Battlefield Battlefield Documentation & Documentation & CommunicationCommunication

C168W035DEPARTMENT OF COMBAT MEDIC TRAINING

Accurate documentation may: 1. Prevent accidental medication overdose

• Alert the receiving MTF to special casualty wounds needing additional treatment

3. Provide a record of care already given

Regardless of the environment, documentation is an important component of

casualty care.

Given a battlefield casualty, complete battlefield communication and

documentation, IAW AR 40-66 Chapter 11 & 15 and

FM 4-02.2 Chapter 1 & 2.

Terminal Learning ObjectiveTerminal Learning Objective

Battlefield DocumentationBattlefield DocumentationWith the person next to you:

Discuss which of the following is the single most important reason to document medical treatment on

the battlefield?

Part of a Soldier's official and permanent medical record.

Informs staff of care provided to the casualty prior to arrival to the (MTF).

Prevent accidental medication overdose. Informs MTF to special casualty care needs.

May be used to record outpatient treatment when the medical record is not available.

Documentation Standards Vary

If all medical treatment MUST BE documented, how can the standards of medical

documentation vary?

What factors effect how we document medical treatment?

The tactical environment and supplies available require us to be flexible and resourceful.

What are some acceptable variations in casualty care documentation?

Battalion Aid Station or Aeromedical personnel usually consists of the SF 600.

Hospital personnel usually consists of computer based records.

DD Form 1380, Field Medical Card

TC3 Casualty Card

Documentation Standards Vary

Recording Medical Care

The same principles and rules concerning documentation

you learned during

EMT & LPCcontinue to apply on the battlefield.

Writ

e

Writ

e

legibly

legibly

Correct errors

Correct errors

appropriately

appropriately

Use only approved Use only approved abbreviationsabbreviations

Checking on your Learning…

Once you begin providing medical care for a casualty,

will you remain with that casualty until he reaches a doctor?

NO

What can disrupt your ability to thoroughly document medical care provided?

Field Medical Field Medical Card (FMC) Card (FMC)

There are 20 FMCs are in each blue book

Each card has an original and carbon copy Carbon protective sheet

Copper wire is attached to fasten card to casualty

Checking on your Learning…

What blocks are required?

1, 3, 4, 7, 9, and 11(134 people, at 7 o’clock, called 911)

What blocks are optional?

Everything else.

Who signs the FMC? You or a medical officer?

A Medical Officer

How and where do you show you wrote the card?

Initial the right side of Block 11

With the scenario provided in your

student handout,

complete casualty documentation on a FMC.

Keep in Mind…A stranger should have the ability to answer the following questions based on your documentation:

What happened to the casualty?

What treatment was given?

Approximately what time did all this occur?

Smith, RachelSmith, Rachel SPCSPC XX

234-56-6789234-56-6789 MPMP

XX

XX

XX

XX

XX

XX 5.0 mg5.0 mg 17351735 17251725Saline lockSaline lock

173017309494

GSW to Right anterior forearm. Loosened previously placed TQ & applied GSW to Right anterior forearm. Loosened previously placed TQ & applied pressure dressing – bleeding controlled. No other injuries noted.pressure dressing – bleeding controlled. No other injuries noted.

Breathing – 16, Pulse – 94, BP – 122/76 at 1730.Breathing – 16, Pulse – 94, BP – 122/76 at 1730.

Currently on antibiotics x2 days for “a cold”Currently on antibiotics x2 days for “a cold”

XX

PBPB

XX

GSWGSW

TC3 Casualty CardTC3 Casualty CardAddresses initial life saving interventions given at Addresses initial life saving interventions given at

the Point of Wounding.the Point of Wounding.

Used widely by Rangers and Special Operation Used widely by Rangers and Special Operation medics.medics.

Fill in the blanks Fill in the blanks are self-explanatoryare self-explanatory

Circle or X Last Treatment GivenCircle or X Last Treatment GivenProvide as m

uch

Provide as much

information as is

information as is

available at the tim

e of

available at the tim

e of

treatment

treatment

Rule of 9s

Rule of 9s

on picture

on picture

Your NameYour Name

Checking on your Learning…

Q: Who signs the TC3 Casualty Card?

A: The person providing care.

With the same scenario provided in your

student handout,

complete casualty documentation on a

TC3 Casualty Card.

Remember…What happened to the casualty?

What treatment was given?

Approximately what time did all this occur?

SPC Smith, RachelSPC Smith, Rachel

Today’s date and timeToday’s date and time

Saline Lock - 18 ga - L ACSaline Lock - 18 ga - L AC

Morphine – 5.0 mg Given @ 1735 - IVMorphine – 5.0 mg Given @ 1735 - IV

P. BradyP. Brady

Upon arrival, TQ in place – Loosened & Upon arrival, TQ in place – Loosened &

placed pressure dressing – bleeding controlled.placed pressure dressing – bleeding controlled.

Previous meds – antibiotics x2 days POPrevious meds – antibiotics x2 days PO

Previous Med Hx - ColdPrevious Med Hx - Cold

XX

17301730

AA

9494

1616

122/76122/76

GSW

GSW

Entrance

,

Entrance

,

no exit

no exit

Medical EvacuationWhen does medical evacuation begin?When medical personnel receive injured/ill Soldiers

When does medical evac end?As far rearward as the casualty's medical condition

warrants or the military situation requires

Medical Evacuation

The Senior Military Person/Tactical Leader

determines if a request for evacuation is made?

