Other topics by role of care include:
Role 1
- Decontamination operations, doctrinally requires at least eight nonmedical personnel augmentees from supported units.26In situations where augmentees are not available, medical staff may have to conduct decontamination operations with their organic staff.
- Training for appropriate personnel (unit/mission dependent) such that those personnel are able to conduct the basic assessment/management for bioincident/infectious disease recognition in incoming patients is critical.
- Courses to consider include The Medical Management of Chemical and Biological Casualties course (MCBC), The Field Management of Chemical and Biological Casualties course (FCBC), The Hospital Management of Chemical, Biological, Radiological, Nuclear and Explosive Incidents Course (HM-CBRNE) and Military Tropical Medicine (MTM) [Appendix D]
- For IPC training, consider having appropriate staff (unit/mission dependent) trained in the Infection Control in the Deployed Environment Course (Appendix D)
- Impacts on medical care in a PCC environment:
- PCC, by definition, is the need to provide Role 1 casualty care for extended periods of time, when the tactical situation may limit or prevent prompt and/or optimal medical care.
- In a PCC/delayed evacuation scenario, the ability to recognize and react to a biothreat will be challenging given the fact that any units in the PCC environment will need to deal with the situation with whatever equipment is available.
- It is important to consider the impacts the declaration (or even suspicion) of a bioincident may have on the ability to evacuate patients and/or receive resupply.
- Thus, a bioincident could actually create a PCC scenario for combat units.
- Bioincident triggered delays may increase all cause morbidity and mortality as patients may not be able to get to higher level of care.
- The management of patients during and following a bioincident in a PCC environment requires effective resource management.
- Medical resources, including antimicrobials, mechanical ventilation, and other supportive measures may be limited.
- It is recommended that all medical facilities have protocols in place to address these challenges, including the establishment of a medical supply cache and the prioritization of patients based on the severity of their condition.
- Early monitoring and management of PPE based off burn rates is essential to ensure medical staff remain protected and to stretch limited resources.
- Early emphasis on telemedicine reach-back services to assist in the identification and management of bioincidents.
Role 2
- Decontamination operations, doctrinally requires at least eight nonmedical personnel augmentees from supported units.26In situations where augmentees are not available, medical staff may have to conduct decontamination operations with their organic staff.
- The lowest echelon clinical laboratory capability and personnel are doctrinally found. Limited sample collection should be performed IAW the test capability of the Role 2 and all clinical infectious disease testing should be referred to the Role 3 ensuring a chain of custody.
- Consider if organic preventive medicine support is available (may vary)
- Training for appropriate personnel (unit/mission dependent) such that those personnel are able to conduct the basic assessment/management for bioincidents/infectious disease recognition
- Courses to consider include MCBC, FCBC, HM-CBRNE and Military Tropical Medicine MTM (Appendix D )
- Reiterate recommendations from Infection Prevention in Combat-related Injuries CPG that Role 2 should have a designated Infection Prevention and Control Officer (IPCO) as an additional duty or a full-time position if supported by manning levels.Recommend IPCO receive additional training in HCID IPC by a course like CSTARS Omaha PBC (Appendix D).
Role 3
- Decontamination operations doctrinally require at least 20 nonmedical personnel from supported units within the geographic area/base cluster of the hospital.26 In situations where augmentees are not available, medical staff may have to conduct decontamination operations with their organic staff.
- Recommend augmentation of deployed roles 3 with microbiology capabilities
- For example, Army Role 3s can be deployed with the 24 or 32 bed augment to ensure microbiology capabilities are present in theatre.
- The augmented Role 3 can initially medically evaluate suspected biowarfare patients, collect samples, properly package samples, establish a chain of custody for collected samples, and, using technical channels, forward collected samples to a supporting medical laboratory for further analysis.Samples should be shipped to the USAMRIID Special Pathogens Lab (SPL) for confirmative/definitive identification.
- The USAMRIID-SPL is a CLIA/CLIP accredited diagnostic laboratory that serves as the definitive infectious disease laboratory for the DoD as a whole.
- Refer to this website: https://usamriid.health.mil/index.cfm/support/spl for contact information pertaining to the USAMRIID-SPL to include a specimen collection and submission manual and submission forms.
- Training for appropriate personnel (unit/mission dependent) such that those personnel are able to conduct assessment/management for bioincidents/infectious disease recognition
- Courses to consider include MCBC, FCBC, HM-CBRNE and Military Tropical Medicine MTM (Appendix D).
- Reiterate recommendations from Infection Prevention in Combat-related Injuries CPG that Role 3 should have a designated Infection Prevention and Control Officer (IPCO) as an additional duty or a full-time position if supported by manning levels.Recommend IPCO receive additional training in HCID IPC by a course like CSTARS Omaha PBC (Appendix D).