SUMMARY OF RECOMMENDATIONS & GUIDELINES

- The intent of this Clinical Practice Guideline (CPG) is to provide guidance for Austere Resuscitative and Surgical Care (ARSC) teams, which are often comprised of conventional forces surgical units employed in support of special operations missions.
- All ARSC teams should receive ARSC-specific, team-centric pre-deployment readiness training to include medical aspects and operational aspects of ARSC, with the result that ARSC teams are capable of protecting themselves and their patients and function well in a tactical environment.
- The purpose of the ARSC team is to mitigate risk for the Operational Commander by providing surgical and resuscitative care for combat casualties. ARSC teams are smaller and more mobile compared to other conventional surgical assets and have less clinical capability and holding capacity. Realistic assessment of the risks and benefits of this capability must be clearly communicated to the Operational Commander.
- Limited resources and staffing require that medical decisions are made in the context of the following variables: time and distance to the next role of care, capability of the next role of care, availability of blood products, sterility, anticipation of further casualties, evacuation capability, security, mobility, and patient holding capacity.
- Patient care must focus on rapid triage, initial resuscitation with blood products, rapid control of hemorrhage and contamination with a damage control approach, and subsequent transfer to higher echelon.
- Ultrasound of the chest and abdomen in patients with penetrating trauma to chest, abdomen, or pelvis or severe blunt trauma should be performed to rule out life threatening injuries.
- A ruck-truck-house model, listed below, can help frame logistical considerations for planning purposes to maximize mobility and flexibility.
- Documentation (e.g., JTS Austere Trauma Resuscitation Record, operative note) must be completed for all patients treated by ARSC teams and submitted to the JTS or uploaded into Theater Medical Data Store (TMDS).