Goals

- Transmit important medical information to the next level of care
- Permanently record information vital to service members injured in combat
- Contribute to performance improvement in prehospital care.

Minimum: TCCC Card DD1380

- The DD1380 is organized as a MIST (Mechanism, Injuries, Signs and Symptoms, Treatments) report (Appendix A).
- Note the time casualty is received and include time of injury (if known and different from when received) and time of all key interventions (e.g., tourniquet, blood transfusion, tranexamic acid [TXA] dosing).
- List injuries and annotate on the diagram. Tourniquets and tourniquet times are also annotated on the diagram.
- Vital signs, including mental status AVPU (alert or responsive to voice, pain, or unresponsive) and pain scale, should be recorded to the greatest extent possible—up to four sets of vital signs can be recorded on the TCCC card.
- Document treatments to include external hemorrhage control, airway, breathing, fluids, medications, and other interventions on the reverse side of the TCCC card.

Better: PFC Flowsheet

As a follow-on to the TCCC card, the PFC flowsheet is used to document trends over time and is the most useful tool to recognize important clinical changes in complex casualties such as decompensation, response to resuscitation, development of complications, effectiveness of medications, etc. The PFC flowsheet is one of the most effective ways to improve the level of care provided in PFC situations.

- When prehospital care transitions to PFC, documentation should transition from the TCCC card to the PFC flowsheet. There is no exact time for this transition to occur; however, once all of the available time blocks on the TCCC card are filled and evacuation to higher level of care is not imminent, then documentation can transition to the PFC flowsheet (Appendix B).
- The PFC flowsheet not only serves to document care and identify trends but also contains a checklist of interventions that may be needed through the included patient care and nursing care checklists. Such checklists can greatly aid task-saturated, fatigued Medics by providing a quick point of reference for important tasks that should be performed regularly to improve care and reduce the risk of complications to their patients.

- The PFC flowsheet also includes:
- Vital signs
- Fluid input and output
- Medication times, route, dose
- Physical exam findings
- Problem list
- Treatment plan
- Telemedicine call script

Best: AAR

- An AAR should be completed after patient handoff. In addition to the TCCC card and PFC flowsheet, a structured AAR is used to collect lessons learned and improve care. In cases where documentation is not able to be completed before patient handoff or was lost after handoff, the AAR can also serve as a supplement to the medical record.
- TCCC and PFC AARs are available at http://jts.health.mil/index.cfm/PI_CPGs/cpgs
- TCCC or PFC AARs, along with any medical documentation not completed before patient handoff, should be completed within 24 hours of patient handoff and summited to the Joint Trauma System (JTS) prehospital organizational email box: usarmy.jbsa.medcom-aisr.list.jts-prehospital@mail.mil
- The unclassified medical AAR should be accomplished in addition to unit-required classified AARs.