1. The following (1 st ) page of the flowsheet Justin has been developing, is meant to be used initially as you either receive a patient into your med room or aid station, or arrive at a more secure area that you will be sitting at for a while. This allows you to do an initial assessment and list all the injuries you find in order to form a preliminary plan.

2. Problem ListPlan 1 2 3 4 5 6 7 8 9 10 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:___________ Page 1 of 6

3. The following (2 nd and 3 rd ) pages are meant to be used in series, one after you fill the other, in order to extend the amount of time you are able to trend vital signs.

4. TIME → BP ˅ 220 ˄ 200 180 HR 160 ● 140 120 Respirations R100 80 ET CO2 o60 40 20 Eyes4 Verbal5 Motor6 GCS15 Fluid IN Output ml/hr KETAMINE DOSE: TIME: VERSED DOSE: TIME: FENTANYL DOSE: TIME: OTHER DRUGSDOSE: TIME: OTHER DRUGSDOSE: TIME: Page 2 of 6

5. TIME → BP ˅ 220 ˄ 200 180 HR 160 ● 140 120 Respirations R100 80 ET CO2 o60 40 20 Eyes4 Verbal5 Motor6 GCS15 Fluid IN Output ml/hr KETAMINE DOSE: TIME: VERSED DOSE: TIME: FENTANYL DOSE: TIME: OTHER DRUGSDOSE: TIME: OTHER DRUGSDOSE: TIME: Page 3 of 6

6. The next 4 th Page are excerpts taken directly from the nursing care portion of the SOF Med Handbook to remind the medic of the nursing care he should be doing.

7. 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 Page 4 of 6

8. The 5 th page originally only had the GSC cheat sheet and a lot of white space so I added the Telemedicine script and recommendation prompts.

9. Glasgow Coma Scale TIME Eye Opening Response Spontaneous4 To Verbal Command3 With Painful Stimulus2 No Response1 Best Verbal Response Oriented5 Confused4 Inappropriate words3 Incomprehensible Sounds2 No Response1 Best Motor Response Obeys Commands6 Localizes Pain5 Withdraws (Pain)4 Flexion (Pain)3 Extension (Pain)2 No Response1 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: Page 5 of 6

10. The last page originally only had the “Plan” section. I later added the section that allows prioritizing of the treatments. It can be used to either specifically prioritize treatments, interventions and nursing care after the initial procedures are identified or can be used separately after the first sheet has been filled out and checked off. I personally have multiple copies of the last sheet printed off and laminated so that I can update the plan every few hours and hang it for everyone to see. I also use this in conjunction with the 2 sided PFC Casualty Card I have personally been developing.

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

12. All 6 Pages Laminated for Continuity And Z-Folded for ease of Transport

13. Will work well if no walls are available

14. Laminated for use on the wall