PATIENT PREPARATION

The goal of ERC casualty preparation is to provide the continued level of medical support as the casualty is transported throughout the battlespace and differing roles of care. Considerations for planning during transport can be categorized into groups of concerns: 1)safety, 2) access, and 3) organization. When planning for any casualty transfer, the transport team should prepare for 2-3 times longer transport time than initially projected (i.e. If the transport is anticipated to take 2 hours, plan for 4-6 hours).

Transport safety includes the safety of both the casualty and the ERC team’s interaction with the casualty. All casualties should be provided thermal regulation, visual protection, and auditory protection from the transport environment. Casualty preparation for transport can be divided into two phases: ground preparation and transport team preparation.

GROUND PREPARATION

1. Prepare the patient for the transport team to arrive.
2. Sending facility develops the 9-Line casualty request and M.I.S.T. (Mechanism of injury, Injuries sustained, Signs/symptoms, Treatment given) report
3. Gather the casualty’s medications, personal effects, identification, travel orders, and documentation.
4. Complete any time or resource intensive interventions prior to ERC team arrival to optimize transport requirements and minimize delays.

TRANSPORT (ERC) TEAM PREPARATION

Consists of planning and execution phases.

Planning Phase

This phase begins upon receipt of the 9-line medical evacuation request and M.I.S.T. report. Each aspect of the 9-Line request is important for the transport team, but emphasis is placed on the number and criticality of casualties, as well as the tactical situation. Accuracy is key - as the incoming ERC team must ensure that the casualty load will not overwhelm their resources or capabilities. The ERC team’s clear understanding will lead to their arrival with the correct resources and the patient disposition to the appropriate medical facility.

Execution Phase

During this phase, time is of the essence. Upon arrival at the initiating facility, the ERC team should contact the provider requesting the evacuation. The goal is to decrease the amount of time spent preparing the patient and rapidly move to transport. The ERC team will assign tasks to ensure that each member is appropriately utilized. Tasks that should be completed by the team include receiving report, assessing the patient, validating the movement of the casualty, verifying correct packaging in preparation for departure, packaging the patient for transport, and development of the en route plan.

1. Report and Patient Assessment

The ERC team will guide the report and assessment process. The use of the MARCH acronym (Appendix B) can assist both the sending and transport teams in communicating the appropriate information in the least amount of time. Often the priorities of the sending team differ from those of the ERC team. The ERC team should receive report, ask questions pertinent to the status and transfer of the patient, and then provide an opportunity for the sending team to provide additional information. If hand off must occur in high ambient noise environments such as engines running on/off-load or helicopter hot-load sending, provider should point to each wound(especially areas of controlled or suspected hemorrhage) with confirmation of receiving team of wounds/injuries. Use of a communication device (such as the Atlantic Signal Tactical Medic Intercom) that allows sending and receiving team aircraft-side verbal communication is hugely beneficial and units/teams should coordinate this beforehand.

Once the report has been completed, an assessment will be performed to confirm findings and interventions. This assessment will develop the “Do Now” status of the casualty. The “Do Now” criteria are the current MARCH findings from the report and the assessment that need immediate intervention to prepare for transport. As each of the “Do Now” criteria are identified, secondary logistic supply needs and assessment needs are developed.

2. Validate the Movement of the Casualty

The findings of the ERC casualty assessment assist in the validation of the decision to transport the casualty. The JTS CPG on the Interfacility Transport of Casualties Between Theater MTFs gives clear guidance on the resuscitation goals that should be followed to identify when a casualty is safe to transfer. If one or more of these goals is not met, a plan must be developed to optimize the casualty in accordance with resources and tactical situations.

3. Verify Correct Packaging in Preparation for Departure

Once the casualty is validated for movement, supply needs can be filed under the “Take With” portion of casualty transport planning. The goal of this portion of the planning process is to ask the “what if“ question for each of the casualty’s interventions. This item list will include back-up support devices and batteries, dressing reinforcement supplies, next step interventions, medications for continued treatment, and documentation.

4. Packaging the Patient for Transport

Package the casualty to ensure safety of the casualty and team, access to all relevant interventions, and organization of resources. Monitors should be placed on the litter structure or attached to a litter device to ensure that NO EQUIPMENT IS RESTING ON THE CASUALTY, it is fully secure to the litter system, and that all team members have access to and can view the monitors. Securing devices, such as litter straps used for equipment, should not be used for the casualty. All casualties should be secured with a minimum of two strap style devices. It is also recommended that any tubing or wires be secured with litter straps to prevent snaring or disconnection during movement.

5. Development of the “En Route” Plan

Develop the assessment protocol for your casualty while in transport. This is an opportunity for the team to clearly subdivide tasks and ensure that all aspects of casualty care will be met. It is key to remember that vital signs should be checked regularly. This will create a pattern repetition or “battle rhythm” for the transport period.

Documentation and report are developed from the “en route” portion of the casualty transport plan. Depending upon the status and required effort of casualty care during transport, documentation on the DD1380 or DA4700 may prove to be difficult to maintain. It is imperative that, the team monitor, and document vital signs regularly as required by patient acuity, administer, and document medications, and perform and document any interventions in order that they have been completed in the casualty care record.