The tactical leader be notified of an evacuation need as soon as any casualty is identified

Precedence

The precedence assigned to the casualty provides the supporting medical unit and

controlling headquarters with info to determine?

Priorities for committing their evacuation assets.

The need flow, so resources will not be strained.

Over-classification

What is over-classification?To classify a wound as more severe than actuality.

With the person sitting next to you, determine why over-classification is a problem.

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.

Categories

Priority 1 Priority 1A UrgentUrgent Urgent SurgicalUrgent Surgical

Priority 2PriorityPriority

Priority 3RoutineRoutine

Priority 4ConvenienceConvenience

Urgent and Urgent Surgical

What are the considerations for priority 1?

Casualty requires evac within 1 hour:• To save life, limb or eyesight•  To prevent complications

• To avoid permanent disability

What distinguishes Urgent Surgical?Assigned to patients who must receive far-forward surgical intervention to save life and/or stabilize for

further evac.

Urgent

Examples Include (but are not limited to)

Severe Burns (especially to face, hands, feet or genitalia)

Any patient suffering from shock

Urgent Surgical

Examples Include (but are not limited to)

Uncontrollable bleeding (internal bleeding perhaps)

Major head trauma

Priority

What are the considerations for priority 2?

Personnel requiring prompt medical care and should be evacuated within 4 hours if:

• Medical condition could deteriorate to such a degree that casualty will become Urgent

precedence.• Special treatment not available locally.

• Casualty will suffer unnecessary pain or disability.

PriorityExamples Include

(but are not limited to)

Close chest wounds

Brief periods of unconsciousness

Abdominal injuries with no decreased BP

Eye injuries that do not threaten eyesight

Spinal injuries

Soft tissue injuries

Open or closed fractures

Routine

What are the considerations for priority 3?

Personnel requiring evacuation but whose condition is not expected to deteriorate significantly.

Casualty should be evacuated within 24 hours.

Examples Include (but are not limited to)

Dislocated Finger

Convenience

What are the considerations for priority 4?

Evacuation by medical vehicle is a matter of medical convenience rather than necessity.

Examples Include (but are not limited to)

Soldier has chronic lower back pain and must be evacuated to a facility that has MRI capabilities.

CASEVAC

The use of non-medical platforms of opportunity that are available to transport

casualties.

Medical personnel or supplies are NOT assigned to CASEVAC platforms.

- your unit may need to augment these platforms with supplies, CLS or a medic.

Unit Responsibilities

Units requesting evacuation have certain responsibilities in the overall evacuation

efforts.With the person sitting next to you and

the information in your student handout, choose the single most important

unit responsibility.(You have 2 minutes to discuss – be prepared to defend your answer.)

Checking on your Learning…

Q: What is the difference between MEDEVAC and CASEVAC?

 

Q: What are the types of precedence and maximum time for each?

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

9-Line MEDEVAC ReviewLines 1 thru 5

Line 1: Line 1: Location of pickup site.

Line 2: Line 2: Radio frequency, call sign and suffix.

Line 3: Line 3: Number of patients by precedence.

Line 4: Line 4: Special equipment.

Line 5: Line 5: Number of patients by type.

9-Line MEDEVAC ReviewLines 6 thru 9

Line 6: Line 6: At War: Security of pickup site At Peace # and type of wound or

illness

Line 7: Line 7: Method of marking pickup site

Line 8: Line 8: Patient nationality and status

Line 9: Line 9: At War: CBRN (NBC) contamination At Peace: Terrain

Checking on your Learning…

Properly demonstrate use of the word “break” when transmitting Line 3 with the following:

2 Urgent, 4 Priority, 1 Routine.

Line Tree – Alpha too, break, Charlie fower, break, Delta wun.

Checking on your Learning…

Which two lines change in wartime versus peacetime?

Line 6 and Line 9

During wartime, how should you communicate “no danger” of CBRN?

It is not necessary to explicitly communicate there is not a CBRN danger.

Omit Line 9.

Transmitting the MEDEVAC

Who’s information should be relayed in Line 2?

The individual to be contacted at pickup site.

What is the opening statement of a MEDEVAC request?

“I have a MEDEVAC request.”

Transmitting the MEDEVAC

At a minimum, which lines must be transmitted to get evacuation en-route?

Lines 1-5

How much time do you have to relay the first 5 lines?

25 seconds

Practical Exercise

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.

Practical Exercise 1 Solution

1. NH35971068

2. 37560, break Mad Dog 33

3. B-1, break D-1

4. A

5. L-1, break A-1

6. P

7. A

8. A, break B

Practical ExerciseYou 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.

Practical Exercise 2 Solution

1. NH46624912

2. 34900, break Mad Dog 42

3. A-2, break, B-1, break, C-1

4. A

5. L-4

6. N

7. C

8. A

SummarySummary

List different ways or tools to document casualty care on the battlefield?

DD Form 1380, Field Medical Card – StandardTC3 Casualty Card – Standard

Sharpie Marker on tape - NonstandardSharpie 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.

Questions?