PFC Basics: Documentation-Chart then Trend

The primary reason for the development of the PFC documentation is to enable the medic to more effectively and more efficiently take care of a patient beyond anticipated timelines. When we designed the PFC flowsheet, we wanted a single document that a medic could laminate and stick in the back of their aidbag, hopefully, without ever having to pull it out except for in training. Ideally, every patient would receive a quick evacuation and the medic would only have to do good TCCC. Since we know that this is not the case, the PFC documentation was custom built to enable anyone, regardless of level of training and proficiency, to help improve what they were already doing. Non-Medics, Resuscitation teams, Medics, it doesn’t matter. When technology fails, and it will, we think that having a dedicated, analog record of treatment can help reduce the cognitive burden faced by a small team who is most likely tired, and overwhelmed. The integrated checklists and visual reminders should act as cues to action.

Non-Medic team members can and have been trained to assist with this. They can take the vitals and certainly write them down and communicate changes when the medic is busy with any other tasks. The first part of this is to take accurate and repeatable vital signs. If the inputs are not accurate, the charting and trending will be inaccurate or worse, misleading. Once the vitals are taken, and are being communicated, it has been found easier to quickly write down the actual numbers on a designated chart prior to marking down the symbols on the PFC card. This has the added benefit of maintaining a legible set of numbers to use during telemedicine calls and later for data collection. Here is the chart that the Non-Medic SOFACC students started using and then we just cleaned it up, edited it and organized it into its current form.

Many of the best TTPs we develop or discover originate from students who find a unique way to tackle a common problem. The student may not think anything of it and the lane proctor may be so engrossed that they too miss out on the utility of the incremental gain that evolved in front of their eyes. Some are more obvious than others. Sometimes these things are so common sense that we can’t believe no one else has made note of it and disseminated it. If you notice someone doing something that would make the life of a medic easier and want to take a picture with a quick write up, send it in and help out the next guy! It is the most frustrating thing to see multiple people reinventing the same wheel over and over.

Keep reading for updates to the latest and greatest PFC Flowsheet AKA the PFC Card….

I inserted the Modified Lund and Browder Chart. Try it before you hate it. You simply shade in the blocks on the figure corresponding to the burns on the casualty, count the blocks and divide by 4 to get TBSA. Each of the small blocks is .25% TBSA. The number one complaint that I heard about old versions of the card were that the Lund and Browder chart was difficult to use and did not even equal 100%. It is said that this was likely a typo that got released to the public and then no one ever changed it. Ha This makes sense to me. Try it. Let us know how it works for you.

We added a spot to remind the user to calculate shock index in the margin of the graph. SI=HR/SBP

You may have noticed that in the previous version that we offset the numbers along the margins so that they directly matched up to the line that they were supposed to represent. That should make trending less confusing.

We added a couple columns to the problem list under the MIST section that should help the user formulate a plan and better communicate telemed concerns.

In the notes section, I added a checklist of the PFC principles that we started using in 2015 with a couple additions. I know this blank space is sacred but have consistently seen teams just reverting back to reactionary medical treatment as opposed to formulating plans and being proactive. The principles checklist should help remind the user of things beyond procedures to make the clinic run more smoothly.