PFC Medical Planning

Couldn’t get a ventilator to bring? Use the 10 Capabilities Grid to Figure out what capability you are deficient on and then Identify what asset in your AO has it available. Couldn’t get a ventilator to bring? Make finding one a priority in your planning and note it on your grid and map

10 Essential PFC Capabilities 1. Monitoring 2. Resuscitate 3. Ventilate and oxygenate 4. Control the Airway 5. Sedation and Analgesia 6. Physical Exam and Diagnostics 7. Nursing and Hygeine 8. Surgical Interventions 9. Telemedical Consult 10. Package and Prepare for flight Minimum BP Cuff, Stethescope, Pulse Ox, Foley Fresh Whole Blood Kit Bag-Valve-Mask with PEEP Valve Awake Ketamine Cric Opiate Analgesics titrated through IV Physical Exam without advanced clean, warm, dry, padded, catheterized Chest tube, cric Make comms, present patient and key vitals Be familiar with stressors of flight Better Capnometry 2-3 cases of LR for Burn Resus O2 Concentrator Long duration sedation Sedation with Ketamine/option of midazolam Ultrasound and point of care labs Elevate head of real beddebride, washout NG/OG Fasciotomy debridement, amputation Add labs and ultrasound video Trained in critical care transport Best Vital Signs Monitor PRBS, FFP, Type specific donors Portable Ventilator Proficient in Rapid Sequence Intubation Educated and practiced imulti drug sedation Experienced and trained in above Experienced in all nursing care concerns Trained and experienced in above Real time video conference Experienced in critical care transport Ruck Pulse Ox, Head Lamp 1 FWB Kit per man, 2 250cc bag NS BVM with PEEP Valve Cric Kit, LMA/SGA, lidocaine and ketamine IM Fentanyl TML, Perc PO, Ketamine IM/ IV Urinalysis test strips, fluorescein strips Compct Foley kit, Sterile kerlix, litter padding Cric, 10gNeedle D Scalpel Cell Phone and call sheet Have checklist available Truck BP Cuff, Stethescope, capnometry, small monitor Casre LR, Additional FWB Kits, 3% Saline SAVent or SAVE 2 RSI, LMA/SGA, Cric kit ketamine bag IV Ketamine IV with midazolam Blood tubes to drop off labs at HN clinic on the way Padded litter, NG, Sterile Chest Tube Kit with drapes Cell phone and call sheet, sat phone, radio Checklist plus flight evac kit House Add defibrillation 2 additional cases LR, Case NS, Additional 3% Saline No Ventilator; Available with SURG team at capitol All from above Add Benzo if not available for truck Same as above No Lab capability; Available with SURG team at capitol Real matress with head elevated, nursing care kit sleeping bg Sterile Surgical Kit with Drapes, Gowns and scrub soap Secure comms, email Extensive evac kit Plane Take all of above All of above SAVent on O2 All above calculate for flight and double All above calculate for flight time and double Padded Litter, Sleeping Bag 10g needle D Chest tube kit Cric kit Through aircraft From Above

Now on to the moving pieces…

Team Members/ Organic Assets Type and Name Telephone Radio Freq / Call Sign eMail Medical Capabilities Limitations Special Equipment Senior Medic: John Smith +27 456-345-6789 18D1 Junior Medic: RFR: TCCC/MARCH: CLS First Aid/Buddy Aid NO MEDICAL TRAINING (liabilities)

Surgical Assets Type Of Team / Number Pax? Telephone / Date Last checked Radio Freq / Call Sign eMail Blood Available? Highest Trained Person Surgical Capabilities Surgical Limitations Able to Travel? How Far? With whom? Battalion FAS FWB Kits SOST MFST CSH Local Surgeon

