GORGRP, Inc.

Global Operational

Resources Group

ATP Protocols & Notes

Latest Revision: 2009/2015
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REVISED BY ISRMP 23/12/2015 FOR DISTRIBUTION
1. The Advanced Tactical Practitioner (ATP) protocols are given here,
with short Chief Medical Officer (CMO) notes. These are given as
RMP’s are most likely to find themselves operating under the ATP
protocols, and they provide an adequate – if very limited –
introduction to remote medical care. You need to be familiar with
them, and especially their limitations and narrow scope of practice.

2. The GORGRP RMP Protocols are much more extensive in all

aspects and provide for the finest possible care in remote settings.
Note however that in GORGRP, each RMP is assessed individually
and assigned an individual scope of practice in keeping with their
knowledge-skills-experiences, site limitations, etc. Your situation may
place you in a ‘one size fits all’ program and you may need to
advocate for an expanded scope in keeping with your RMP status.
 i. TABLE OF CONTENTS

2) Don’t Forget…(Clinical Pearls)---------------------------------------------------------------------------------6

3) Abdominal Pain---------------------------------------------------------------------------------------------------7
4) Abscess----------------------------------------------------------------------------------------------------------------7
5) Allergic Rhinitis/ Hay Fever/ Cold-Like Symptoms---------------------------------------------------------8
6) Altitude Illness-----------------------------------------------------------------------------------------------------9
7) Anaphylactic Reaction--------------------------------------------------------------------------------------------11
8) Asthma (Reactive Airway Disease)------------------------------------------------------------------------------12
9) Back Pain------------------------------------------------------------------------------------------------------------13
10) Barotrauma------------------------------------------------------------------------------------------------------14
11) Behavioral Changes (Includes Psychosis, Depression, Suicidal Impulses)-------------------------5
12) Bronchitis/Pneumonia----------------------------------------------------------------------------------------16
13) Cellulitis/Abscess-----------------------------------------------------------------------------------------------17
14) Chest Pain--------------------------------------------------------------------------------------------------------18
15) Constipation/Fecal Impaction-------------------------------------------------------------------------------20
16) Contact Dermatitis---------------------------------------------------------------------------------------------21
17) Corneal Abrasion/ Corneal Ulcer/ Conjunctivitis------------------------------------------------21
18) Cough-------------------------------------------------------------------------------------------------------------23
19) Deep Venous Thrombosis (DVT)----------------------------------------------------------------------------24
20) Dehydration------------------------------------------------------------------------------------------------------25
21) Dental Pain-------------------------------------------------------------------------------------------------------26
22) Determinationof Death/Discontinuing Resuscitation---------------------------------------------------27
23) Ear Infection (Includes Otitis Media and Otitis Externa)---------------------------------28
24) Envenomation-------------------------------------------------------------------------------------------------29
25) Epistaxis-------------------------------------------------------------------------------------------------------30
26) Flank Pain (Includes Renal Colic, Pyelonephritis, Kidney Stones)---------------------31
27) Fungal Skin Infection---------------------------------------------------------------------------32
28) Gastroenteritis-------------------------------------------------------------------------------------------------33
29) Headache--------------------------------------------------------------------------------------------------------34
30) Head and Neck Infection (Includes Epiglottitis and Peritonsillar Abscess)--------------35
31) HIV Post Exposure Prophylaxis------------------------------------------------------------36
32) Hyperthermia----------------------------------------------------------------------------------------------------37
33) Hypothermia-----------------------------------------------------------------------------------------------------38
34) Ingrown Toenail-------------------------------------------------------------------------------------------------39
35) Joint Infection------------------------------------------------------------------------------------------------40
36) Kidney Stone - See Flank Pain--------------------------------------------------------------------31
37) Loss of Consciousness (without Seizures)--------------------------------------------------------41
38) Malaria------------------------------------------------------------------------------------------------------------42
39) Meningitis---------------------------------------------------------------------------------------------------------43
40) Nausea and Vomiting-----------------------------------------------------------------------------------44
41) Otitis Externa - See Ear Infection----------------------------------------------------------------28
42) Otitis Media - See Ear Infection--------------------------------------------------------------------28
43) Pain Management-----------------------------------------------------------------------------------------------45
44) Pneumonia - See Bronchitis-----------------------------------------------------------------------16
45) Pulmonary Embolus - See Chest Pain-------------------------------------------------------------18
46) Pyelonephritis - See Flank Pain----------------------------------------------------31
47) Renal Colic - See Flank Pain------------------------------------------------------------------------31
48) Seizure------------------------------------------------------------------------------------------------------------46
49) Sepsis/ Septic Shock------------------------------------------------------------------------------------------- 47
50) Smoke Inhalation----------------------------------------------------------------------------------------------48
51) Spontaneous Pneumothorax-------------------------------------------------------------------------------49
52) Subungual Hematoma-------------------------------------------------------------------------------------50
53) Testicular Pain------------------------------------------------------------------------------------------------51
54) Urinary Tract Infection---------------------------------------------------------------------------------------52
 DON’T FORGET…
(CLINICAL PEARLS)
When IV route is recommended, but not obtainable, consider IO, IM, or PO unless contraindicated.

Currently available SL medication formulations include: Benadryl Quikstrips, Sudafed PE SL, Zofran ODT.

If crystalloids (Normal Saline or Lactated Ringer’s) are recommended but not available, substitute Hextend
or Hespan if available.

DO NOT give Epinephrine IV.

All IV medications may be given slow IV push with the exception of antibiotics which should be in a
drip.

Remember to document dose and time of all medications so the receiving facility may be informed.

Do not use local anesthetic with epinephrine on the fingers, toes or penis.

When oxygen is called for in the Protocols, the authors realize that it is recommended, but may not be availa
ble.

Due to the high level of physical fitness of SOF personnel, there may be a prolonged period of mental lucidi-
ty and apparent stable vital signs despite a severe injury. Treat the injury, not the operator!

Medical Documentation (SOAP note): In order to ensure proper care and medical information transfer dur-
ing patient treatment a standardize format for medical documentation is required. The standard format is the
SOAP note (Subjective, Objective, Assessment, and Plan).

Subjective: In the patient’s own words, describe the chief complaint. At a minimum you need to
include the OPQRST (Onset, Provocation, Quality, Radiation, Severity, and Time line of symptoms).
AMPLE (Allergies, Medication, Past Medical and Surgical history, Last meal, and Events leading up to this
condition) history is also included in this section

Objective: vital signs and physical examination findings. At a minimum you need to document perti-
nent positives and negatives, and measurements of injuries or lesions. Be as detailed as possible.

Assessment: a brief summary of your medical decision making to include what you think it is and what
it is not. Include your differential diagnosis list in this section.

Plan: your course of treatment to include any medications, additional studies, consultation, rehabilitation,
evacuation category and disposition of the patient.
CMO Notes: Serial abdominal examinations
– every 30-120 minutes as indicated - is the
key to diagnosing serious abdominal
conditions. Worsening despite fluids, anti-
emitics, and anti-acid medications is an
indication for evacuation.

CMO Notes: Loss of appetite is often an early

sign of more serious problems. Intermittent
N/V is often seen with early obstruction. FEVER
+/- STRAWBERRY JAM STOOL is always a
serious problem.