CONTENTS: 1. U.S. ARMY MEDEVAC CRITICAL CARE FLIGHT PARAMEDIC STANDARD MEDICAL OPERATING GUIDELINES 2. Tactical Evacuation After Action Report & Patient Care Record 3. INSTRUCTIONS: DA Form 4700 OP4, Tactical Evacuation (TACEVAC) After Action Report (AAR) and Patient Care Record (PCR) [MEDICAL RECORD-SUPPLEMENTAL MEDICAL DATA] 4. DD Form 1380 TACTICAL COMBAT CASUALTY CARE (TCCC) CARD 5. JOINT TRAUMA SYSTEM DEVELOPMENT, CONCEPTUAL FRAMEWORK, AND OPTIMAL ELEMENTS 6. The United States Military Joint Trauma System Assessment: A Report Commissioned by the US Central Command Surgeon Sponsored by Air Force Central Command A Strategic Document to Provide a Platform for Tactical Development (2018) INTRODUCTION This current set of medical guidelines has gone through some significant improvements since the original release in 2014 and were developed through a collaboration of Emergency Medicine professionals, experienced Flight Medics, Aeromedical Physician Assistants, Critical Care Nurses, and Flight Surgeons. There has been close coordination in the development of these guidelines by the Joint Trauma System, Committee of En Route Combat Casualty Care and the Committee of Tactical Combat Casualty Care. Our shared goal is to ensure excellent en route care that is standard across all evacuation and emergency medical pre-hospital units. It is our vision that all of these enhancements and improvements will advance en route care across the services and the Department of Defense. The CCFP Program Office facilitates appropriate training and medical education to the CCFP providers. The CCFP program of instruction ensures the appropriate skills and knowledge required for CCFPs to apply these medical guidelines during aeromedical evacuation. Unit medical trainers and medical directors should evaluate CCFPs ability to follow and execute the medical instructions herein. These medical guidelines are intended to guide Critical Care Flight Paramedics (CCFP) and prehospital professionals in the response and management of emergencies and the care and treatment of patients in both garrison and theater of war environments. Unit medical providers are not expected to employ these guidelines blindly. Unit medical providers are expected to manipulate and adjust these guidelines to their unit’s mission and medical air crew training / experience. Medical directors or designated supervising physicians should endorse these guidelines as a baseline, appropriately adjust components as needed, and responsibly manage individual unit medical missions within the scope of practice of their Critical Care Flight Paramedics, Enroute Critical Care Nurses, and advanced practice aeromedical providers.

CONTENTS: 1. U.S. ARMY MEDEVAC CRITICAL CARE FLIGHT PARAMEDIC STANDARD MEDICAL OPERATING GUIDELINES - CY20 Version Published January 2020, 278 pages 2. TCCC Guidelines for Medical Personnel - 1 August 2019, 24 pages 3. Joint Trauma System Clinical Practice Guideline Special Edition v2.0 - Management of COVID-19 in Austere Operational Environments (Prehospital & Prolonged Field Care) - 28 May 2020, 40 pages 4. DoD C-19 PRACTICE MANAGEMENT GUIDE - Clinical Management of COVID-19, 124 pages 5. COVID-19 Considerations in the Deployed Setting (Presentation) - 27 May 2020, 35 pages INTRODUCTION The STANDARD MEDICAL OPERATING GUIDELINES (SMOG) continues to go through significant improvements with each release as a result of the collaboration of Emergency Medicine professionals, experienced Flight Medics, Aeromedical Physician Assistants, Critical Care Nurses, and Flight Surgeons. There has been close coordination in the development of these guidelines by the Joint Trauma System, and the Defense Committees on Trauma. Our shared goal is to ensure the highest quality en route care possible and to standardize care across all evacuation and emergency medical pre-hospital units. It is our vision that all of these enhancements and improvements will advance en route care across the services and the Department of Defense. Unit medical trainers and medical directors should evaluate Critical Care Flight Paramedics (CCFP) ability to follow and execute the medical instructions herein. These medical guidelines are intended to guide CCFPs and prehospital professionals in the response and management of emergencies and the care and treatment of patients in both garrison and combat theater environments. Unit medical providers are not expected to employ these guidelines blindly. Unit medical providers are expected to manipulate and adjust these guidelines to their unit’s mission and medical air crew training / experience. Medical directors or designated supervising physicians should endorse these guidelines as a baseline, appropriately adjust components as needed, and responsibly manage individual unit medical missions within the scope of practice of their Critical Care Flight Paramedics, Enroute Critical Care Nurses, and advanced practice aeromedical providers. The medication section of this manual is provided for information purposes only. CCFPs may administer medications only as listed in the guidelines unless their medical director (supervising physician) orders a deviation. Other medications may be added, so long as the unit supervising physician and/or medical director approves them. This manual also serves as a reference for physicians providing medical direction and clinical oversight to the CCFP. Treatment direction, which is more appropriate to the patient’s condition than the guideline, should be provided by the physician as long as the CCFP scope of practice is not exceeded. Any medical guideline that is out of date or has been found to cause further harm will be updated or deleted immediately. The Medical Evacuation Concepts and Capabilities Division (MECCD) serves as the managing editor of the SMOG and are responsible for content updates, managing the formal review process, and identifying review committee members for the annual review. The Standard Medical Operating Guidelines are intended to provide medical procedural guidance and is in compliment to other Department of Defense and Department of the Army policies, regulatory and doctrinal guidance. Nothing herein overrides or supersedes laws, rules, regulation or policies of the United States, DoD or DA.

