Communication and Documentation


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Communication and Documentation

  1. 1. Battlefield Documentation & Communication C168W035 DEPARTMENT OF COMBAT MEDIC TRAINING
  2. 2. <ul><li>Accurate documentation may: </li></ul><ul><li>Prevent accidental medication overdose </li></ul><ul><li>Alert the receiving MTF to special casualty wounds needing additional treatment </li></ul><ul><li>3. Provide a record of care already given </li></ul><ul><li>Regardless of the environment, </li></ul><ul><li>documentation is an important component of casualty care. </li></ul>
  3. 3. <ul><li>Given a battlefield casualty, </li></ul><ul><li>complete battlefield communication and documentation , </li></ul><ul><li>IAW AR 40-66 Chapter 11 & 15 and FM 4-02.2 Chapter 1 & 2. </li></ul>Terminal Learning Objective
  4. 4. Battlefield Documentation <ul><li>With the person next to you: </li></ul><ul><li>Discuss which of the following is the single most important reason to document medical treatment on the battlefield? </li></ul><ul><li>Part of a Soldier's official and permanent medical record. </li></ul><ul><li>Informs staff of care provided to the casualty prior to arrival to the (MTF). </li></ul><ul><li>Prevent accidental medication overdose. Informs MTF to special casualty care needs. </li></ul><ul><li>May be used to record outpatient treatment when the medical record is not available. </li></ul>
  5. 5. Documentation Standards Vary <ul><li>If all medical treatment MUST BE documented, how can the standards of medical documentation vary? </li></ul><ul><li>What factors effect how we document medical treatment? </li></ul><ul><li>The tactical environment and supplies available require us to be flexible and resourceful. </li></ul>
  6. 6. <ul><li>What are some acceptable variations in casualty care documentation? </li></ul><ul><li>Battalion Aid Station or Aeromedical personnel usually consists of the SF 600. </li></ul><ul><li>Hospital personnel usually consists of computer based records. </li></ul><ul><li>DD Form 1380, Field Medical Card </li></ul><ul><li>TC3 Casualty Card </li></ul>Documentation Standards Vary
  7. 7. Recording Medical Care <ul><li>The same principles and rules concerning documentation </li></ul><ul><li>you learned during </li></ul><ul><li>EMT & LPC </li></ul><ul><li>continue to apply on the battlefield. </li></ul>Write legibly Correct errors appropriately Use only approved abbreviations
  8. 8. Checking on your Learning… <ul><li>Once you begin providing medical care for a casualty, </li></ul><ul><li>will you remain with that casualty until he reaches a doctor? </li></ul><ul><li>NO </li></ul><ul><li>What can disrupt your ability to thoroughly document medical care provided? </li></ul>
  9. 9. Field Medical Card (FMC) <ul><li>There are 20 FMCs are in each blue book </li></ul><ul><li>Each card has an original and carbon copy Carbon protective sheet </li></ul><ul><li>Copper wire is attached to fasten card to casualty </li></ul>
  10. 11. Checking on your Learning… <ul><li>What blocks are required? </li></ul><ul><li>1, 3, 4, 7, 9, and 11 </li></ul><ul><li>(134 people, at 7 o’clock, called 911) </li></ul><ul><li>What blocks are optional? </li></ul><ul><li>Everything else. </li></ul><ul><li>Who signs the FMC? You or a medical officer? </li></ul><ul><li>A Medical Officer </li></ul><ul><li>How and where do you show you wrote the card? </li></ul><ul><li>Initial the right side of Block 11 </li></ul>
  11. 12. <ul><li>With the scenario provided in your </li></ul><ul><li>student handout, </li></ul><ul><li>complete casualty documentation on a FMC. </li></ul><ul><li>Keep in Mind… </li></ul><ul><li>A stranger should have the ability to answer the following questions based on your documentation: </li></ul><ul><li>What happened to the casualty? </li></ul><ul><li>What treatment was given? </li></ul><ul><li>Approximately what time did all this occur? </li></ul>
  12. 13. Smith, Rachel SPC X 234-56-6789 MP X X X X X X 5.0 mg 1735 1725 Saline lock 1730 94 GSW to Right anterior forearm. Loosened previously placed TQ & applied pressure dressing – bleeding controlled. No other injuries noted. Breathing – 16, Pulse – 94, BP – 122/76 at 1730. Currently on antibiotics x2 days for “a cold” X PB X GSW
  13. 14. TC3 Casualty Card Addresses initial life saving interventions given at the Point of Wounding. Used widely by Rangers and Special Operation medics.
