CAPÍTULO III: DETERMINACIÓN DE REQUERIMIENTOS
1.3. Especificación de requerimientos informáticos
L-6. The 91W Health Care Specialist
Health care specialists assigned to treatment teams, holding squad, and ambulance teams of the medical company/troop serve as integral members of the warfighting team by combining the skills of soldier and medical caregiver. The 91W performs emergency and evacuation care under the medical direction of a physician or other credentialed providers. Serves as a clinical technician in inpatient and outpatient areas of MTFs. Performs basic force health protection care for individual soldiers and small units. Is trained for combat and other operational environments. Conducts casualty triage and provides medical care for patients in all operational environments to include enroute care during ground and air ambulance evacuations.
The 91W is certified to the national standards of emergency medical technician–basic (EMT–B) and augmented by the national EMT–intermediate curriculum.
L-7. Core Competencies of the 91W
The 91Ws of medical company/troop must be trained/credentialed in several areas of core competencies.
These core competencies are examples of specific skills that establishes the scope and depth of clinical practice that are outlined in Tables L-1 through L-3 below.
Table L-1. Core Competency for Emergency Medical Care
CORE COMPETENCY IN EMERGENCY CARE FOR THE 91W IS INCLUSIVE OF THE FOLLOWING:
• BATTLEFIELD AND OPERATIONAL FOCUS
• FAR FORWARD PRIMARY CARE
• SKILLS TO SUPPORT UNIT READINESS AND OPERATIONAL NEEDS
• SKILLS IN CONTEXT OF TACTICAL/OPERATIONAL ENVIRONMENT EXAMPLES:
A. ALL EMT–BASIC SKILLS
1. ABCs (AIRWAY, BREATHING, CIRCULATION), CPR (CARDIOPULMONARY RESUSCITATION), OXY-GEN THERAPY, SUCTION, AND SO FORTH.
2. BLEEDING CONTROL, BANDAGING, SPLINTING
3. BLS (BASIC LIFE SUPPORT) CARE FOR A BROAD ARRAY OF EMERGENCIES 4. DOCUMENTATION OF MEDICAL CARE
Table L-1. Core Competency for Emergency Medical Care (Continued)
B. ADVANCED AIRWAY MANAGEMENT (INTUBATION, CRICOTHYROTOMY) C. DECOMPRESSION OF TENSION PNEUMOTHORAX
D. VASCULAR ACCESS: INTRAVENOUS, INTRAOSSEOUS E. FLUID RESUSCITATION
F. NBC MEDICAL PROCEDURES G. LIMITED MEDICATIONS
1. CONTROLLED MEDICATIONS (SUCH AS MORPHINE) 2. CEPHALOSPORIN (ANTIBIOTIC)
8. OTHER MEDICATIONS AT THE DISCRETION OF THE ATTENDING PHYSICIAN
H. ASSIST WITH AND MAINTAIN MEDICAL INTERVENTIONS INITIATED IN ECHELONS I, II, AND III DURING TRANSPORTATIONS. ASSIST IN THESE PROCEDURES:
