Prolonged field care builds upon the Joint baseline interoperability medical standards listed within the PCC guidelines for advanced trained medical personnel. The following recommendations are intended to assist advanced trained medical personnel with the continuation of more advanced procedures.
Perform advanced airway suction only when needed (e.g., copious secretions, colored secretions, change in oxygenation status, suspected mucus plug). Use sterile technique for advanced airways (e.g., endotracheal tubes) or clean technique for the mouth and throat.
Guide for advanced airway suctioning
If possible, remove the catheter. Consider use of a condom catheter (for males) or urinary wicking device (for females).
*External (non-indwelling) catheters may not effectively collect output, since they do not necessarily empty the bladder immediately. Therefore, output measurements may be falsely low if using an external-collection catheter to measure active resuscitation efforts.*
Catheter care should be performed as a part of daily bathing routine, after bowel incontinence, and if secretions build up around the urinary meatus. It should be completed at least every 24 hours. This helps to reduce the risk of catheter-associated urinary tract infection. The drainage bag should be emptied every 24 hours or whenever the main chamber becomes full. A securement device included in the foley bag kit or tape should be used to secure the tubing to the casualty’s thigh to prevent the foley from being accidentally removed if pulled.
Use a basin, warm water, non-irritating soap, and towels to perform catheter every 24 hours.
Guide for performing catheter care:
NUTRITION FOR INTUBATED CASUALTIES
Casualties who are intubated and/or sedated and held at the Role 1 for up to 48-72 hours should receive a feeding tube (nasogastric or orogastric) to initiate enteral nutrition. If there is concern for facial fractures/skull base fracture, place orogastric tube and avoid nasogastric tube placements. Although a controversial topic, feeding at the Role 1 – is possible, as demonstrated by Frizzi, et al.16 Evidence shows that delaying nutrition in large burn patients (≥20% TBSA) increases odds of mortality by 2% for each hour delayed in enteral feeding initiation.17 This translates to an increased mortality risk of 96% in 48 hours, emphasizing the importance of early enteral feeds when possible. Before tube feeds are initiated, it is imperative to ensure proper tube position, with x-ray confirmation being the gold standard. If x-ray is not available and tube feeds are deemed necessary, the following methods should be used to clinically confirm proper position: 1) quickly push air through the tube while auscultating the left upper quadrant (over the stomach) to confirm a “whoosh” AND 2) return of gastric or bile aspirate.
For enteral nutrition contraindications, please refer to the JTS CPG for Nutritional Support Using Enteral and Parenteral Methods.
***Placement of a feeding tube, particularly in a patient with altered mental status without appropriate confirmation of proper positioning may lead to significant morbidity or mortality from aspiration risk.
Refer to the PCC guidelines and Analgesia and Sedation Management during Prolonged Field Care CPG for a thorough guide to pain and sedation management.
Pearls
If available, check blood glucose level (BGL) every 8 hours or more frequently as dictated by casualty status for casualties that are NPO. A low BGL (less than 80 mg/dL) must be treated immediately with oral sugar, juice, or IV glucose. A high BGL (greater than 200 mg/dL) is less dangerous than low glucose and may be treated if the capability is available.20