APPENDIX A: ARSC EQUIPMENT CONSIDERATIONS

The following equipment lists are not complete packing lists. Teams should pack according to mission requirements, with expected numbers and types of patients significantly impacting quantities of medications and supplies.

For specific surgical instrument recommendations, please refer to: Hale DF, Sexton JC, Benavides LC, Benavides JM, Lundy JB. Surgical Instrument Sets for Special Operations Expeditionary Surgical Teams. J Spec Oper Med. Fall 2017;17(3):40-45. h

Disclosure: This CPG, the U.S. Air Force, U.S. Army, U.S. Navy, and DoD does not endorse or promote any specific products.

#### Ruck model—Plan for 1-2 surgical patients with 80% of combat trauma injury patterns

TCCC equipment

· Litter

· Tourniquets

· Dressings, splints (e.g. Combat Gauze®, ACE, medical tape, CobanTM, KerlixTM)

· Needle Decompression catheters

· Airway equipment (e.g. oropharyngeal airways, nasopharyngeal airways, definitive airways, AMBU bag, etc.)

· Muzzle and large ETTs for MWD use

Nursing equipment

· Personal Protective Equipment

· IV start kits, IO devices, extension tubing, Blood tubing

· Syringes/flushes

· IV fluids

· Assorted lines/tubes/drains

· Walking Blood Bank supplies (citrate bags, Eldon cards)

Airway and anesthesia equipment

· Airway instrumentation

· Ventilation equipment

· Regional anesthetic block needles

· Dial-a-flow (infusion set)

· Centurion pressure transducer

· Non-elastic bougie

Medications

· Tranexamic acid

· IV Calcium

· Anesthetics

· IV and PO Analgesics

· IV and PO Antibiotics

· ACLS medications

· Antiepileptics

· IV Fluids (including hypertonic saline for TBI)

· Assorted ‘sick call’ meds

Surgical instruments

· Major Instrument Set

· Chest set with rib-spreader and Lebsche knife

· Limited Vascular set – a few fine instruments and vascular clamps

· Orthopedic bone saw (Gigli wires are intended to be single use, are fragile, and are difficult to re-sterilize)

Suture material

· Absorbable suture, given high likelihood of contaminated wounds

· Heavy PDS for fascia

· Fine Prolene for vascular repair

· Fine PDS for urologic and airway repairs

· Absorbable free ties for ligation of small vessels

· Heavy silk to secure tubes/drains

· Umbilical tape

· Heavy chromic for hepatic repairs

· Bone wax for amputations

· Vessel loops, large and small

· Pledgets

Other surgical equipment

· Head Lamps

· Cricothyroidotomy Kit

· GIA Staplers with reloads

· Topical Hemostatic Agents

· Surgical Sponges (Ample supply of sponges cannot be overstated or overemphasized)

· Vascular Shunts

· REBOA catheter and introducer kit

· Chest Tubes, chest seals, and Heimlich valves

· Skin staplers

· Temporary Abdominal Closure device (e.g., Ioban)

Electronics

· Portable, battery powered ETCO2 monitor

· Video laryngoscope (GlideScope®)

· Portable, battery powered pulse ox monitor

· Portable, battery powered vital signs monitor

· Blood cooling container (e.g., golden hour box)

· Hand-held Doppler device

· Hand-held ultrasound device

· Portable ventilator

· In-line IVF/blood warming device

· Clippers for MWD use

Operational equipment

· Internal and external communication equipment (e.g., hand-held encrypted radios, Peltors)

· Eye protection, ear protection

· Night vision equipment

· Headlamp capable of red/green/blue light

· Navigation tool(s) (e.g., lenzatic compass, GPS)

· Survival equipment (e.g., blood chit, escape and evasion kit)

· Tactical protective equipment (body armor), IFAK

· Personal weapons and ammunition

#### Truck model—Pack for 2-5 surgical patients with 80% of injury patterns. Includes increased quantities of all Ruck items.

Added TCCC equipment

· Litters

· MASCAL kit

· CBRNE kit

Added anesthetic equipment

· Oxygen

· OG tubes

· RIC catheters

Added surgical instruments

· Consider 2 or more of each instrument set

· Limited external fixator set

Other surgical equipment

· Operating Table/Litter Stands + Arm Boards

· Broselow bag

Added electronics

· Point of care laboratory testing (iSTAT requires regular maintenance including calibration and cartridges must be temperature controlled)

· Battery-powered blood fridges and/or freezers

· Belmont Rapid Infuser

Added operational equipment

· Person-portable generator to power electronics with maintenance kit

· Space heater

· Fuel for generator

· Tentage to set up patient care space

#### House model—This model may allow for true surgical sets. The number of sets required will depend on how many simultaneous OR tables the site is intended to provide. Consider frequency and time required to re-sterilize instruments. Includes increased quantities of all Truck items.

Anesthetic equipment

· MAC catheters

Medications

· Increased IV Fluids

Surgical instruments

· Consider several of each instrument set above

· Craniotomy set

· Several external fixator sets

· Surgical suction and tubing

· Surgical energy device (e.g., Bovie)

Other surgical equipment

· Consider larger capacity blood refrigeration equipment

· Litters

· More than 1 OR Table/Litter Stands + Arm Boards

· Overhead Free-standing Lighting

· Plasma thawer or Belmont Rapid Infuser

· Instrument sterilizer

· More robust MASCAL kit

· Additional litters

Electronics

· Arterial line pressure monitoring equipment

Operational equipment

· Larger generator(s) with required fuel, wiring, circuit panels

· Multiple space heaters

· Wall mounted lighting