CONTENTS: 1. U.S. ARMY AEROMEDICAL EVACUATION CRITICAL CARE FLIGHT PARAMEDIC STANDARD MEDICAL OPERATING GUIDELINES - CY23 Version Published January 2023, 318 pages 2. TCCC Guidelines for Medical Personnel - 15 December 2021, 19 pages 3. JTS Clinical Practice Guidelines, 2,260 total pages - current as of 19 September 2023: INTRODUCTION The SMOG continues to go through significant improvements with each release as a result of the collaboration of Emergency Medicine professionals, experienced Flight Medics, Aeromedical Physician Assistants, Critical Care Nurses, and Flight Surgeons. There has been close coordination in the development of these guidelines by the Joint Trauma System, and the Defense Committees on Trauma. Our shared goal is to ensure the highest quality en route care possible and to standardize care across all evacuation and emergency medical pre-hospital units. It is our vision that all of these enhancements and improvements will advance en route care across the services and the Department of Defense. Unit medical trainers and medical directors should evaluate Critical Care Flight Paramedics (CCFP) ability to follow and execute the medical instructions herein. These medical guidelines are intended to guide CCFPs and prehospital professionals in the response and management of emergencies and the care and treatment of patients in both garrison and combat theater environments. Unit medical providers are not expected to employ these guidelines blindly. Unit medical providers are expected to manipulate and adjust these guidelines to their unit’s mission and medical air crew training / experience. Medical directors or designated supervising physicians should endorse these guidelines as a baseline, appropriately adjust components as needed, and responsibly manage individual unit medical missions within the scope of practice of their Critical Care Flight Paramedics, Enroute Critical Care Nurses, and advanced practice aeromedical providers. The medication section of this manual is provided for information purposes only. CCFPs may administer medications only as listed in the guidelines unless their medical director and/or supervising physician orders a deviation. Other medications may be added, so long as the unit supervising physician and/or medical director approves them. This manual also serves as a reference for physicians providing medical direction and clinical oversight to the CCFP. Treatment direction, which is more appropriate to the patient’s condition than the guideline, should be provided by the physician as long as the CCFP scope of practice is not exceeded. Any medical guideline that is out of date or has been found to cause further harm will be updated or deleted immediately. The Medical Evacuation Concepts and Capabilities Division (MECCD) serves as the managing editor of the SMOG and are responsible for content updates, managing the formal review process, and identifying review committee members for the annual review. The Standard Medical Operating Guidelines are intended to provide medical procedural guidance and is in compliment to other Department of Defense and Department of the Army policies, regulatory and doctrinal guidance. Nothing herein overrides or supersedes laws, rules, regulation or policies of the United States, DoD or DA.

The purpose of the handbook is to provide these medical professionals a printed resource that outlines the latest techniques and procedures used by the US Army Medevac and critical care flight paramedic communities.

This handbook was previously distributed as a supplement to the Journal of Special Operations Medicine. The realm of special operations forces (SOF) medicine is a unique and ever-changing one that demands specialized training for our joint SOF. Managing trauma on today’s battlefield presents a dynamic array of challenges where limited resources can be rapidly overwhelmed. An austere environment, hostile gunfire, and delays in casualty evacuation (CASEVAC) are the norms for the special operations medic. The material in this handbook was gleaned from special operations medics operating in the Global War on Terrorism and other operational environments. It should not be viewed as a substitute for the professional training and judgment of special operations medics; rather, it is designed to be a hip-pocket reference on the tactics, techniques, and procedures (TTP) of SOF-relevant tactical combat casualty care. Key Lessons Ninety percent of combat loss of life occurs before casualties ever reach a military treatment facility (MTF); treatment prior to casualty evacuation is vital. Litter carries are fundamental for good patient care; they prevent further injury and get individuals off target as soon as possible. Rehearse manual carry methods prior to deployment. Every special operations warfighter should carry a tourniquet and be thoroughly familiar with its application. When managing multiple casualties, apply the principles of triage in classifying the priority of treatment and evacuation. Rehearse and employ all of the mechanics of CASEVAC from the point of injury to the handover at a MTF. This handbook provides a number of considerations when employing medical support to SOF in combat. The challenges are numerous, but the special operations medic must deliver medical care to save Soldiers’ lives. The collection of TTP in this handbook will enhance the medic’s ability to determine the optimum method to deliver casualty survival assistance.

The purpose of the handbook is to provide these medical professionals a printed resource that outlines the latest techniques and procedures used by the US Army Medevac and critical care flight paramedic communities.