Tuesday, August 28, 2012

Prolonged Field Care

   For the wilderness and remote medic, casualty evacuation is often a long process. Sometime you may have your patient for a few hours or you may have them for several days while waiting for the weather to clear.
   There are a few different medical mnemonics to help you remember the clinical skills needed for a prolonged field care situation. During the UK BATLS course we teach the H.I.T.M.A.N method. There is also the A.F.I.T.A.R.S.E. We will discuss both options and leave it for you to decide which option is the best fit for you.

First, what is prolonged field care?
   Prolonged Field Care can be needed anytime you may have a patient longer than an hour before you can transfer the casualty into higher definitive medical care. In a military context this can often happen due to contact with enemy combatants or possibly due to adverse weather conditions.
   For the civilian medic this can be found on top of a mountain as you are waiting for mountain rescue or for aviation support. Here in Ireland you may be waiting a long time for the weather to clear.

   This is a topic that is often neglected. Most medical training companies assume that the medic will quickly transfer their casualty into the care of an ambulance based paramedic or the local GP. This is often the case in city based medical establishments. 

   Here in Ireland we live in a remote part of the Ring of Kerry. There are many times that the one ambulance that we have for the entire peninsula will be over an hour away. The GP in town is not available after hours. Even in our own home we have a high probability of practising Prolonged Field Care as we are waiting for a response from the 999 call. 

   It is important for all medically trained professionals to have some skills for dealing with injuries and illnesses in a prolonged environment. Here at Remote Medicine Ireland we teach these skills starting at the basic Wilderness First Aid course all the way up to the paramedic level. We feel that learning how to deal with injuries without advanced support is paramount. 

There are two medical mnemonics to help you remember these skills:

This is a crude but effective memory tool. In medicine it is often the more crass mnemonics that help one remember the skills. 

This is taught in the UK Ministry of Defense. 


A- Ask the casualty how they are
      You have already finished your casualty exam. Now talk to your patient.

F- Fluids
      Monitor urine output and improvise a way to let the casualty void.
      Hydrate your casualty.

I- Infection
      Keep wounds clean and treat with antibiotics if trained.
     You have a six hour window before your wounds will become infected.

T- Tubes
      Ensure your cannulation lines, ET tubes, IV sites, Foley Catheters are clean and free of blockage.

A- Analgesia
      Think about pain management for your casualty. 

R- Records
      Document your patient assessment and reassessment. 

S- Sanitation
     Keep the casualty clean. This means baths if they are sweaty or dirty. This means that you need to think about their voiding.

E- Environment
     In a remote setting you have to deal with the casualty being too hot or too cold. More often than not they will be too cold. 


H- Hydration
I- Infection
T- Tubes
M- Medication
A- Analgesia
N- Nutrition 

It is up to the individual medic which system you choose to use. Here at RMI we teach the AFITARSE mnemonic as it seems to be easier for students to memorize. 

You can learn prolonged field care by reading about wilderness and remote medicine but a better option is to come to Ireland and take our Remote EMT course.

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