ECCCHO: Effective Combat Casualty Care Handoff Operations

According to the Joint Commission, approximately 70% of sentinel events in medical care are related to communication mishaps, and despite regular and frequent occurrence, poor communication during patient handoffs (i.e., transfer of patient care information, responsibility, and authority from one provider to another) remains a major contributor to medical errors (Nether, 2017; The Joint Commission, 2017, SEA 58). These estimates are based on the 21,000 health care organizations accredited by the Joint Commission but ignore errors in combat casualty where these numbers are likely to be higher due to the harsh nature of combat environments. Why do patient handoffs matter? Patient handoffs are critical for facilitating and informing decisions about the next level of care and can impact treatment throughout the continuum of care. A standardized approach can help mitigate known risks related to information loss. In addition, the written information transferred during a handoff serves as a patient record. This record informs the patient’s long-term care and determines disability benefits for life. Handoffs are conducted by teams of at least two; and in combat casualty care, there are many known challenges. First, these teams could have little or no previous interactions and may even involve transport teams with no medical background, further complicating communication and coordination of care. Operational experience suggests that context/environment, experience, expertise, and state of the individuals involved in the care of the wounded are among the many factors that could affect successful handoff. These factors impact the way in which information is captured and communicated, which drive the success of the handoff. Imagine a common scenario in recent engagements involving a Marine unit on a foot patrol in Afghanistan—one explosion, then another. This routine procedure of transferring care from one provider to another is fraught with challenges. On the bird, the medic gives the patient more morphine because he appears to be in extreme pain. Unfortunately, the patient immediately deteriorates as his heart slows and blood pressure drops. The patient dies due to a combination of morphine overdose and blood loss. The ultimate goal of this proposed work is to improve combat survivability and reduce preventable deaths by focusing on the challenges that revolve around communication during patient handoffs in combat situations. Products of this work will be a patient handoff protocol based on science and operational requirements and associated training linked to existing Tactical Combat Casualty (TCCC) training. The Effective Combat Casualty Care Handoff Operations (ECCCHO) protocol incorporates the science of effective team communications as well as current best practices in the field. Associated ECCCHO training was developed based on adult learning principles and operational training constraints.