CASEVAC and Casualty Documentation PFN: SOMEML08. Terminal Learning Objective. References. Hours: 1.0 Instructor:

Transcription

1 CASEVAC and Casualty Documentation PFN: SOMEML08 Hours: 1.0 Instructor: Slide 1 Terminal Learning Objective Action: Communicate knowledge of CASEVAC and casualty documentation Condition: Given a lecture in a classroom environment Standard: Received a minimum score of 75% on the written exam IAW course standards Slide 2 References AR Medical Record Administration and Health Care Documentation FM Medical Evacuation in a Theatre of Operations, Tactics, Techniques and Procedures FM Medical Evacuation STP 8 68W13 SM TG Soldiers Manual and Trainer s Guide Slide 3 1

2 Reason Slide 4 Agenda Define and differentiate between CASEVAC, MEDEVAC, and TACEVAC Describe the procedures for requesting casualty evacuation Describe the process of documenting casualty information Define the 4 roles of military care Slide 5 Define and differentiate between CASEVAC, MEDEVAC, and TACEVAC Slide 6 2

3 MEDEVAC Clearly marked medical platform Medical personnel and supplies onboard Configured to receive patients Not allowed to be armed or render lethal aid under the Geneva convention Slide 7 CASEVAC and TACEVAC CASEVAC Casualty Evacuation The Unregulated (by the Geneva Convention) movement of casualties. Does not have to be on a strictly medical platform (gun truck, LMTV, MRAP, armed aircraft, etc) Is not marked as a medical platform, and can there fore render lethal aid TACEVAC Tactical Evacuation Blanket Category that includes booth CASEVAC and MEDEVAC The current language used by the TCCC committee Denotes any and all transport that evacuates a PT in a tactical situation. Intended as a blanket term allaying confusion on what is MEDEVAC vs. TACEVAC Slide 8 Decision to MEDEVAC/CASEVAC Made by the Senior Military Person Present Decision based on mission requirements, tactical situation and the advice and input of the senior medical provider Slide 9 3

4 Describe the procedures for requesting casualty evacuation Slide 10 Basic 9 Line Format Line 1: Location Line 2: Radio Freq/Call Sign Line 3: Number of Patients by Precedence Line 4: Special Equipment Line 5: Number of Patients by Type Line 6 (Wartime): Security Line 6 (Peacetime) Type of Injury Line 7: Method of Marking Line 8: Patient Nationality and Status Line 9 (Wartime): NBC Line 9 (Peacetime): Terrain description Slide 11 Line 1 2 (LINE 1) Location of Pickup Site Grid zone designator, map sheet number, and six digit grid Codename (LINE 2) Radio Frequency and Call Sign Frequency/Call sign for the unit on the ground with the casualty Slide 12 4

5 Line 3 (LINE 3) Number of Patients by Precedence A = Urgent: 2 Hours to save life, limb or eyesight B = Urgent Surgical: Forward surgical intervention required to save life or permit survival along evacuation chain C = Priority: 4 Hours D = Routine: 24 Hours E = Convenience: Slide 13 Slide 14 Line 4 (LINE 4) Special Equipment Required Ventilator Extraction devices (Jungle Penetrator, other hoisting equipment, etc.) Use applicable Brevity Codes A None B Hoist C Extraction equipment D Ventilator Slide 15 5

6 Line 5 (LINE 5) # of Patients by Type Ambulatory versus litter Critical for sending correct number and type of EXFIL platforms with proper configuration Utilize applicable Brevity Codes L Litter patient A Ambulatory patient Slide 16 Line 6 (LINE 6) Wartime: Security of Pickup Site Encrypt applicable Brevity Codes N No enemy troops in area P Caution: Enemy contact unlikely E Caution: Enemy contact possible X Danger: Active enemy in area Slide 17 Line 6 (LINE 6) Peacetime: Wound, Injury or Illness Spins up the appropriate personnel and equipment Smart guys might bring something you forgot to request Provide specific wound(s) information Blunt or penetrating, GSW, shrapnel, MVA Patient s blood type if known Slide 18 6

7 Line 7 (LINE 7) Method of Marking Pickup Site Day: Panels, smoke (You pop, He identifies color, You confirm) Night: Pyrotechnics, chemlights, strobe etc. Whatever you use, make sure you perform a functions check and secure it to the PZ if necessary Utilize applicable Brevity Codes A Panels, B Pyro, C Smoke, D None, E Other Slide 19 Line 8 (LINE 8) Patient Nationality and Status Friendly INDIG Versus Enemy INDIG Utilize applicable Brevity Codes A US military B US civilian C Non US military D Non US civilian E EPW Slide 20 Line 9 (LINE 9) Wartime: NBC Contamination Utilize applicable Brevity Codes N Nuclear B Biological C Chemical (LINE 9) Peacetime: Terrain Description Trees, wires, slope of terrain Can use major terrain feature for PZ ID Slide 21 7

8 MIST Report Given with 9 line request Provides additional information on patient s condition M Mechanism of injury and time of injury I Injury or illness S Symptoms and vital signs T Treatment given Slide 22 Describe the process of documenting casualty information Slide 23 Facts 30,000 Wounded in Action in OEF/OIF Less than 10% have any form of prehospital documentation In only 1% of cases is the information sufficient Home grown formats were used in many cases of successful documentation Slide 24 8