CasEvac Platforms Type Vehicle / Aircraft / Location Telephone Date Last called Radio Freq / Call Sign eMail Capablities / Distance / Speed / Equipment Limitations (Contract, Weather etc..) Military or Civilian? Country of Origin? Medic On Board? Contract Info Distance, Cash Other Good to Know Info Razor / ATV Team Truck HN Ambulance Civilian Helo Casa 212 Twin Otter Cessna

Strategic Evacuation Platforms Type Vehicle / Aircraft / Location Telephone Date Last called Radio Freq / Call Sign eMail Capablities / Distance / Speed / Equipment Limitations (Contract, Weather etc..) Military or Civilian Contract Info Distance, Cash Other Good to Know Info C-146 C-130 C-17 Civilian Air Evac

Refueling Stations / FARPs Name Telephone / Date Last Checked? By Whom? Radio Freq / Call Sign eMail Location Country / State / City / Address / Grid Manned? Limitations Evaluation Last Done. By whom? Other Good to Know Info MSS 1 MSS 2 Airstrip A Airstrip B Main Airport FARP I FARP II

Telemedicine Contacts Who Telephone / Date last checked Radio Freq / Call Sign eMail Last time checked? By whom? Level of Training / Specialty Location

Facilities Name Telephone / Date Last Checked? By Whom? Radio Freq / Call Sign eMail Location Country / State / City / Address / Grid Capabilities Surg? Blood? Imaging Limitations Evaluation Last Done. By whom? Other Good to Know Info MSS 1 MSS 2 Team House / Aid Station Battalion FAS CSH Local Clinic Local Hospital

Add Regional Map And Locations Clinic Coalition Med Facility / Team Host Nation Med Facility Air Port / Landing Strip Team Houses / Bases H LZ / FARP MSS 600km LZ 143 C-130 600km Range / Distance Scale

Add Local Map and Locations Clinic Coalition Med Facility / Team Host Nation Med Facility Air Port / Landing Strip Team Houses / Bases H LZ / FARP MSS H 50 km LZ 143 MI 17 Helo 50km Range / Distance Scale

Refer to the example in each section as guidance. The first shaded block on the left is for the unit. In this example are the minimum requirements needed (ie, Medical Capabilities, CASEVAC Platforms, PACE Plan and Considerations) Refer to the example in each section as guidance. Medical Capabilities: Information will focus to care beyond the capabilities of SF/SOF medic The phrase “Self aid/buddy aid” and “all team members are TCCC qualified” are unacceptable. This statement is already assumed. Refer to #1. Designated numbers/letters within this block will correspond throughout the plan. Only ID what and where the assets are located. CASEVAC PLATFORM: Consideration should be given to infill aircraft? Can they loiter if immediate exfil is needed? Include all air assets intended to use in CASEVAC plan (Contract Aviation, Personal Recovery, SOCAF owned, Coalition and HN (if feasible)). Consideration should be given to platform’s spin up and launch times over the geographical distance as well as the platforms limitations ie. night vision capable, spin up times, ability to land on improved/ unimproved surfaces and distances. This needs to be captured in a narrative portion of the plan and depicted graphically on the map. PACE PLAN: Best plan to reach DCS and/or ER- “Bang =>Fix” “P” “A””C””E” will be colored coded and correspond with MRS (medical risk scale) Example: “P” is 6 hours, the color designation would be orange. “A” is 9 hours, the color designation would be amber “C” is 4 hours, the color designation would be green “E” is 12 hours, the color designation would be red POI/Physical place (Bang) or area you move the patient to EVAC (Fix). this locale can be on the OBJ, Team House, AF to launch from, or a hasty HLZ POI -> next level of care Minimum information: Flight time and distance (NM)] 243NM 1h 00m Accumulated times will include posture and patient transfer Total times will reflect MRS [POI/or launch] to ERST-DCST [DCS] Considerations: Highlight relevant issues not noted “Driving through Nairobi at night will affect patient transportation to AGA KHAN “Pilots are not NVG qualified to fly at night” Relevant facts to this specific mission What are the refuel times if you have to “lily pad” across to your next destination? What are your patient transfer times? Expect changes due to operational needs Medical Risk Scale: This is in reference to your BEST plan; which is your “P.” “ER” is your primary ER “DCS” is your primary DCS Phone numbers: Order of precedence of phone numbers is referenced above. Split up in 2 sections: Internal/External Internal should be “down and in” External should be “up and out” Phone numbers should be limited due to the SOCFWD JOC’s and the Surgeons will coordinate follow on care. Definitions: ER – Emergency Room is a facility/location that is able to stabilize a patient prior to surgery. It’s also a capability above the tactical element (ex: TCCET, MOG UN ER, CCET, SOST) DCS- Damage Control Surgery is the rapid initial control of hemorrhage and contamination with packing and a temporary closure.

