Surveillance Medical Training
Visi Servo" (Saving the Unseen)
Given their detached operational roles, LRS teams have a critical need for combat lifesaving training. Following is a recommended combat lifesaver (CLS) program. The program should ideally be taught over a course of 5 days by detachment/company medics. If your detachment does not have a medic, this outline should be given to the medical personnel teaching the course. The course should be taught in place of the standard CLS course due to the unique LRS environment and the time it takes for an injured soldier to reach definitive medical care. If possible, each team should have two combat lifesavers, one in the hide site and one in the surveillance site.
1. Recommended CLS course topics:
- Kinematics of trauma, to include wound ballistics, blast injuries, and mechanisms of injury.
- Advanced airway management, to include needle and surgical cricothyrotomy.
- Respiratory management, including open chest wounds, tension pneumo/hemothorax, and flail chest.
- Cardiac/circulatory management in reference to control bleeding, pulse sites, heart rates, and recognition of cardiac tamponade; suturing minor lacerations.
- Shock management, types of shock, and their causes and treatment.
- Treatment for simple, closed, and angulated fractures/dislocations. (This should include infection control in open wounds and fractures.)
- Signs and symptoms of open and closed head injuries and their treatment.
- Overview of the spinal column; treatment for spinal injuries, focusing on immobilization and creative spine board procedures.
- Classification of burns, with treatment and fluid loss concerns.
- Primary and secondary patient surveys.
- Hot and cold weather injuries, with their prevention and treatment.
- Personnel one- and two-man carries and improvised litters.
- IV training with regard to proper equipment selection and preparation; multiple live IV sticks until a moderate level of proficiency is achieved by utilizing quarterly training after certification.
- MEDEVAC training covering nine-line requests, safe helicopter procedures, loading patients onto the aircraft, and hoist operations.
- Trauma lane involving multiple casualties during an 8-mile road march.
- Cumulative written 75-question test.
2. Recommended packing list for LRS combat lifesaver (CLS) bags:
- 2 SAM splints
- 3 petroleum gauze (may also be in survival kits)
- 2 rolls of 1" tape
- 2 rolls of 3" tape
- 2 ace wraps (2")
- 2 ace wraps (4")
- 1 curved 5-1/2" hemostat (may be on individual)
- 2 packages of 3-0 non-absorbable suture (may be on individual)
- 4 packages of betadine swabsticks
- 6 rolls of kerlex
- 2 bottles of povidone solution (may be in survival kits)
- 25 alcohol pads
- 8 4"x4" gauze
- 2 7.0 cut down endotracheal tubes with a bevel and size #11 scalpel
- 1 bag valve mask outside of CLS bag
- 1 bag of 800mg Motrin
- 1 bag of Tylenol
- Poleless litter outside of CLS bag
- 2 1000ml IV bags with stick kits (may be carried if each team member does not already have)
- Bee sting kits (should be issued to previously identified personnel during PCI)
3. Scope of practice for LRSD/C medics:
- Medics assigned to LRS units should ideally have an EMT-intermediate or higher license with pre-hospital or basic trauma life support, CPR, and advanced cardiac life-support training.
- Medics should obtain a memorandum extending their scope of practice to equal an Air Force/Navy individual duty medical technician. The ability to provide prescription drugs and advanced medical procedures is crucial in an isolated environment.
4. Garrison duties for LRSD/C medics:
- Establish a designated time for internal sick call hours, allowing time for flexibility in reference to mission schedules.
- Provide and track class VIII supplies for the CLS bags and internal medical equipment.
- Provide 24-hour emergency/clinical medical support to the detachment/company.
- Provide medical coverage for jumps, ranges, SPIES/FRIES, etc. Medics may arrange for external medical support through the operations cell to allow them time to participate in training.
- Teach basic medical classes to the detachment/company.
- Teach quarterly training to CLS personnel, focusing on IV sticks and advanced medical skills to maintain proficiency.
- Track dental categories.
- Act as detachment/company field sanitation NCO.
- Maintain detachment/company medical records and arrange for school physicals.
- Assist in the medical station for SRP.
- Serve as the commander's "medical conscience."
- Assist in all other duties as designated by the 1SG. (Ideally, medics should work for the detachment/company 1SG.)
5. Field/deployment duties of LRSD/C medics:
- Assist team leaders in PCI of teams' medical equipment and supply class VIII.
- Conduct PCI of each team's CLS bags and stock to standard.
- If not already given, conduct a brief of target areas' hazardous wildlife, climate, and vegetation. Information may be obtained from the community health nurse or from preventive medicine.
- PCI own medical equipment with enough supplies to sustain for prolonged periods without resupply. Packing lists and equipment will be created for detachment medics where there is no MTOE.
- Maintain a record of detachment/company personnel's blood type, allergies, and pre-existing medical conditions.
- Establish a detachment/company aid station once on site.
- Locate nearest level one trauma facility and designate a landing site for dustoff. Have a strip map or drive route to closest medical facility.
- Establish sick call hours with flexibility to mission times.
- Assist with construction of the medical portion of Paragraph 4 in the operations order, to include coordination with aviation assets with the grid to the closest level one trauma facility. Obtain information on hazardous wildlife, plant life, disease infested areas, and sources of potable water.
- Provide medical aid to the teams after missions, addressing health and hygiene matters.
- Serve as the commander's "medical conscience."
- Assist with duties designated by the 1SG.
NOTE: On high-risk missions, units may consider inserting a medic with the team. A quick-reaction force (QRF) may not reach the team in time to salvage any patients who sustain injuries during the fire fight. If a medic is not inserted with the team, he may be positioned with the QRF. Medics may also be placed on the insertion/extraction aircraft to provide medical coverage during hot infiltration/exfiltration. Detachment/company medics should be on standby while teams are inserted, not only for QRF response, but to provide "medicine across the battlefield" advice to teams on the ground. For example: If a team member becomes ill or injured and the team leader or senior CLS is not sure what to do or what treatment to render, they may speak to the medic over the radio to provide treatment, advice, or a solution.
6. MEDEVAC procedures for inserted teams:
- Upon insertion, teams should designate an area for use as a MEDEVAC landing area in case a team member falls ill and requires immediate medical extraction.
- Teams should plan medical evacuation points along their routes to facilitate landing of a MEDEVAC aircraft or hoist with jungle penetrator or sked.
- The team senior CLS should relay guidance to the team leader in reference to a patient's status and evacuation urgency.
- Team leaders may want to radio the unit's medic for treatment advice or patient evacuation urgency.
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