9 Why Document? Transfer critical patient information to the next provider Legal record of care/potential disability benefits post service Gather data to enhance training and equipment for the pre hospital provider Slide 25 DD Form 1380 Field Medical Card (FMC) Slide 26 Tactical Combat Casualty Care (TCCC) Card DA Form 7656 Slide 27 9

10 TCCC Card 2014 Version Slide 28 Scenario While on a vehicle patrol, the second vehicle in your movement hits an IED while moving at 25 mph. It is The driver is killed and Joe your commo man is thrown 20 feet from the vehicle. He has no allergies. He has a lower left leg amputation, shrapnel to right posterior shoulder and neck, and his airway is compromised. You cric him on the scene. At 0205 you treat the amputation with a tourniquet and stump dressing. You give him 500 ml Hextend IV. Slide 29 Scenario Continued You administer 50 mg Ketamine IN at 0230 You administered 1 gm Ertapenem IV at 0230 Vitals were taken at 0210 and 0232, patient was responsive to pain on both occasions. Pulse was 120 and strong on both readings. Respirations were 18 S/R, and Pt had palpable radial pulses on 2 nd reading after Hextend administration. Patient was evacuated at Slide 30 10

11 Slide 31 Slide 32 Verbal Handoff What on this card should be included in a verbal handoff to evacuation personnel? How would you conduct a handoff if you didn t have time for written documentation? Slide 33 11

12 Define the 4 roles of military care Slide 34 Multi Tiered System "Roles" 1 through 4 Covers point of injury through definitive care, and every step in between No tier will be skipped unless strictly for reasons of medical expediency Same system utilized throughout DOD, but with different actual unit structures Slide 35 Role 1: 1 st Responder throughbn Aid Station INTENT: Stabilize as permitted by organic capabilities and evacuate rapidly. 1 st echelon of Care Medic/Corpsman, 18D/SOCM, PA No definitive surgical capability Extremely limited Patient hold capability Conventional: Typically a Bn Aid station SOF: medical capabilities at team level are essentially Role 1 care Slide 36 12

13 Role 2: Furthest Forward Primary Care INTENT: Provide primary care to assigned forward deployed unit, stabilize combat casualties within organic capabilities. PA/medics Brigade level asset (Army) means different things to different services May include X ray, dental, preventive med, laboratory. Has blood products, capable of advanced trauma management Limited patient hold. Slide 37 Role 2: Cont. NATO doctrine includes damage control surgery as a role 2 capability, US doctrine does not. HOWEVER US Navy has surgical capability (shipboard platform) organic to role 2, USMC has integrated capability. US Air Force has both a surgical role 2 and stand alone surgical capability US Army compartmentalizes between the medical company (non surgical role 2) and the stand alone Forward Surgical Team. Slide 38 Forward Surgical Team INTENT: Deploy damage control surgery capability as far forward as possible. Stand along surgical capability Mobile team, requires support: power, water, etc. Slightly different structures for different services, same essential objective Ideally housed in a role 2 facility, upgrading the role 2 for a true surgical capability Slide 39 13

14 Role 3: Short Term Definitive Care INTENT: Definitive (surgical) treatment followed by either RTD or further evacuation. Surgery capable definitive care facility with large patient hold capacity. Gets a solid patient disposition, then sends patient back to unit for light duty etc. or CONUS for advanced follow on care. Typical patient dwell time 1 week or less. Slide 40 Role 4: CONUS or Allied Country Care INTENT: Provides full spectrum medical services in the environment of first world care. Role 4 medical care is found in CONUS based hospitals and other safe havens. Mobilization requires expansion of military hospital capacities and the inclusion of the Department of Veterans Affairs and civilian hospital beds in the National Disaster Medical System to meet the increased demands created by the evacuation of patients from the area of operations. Emergency War Surgery Handbook Slide 41 SOF vs. Conventional Forces SOF Supported as Mission dictates. May be supported by conventional forces, may build a completely different network. Call goes to HQ element (sometimes), and is routed as mission dictates Support structure changes radically with mission and location. You might have to build your own support. Conventional Has doctrinally set support structures that fit within the organization's doctrinal role. Patient doctrinally goes to role 1 and progresses up the chain TO&Es are always there Slide 42 14

15 Questions? Slide 43 Agenda Define and differentiate between CASEVAC, MEDEVAC, and TACEVAC Describe the procedures for requesting casualty evacuation Describe the process of documenting casualty information Define the 4 roles of military care Slide 44 Reason Slide 45 15

16 References AR Medical Record Administration and Health Care Documentation FM Medical Evacuation in a Theatre of Operations, Tactics, Techniques and Procedures FM Medical Evacuation STP 8 68W13 SM TG Soldiers Manual and Trainer s Guide Slide 46 Terminal Learning Objective Action: Communicate knowledge of CASEVAC and casualty documentation Condition: Given a lecture in a classroom environment Standard: Received a minimum score of 75% on the written exam IAW course standards Slide 47 CASEVAC and Casualty Documentation PFN: SOMEML08 Hours: 1.0 Instructor: Slide 48 16