PCC Nursing Checklist

Nursing care checklist for prolonged casualty care, organized by cadence. Hourly tasks cover vitals, mental status, urine output, pain and sedation, bleeding checks, and line patency. Recurring tasks cover repositioning, range of motion, pressure-point and skin care, cuff pressure checks, intake and output, wound and dressing care, line rotation, oral and eye care, DVT prophylaxis, and documentation. Aligned with JTS prolonged casualty care nursing guidance.

Prolonged Casualty Care

Nursing Checklist

Shift-cadence care tasks

Round-the-clock care for a prolonged casualty, grouped by how often each task is due.

Hourly

q1h0/7

Vitals: HR, BP, RR, SpO2, temp (and EtCO2 if advanced airway)

Mental status / GCS trend

Urine output recorded (goal >0.5 mL/kg/hr adult)

Pain score and sedation depth assessed

Bleeding / dressing check on active wounds

IV / IO site patency and flow confirmed

Airway: tube depth, secured, waveform present if intubated

Every 2 hours

q2h0/5

Reposition to offload pressure points

Passive range of motion to all extremities

Heels, sacrum, occiput, elbows inspected and padded

Head of bed at 30 degrees confirmed

Reassess distal pulses on injured / splinted limbs

Every 4 hours

q4h0/7

Full head-to-toe reassessment

Cuff pressure check (ETT / cric / trach), 20-30 cmH2O

Lung sounds, bilateral and clear

Bowel sounds / abdominal distension check

NG/OG external length mark verified if present

Intake and output tallied, running balance updated

Temperature management: actively warming or cooling as needed

Every 8 / shift

q8-12h0/10

Wound cleaned / irrigated, dressing changed per plan

IV/IO site rotated if due (IO 24h, PIV 72-96h)

Foley meatal care and securement check

Stoma / line site care (cric, chest tube)

Oral hygiene performed

Eye care (lubrication, lids closed if sedated)

DVT prophylaxis: ROM, compression, ambulate if able

Skin survey for breakdown documented

DD 1380 / SF 600 updated, supplies inventoried

Handoff brief prepared for relief

As needed

prn0/6

Suction airway when secretions audible or SpO2 falling

Bolus analgesia / sedation per protocol for breakthrough

Antiemetic for nausea before it compromises the airway

Recheck after every casualty movement or transport

Re-secure all tubes and lines after any reposition

Escalate to telemedicine for any unexplained deterioration

Cadence is a floor, not a ceiling. A deteriorating casualty gets reassessed continuously. Document every task with a time on the SF 600 flow sheet so the next provider can trend it.