Review of the new Nursing Care CPG

Introduction & Scope

  • Intended for TCCC-certified providers in prolonged field care (PFC) environments where timely evacuation is not possible.
  • Aims to prevent complications (e.g. DVT, pressure ulcers, infections) through essential nursing care performed with minimal resources.
  • Emphasises utilisation of cross-trained support staff and standardised checklists.

Assessment

  • Regular monitoring is documented via the PFC flowsheet (Appendix A).
  • Minimum equipment: manual BP cuff, thermometer, stethoscope, pulse oximeter, glucometer, urinary catheter, torch, watch.
  • Better: digital wrist BP cuff.
  • Best: portable vital‑sign monitor with capnography and continuous display functionality.

Vital Signs & Tube Monitoring

  • Record BP, heart rate, respiratory rate, temperature, SpOâ‚‚, capnography (if available), Glasgow Coma Scale, pain score, and peripheral pulses.
  • Inspect and secure tubes (ETT/cricothyroid, NG, IV lines, chest tubes, urinary catheter).
  • Special emphasis on frequent checks for ETT positioning in burn patients due to oedema.
  • Avoid routine NG tube placement unless radiographic/intraoperative confirmation is available – caution in austere environments.

Fluid Intake & Output Monitoring

  • Maintain IV drip monitoring and oral fluid administration.
  • Target urine output: 30–50 mL/h in a normal adult, 100–200 mL/h if rhabdomyolysis suspected.
  • Monitor wound and tube drainage output.

Skin & Splint Inspection

  • Evaluate skin under splints, tapes, around nares and mouth for pressure, dermatitis, erythema, cracking, breakdown, and allergic reactions.
  • Ensure pulses distal to splints are preserved.
  • Elevate head and legs using improvised supports (e.g. folded chair) as required.

Planning & Documentation

  • Use Appendix A (flowsheet) and Appendix B (care plan template) to document scheduled nursing interventions.
  • Appendix C demonstrates a filled example for orientation.
  • Appendices D–F cover packing lists and skills checklists for training and deployment preparation.

Specific Nursing Interventions

  • Flush saline locks: using syringe, alcohol prep, saline bag—intervals defined by tier of care.
  • Airway suction: for advanced airway management in ventilated or intubated patients.
  • Repositioning & padding checks are performed to prevent pressure injuries under splints.
  • Oral care: including regular mouth hygiene for ventilated or immobilised patients.
  • Foley catheter care: maintenance and infection prevention.
  • Skin care: cleansing, drying, application of lotion for dryness management.
  • Tape changes: prevent skin breakdown.
  • Lower limb massage/DVT prophylaxis: stimulation techniques for immobile patients.
  • Passive range of motion exercises: to minimise contractures.
  • Turn–cough–deep breathe exercises: support respiratory function and prevent pneumonia.

Appendices

  • Appendix A: PFC flowsheet and nursing care checklist (minimum to best).
  • Appendix B: 12/24-hour nursing care planner.
  • Appendix C: Example care plan completion.
  • Appendix D: Assessment & intervention packing list.
  • Appendix E: Skills checklist for clinical training.
  • Appendix F: Notes on off-label practices referenced in the CPG

Key Points

  • Nursing care is pivotal to preventing avoidable outcomes (e.g. infection, DVT, respiratory decline) in protracted injury care.
  • The guideline operates on a tiered approach: minimum»better»best, facilitating adaptability in resource-limited settings.
  • Standardised documentation enhances continuity and delegation of care.
  • Cross-training teammates reduces the burden on the primary caregiver.

The Bottom Line: Be a better medic. Add these to your Ruck kit: a wrist BP cuff and a glucometer/lactate monitor. Few medics have this.

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