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Contains the following key public domain (not copyrighted) U.S. Government publication(s) on one Data CD in one Adobe Acrobat PDF file - 2,561 total pages - NO PAPER COPY PROVIDED.

CONTENTS:

1. U.S. ARMY AEROMEDICAL EVACUATION CRITICAL CARE FLIGHT PARAMEDIC STANDARD MEDICAL OPERATING GUIDELINES - CY22 Version Published January 2022, 320 pages

2. TCCC Guidelines for Medical Personnel - 15 December 2021, 19 pages

3. JTS Clinical Practice Guidelines, 2,222 total pages - current as of 16 December 2022:

CPG Index

Acute Coronary Syndrome 14 May 2021 ID86

Acute Extremity Compartment Syndrome and Role of Fasciotomy (CS) in Extremity War Wounds 25 Jul 2016 ID17

Acute Respiratory Failure 23 Jan 2017 ID06

Airway Management in Prolonged Field Care 01 May 2020 ID80

Airway Management of Traumatic Injuries 17 Jul 2017 ID39

Amputation Evaluation and Treatment 01 Jul 2016 ID07

Analgesia and Sedation Management during Prolonged Field Care 11 May 2017 ID61

Anesthesia for Trauma Patients 05 Apr 2021 ID40

Aural Blast Injury Acoustic Trauma and Hearing Loss 27 Jul 2018 ID05

Austere Resuscitative Surgical Care 30 Oct 2019 ID76

Blunt Abdominal Trauma Splenectomy Post-splenectomy Vaccination 13 May 2020 ID09

Burn Care 11 May 2016 ID12

Burn Management PFC 13 Jan 2017 ID57

Catastrophic Non-Survivable Brain Injury 27 Jan 2017 ID13

Cervical Thoracolumbar Spine Injury 19 Jun 2020 ID15

Chemical Biological Radiological Nuclear Injury Response Part 2-Medical Management 25 Mar 2022 ID69

Chemical Biological, Radiological Nuclear Injury Part1 Initial Response 01 May 2018 ID69

Crush Syndrome PFC 28 Dec 2016 ID58

Damage Control Resuscitation 12 Jul 2019 ID18

Damage Control Resuscitation PFC 01 Oct 2018 ID73

Deep Venous Thrombosis Inferior Vena Cava Filter 02 Aug 2016 ID36

Documentation Prolonged Field Care 13 Nov 2018 ID72

Documentation Requirements for Combat Casualty Care 18 Sep 2020 ID11

Drowning Management 27 Oct 2017 ID64

Emergency General Surgery in Deployed Locations 01 Aug 2018 ID71

Emergency Life-saving Cranial Procedures by Non-Neurosurgeons in Deployed Setting 23 Apr 2018 ID68

Emergent Resuscitative Thoracotomy ERT 18 Jul 2018 ID20

Eye Trauma Initial Care 01 Jun 2021 ID03

Frostbite and Immersion Foot Care 26 Jan 2017 ID 59

Frozen and Deglycerolized Red-Blood Cells 11 Jul 2016 ID26

Genitourinary (GU) Injury Trauma Management 06 Mar 2019 ID42

Global Snake Envenomation Management 30 Jun 2020 ID81

Global Spider and Scorpion Envenomation Management 09 Feb 2021 ID84

High Bilateral Amputations and Dismounted Complex Blast Injury 01 Aug 2016 ID22

Hyperkalemia and Dialysis in Deployed Setting 25 Apr 2022 ID52

Hypothermia Prevention Monitoring and Management 20 Sep 2012 ID23

i-STAT Portable Blood Analyzer Austere Locations CCAT 29 Jan 2020 ID47

Infection Prevention in Combat-related Injuries 27 Jan 2021 ID24

Inhalation Injury Toxic and Industrial Chemical Exposure  26 Jul 2016 ID25 updated

Interfacility Transport of Patients between Theater Medical Treatment Facilities 24 Apr 2018 ID27

