1. PFC Medical Planning

2. 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

3. 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,
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

4. Now on to the moving pieces…

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

6. Surgical Assets Type Of Team / Number Pax? Telephone /
Date Last checked
Radio Freq / Call Sign
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

7. CasEvac Platforms Type Vehicle / Aircraft / Location Telephone
Date Last called
Radio Freq / Call Sign
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

8. Strategic Evacuation Platforms
Type Vehicle / Aircraft /
Location
Telephone
Date Last called
Radio Freq / Call Sign
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

9. Refueling Stations / FARPs
Name
Telephone /
Date Last Checked?
By Whom?
Radio Freq / Call Sign
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

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

11. Facilities Name Telephone / Date Last Checked? By Whom?
Radio Freq / Call Sign
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

12. 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

13. 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

14. 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.

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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.