Deployed Critical Care Battle Rhythm

Objectives

Battle Rhythm template for the deployed Critical Care (CC).

Scope

This guideline outlines a suggested CC battle rhythm for use in the deployed setting. Detailing ward and board rounds, shift patterns and workforce and a proposed daily checklist. 

Audience

Critical Care Nurses, Doctors, Physiotherapists, and deployed command team.

Initial Assessment & Management

BATTLE RHYTHM

1.     A template Battle Rhythm for a deployed MTF is detailed below.

WARD AND BOARD ROUNDS

2.       Ward and Board rounds discuss clinical information, therefore personnel on these rounds are kept as small as reasonably practicable, with only those personnel required attending. The DMD will decide who is required depending on the work flow and the current operational situation at the time. The Board round is the opportunity for the OC to be briefed on the inpatient status of his/her facility. When Board rounds are being conducted HMC/Ops room (if co-located) must be closed to all other personnel.

3.      The composition of WARD Rounds are as follows:

• • Deployed Medical Director
  • Senior Nursing Officer
  • Relevant Heads of Department
  • Physician +/-
  • Surgeon(s) +/-
  • Intensivist/Anaesthetist +/-
  • Aeromedical Evacuation Liaison Officer
  • Trauma Nurse Co-ordinator
  • Pharmacist/Pharmacy Tech
  • Physiotherapist

4.      The composition of the BOARD Rounds are as follows:       

• • Officer Commanding 
  • Deployed Medical Director
  • Senior Nursing Officer 
  • Aeromedical Evacuation Liaison Officer
  • Trauma Nurse Co-ordinator

CC SHIFT PATTERNS AND WORKFORCE

5.      Shift patterns will vary depending on the operational tempo.

• • HoDs are expected to be in the facility daily.
•  
  • Each team should have an allocated team leader. To manage the running of the team and workforce allocations. Team leaders are expected to take patients as required and deputise for the HoD during out of hours periods.
•  
  • Day, Night, Off (sleep/standby) shift pattern should be utilised and be prepared to change shift patterns in the case of Major Mass Incident or surge. This can be reviewed as the deployment progresses.

• • If the department is empty of patients and the tempo is low a Late, Early, Night Off (sleep/standby) shift pattern may be considered. There must always be a minimum of two personnel in the department. A call out list must be generated, including a list of personnel's locations when off shift with a robust recall plan in place.

DAILY ROUTINE

6.      The following checklist provides guidance and should be used as a handrail to guide practice. Daily routines should be responsive and adapted to consider the local setting and operational activity.