  14. 15. Fill in the blanks are self-explanatory Circle or X Last Treatment Given Provide as much information as is available at the time of treatment Rule of 9s on picture Your Name
  15. 16. Checking on your Learning… <ul><li>Q: Who signs the TC3 Casualty Card? </li></ul>A: The person providing care.
  16. 17. <ul><li>With the same scenario provided in your </li></ul><ul><li>student handout, </li></ul><ul><li>complete casualty documentation on a </li></ul><ul><li>TC3 Casualty Card. </li></ul><ul><li>Remember… </li></ul><ul><li>What happened to the casualty? </li></ul><ul><li>What treatment was given? </li></ul><ul><li>Approximately what time did all this occur? </li></ul>
  17. 18. SPC Smith, Rachel Today’s date and time Saline Lock - 18 ga - L AC Morphine – 5.0 mg Given @ 1735 - IV P. Brady Upon arrival, TQ in place – Loosened & placed pressure dressing – bleeding controlled. Previous meds – antibiotics x2 days PO Previous Med Hx - Cold X 1730 A 94 16 122/76 GSW Entrance, no exit
  18. 19. Medical Evacuation <ul><li>When does medical evacuation begin? </li></ul><ul><li>When medical personnel receive injured/ill Soldiers </li></ul><ul><li>When does medical evac end? </li></ul><ul><li>As far rearward as the casualty's medical condition warrants or the military situation requires </li></ul>
  19. 20. Medical Evacuation <ul><li>The Senior Military Person/Tactical Leader determines if a request for evacuation is made? </li></ul><ul><li>The tactical leader be notified of an evacuation need as soon as any casualty is identified </li></ul>
  20. 21. Precedence <ul><li>The precedence assigned to the casualty provides the supporting medical unit and controlling headquarters with info to determine? </li></ul>Priorities for committing their evacuation assets. The need flow, so resources will not be strained.
  21. 22. Over-classification <ul><li>What is over-classification? </li></ul><ul><li>To classify a wound as more severe than actuality. </li></ul><ul><li>With the person sitting next to you, determine why over-classification is a problem. </li></ul><ul><li>When properly classified, patients will be picked up as soon as logistically and/or tactically possible. Pick up consistent w/ available resources & pending missions. Those of greatest need are evacuated & receive care first ensure their survival. </li></ul>
  22. 23. Categories <ul><li>Priority 1 Priority 1A </li></ul><ul><li>Urgent Urgent Surgical </li></ul><ul><li>Priority 2 </li></ul><ul><li>Priority </li></ul><ul><li>Priority 3 </li></ul><ul><li>Routine </li></ul><ul><li>Priority 4 </li></ul><ul><li>Convenience </li></ul>
  23. 24. Urgent and Urgent Surgical <ul><li>What are the considerations for priority 1? </li></ul><ul><li>Casualty requires evac within 1 hour: </li></ul><ul><li>To save life, limb or eyesight </li></ul><ul><li>  To prevent complications </li></ul><ul><li>To avoid permanent disability </li></ul><ul><li>What distinguishes Urgent Surgical? </li></ul><ul><li>Assigned to patients who must receive far-forward surgical intervention to save life and/or stabilize for further evac. </li></ul>
  24. 25. Urgent <ul><li>Examples Include </li></ul><ul><li>(but are not limited to) </li></ul><ul><li>Severe Burns </li></ul><ul><li>(especially to face, hands, feet or genitalia) </li></ul><ul><li>Any patient suffering from shock </li></ul>
