1. Effective Medic-ing Through Documentation
What I hope to add to your toolbox:
Using documentation throughout a PFC scenario
Trending to anticipate
Why good doctors appear lazy and you should too
Share your mental model and Lead
Identifying injuries and making a plan
Implementing a care plan
Medical Checklists

14. A B C TACTICAL CASUALTY RESPONSE – PROLONGED CARE DOCUMENTATION Kat.:
NAME
FIRST NAME
DATE OF BIRTH
MALE
FELMALE
adress /
BODY-WEIGHT KG
health - insurance
TIME OF INJURY
Date and Time
POINT
OF INJURY
MECHANISM
TREATMENT FACILITY
MEDIC NAME
TELEMED
POINT OF CONTACT
PATIENT / INCIDENT HISTORY:
INITIAL VITAL PARAMETERS
A V P U
Resp. Rate
/min.
Pulse
SpO2 % BP
mmHG
MASCAL
Casualty-Nr.:
INITIAL TREATMENT
INJURIES
TBI
EYE – INJURY
AIRWAY OBSTR.
BLEEDING
ART. BLEEDING
AMPUTATION
FRACTURE (OPEN/CLOSE)
BURNS
HEMATOMA
EYE SHIELD
OPA / NPA
LARYNX-TUBE
CRIC
NEEDLE DECOMPRESSION
CHEST SEAL /-DRAIN
BANDAGE
I.V. / I.O. ACCESS
TOURNIQUET
WOUND PACKING
HEMOSTATIC AGENT
BURNS TREATMENT
SPLINT
Precedence
Kat.:
90 min. Role 2 or 3 A
URGENT
4 hrs. Role 2 or 3
PRIORITY B
24 hrs. Role 2 or 3 C
ROUTINE
TQ Time
ND Time
MEDICATION

15. TACTICAL CASUALTY RESPONSE – PROLONGED CARE DOCUMENTATION
DATE:
TIME OF ACTION
A V P V / Kat A B C /
RespRate (spont./ventilator) /min.
Ventilator Vol. ( l/ min.)
Ventilator Pressure ( mbar ) / PEEP
RESPIRATORY SOUNDS (stethoskop)
SpO2 (%)
PULSE (measuerement point) /min.
BLOOD PRESSURE ( xx/yy mmHg )
BODY- CORE – TEMP. ( °C / °F )
PMS (perfusion / motoric / sensitivity)
ACTIONS TAKEN:
OXYGEN - INHALATION ( l/ min.)
FLUID IN
(Type ?)
p.o.
i.v.
i.o.
FLUID OUT
ANALGESIC
i.m.
ANTIBIOTIC
Other MED. (Type / mg / i.v. i.o. p.o.)
TQ release / replacement time
BANDAGE change / clean wounds
CATHETER / TUBE desinfection
Splinting / check SPLINT
WASH Patient / Tooth-brush
POSITIONING
HYPOTHERMIA - PREVENTION
TELEMED
OTHER
TREATMENT FACILITIY
MEDIC NAME
°C / °F
NAME OF PATIENT
ROOM TEMPERATURE

18. - “ PCN Blast/ Shrapnel Sucking Cx Wound R side Occlusive/ Needle D R
Smith, John
1234
8 June
1030 31
B Neg
PCN
Blast/ Shrapnel
Sucking Cx
Wound R side
Occlusive/
Needle D R
mid ax
N/A
1300
yellow R
1230
120
300
Dark Red
Tea
1530 15
1800
Dark yellow
Clear
Cloudy 50
16 F “
2000
Ammonia -
Thick
36 F
2030 20
1430
200
100
Pt sustained 3 x 1cm wound
from mortar shrapnel in upper
right chest from blast 50 feet
away, partially shielded by a
wall. Pt was not wearing
armor or helmet. No exit
wound, No other injuries.
Neuro exam unremarkable.
2015- Muffled Heart Tones,
Narrowing pulse pressures
FWB units IV L AC
Invanz 1g IV L AC
Fentanyl800mcg OTM Mouth
Ketamine 20mg IM L Shoulder
Ketamine Drip IV L AC
Versed Drip IV L AC
TXA gm IV R AC
1415
13.0 41
130K
96.2
0.02
139.5
3.75
2.30
105
7.28
48.2
332
27.5
22.0
+2.2 72
1.2 78
1700
14.8 45
180K
97.4
0.09
142.3
4. 22
2.36
7,34
46.4
35.1
25.3
23.2
74.3
.94

19. x 11 12 13 14 15 16 17 18 19 20 00 30 45
99.2
98.5
98.0
97.7
97.4
97.1
96.8
96.9
97.2
97.5
97.9
98.1
98.2
97.8 2 5 7 4 3
120 25 35 50 40
Cx tUBE
300
250
200
150
100 80 60
Foley

20. Tips When Trending
If you are manually trending vital signs stand back and look at what is going on with your patient
-Does it match his clinical appearance?
-Does it matter in that case?