The only acceptable CASEVAC/CONOP slide as of 08 Feb 2017 Several areas all working together to interpret risk and coordination of further care Simplified from previous Amalgamation of varying input from SF/SOF PAs, Surgeons, and medics that were rotating through. Each commander and unit have their own spice they want to add Ground truth What's important Create a story line for your evacuation

Medical/CASEVAC CONOP slide Why Amount of force providers rotating Different medical plans Lack of research Mutual support Other COCOM priorities Squeezing the balloon True purple environment. Numerous units with different philosophies on how to handle the challenges of the tyranny of distance No one cross talking Education of our invested leaders Primary problem was the shortage of CASEVAC platforms compounded by the lack of surgical assets Priorities of limited surgical and CASEVAC platforms going to other COCOMS Enemy disposition “Squeezing the balloon” Squeeze one area, it’ll flex in another area Increase of enemy activity from other theaters Perfect breeding ground

Header/top of slide Classification noted Country of operations. If it’s multiple countries, use SOCFWD flag SOCAFRICA flag on the right Title will be Operation/Team name MEDEVAC or CASEVAC CONOP At the top right place your classification If your operation is in multiple countries use your SOCFWD flag SOCAFRICA flag will be on the right Where the “MEDEVAC/CASEVACE CONOP TEACHING SLIDE” is at you will put either: Your operation with the name CASEVAC SLIDE ex: Bubble Bee Tuna CASEVAC CONOP

Medical Capabilities Focus to care is beyond the capabilities of SF/SOF medic “Self aid/buddy aid” and “all team members are TCCC qualified” are unacceptable - already assumed. Underwear goes on the inside. Designated numbers/letters within this block will correspond throughout the plan. Triangle will correspond with the medical risk scale at the bottom and the map The circled numbers will correspond where on the map they are located

CASEVAC PLATFORM: Thought should be given to infil and exfil platform. Can they loiter if immediate exfil is needed? Include all platforms intended to be used in CASEVAC plan (Contract Aviation, Personal Recovery, SOCAF owned, Coalition and HN (if feasible). What is your platform’s spin up and launch times over the geographical distance?, Thought to platforms ability to land on improved/ unimproved surfaces and travel time and speed. This needs to be captured in a narrative portion of the plan and depicted on the map to the right. Different approaches to your PACE plan/CASEVAC PLATFORM Platform can be FW/RW or truck These letters and colors need to be associated on the map to the right

PACE OPTIONS A coherent application of assets available to you A clear understanding of what you will be doing. Explain to your commander how you will evacuate your teammate

Considerations & Limitations Highlight relevant issues not noted “Driving through Nairobi at night will affect patient transportation to AGA KHAN “Pilots are not NVG qualified to fly at night” Relevant facts to this specific mission What are the refuel times if you have to “lily pad” across to your next destination? What are your patient transfer times? Expect changes due to operational needs Relevant facts Do not overload your considerations There will be standards for Africa ex: Host nation blood

