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JTS Analyzes Search and Rescue After Action Reports to Uncover Deficiencies,
Develops Performance Improvement Metrics

https://prolongedfieldcare.org/2022/03/18/joint-trauma-system-newsletter-update/

The JTS PI and CTS Operations branches published in-depth review of after action reports (AARs) from over 252 search and rescue (SAR) missions from 2018 - 2021. The report is in response to the U.S. Navy SAR’s request that JTS assess its operations. It analyzes the context in which Naval SAR operations oc- curred as well as medical procedures and patient demographics. JTS identified deficiencies in equipment, personnel, and documentation and developed a list of PI metrics. The need for standardization is keenly felt in the field. AAR comments reinforce the need for standardized equipment like cardiac kits, medication kits, and advanced life support tools. For example, SAR crews report they do not have the equipment or skills to perform rapid intubation of patients. The report was unable to conclude whether or not standardized medication kits are available to SAR teams. The report did find skills of attendant medical personal vary considerably across SAR missions. Thirty-one percent of missions were executed by a single EMT-B, while 19% were executed by a single EMP-P, and 17% were executed by two medical attendants. In some cases, both a registered nurse and physician were present, while other times only one was pre- sent.

JTS identified opportunities for improving documentation. Vague or incomplete information in the after action reports makes it more difficult to conduct accurate assessments. Accurate information is critical for mission success. Casualty classification was one area of deficiency. The report found that there is only an 81% overall accuracy in the SAR Rescuer Skill Type
casualty classification. This puts casualty classification high on the list of performance improvement (PI) priorities. Casualty classification includes all the critical information of the patient, most notably the type and severity of injury and location of the patient. It is imperative that patients are accurately classified at the start of the mission, since this determines everything from prioritizing patient care to the medical and logistical resources. A key metric for success is the comparison between the dispatched category and the assessed category of the casualty. Dispatch’s casualty classification should match the classification assessed upon the arrival at the mission destination. Having accurate information upfront is critical for SAR teams to accurately triage the casualty in advance, which dictates urgency, timing, equipment, and all other areas of mission prep. Inconsistent SAR documentation impacts the ability for SAR teams to record accurate information. For example, the DA4700 form has a list of specific mechanisms of injury (MOI), which are tailored towards battlefield en route care and not necessarily applicable to SAR operations. JTS reported roughly one fifth (55 out of 252 cases) of SAR cases recorded the MOI as either “other” or left blank. “Other” or left unchecked ultimately makes the data less useful and harder to interpret. In cases of hypothermia, the patient’s temperature was only recorded in 13% of cases. An emphasis on documentation training may
fill the gaps in SAR documentation.

The situation is further complicated by the fragmented nature of the available guidance for SAR teams. JTS discovered SAR teams rely on guidelines from multiple sources, bringing into question source credibility and guidance consistency.

The lack of training is at the root of the deficiencies. Additionally, actual mission engagements do not provide for redundancy which would lead to proficiency, proving that personnel training is of paramount importance. For instance, in one exercise, Special Operations assets had to be utilized for Casualty Evacuation (CASEVAC) purposes because the CASEVAC plan proved insufficient during the course of the exercise. The AARs recommended regular testing and evaluation of CASEVAC plans.

Response to the JTS SAR report has been positive and supportive. LCDR Paul Roszko, Director of Emergency Medical Services, Navy Medical Forces, called the report “excellent” and viewed the findings as an opportunity to improve trauma training across the Services. The report prompted Rosko to question why there is not standardized casualty cards or simulations. He would like to take real-life cases and turn them into vignettes or simulations for squadron training. JTS does include an example of a SAR casualty vignette as a tool to improve SAR training. “The data is clear that the SAR community does a lot more than just treat trauma patients,” said Rozko. “Perhaps identifying a few common medical cases or other types of commonly encountered injuries and specifying what our "standard of care" reference point is would allow the JTS PI team to provide more feedback on the quality of care provided.”