1. NASOGASTRIC INSERTION
2. FOLEY CATHETER INSERTION AND MAINTENANCE 3. CHEST TUBE(S) INSERTION AND MAINTENANCE I. TRIAGE/MASCAL
J. ALL EMERGENCY CARE SKILLS ARE TRANSFERABLE TO INPATIENT/PATIENT HOLDING SETTING
Table L-2. Core Competency for Primary Medical Care
CORE COMPETENCY IN PRIMARY CARE FOR THE 91W IS INCLUSIVE OF THE FOLLOWING:
• SICK CALL NEEDS OF FAR-FORWARD UNITS
• ACUTE DENTAL, PSYCHOLOGICAL, AND OTHER PRIMARY CARE NEEDS
• PROTOCOL-DRIVEN COMMON FIELD CLINICAL PROBLEMS EXAMPLES:
A. HEADACHE, COUGH, SORE THROAT AND OTHER MINOR COMPLAINTS B. SPRAINED ANKLE, BRUISES, CUTS AND OTHER MINOR INJURIES C. MINOR WOUND CARE AND CLOSURES (STAPLES/SUTURES) D. LIMITED OVER-THE-COUNTER (OTC) MEDICATIONS
7. OTHER AVAILABLE OTC MEDICATIONS APPROVED BY A PHYSICIAN
E. REHABILITATION OF HEAT EXHAUSTION, FATIGUE, COLD EXPOSURE, AND SO FORTH F. ASSIST PHYSICIAN/PA IN SICK CALL PROCEDURES
G. APPROPRIATE DOCUMENTATION (PATIENT CHARTING AS APPROPRIATE) H. CONDUCT BASIC AMBULATORY CARE—TRIAGE
Table L-3. Core Competency for Medical Evacuation
CORE COMPETENCY IN PATIENT EVACUATION AND RETRIEVAL FOR THE 91W IS INCLUSIVE OF THE FOLLOWING:
• EXTRACTION OFF THE BATTLEFIELD
• EXTRICATION FROM ALL TYPES OF COMBAT VEHICLES AND AIRCRAFT
• ONGOING EVACUATION CARE
E. OPERATING TACTICAL GROUND AMBULANCES (TRACKED AND WHEELED) F. BASIC EN ROUTE MEDICAL CARE ONGOING FOR UP TO 48 HOURS
G. APPLICATION OF TACTICAL MEDICAL EVACUATION PROCEDURES AND RADIO COMMUNICATIONS
L-8. Medical Training
Tables L-4 through L-6 contains the critical tasks to be used by the commander in the development of unit medical training program for assigned or attached 91W personnel. The training will be conducted under the auspices of a licensed physician. The 91W will be certified to the national standards of EMT-B and augmented by the national EMT-intermediate curriculum. The commander (medical company/troop) will coordinate with the senior medical officer for consultation as needed, supervision of the unit’s continuing education program, and to serve as the medical liaison between the unit and other services/facilities.
Table L-4. 91W10/20 Critical Task List
1. PERFORM AN INITIAL CASUALTY ASSESSMENT
TRAUMA/MEDICAL ASSESSMENTS (RESPONSIVE AND UNRESPONSIVE), BOTH ADULT AND PEDIATRIC (VS), HISTORY (HX), SUBJECTIVE OBJECTIVE PROCEDURE NOTES, AUSCULTATE BREATH/BOWEL SOUNDS, MENTAL STATUS, GLASGOW COMA SCALE, PRIORITIZE INJURIES OF INDIVIDUAL CASUALTY/PATIENT, COMPLETE SPECIFIC FORMS