21. Tips When Trending
If you are manually trending vital signs stand back and look at what is going on with your patient
-Does it match his clinical appearance?
-Does it matter in that case?
Anticipate what is happening and devise a plan

22. Tips When Trending
If you are manually trending vital signs stand back and look at what is going on with your patient
-Does it match his clinical appearance?
-Does it matter in that case?
Anticipate what is happening and devise a plan
Teleconsult before there is an emergency

23. Tips When Trending
If you are manually trending vital signs stand back and look at what is going on with your patient
-Does it match his clinical appearance?
-Does it matter in that case?
Anticipate what is happening and devise a plan
Teleconsult before there is an emergency
Create a threshold or red flag as to when you will act and share them
-Mark them on the chart

24. x 11 12 13 14 15 16 17 18 19 20 00 30 45
99.2
98.5
98.0
97.7
97.4
97.1
96.8
96.9
97.2
97.5
97.9
98.1
98.2
97.8 2 5 7 4 3
120 25 35 50 40
Cx tUBE
300
250
200
150
100 80 60
Foley
Threshold or Red Flag
to initiate treatment
drawn on the chart

25. Tips When Trending
If you are manually trending vital signs stand back and look at what is going on with your patient
-Does it match his clinical appearance?
-Does it matter in that case?
Anticipate what is happening and devise a plan
Teleconsult before there is an emergency
Create a threshold or red flag as to when you will act and share them
-Mark them on the chart
Prepare equipment checklists for your intervention

27. Tips When Trending
If you are manually trending vital signs stand back and look at what is going on with your patient
-Does it match his clinical appearance?
-Does it matter in that case?
Anticipate what is happening and devise a plan
Teleconsult before there is an emergency
Create a threshold or red flag as to when you will act and share them
-Mark them on the chart
Prepare equipment checklists for your intervention
Brief your team on what to expect while you have time.
-Ask for other ideas now while you have time
-Don’t accept them later

28. Tips When Trending
If you are manually trending vital signs stand back and look at what is going on with your patient
-Does it match his clinical appearance?
-Does it matter in that case?
Anticipate what is happening and devise a plan
Teleconsult before there is an emergency
Create a threshold or red flag as to when you will act and share them
-Mark them on the chart
Prepare equipment checklists for your intervention
Brief your team on what to expect while you have time.
-Ask for other ideas now while you have time
-Don’t accept them later
Don’t second guess your plan once it’s time to act
-Stress and the gravity of the situation will play devil’s advocate

29. Tips When Trending
If you are manually trending vital signs stand back and look at what is going on with your patient
-Does it match his clinical appearance?
-Does it matter in that case?
Anticipate what is happening and devise a plan
Teleconsult before there is an emergency
Create a threshold or red flag as to when you will act and share them
-Mark them on the chart
Prepare equipment checklists for your intervention
Brief your team on what to expect while you have time.
-Ask for other ideas now while you have time
-Don’t accept them later
Don’t second guess your plan once it’s time to act
-Stress and the gravity of the situation will play devil’s advocate
Act without hesitation when it’s time

30. x 11 12 13 14 15 16 17 18 19 20 00 30 45
99.2
98.5
98.0
97.7
97.4
97.1
96.8
96.9
97.2
97.5
97.9
98.1
98.2
97.8 2 5 7 4 3
120 25 35 50 40
Cx tUBE
300
250
200
150
100 80 60
Foley
Threshold or Red Flag
to initiate treatment
drawn on the chart

31. Tourniquet Time:__________ Time Converted:___________ Problem List
Name: _________________________________ Age:___
Weight: _______Lbs _______Kg
Allergies: ______________________________________
Past Med Hx:___________________________________
Past Surg Hx:___________________________________
Incident History: I have (# patients), stable/unstable, Incident occurred: ______________________________
Mechanism of injury was _________________________
______________________________________________
I am expecting to evac the patient to:________________
Estimated time to evacuation is now: ________________ ETA at definitive care is: __________________________ CASEVAC POC is: ________________________________
Tourniquet Time:__________ Time Converted:___________
Problem List
Plan 1 2 3 4 5 6 7 8 9 10

