Factors Related to Accuracy and Completeness of Field Medical Documentation

Abstract : Medical data for combat casualties at the first echelon of care are often unavailable. The NATO-approved method for recording battlefield medical data, DD Form 1380 Field Medical Card (FMC), is frequently missing from casualty medical records. The objective of this study was to address this problem by investigating factors that affect tile documentation of medical data during combat missions. Measurements were obtained to determine the amount of time required to complete a FMC and to assess the accuracy and completeness of the data recorded. Measures obtained during simulated combat training exercises were made during daylight, twilight, and nighttime conditions, and under varying levels of combat intensity. The results of the investigation showed that accuracy and completeness of FMC data were directly related to the time available or allotted to documentation by the corpsman. The average amount of time taken to complete the FMC was 3:09 min. This was estimated to be approximately one half of the amount of time allotted for the entire patient encounter. The average amount of time required to obtain data of acceptable accuracy and completeness was 3:26 min. These results indicate that it takes longer to produce satisfactory documentation using the FMC than conditions typically permit. Consequently, corpsmen appear to be making a rational decision to spend all available time on casualty treatment rather than use precious time to produce documentation that may be of little use.