  25. 26. Urgent Surgical <ul><li>Examples Include </li></ul><ul><li>(but are not limited to) </li></ul><ul><li>Uncontrollable bleeding </li></ul><ul><li>(internal bleeding perhaps) </li></ul><ul><li>Major head trauma </li></ul>
  26. 27. Priority <ul><li>What are the considerations for priority 2? </li></ul><ul><li>Personnel requiring prompt medical care and should be evacuated within 4 hours if: </li></ul><ul><li>Medical condition could deteriorate to such a degree that casualty will become Urgent precedence. </li></ul><ul><li>Special treatment not available locally. </li></ul><ul><li>Casualty will suffer unnecessary pain or disability. </li></ul>
  27. 28. Priority <ul><li>Examples Include </li></ul><ul><li>(but are not limited to) </li></ul><ul><li>Close chest wounds </li></ul><ul><ul><li>Brief periods of unconsciousness </li></ul></ul><ul><ul><li>Abdominal injuries with no decreased BP </li></ul></ul><ul><ul><li>Eye injuries that do not threaten eyesight </li></ul></ul><ul><ul><li>Spinal injuries </li></ul></ul><ul><ul><li>Soft tissue injuries </li></ul></ul><ul><ul><li>Open or closed fractures </li></ul></ul>
  28. 29. Routine <ul><li>What are the considerations for priority 3? </li></ul><ul><li>Personnel requiring evacuation but whose condition is not expected to deteriorate significantly. </li></ul><ul><li>Casualty should be evacuated within 24 hours. </li></ul><ul><li>Examples Include </li></ul><ul><li>(but are not limited to) </li></ul><ul><li>Dislocated Finger </li></ul>
  29. 30. Convenience <ul><li>What are the considerations for priority 4? </li></ul><ul><li>Evacuation by medical vehicle is a matter of medical convenience rather than necessity. </li></ul><ul><li>Examples Include </li></ul><ul><li>(but are not limited to) </li></ul><ul><li>Soldier has chronic lower back pain and must be evacuated to a facility that has MRI capabilities. </li></ul>
  30. 31. CASEVAC <ul><li>The use of non-medical platforms of opportunity that are available to transport casualties. </li></ul><ul><li>Medical personnel or supplies are NOT assigned to CASEVAC platforms. </li></ul><ul><li>- your unit may need to augment these platforms with supplies, CLS or a medic. </li></ul>
  31. 32. Unit Responsibilities <ul><li>Units requesting evacuation have certain responsibilities in the overall evacuation efforts. </li></ul><ul><li>With the person sitting next to you and the information in your student handout, choose the single most important unit responsibility. </li></ul><ul><li>(You have 2 minutes to discuss – be prepared to defend your answer.) </li></ul>
  32. 33. Checking on your Learning… <ul><li>Q: What is the difference between MEDEVAC and CASEVAC? </li></ul><ul><li>  </li></ul><ul><li>Q: What are the types of precedence and maximum time for each? </li></ul>A: MEDEVAC has assigned medical resources. CASEVAC does not. Urgent & Urgent Surgical = 1 hour Priority = 4 hours Routine = 24 hours Convenience = at the unit’s convenience
  33. 34. 9-Line MEDEVAC Review Lines 1 thru 5 <ul><li>Line 1: Location of pickup site. </li></ul><ul><li>Line 2: Radio frequency, call sign and suffix. </li></ul><ul><li>Line 3: Number of patients by precedence. </li></ul><ul><li>Line 4: Special equipment. </li></ul><ul><li>Line 5: Number of patients by type. </li></ul>
  34. 35. 9-Line MEDEVAC Review Lines 6 thru 9 <ul><li>Line 6: At War: Security of pickup site </li></ul><ul><li> At Peace # and type of wound or illness </li></ul><ul><li>Line 7: Method of marking pickup site </li></ul><ul><li>Line 8: Patient nationality and status </li></ul><ul><li>Line 9: At War: CBRN (NBC) contamination </li></ul><ul><li> At Peace: Terrain </li></ul>
