g., CAT, SOFT-T)

#### Pain and Sedation Management

- Analgesics (fentanyl, morphine)
- Sedatives (midazolam, ketamine)
- Syringe drivers for continuous drug infusion
- Local anesthetics (lidocaine, bupivacaine)

#### Neurological Management

- Cervical collars (C-collars) in different sizes
- Spinal immobilization board (backboard) or vacuum mattress
- Head immobilization devices (foam blocks, straps)
- Portable monitors (for neurological assessments)

#### Wound Care and Dressings

- Sterile dressings (4x4, abdominal pads, kerlex)
- Burn dressings
- Compression bandages (ACE wrap, elastic bandages)
- Surgical tape (various widths)
- Sterile gloves (assorted sizes)
- Gauze rolls and sponges
- Sterile irrigation solutions and syringes
- Suture kits and wound closure strips (Steri-Strips)
- Trauma shears
- Antiseptics (chlorhexidine, povidone-iodine)

#### Fracture and Musculoskeletal Support

- Splinting materials (SAM splints, vacuum splints)
- Traction splints for femur fractures
- Elastic bandages for stabilization
- Immobilization devices (KEDs, pelvic binders)

#### Patient Transport and Packaging

- Litter/stretcher (preferably NATO-standard)
- Stretcher straps and securement systems
- Hypothermia prevention equipment (e.g., HPMK)
- Patient body bags for remains if necessary (for fatal cases)
- Eye protection
- Ear protection

#### Monitoring and Diagnostics

- Multiparameter patient monitor (for HR, SpO2, BP, temperature)
- Defibrillator (if not part of patient monitor)
- Blood glucose monitor with test strips
- Portable ultrasound (for FAST exams, IV access, etc.)
- Urinary catheterization kits (Foley catheter, urine collection system)
- Point-of-care testing devices (iSTAT for ABG, lactate, etc.)
- ECG monitor leads and patches

#### Infection Control and Safety

- Personal protective equipment (PPE) for providers (goggles, gowns, gloves, masks)
- Hand sanitizers
- Alcohol pads
- Disinfectant wipes and solutions
- Biohazard disposal bags
- Sharps containers

#### Documentation and Administrative

- Patient care documentation forms
- Wristbands with patient ID information
- Portable labeling systems for medication and patient identification
- Sharpies and waterproof pens for marking IV lines, wounds, etc.
- Clipboard or tablet for electronic patient records (if applicable)
- Whiteboard and dry erase marker (for communication with patient and platform crew, if no internal communication available)

#### Miscellaneous Equipment

- Flashlight or headlamp for low-light settings
- Batteries for portable equipment (ventilator, defibrillator, etc.)
- Extra IV tubing, extension sets, and connectors
- Medications for emergency management (epinephrine, atropine, naloxone)
- Space blankets for hypothermia prevention (if APLS or HPMK not available)
- Hydration bottles or IV fluid hydration systems
- Backpack for provider (use as go-bag in case stuck on location)
- Knee pads
- Drop pouch
- Small rigid case (Pelican 1060) to carry medications)

This list includes equipment typically used in both Role 1-3 settings and for the packaging and transport of critically injured patients, ensuring continuous care during evacuation. However, specific materials may vary depending on the injury pattern and patient needs.

For additional information including National Stock Number (NSN), please contact dha.ncr.med-log.list.lpr-cps@health.mil

DISCLAIMER: This is not an exhaustive list. These are items identified to be important for the care of combat casualties.