32. Identify injuries and make a plan

33. Convert to pressure dressing
Name: _________________________________ Age:___
Weight: _______Lbs _______Kg
Allergies: ______________________________________
Past Med Hx:___________________________________
Past Surg Hx:___________________________________
Incident History: I have (# patients), stable/unstable, Incident occurred: ______________________________
Mechanism of injury was _________________________
______________________________________________
I am expecting to evac the patient to:________________
Estimated time to evacuation is now: ________________ ETA at definitive care is: __________________________ CASEVAC POC is: ________________________________
Tourniquet Time:__________ Time Converted:___________
0330
Problem List
Plan 1
Clean
 Suture 2
 Clean
Suture 3
Maintain Occlusive Dressing 
Monitor For Tension 4 5
Convert to pressure dressing 
Clean  6
Maintain Occlusive Dressing   7 8 9 10
Facial Lac
Cric
GSW L Chest
Pressure Dressing L Arm 1. X
TQ L Leg 2. 6. X X 3. X
Exit L Back 4. X X 5.

34. KETAMINE VERSED FENTANYL
TIME → BP ˅
220 ˄
200
180 HR
160 ●
140
120
Respirations R
100 80
ET CO2 o 60 40 20
Eyes 4
Verbal 5
Motor 6
GCS 15
Fluid IN
Output ml/hr
KETAMINE
DOSE:
TIME:
VERSED
FENTANYL
OTHER DRUGS

35. KETAMINE VERSED FENTANYL
TIME → BP ˅
220 ˄
200
180 HR
160 ●
140
120
Respirations R
100 80
ET CO2 o 60 40 20
Eyes 4
Verbal 5
Motor 6
GCS 15
Fluid IN
Output ml/hr
KETAMINE
DOSE:
TIME:
VERSED
FENTANYL
OTHER DRUGS

36. Pt Comfort / Positioning
TALK TO THE PATIENT – orient to time and place, explain procedures, elevate HOB,
Baby-wipe bath, pad: occiput, spine, sacrum, elbows, heels, Reposition Q2H, insert wedges and pillows,
Vital Signs
Q 15, report as a trend, trend full GCS if applicable, pulse ox is 3-4 minutes old info
Tubes
ET placement – cuff pressure esp. IN FLIGHT! Place NG & remove contents, secure Foley
Pulmonary status
Supplemental O2, monitor SpO2, Lung sounds, can he posture/position on his own? Pursed lip breathing
Ventilations
Reinforce BVM principles with helpers, end point is patient comfort, just enough to expand the chest, one hand!
Hydration
Maintenance fluids 125cc/h, Measure In and outs
Wounds and dressings
Irrigate and dress, replace wet to dry, inspect for rashes and sores, antibiotics
Splints
circulation check, tighten or loosen
Bladder care
Last void, distended? Clean Foley site
Eye Care
Contacts? Tape eyes? Drops or Ointment
Mouth
Loose teeth, mucous membranes moisturized, cleaning/ brushing
Skin
Pressure sores? Maceration due to incontinence, diaper rash?
DVT
Calf massage every Hr
Head injury
MACE Card
Acts of daily living: breathing, swallowing, coughing, drinking, eating, re-positioning, toileting, hygeine
Nursing care items: Blankets, pillows, gowns, towels, sheets, basins, trash bags, irrigation water

37. TeleMed Recommendations:
Glasgow Coma Scale
TIME
Eye Opening Response
Spontaneous 4
To Verbal Command 3
With Painful Stimulus 2
No Response 1
Best Verbal Response
Oriented 5
Confused
Inappropriate words
Incomprehensible Sounds
Best Motor Response
Obeys Commands 6
Localizes Pain
Withdraws (Pain)
Flexion (Pain)
Extension (Pain)
Call script:
“THIS IS _________________, (JOB/POSITION):___________________.
I HAVE A PATIENT WITH ___________ WHO I THINK HAS ___________,
AND I NEED _____________________________________________________.”
CHIEF COMPLAINT: ______________________________________________
BRIEF HISTORY:__________________________________
PE: VITALS: HR:____________ BLOOD PRESSURE: _________________
RESPIRATION RATE: _________ OXYGEN SATURATION: ____________
TEMPERATURE: _________ MENTAL STATUS (AVPU): ______________
BRIEF EXAM: ____________________________________________________
_________________________________________________________________.
“I NEED _______________.” (CONSULTATION, HELP, ADVICE, TRANSPO…)
TeleMed Recommendations:
1.Fluids/Meds:
2.Interventions:
3.Procedures:
4.Red Flags:
5.Other:

38. Priority of Procedures
Problem List
Plans 1 2 3 4 5 6 7 8 9 10
Priority of Procedures