Return to duty

MINIMAL A casualty would be classified as minimal is one who (1) can be treated by a medic and does not need to see a physicians or physician s assistant, (2) will not be evacuated, and (3) will return to duty within a day or so. 

Includes rehabilitative and recovery therapy for those who may return to duty if convalescence from injury does not exceed the established theater evacuation policy. This level of care is becoming less prevalent in contemporary warfare and battlefield patient management. Highest level treatment capability Army field hospitals, general hospitals, and combat support hospital echelon above corps. 

The second category includes casualties who appear to have non-hfe-threatening injuries, but who are unable to return to duty. Casualties with the following conditions must be hospitalized for further care ... 

B. It may become necessary for all hospitals to be able to establish and operate a continuous minimal treatment facility as part of the regular operational plan. This minimal treatment facility would be used to house those patients who cannot return to duty and who do not require or warrant hospitalization in the regular or intensive treatment part of the hospital. This is necessary since, whether patients in an evacuation chain are hospitalized or not, they must be held somewhere and accounted for. They must be housed, fed, and given at least minimal care, and they must be near definitive medical care so that they can receive additional medical treatment in an efficient manner when time and resources permit. In such a minimal treatment facility, the emphasis would be on self-care since the staffing would have to be minimal. 

A. Radiation Injury Unlikely. If there are no symptoms associated with radiation injury, patients are judged to be at minimal risk for radiation complications. These patients should be triaged according to the severity of the conventional injuries. If the patients are free of conventional injuries or disease states that require treatment, they should be returned to duty. 

Combat effective. No medical care, return to duty. 

DT PD from 4 hours until recovery. UT PD from 6 to 20 hours PD from 6 weeks until recovery. At 3 to 5 weeks medical care for 10 to 50 %. At high end of range, death may occur to more than 10 %. Survivors return to duty. 

DT PD from 3 hours until death or recovery. UT PD from 4 to 40 hours and from 2 weeks until death or recovery. At 2 to 5 weeks medical care for 10 to 80 %. At low end of range, less than 10 % deaths at high end, death may occur for more than 50 % survivors return to duty. 

Evaluation of Suspected Laser Injuries. Evaluation of possible laser injuries requires a search for specific findings on physical examination. The medic must determine quickly if the affected soldier is fit to return to duty or if he should be referred to the battalion aid station for further evaluation and/or treatment. The combat lifesaver and combat medic laser eye injury evaluation matrix (Figure 6-G) is a reproduction from FM 8-50. 

Temporary loss of vision. Bright light experience. No pain. External exam normal. Internal exam normal. Glare, dazzle, or flash-blindness. (Low dose laser.) None. Return to duty. 

Various factors should be considered before an individual who has been a nerve agent casualty is returned to duty. In an industrial setting (depot or laboratory), the criteria for reactivation are that the individual s RBC-ChE activity must have returned to within 80% of its baseline value and that the individual is otherwise symptom- and sign-free. 

A soldier who has had signs of severe exposure, with loss of consciousness, apnea, and convulsions, may have milder CNS effects for many weeks after recovery from the acute phase of intoxication. Except in dire circumstances, return to duty during this period should not be considered for such casualties. 

The need for soldiers in a frontline military operation may require that every walking casualty be returned to duty. In an otherwise asymptomatic casualty, the primary limiting factors will be (1) the soldier s visual acuity compared with the visual demands of the job and (2) the soldier s mental status compared with the intellectual demands of the job. Prolonged mental changes can be subtle and may require a careful examination to detect. 

A casualty in the minimal category is one who needs minor care and who is expected to return to duty within hours after that care is provided. In a noncontaminated environment, these casualties will generally not be evacuated. 

Casualties with minor wounds might be treated here if they can be returned to duty. However, most will need to have their protective garments replaced and will (1) go through decontamination, or (2) go through a MOPP exchange procedure if they have a second set of garments, or (3) be returned to their own units for resupply. These latter casualties may... 

From the emergency treatment station the casualty will (a) return to duty, (b) go to the decontamination area, or (c) go to the ambulance area for evacuation in a dirty ambulance. 

A minority of casualties who are able to walk will be decontaminated at the BAS or other low echelon of care. Most walking casualties who require significant medical attention will have nonurgent injuries and can be evacuated to a higher echelon for needed care. Casualties in either of these categories, those who need significant care and those who can be returned to duty after MOPP replacement, can be evacuated in a dirty vehicle. 

In an unfavorable tactical situation, another consideration may arise. Casualties with minor wounds, who otherwise may be classified minimal, might have highest priority for care to enable them to return to duty. The fighting strength thus preserved could save medical personnel and casualties from attack. 

Minimal casualties who have minor injuries, can be helped by nonphysician medical personnel, will not be evacuated, and will be able to return to duty shortly. 

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