2. PERFORM ONGOING CASUALTY MANAGEMENT
VS DEFICITS AND TX, ONGOING MEDICAL MANAGEMENT IN BOTH LIMITED AND UNLIMITED RESOURCE ENVIRONMENTS, PROVIDE CARE FOR COMPLICATIONS WITHIN AIR/GROUND EVACUATIONS, TRIAGE CASUALTIES
3. PERFORM A CASUALTY RESUSCITATION
UNRESPONSIVE AND RESPONSIVE CASUALTIES, CARDIOPULMONARY RESUSCITATION (CPR), AIRWAY ADJUNCTS, AIRWAY DEVICES, ADMINISTRATION OF OXYGEN (O2), HEAD POSITIONS, COMPLETE SPECIFIC FORMS
Table L-4. 91W10/20 Critical Task List (Continued)
4. ESTABLISH AN AIRWAY
ESTABLISH AIRWAY, USING AIRWAY ADJUNCTS, CONFIRM PLACEMENT, USE AMBU BAG AND TRACHEAL SUCTION AS REQUIRED. USE MEDICATIONS FOR CONTROL OF THE INTUBATED PATIENT
5. MANAGE AN AIRWAY
FOCUSED ASSESSMENT, ADMINISTRATION OF O2 MASKS, PULSE OXIMETER, SUCTIONING, INTUBATION 6. TREAT A CASUALTY FOR A BURN INJURY
FOCUSED ASSESSMENT (BURN SURFACE AREA/DEPTH), AIRWAY MANAGEMENT, STABILIZING TX, PAIN MANAGEMENT, WOUND CARE. (INCLUDE KNOWLEDGE ON CHEMICAL AND ELECTRICAL BURNS), PREPARE FOR EVACUATION
7. TREAT A CASUALTY FOR A MAXILLOFACIAL AND NECK INJURY
FOCUSED ASSESSMENT, AIRWAY MANAGEMENT, MANAGE AREA-SPECIFIC BLEEDING, TX TEETH INJURIES, AND PAIN MANAGEMENT, EAR INJURY
8. TREAT A CASUALTY FOR AN OCULAR INJURY
FOCUSED ASSESSMENT (HX, INCIDENT, COMPLAINTS, ACUITY, PUPIL, ORBITAL RIM, CHEMICAL), IRRIGATE EYES, SUPERFICIAL FOREIGN BODY REMOVAL, EXTRUSIONS OF THE EYE, BURNS AND CONTUSIONS, APPLICA-TION OF BANDAGES, PREPARE FOR EVACUAAPPLICA-TION
9. TREAT A CASUALTY FOR HEAD INJURY
FOCUSED ASSESSMENT, OPEN AND CLOSED INJURIES, TX FOR SPECIFIC INJURY, PREPARE FOR EVACUATION 10. TREAT A CASUALTY FOR A CHEST INJURY
FOCUSED ASSESSMENT, OPEN/CLOSED CHEST INJURES, NEEDLE DECOMPRESSION, FLAIL CHEST, EMPHY-SEMA, TENSION PNEUMOTHORAX, ADMINISTRATION OF O2, PAIN MANAGEMENT, PREPARE FOR EVACUATION, BLAST INJURY
11. TREAT A CASUALTY FOR AN ABDOMINAL INJURY
FOCUSED ASSESSMENT (BOWEL SOUNDS), TX OPEN AND CLOSED INJURIES (BANDAGES AND POSITION), IV FLUID MANAGEMENT, PREPARE FOR EVACUATION
12. TREAT A CASUALTY WITH A WOUND
FOCUSED ASSESSMENT (OPEN/CLOSED), TX FOR LACERATIONS AND FRACTURES (FX), APPLICATION OF DRESS-INGS/BANDAGES, SLINGS, SPLINTS, SUPERFICIAL REMOVAL OF FOREIGN BODY(IES), WOUND CARE, ESTABLISH A STERILE/CLEAN FIELD, PERFORM SIMPLE SKIN CLOSURE TECHNIQUES, PAIN MANAGEMENT, PREPARE FOR EVACUATION