Medical Risk Scale This is in reference to your BEST plan; which is your “P.” “ER” is your primary ER “DCS” is your primary DCS Definitions: ER – Emergency Room is a facility/location that is able to stabilize a patient prior to surgery. It’s also a capability above the tactical element (ex: TCCET, MOG UN ER, CCET, SOST) DCS- Damage Control Surgery is the rapid initial control of hemorrhage and contamination with packing and a temporary closure. One of the most important portions of the slide <4 hours is a combination What the AFRICOM Commander will accept as risk Based upon the Kyle N. Remick, MD, et al. article in the Journal of Trauma Acute Care Surgery 3) Where are your closets American Asset at

MAP This is a pictorial representation of all the information we had on the left translated onto the map A visual for your information Should systematically match what you have on the left The Blue triangles connote where your closets American DCS and ER assets are located and matches your medical risk scale Visual representation of your CASEVAC plan you had laid out on the left side. You shouldn’t overload your visual representation. Be brief KISS method

CONTACT INFORMATION Order of precedence of phone numbers Clear and concise Split up in 2 sections: Internal/External Internal should be “down and in” External should be “up and out” Phone numbers should be limited due to the SOCFWD JOC’s and the Surgeons will coordinate follow on care. Relationship needs to be established with your SOCFWD Surgeon/planner The Surgeon and planner will be the conduit for your needs “Up and out” which is your internal contacts “down and in” which is your external contacts

Refer to the example in each section as guidance. The first shaded block on the left is for the unit. In this example are the minimum requirements needed (ie, Medical Capabilities, CASEVAC Platforms, PACE Plan and Considerations) Refer to the example in each section as guidance. Medical Capabilities: Information will focus to care beyond the capabilities of SF/SOF medic The phrase “Self aid/buddy aid” and “all team members are TCCC qualified” are unacceptable. This statement is already assumed. Refer to #1. Designated numbers/letters within this block will correspond throughout the plan. Only ID what and where the assets are located. CASEVAC PLATFORM: Consideration should be given to infill aircraft? Can they loiter if immediate exfil is needed? Include all air assets intended to use in CASEVAC plan (Contract Aviation, Personal Recovery, SOCAF owned, Coalition and HN (if feasible)). Consideration should be given to platform’s spin up and launch times over the geographical distance as well as the platforms limitations ie. night vision capable, spin up times, ability to land on improved/ unimproved surfaces and distances. This needs to be captured in a narrative portion of the plan and depicted graphically on the map. PACE PLAN: Best plan to reach DCS and/or ER- “Bang =>Fix” “P” “A””C””E” will be colored coded and correspond with MRS (medical risk scale) Example: “P” is 6 hours, the color designation would be orange. “A” is 9 hours, the color designation would be amber “C” is 4 hours, the color designation would be green “E” is 12 hours, the color designation would be red POI/Physical place (Bang) or area you move the patient to EVAC (Fix). this locale can be on the OBJ, Team House, AF to launch from, or a hasty HLZ POI -> next level of care Minimum information: Flight time and distance (NM)] 243NM 1h 00m Accumulated times will include posture and patient transfer Total times will reflect MRS [POI/or launch] to ERST-DCST [DCS] Considerations: Highlight relevant issues not noted “Driving through Nairobi at night will affect patient transportation to AGA KHAN “Pilots are not NVG qualified to fly at night” Relevant facts to this specific mission What are the refuel times if you have to “lily pad” across to your next destination? What are your patient transfer times? Expect changes due to operational needs Medical Risk Scale: This is in reference to your BEST plan; which is your “P.” “ER” is your primary ER “DCS” is your primary DCS Phone numbers: Order of precedence of phone numbers is referenced above. Split up in 2 sections: Internal/External Internal should be “down and in” External should be “up and out” Phone numbers should be limited due to the SOCFWD JOC’s and the Surgeons will coordinate follow on care. Definitions: ER – Emergency Room is a facility/location that is able to stabilize a patient prior to surgery. It’s also a capability above the tactical element (ex: TCCET, MOG UN ER, CCET, SOST) DCS- Damage Control Surgery is the rapid initial control of hemorrhage and contamination with packing and a temporary closure.