Starfleet Combat Medicine Manual

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Starfleet Combat Medicine Manual
DOCUMENT 42506-314
Produced by Starfleet Medical and the Starfleet Information and Instruction Agency
For distribution only within the United Federation of Planets

Aboard a ship, starbase, or planet-side colony, Starfleet Medical personnel provide day-to-day medical care, and treat injuries just like any other doctor. Their main responsibility is the physical well being and health of the crew and civilians on board their ship or base. They are also responsible for low-level sickness care. In crisis situations, this quickly changes and expands anywhere from low-level injury care to high-level surgery.

Historically in warfare, the majority of all combat deaths have occurred prior to a casualty ever receiving advanced trauma management.

Medical Duty Posts

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Medical Officer

A trained and credentialed medical provider, physician or physician assistant, who verbally, or in writing, states assumption of responsibility and liability and is available on-site or can be contacted through established communications. Medical care, procedures, and advanced life-saving activities will be routed through medical control in order to provide optimal care to all sick or injured Starfleet personnel. Medical Control will always be established, regardless of whether the scenario is a combat mission, a training exercise, or routine medical care. Note that, ultimately, all medical care is conducted under the licensure of an assigned, attached, augmenting, or collocated Starfleet physician.

Chief Medical Officer

The Chief Medical Officer (CMO) co-ordinates the efficient running of the Medical department and is responsible for the activities of the personnel therein. It is the CMO's job to ensure that the medical personnel are organized to ensure maximum productivity and also provide maximum medical and emergency response cover for the ship.

Standing Orders and Protocols

These standing orders and protocols are only to be used by Starfleet Medical Officers and Teams.

Purpose

The primary purpose of these protocols is to serve as a guideline for tactical and non-tactical pre-hospital trauma and medical care. Quality out-of-hospital care is the direct result of comprehensive education, accurate patient assessment, good judgment, and continuous quality improvement. All Starfleet medical personnel are expected to know the Trauma Management Team Protocols and understand the reasoning behind their employment. Starfleet Doctors should not perform any step in a standing order or protocol if they have not been trained to perform the procedure or treatment in question. Emergency, trauma, and tactical medicine continues to evolve at a rapid pace. Accordingly, this document is subject to change as new information and guidelines become available and are accepted by the medical community.

Communications

In a case where the Starfleet medical officer cannot contact Medical Control due to an acute time-sensitive injury or illness, a mass casualty scenario, or communication difficulties, all protocols become standing orders. Likewise, in the event that Starfleet Medical Control cannot respond to combadge instructions in a timely fashion required to provide optimal care to a patient, all protocols are considered standing orders. In the event that Starfleet Medical Control was not contacted, and treatment protocols were carried out as standing orders, Starfleet Medical Control will be contacted as soon as feasible following the incident and the medical record will be reviewed and countersigned by Starfleet Medical Control. Retroactive approval for appropriate care will be provided through this process.

When communicating with Starfleet medical control, a medical officer or a receiving facility, a verbal report will include the following essential elements:

Pertinent Information ("SOAP note" format)

  1. Provider – name, and unit.
  2. Patient – name, unit, age, and gender.
  3. Subjective – findings to include chief complaint and brief history of event.
  4. Objective – findings to include mental status, vital signs, and physical exam.
  5. Assessment – to include differential diagnosis and level of urgency.
  6. Plan – to include treatment provided, patient response to treatment, and ETA.


Provide patient status updates as dictated by patient status changes en route.

Patient Care Documentation

Patient care documentation is of paramount importance and should be performed for every patient encounter using a SMA Combat Casualty Card, a Trauma SF 600 Medical Record, or a SF 600 Medical Record.

Trauma Management Team

Squad EMT

A non-medical MOS Medic currently registered as an EMT-Basic/Intermediate by the Department of Medicine (DOM) and designated by the command to operate in this capacity. This individual functions as a bridge between the RFR and the Starfleet Medic in respect to tactical and administrative trauma management. Squad EMTs conduct their scope of practice under the licensure of a medical director.

Special Operations Combat Medic-ATP

Special Operations Combat Medic Advanced Tactical Practitioner (SOCM-ATP) – A Starfleet Medic currently registered as an NREMT-Paramedic by the DOT and/or USSOCOM State-Paramedic (Advanced Tactical Practitioner) who has been awarded the identifier W1 (Special Operations Combat Medic) and has been approved by the unit Medical Director to function at this advanced level of care. A Starfleet Medic can train and direct routine and emergency medical care, establish combat casualty collection points, conduct initial surgical and medical patient assessment and management, triage and provide advanced trauma management, and prepare patients for evacuation.

Routine garrison care includes assisting unit medical officers with daily sick call and requires advanced knowledge in common orthopedic problems, respiratory illnesses, gastrointestinal disorders, dermatological conditions, and environmental hazard illnesses. Starfleet Medics train non-medical personnel on first responder skills and preventive medicine. Starfleet Medics conduct their scope of practice under the licensure of a medical director and are not independent health care providers. Starfleet Medics should always obtain medical director advice and supervision for all care provided. However, on rare occasions Starfleet Medics may be required to operate relatively independently with only indirect supervision in remote, austere, or clandestine locations. In these cases, it is still extremely rare that a Starfleet Medic will be unable to communicate by computer.

Standing Orders

Advanced life support interventions, which may be undertaken before contacting on-line medical control.

  • PROTOCOLS – Guidelines for out of hospital patient care. Only the portions of the guidelines, which are designated as “standing orders”, may be undertaken before contacting an on-line medical director.
  • MEDICAL CONTROL / MEDICAL DIRECTOR / MEDICAL OFFICER – A licensed and credentialed medical provider, physician or physician assistant, who verbally, or in writing, states assumption of responsibility and liability and is available on-site or can be contacted through established communications. Medical care, procedures, and advanced life-saving activities will be routed through medical control in order to provide optimal care to all sick or injured Rangers. Medical Control will always be established, regardless of whether the scenario is a combat mission, a training exercise, or routine medical care. Note that, ultimately, all medical care is conducted under the licensure of an assigned, attached, augmenting, or collocated physician.

The 8 “C.R.I.T.I.C.A.L.” Combat Medicine Tasks

  1. Contain Scene and Assess Casualties.
    1. Return Fire and Secure Scene.
    2. Direct Casualties to Cover.
    3. Evaluate for Life Threatening Injuries.
    4. Triage – Immediate, Delayed, Minimal, Expectant.
    5. Call Medical Personnel for Assistance as Required.
  2. Rapidly Identify and Control Massive Hemorrhage.
    1. Direct & Indirect Pressure.
    2. Tourniquet.
    3. Emergency Trauma Dressing.
  3. Inspect and Ensure Patent Airway.
    1. Open and Clear Airway.
    2. Nasopharyngeal Airway.
  4. Treat Life Threatening Torso Injuries.
    1. Occlusive Seal Dressing.
    2. Needle Decompression.
    3. Abdominal wound management.
  5. Inspect for Bleeding, Gain IV Access, Manage Shock.
    1. Head to Toe Blood Sweeps.
    2. 18 Gauge Saline Lock.
    3. IV Fluids when dictated by Shock.
    4. Prevent Hypothermia.
  6. Control Pain and Prevent Infection.
    1. Combat Wound Pill Pack.
  7. Aid and Litter Team.
    1. Package and Prepare for Transfer.
    2. MEDCO, Litters, Manual Carries.
  8. Leader Coordinated Evacuation.
    1. Casualty Precedence – Critical (Urgent), Priority, Routine.
    2. MEDEVAC Coordination.


REV SD 239112.12