13. TREAT A CASUALTY WITH AN EXTREMITY INJURY
FOCUSED ASSESSMENT (INCLUDE NERVE INJURIES AND OPEN/CLOSED INJURY), TX DISLOCATIONS AND FX, APPLICATION OF SPLINTS/SLINGS AND FX DEVICES, PAIN MANAGEMENT, PREPARE FOR EVACUATION 14. TREAT A CASUALTY WITH A MANGLED BODY PART
FOCUSED ASSESSMENT, TX CRUSHED, PARTIAL AND COMPLETE AMPUTATIONS AND AVULSIONS, IV FLUID MANAGEMENT, PAIN MANAGEMENT, USE OF TOURNIQUET, APPLY DRESSINGS, PREPARE FOR EVACUATION 15. TREAT A CASUALTY WITH AN IMPALED OBJECT
FOCUSED ASSESSMENT, TX ABDOMINAL AND EXTREMITY IMPALEMENTS, PAIN MANAGEMENT, PREPARE FOR EVACUATION
Table L-4. 91W10/20 Critical Task List (Continued)
16. CONTROL BLEEDING
FOCUSED ASSESSMENT, APPLY DIRECT PRESSURE, PRESSURE POINTS, HEMOSTATIC DRESSINGS (WHEN AVAILABLE) PRESSURE DRESSINGS, TOURNIQUET, IV THERAPY (INSERTION AND MANAGEMENT)
17. TREAT FOR SHOCK
FOCUSED ASSESSMENT (VS FOR EBL), DECISION IV FLUID MANAGEMENT/THERAPY, USE OF ALBUMIN, ASSESS URINE OUTPUT, FOLEY INSERTION
18. PROVIDE TREATMENT FOR BITES AND STINGS
FOCUSED ASSESSMENT (TYPE OF INSECT/SNAKE AND SO FORTH), TX INJURY AND COMPLICATIONS, IN-STRUCT PREVENTIVE MEASURES
19. TREAT FOR ANAPHYLAXIS
FOCUSED ASSESSMENT (TYPE OF INCIDENT-FOOD, DRUGS, AND BITES/STINGS); ADMINISTER EPINEPHRINE AND OXYGEN, AIRWAY MANAGEMENT
20. PROVIDE TREATMENT FOR A TOXIC EXPOSURE
FOCUSED ASSESSMENT (INGESTED, CONTACT, INHALED) ADMINISTER IPECAC, CHARCOAL, AIRWAY MANAGE-MENT (CPR), PREPARE FOR EVACUATION
21. MANAGE A SEIZING CASUALTY
FOCUSED ASSESSMENT (INCLUDE HX AND INCIDENT OF ONSET), AIRWAY MANAGEMENT, USE OF DRUGS/
NARCOTICS, PREPARE FOR EVACUATION, POSITION PATIENT 22. TREAT A CASUALTY FOR A COLD INJURY
FOCUSED ASSESSMENT (MINOR TO SEVERE), PROVIDE TX FOR EACH (TEMP CONTROL, REWARMING, AND SO FORTH), INSTRUCT PREVENTIVE MEASURES, AND PREPARE FOR EVACUATION
23. TREAT A CASUALTY FOR A HEAT INJURY
FOCUSED ASSESSMENT (MINOR TO SEVERE), PROVIDE TX FOR EACH (TEMP CONTROL, COOLING, AND SO FORTH), INSTRUCT PREVENTIVE MEASURES, ORAL AND IV FLUID MANAGEMENT, PREPARE FOR EVACUATION 24. MANAGE A BEHAVIORAL CASUALTY
FOCUSED ASSESSMENT (INCLUDE DEPRESSION, SUICIDE, STRESS, AND SO FORTH), INITIATE CARE OR PREVENTIVE MEASURES, PREPARE FOR EVACUATION, STRESS MANAGEMENT PRINCIPLES
25. EXTRACT A CASUALTY
PROVIDE SUPPORT DEVICES, SPINE PRECAUTIONS/IMMOBILIZATIONS, REMOVE FROM GROUND, VEHICLE, TANK, FIXED FACILITY, AIRCRAFT, PROVIDE GROUND SURVEILLANCE FOR LAND MINES/SCENE SAFETY.