Invasive Fungal Infection in War Wounds 04 Aug 2016 ID28

JTS CPG Development Process 27 Sep 2022 ID54

Management of COVID-19 in Austere Operational Environments V3.0 23 Apr 2021

Mechanical Ventilation during CCAT 14 Dec 2021 ID48

Mechnical Ventilation Basics 27 Dec 2021 ID92

Military Working Dog CPG 12 Dec 2018 ID16

Naval Aviation Medical Treatment Protocols Apr 2019

Negative Pressure Wound Therapy CCAT 11 Feb 2020 ID49

Neurosurgery and Severe Head Injury 02 Mar 2017 ID30

Nursing Intervention Prolonged Field Care 22 Jul 2018 ID70

Nutrition Using Enteral and Parenteral Methods 04 Aug 2016 ID33

Ocular Evaluation Disposition After Laser Exposure 14 Feb 2020 ID79

Ocular Injuries Vision-Threatening Conditions PFC 01 Dec 2017 ID66

Orthopaedic Trauma Extremity Fractures 26 Feb 2020 ID56

Pain Anxiety Delirium 26 Apr 2021 ID29

Pelvic Fracture Care 15 Mar 2017 ID34 updated

Prehospital Blood Transfusion 30 Oct 2020 ID82

Prevention of Deep Venous Thrombosis Inferior Vena Cava Filter 02 Aug 2016 ID36

Progressive Return to Activity Following Acute Concussion mTBI Clinical Recommendation 2021

Prolonged Casualty Care Guidelines 21 Dec 2021 ID91

Radiology Imaging Trauma Patients in Deployed Setting 13 Mar 2017 ID01

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Hemorrhagic Shock 31 Mar 2020 ID38

Sepsis Management PFC 28 Oct 2020 ID83

Standard Medical Operating Guidelines (SMOG) for Critical Care Flight Paramedics 2022

Tactical Combat Casualty Care Guidelines 15 Dec 2021

Transcutaneous and Temporary Transvenous Pacing CCAT 30 Jan 2020 ID50

Transfusion in Military Working Dog 10 Dec 2019 ID77

Traumatic Brain Injury PFC 06 Dec 2017 ID63

Unexploded Ordnance (UXO) Management 14 Mar 2017 ID41

UPAC Ventilation Guide 26 Dec 2021

Use of TBI Plasma Biomarkers after Potentially Concussive Event-16 Aug 2021 ID90

Vascular Injury 12 Aug 2016 ID46

Ventilator Associated Pneumonia (VAP) 07 May 2020 ID45

War Wounds Debridement and Irrigation 27 Sep 2021 ID31

Wartime Thoracic Injury 26 Dec 2018 ID74

Whole Blood Transfusion 15 May 2018 ID21

Wound Management PFC 24 Jul 2017 ID62



INTRODUCTION

The SMOG continues to go through significant improvements with each release as a result of the
collaboration of Emergency Medicine professionals, experienced Flight Medics, Aeromedical Physician
Assistants, Critical Care Nurses, and Flight Surgeons. There has been close coordination in the
development of these guidelines by the Joint Trauma System, and the Defense Committees on Trauma.
Our shared goal is to ensure the highest quality en route care possible and to standardize care across all
evacuation and emergency medical pre-hospital units. It is our vision that all of these enhancements and
improvements will advance en route care across the services and the Department of Defense.

Unit medical trainers and medical directors should evaluate Critical Care Flight Paramedics (CCFP) ability
to follow and execute the medical instructions herein. These medical guidelines are intended to guide
CCFPs and prehospital professionals in the response and management of emergencies and the care and
treatment of patients in both garrison and combat theater environments. Unit medical providers are
not expected to employ these guidelines blindly. Unit medical providers are expected to manipulate
and adjust these guidelines to their unit’s mission and medical air crew training / experience. Medical
directors or designated supervising physicians should endorse these guidelines as a baseline,
appropriately adjust components as needed, and responsibly manage individual unit medical missions
within the scope of practice of their Critical Care Flight Paramedics, Enroute Critical Care Nurses, and
advanced practice aeromedical providers.

The medication section of this manual is provided for information purposes only. CCFPs may administer
medications only as listed in the guidelines unless their medical director and/or supervising physician
orders a deviation. Other medications may be added, so long as the unit supervising physician and/or
medical director approves them.

This manual also serves as a reference for physicians providing medical direction and clinical oversight to
the CCFP. Treatment direction, which is more appropriate to the patient’s condition than the guideline,
should be provided by the physician as long as the CCFP scope of practice is not exceeded.

Any medical guideline that is out of date or has been found to cause further harm will be updated or
deleted immediately. The Medical Evacuation Concepts and Capabilities Division (MECCD) serves as the
managing editor of the SMOG and are responsible for content updates, managing the formal review
process, and identifying review committee members for the annual review.

The Standard Medical Operating Guidelines are intended to provide medical procedural guidance and is
in compliment to other Department of Defense and Department of the Army policies, regulatory and
doctrinal guidance. Nothing herein overrides or supersedes laws, rules, regulation or policies of the
United States, DoD or DA.