Quick Start — Critical Case Checklist
| # | Who | Action |
|---|---|---|
| 1 | Nurse | Triage RED → highest priority |
| 2 | Physician | Consult → decide on surgery → create surgical record |
| 3 | Anesthesia | Pre-op assessment → anesthesia record → intraoperative monitoring |
| 4 | Blood Bank | Confirm blood type → issue units → record transfusion |
| 5 | BioMed | Check out instrument set → post-op return → sterilization record |
| 6 | Cashdesk | Consolidate all items → close the billing record |
Patient Journey: A RED-Tagged Casualty
At 4 PM, a patient with significant bleeding is brought in on a stretcher. The nurse immediately assigns triage category RED (Immediate).
Unlike the previous article's patient with a stable fracture, this one needs surgery, needs blood, and needs multiple roles working simultaneously.
Stage 1: Triage RED
In the Nurse Station PWA, RED means "treat immediately or risk death."
After selecting RED, this patient appears at the top of the physician's queue, highlighted in red. The system ensures RED patients are never pushed below YELLOW or GREEN patients.
Stage 2: Physician Decides on Surgery
After assessment, Dr. Wang determines emergency surgery is needed. In the Doctor Station PWA, he:
- Records the diagnosis and surgical decision
- Creates a surgical record — selects the procedure type, enters the surgeon's name
- The system marks the patient status as "In Surgery"
From this moment, multiple roles need to act in parallel.
Stage 3: Anesthesia (Anesthesia Station PWA)
The anesthesiologist opens the Anesthesia Station PWA and sees this case requires anesthesia support.
Pre-operative assessment:
- Patient demographics (auto-populated)
- Allergy confirmation
- ASA classification
- Planned anesthesia type
Intraoperative record:
- Medications administered (PIO format: drug/dose/route)
- Intraoperative vital signs (recorded every 5-15 minutes)
- Surgery start and end times
Stage 4: Blood Transfusion (Blood Bank PWA)
The patient is bleeding heavily and needs a transfusion. The blood bank technician opens the Blood Bank PWA.
Transfusion workflow:
- Check inventory — confirm available units of the required blood type
- Issue blood — select a specific unit and confirm issuance
- Record transfusion — who issued it, to whom, when, and which specific bag
The blood bank system tracks the complete lifecycle of every blood unit: receiving → storage → issuance → transfusion. This is called the chain of custody. At any point, you can trace where a bag of blood is and who handled it.
Emergency O-negative in urgent situations: If there's no time to confirm blood type, O-negative (universal donor) can be issued directly. The system allows this but flags it as "emergency issuance" for post-hoc audit.
Stage 5: Equipment Management (BioMed PWA)
Surgery requires an instrument set. The BioMed technician opens the Equipment Management PWA:
- Checkout — select an instrument set from the inventory, record which surgery it's assigned to
- In use — the set is marked as "in use" during surgery
- Return — post-op, the set is returned
- Sterilization — record sterilization completion, the set returns to available status
An instrument set must be in AVAILABLE status to be checked out. If it shows "In Maintenance" or "Sterilizing," it's temporarily unavailable.
This cycle is called the SPD cycle (Supply Processing Distribution). In field environments with limited instrument sets, tracking each one's status is critical.
Stage 6: Billing (Cashdesk PWA)
After surgery, all treatment items need to be consolidated for billing. The Cashdesk PWA aggregates all charges for this patient in one view:
- Surgical fees
- Anesthesia fees
- Blood products used
- Medications used
- Instrument sets used
The cashdesk isn't for collecting payment from patients in a disaster zone — it's for recording resource consumption. This data feeds into resupply requests, insurance claims, and administrative settlement.
Blood Management Essentials
Blood products are the most sensitive of all medical supplies. Key principles:
Expiry management: The Blood Bank PWA displays the expiration date for each unit. Units nearing expiry are flagged with warnings. Expired units cannot be issued.
First-in, first-out: When issuing, prioritize units closest to expiry to reduce waste.
Donor interval protection: If your station operates a Walking Blood Bank (field donations), the system tracks each donor's last donation date and automatically blocks repeat donations within 56 days.
Temperature and transport: The system records receiving condition, but temperature monitoring requires physical equipment (refrigerator thermometer). The system can record temperature readings but cannot measure them directly.
Frequently Asked Questions
Blood inventory shows zero? Blood products, like medicines, must be "received" before they appear in inventory. Go to the Blood Bank PWA, select "Receive Blood," and enter the blood type, unit count, and expiration date.
Instrument set checkout fails? Verify the set's status is AVAILABLE. If it shows "In Use" or "In Maintenance," the return or maintenance workflow must be completed first.
Where can I view surgical records? The Doctor Station PWA shows all surgical records on the patient detail page. The Admin role can see station-wide surgery statistics on the Dashboard.
Can anesthesia records be filled in after the fact? Yes. During an emergency, focus on treating the patient. Records can be completed afterward. The system records both "actual procedure time" and "entry time" to maintain the audit trail.
Can billing be skipped? It can be deferred but shouldn't be skipped. Billing data is the foundation for resupply requests. Without it, you can't accurately calculate the station's resource consumption rate.
Series Navigation
This is the third article in the xGrid Field Station Operations Guide series. Full series:
- Three Minutes to Online — From Power-On to a Fully Operational Station
- The Patient Journey — From Triage to Discharge
- Surgery and Transfusion — Managing Critical Cases (this article)
- LSCO Battlefield Medicine — A Field Medic's Operations Manual
- Daily Operations — Inventory, Blood Bank, and Shift Handoffs
This article covered the most complex treatment scenario inside a medical station. Next, we leave the station and look at how field medics use the LSCO system on the front line.