26. PERFORM CASUALTY TRIAGE
MASCAL-CORRECTLY TRIAGE CASUALTIES INTO DELAYED, IMMEDIATE, MINIMAL, OR EXPECTANT 27. EVACUATE A CASUALTY BY GROUND
ASSESS AND TRIAGE CASUALTY/IES FOR TYPE OF ROUTE APPROPRIATE FOR INJURY, LOAD AND UNLOAD A CASUALTY, LITTER CARRIES
28. EVACUATE A CASUALTY BY AIR
ASSESS AND TRIAGE CASUALTY/IES FOR TYPE OF ROUTE APPROPRIATE FOR INJURY, LOAD AND UNLOAD A CASUALTY, LITTER CARRIES
29. MANAGE MEDICAL COMMUNICATIONS
REQUEST FOR CASUALTY EVACUATION, WRITTEN FORMS OF COMMUNICATION, 9 LINE, USE OF VARIOUS EQUIPMENT, TELEMEDICINE, GUIDE COMBAT LIFE SAVERS
Table L-4. 91W10/20 Critical Task List (Continued)
30. PROVIDE POSTMORTEM CARE
PREPARE AND WRAP BODY, GRAVES REGISTRATION
31. PROVIDE TREATMENT FOR A BIOLOGICAL EXPOSED CASUALTY FOCUSED ASSESSMENT, TRIAGE, APPROPRIATE TX PER PROTOCOL 32. PROVIDE TREATMENT FOR A NUCLEAR EXPOSED CASUALTY FOCUSED ASSESSMENT, TRIAGE, APPROPRIATE TX PER PROTOCOL 33. PROVIDE TREATMENT FOR A CHEMICAL AGENT CASUALTY FOCUSED ASSESSMENT, TRIAGE, APPROPRIATE TX PER PROTOCOL 34. DECONTAMINATE A CASUALTY
FOCUSED ASSESSMENT, APPROPRIATE DECONTAMINATION PROCEDURES 35. PERFORM MEDICAL SCREENING
ADMINISTER IMMUNIZATIONS, PERFORM SICK CALL PROCEDURES UTILIZING THE ALGORITHM DIRECTED TROOP MEDICAL CARE, PERFORM EMERGENCY INCIDENT REHABILITATION
36. PROVIDE BASIC CARE
BED BATH, BLOOD DRAWS (NEEDLE/VACUTAINER), MAINTAIN BLOOD/FLUID PRECAUTIONS 37. PREVENT THE SPREAD OF DISEASE
PERFORM BASIC FIELD SANITATION, INSTRUCT ON PERSONAL HYGIENE IN REMOTE ENVIRONMENTS, PREVENT NOSOCOMIAL INFECTIONS, WASH HANDS, DISPOSE OF INFECTIOUS WASTE, BODY SUBSTANCE ISOLATION
38. TREAT A CASUALTY FOR SPINE INJURY
FOCUSED ASSESSMENT, C-SPINE AND NERVE INJURIES, APPROPRIATE IMMOBILIZATION 39. TREAT CARDIOPULMONARY SYMPTOMS
FOCUSED ASSESSMENT, CHEST PAIN, HA, ABDOMINAL PAIN, SITE OF BURN; DIFFERENTIAL DIAGNOSIS OF CHEST PAIN
40. TREAT GASTROINTESTINAL SYMPTOMS
FOCUSED ASSESSMENT, ACUTE ABDOMINAL PAIN, N/V/D 41. TREAT GENITOURINARY SYMPTOMS
FOCUSED ASSESSMENT, UTIs, STDs (UNDER TREAT INFECTIOUS DISEASE), VAGINAL DELIVERY (ISOLATED ENVIRONMENT IN EMERGENCY CASES ONLY)
42. TREAT NEUROLOGICAL SYMPTOMS FOCUSED ASSESSMENT, TX PER PROTOCOL 43. TREAT METABOLIC/ENDOCRINE SYMPTOMS
FOCUSED ASSESSMENT, ASSIST WITH TX OF HYPOGLYCEMIA PER PROTOCOL 44. TREAT INFECTIOUS DISEASE IMMUNOLOGICAL SYMPTOMS
FOCUSED ASSESSMENT, TRIAGE, APPROPRIATE TX PER PROTOCOL 45. TREAT SKIN DISORDERS
FOCUSED ASSESSMENT, TRIAGE, APPROPRIATE TX PER PROTOCOL 46. VAGINAL DELIVERY (EMERGENCY CASES ONLY)
FOCUSED ASSESSMENT, MANAGE AIRWAY, MANAGE AREA BLEEDING, PAIN MANAGEMENT, FETAL ASSESS-MENT, UMBILICAL CORD MANAGEMENT