  35. 36. Checking on your Learning… <ul><li>Properly demonstrate use of the word “ break” when transmitting Line 3 with the following: 2 Urgent, 4 Priority, 1 Routine. </li></ul><ul><li>Line Tree – Alpha too, break, Charlie fower, break, Delta wun. </li></ul>
  36. 37. Checking on your Learning… <ul><li>Which two lines change in wartime versus peacetime? </li></ul><ul><li>Line 6 and Line 9 </li></ul><ul><li>During wartime, how should you communicate “no danger” of CBRN? </li></ul><ul><li>It is not necessary to explicitly communicate there is not a CBRN danger. </li></ul><ul><li>Omit Line 9. </li></ul>
  37. 38. Transmitting the MEDEVAC <ul><li>Who’s information should be relayed in Line 2? </li></ul><ul><li>The individual to be contacted at pickup site. </li></ul><ul><li>What is the opening statement of a MEDEVAC request? </li></ul><ul><li>“ I have a MEDEVAC request.” </li></ul>
  38. 39. Transmitting the MEDEVAC <ul><li>At a minimum, which lines must be transmitted to get evacuation en-route? </li></ul><ul><li>Lines 1-5 </li></ul><ul><li>How much time do you have to relay the first 5 lines? </li></ul><ul><li>25 seconds </li></ul>
  39. 40. Practical Exercise <ul><li>A vehicle in your small convoy was hit by an IED. One US Soldier and one embedded reporter are casualties. One you deem urgent surgical needing evacuation by litter, the second is ambulatory and you categorize as routine. Your frequency is 37560, call sign Mad Dog 33, location NH35971068. No special equipment is necessary. There may be enemy in the area and you have panels to mark the location. </li></ul>
  40. 41. Practical Exercise 1 Solution <ul><li>NH35971068 </li></ul><ul><li>37560, break Mad Dog 33 </li></ul><ul><li>B-1, break D-1 </li></ul><ul><li>A </li></ul><ul><li>L-1, break A-1 </li></ul><ul><li>P </li></ul><ul><li>A </li></ul><ul><li>A, break B </li></ul>
  41. 42. Practical Exercise <ul><li>You have been directed to relay a MEDEVAC request for the four injured US Solders currently en route to the MEDEVAC pick up site. You have been told there are 2 urgent, 1 priority and 1 urgent surgical. All four are litter bound. Smoke will be used to mark the pick up site which is considered secure. Call Sign: Mad Dog 42. Your Frequency: 37500. Your Current Location: NH48734972. Call Sign of the requesting Medic currently evacuating the patients: MV45. Frequency of the requesting unit: 34900. Patient/MEDEVAC Location: NH46624912. The unit did not request any special equipment. </li></ul>
  42. 43. Practical Exercise 2 Solution <ul><li>NH46624912 </li></ul><ul><li>34900, break Mad Dog 42 </li></ul><ul><li>A-2, break, B-1, break, C-1 </li></ul><ul><li>A </li></ul><ul><li>L-4 </li></ul><ul><li>N </li></ul><ul><li>C </li></ul><ul><li>A </li></ul>
  43. 44. Summary List different ways or tools to document casualty care on the battlefield? DD Form 1380, Field Medical Card – Standard TC3 Casualty Card – Standard Sharpie Marker on tape - Nonstandard Sharpie Marker on the skin – Nonstandard What is the #1 goal of battlefield documentation? Provide written record of findings & treatment. You will NOT accompany casualties through evacuation system; documentation is necessary to tell others what you found and did.
  44. 45. <ul><li>Questions? </li></ul>