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[[File:Prolonged Field Care the New Normal says Army, MRMC Brass.jpg|thumb|376x376px|U.S. Army General Barbara Holcomb delivering a keynote speech on prolonged field care at the 2017 Military Health System Research Symposium]]
[[File:Prolonged Field Care the New Normal says Army, MRMC Brass.jpg|thumb|376x376px|U.S. Army General Barbara Holcomb delivering a keynote speech on prolonged field care at the 2017 Military Health System Research Symposium]]


Prolonged Casualty Care refers to the specialized medical care provided to individuals who have sustained injuries or illnesses in situations where immediate evacuation to a medical facility or next tier of healthcare provision is delayed, challenging, or not feasible.<ref>{{Cite journal |last1=Smith |first1=Michael |last2=Johnston |first2=K. |last3=Withnall |first3=R. |date=2021-04-01 |title=Systematic approach to delivering prolonged field care in a prehospital care environment |url=https://militaryhealth.bmj.com/content/167/2/93 |journal=BMJ Mil Health |language=en |volume=167 |issue=2 |pages=93–98 |doi=10.1136/jramc-2019-001224 |issn=2633-3767 |pmid=32111674|s2cid=211564442 }}</ref> This concept is applicable in various contexts, including military operations, wilderness emergencies, and disaster response scenarios. Definitions may exhibit slight variations, but they generally convey the same fundamental meaning:<blockquote>"Field medical care, applied beyond doctrinal planning time-lines"<ref>{{Cite journal |last=Keenan |first=Sean |date=2016 |title=Deconstructing the Definition of Prolonged Field Care |url=https://prolongedfieldcare.org/wp-content/uploads/2016/01/deconstructing-prolonged-field-care.pdf |journal=Prolonged Field Care}}</ref>
Prolonged Casualty Care refers to the specialized medical care provided to individuals who have sustained injuries or illnesses in situations where immediate evacuation to a medical facility or next tier of healthcare provision is delayed, challenging, or not feasible.<ref>{{Cite journal |last1=Smith |first1=Michael |last2=Johnston |first2=K. |last3=Withnall |first3=R. |date=2021-04-01 |title=Systematic approach to delivering prolonged field care in a prehospital care environment |url=https://militaryhealth.bmj.com/content/167/2/93 |journal=BMJ Mil Health |language=en |volume=167 |issue=2 |pages=93–98 |doi=10.1136/jramc-2019-001224 |issn=2633-3767 |pmid=32111674|s2cid=211564442 }}</ref>
This concept is applicable in various contexts, including military operations, wilderness emergencies, and disaster response scenarios. Definitions may exhibit slight variations, but they generally convey the same fundamental meaning:<blockquote>"Field medical care, applied beyond doctrinal planning time-lines"<ref>{{Cite journal |last=Keenan |first=Sean |date=2016 |title=Deconstructing the Definition of Prolonged Field Care |url=https://prolongedfieldcare.org/wp-content/uploads/2016/01/deconstructing-prolonged-field-care.pdf |journal=Prolonged Field Care}}</ref>


"Field medical care that is applied beyond “doctrinal planning time-lines” by a tactical medical practitioner in order to decrease patient mortality and morbidity."<ref>{{Cite journal |last1=Dolan |first1=Connor P. |last2=Valerio |first2=Michael S. |last3=Lee Childers |first3=W. |last4=Goldman |first4=Stephen M. |last5=Dearth |first5=Christopher L. |date=2021-02-04 |title=Prolonged field care for traumatic extremity injuries: defining a role for biologically focused technologies |journal=npj Regenerative Medicine |language=en |volume=6 |issue=1 |page=6 |doi=10.1038/s41536-020-00117-9 |issn=2057-3995 |pmc=7862384 |pmid=33542235}}</ref>
"Field medical care that is applied beyond “doctrinal planning time-lines” by a tactical medical practitioner in order to decrease patient mortality and morbidity."<ref>{{Cite journal |last1=Dolan |first1=Connor P. |last2=Valerio |first2=Michael S. |last3=Lee Childers |first3=W. |last4=Goldman |first4=Stephen M. |last5=Dearth |first5=Christopher L. |date=2021-02-04 |title=Prolonged field care for traumatic extremity injuries: defining a role for biologically focused technologies |journal=npj Regenerative Medicine |language=en |volume=6 |issue=1 |page=6 |doi=10.1038/s41536-020-00117-9 |issn=2057-3995 |pmc=7862384 |pmid=33542235}}</ref>

Revision as of 08:32, 13 September 2023

Prolonged Casualty Care

Overview

U.S. Army General Barbara Holcomb delivering a keynote speech on prolonged field care at the 2017 Military Health System Research Symposium

Prolonged Casualty Care refers to the specialized medical care provided to individuals who have sustained injuries or illnesses in situations where immediate evacuation to a medical facility or next tier of healthcare provision is delayed, challenging, or not feasible.[1]

This concept is applicable in various contexts, including military operations, wilderness emergencies, and disaster response scenarios. Definitions may exhibit slight variations, but they generally convey the same fundamental meaning:

"Field medical care, applied beyond doctrinal planning time-lines"[2]

"Field medical care that is applied beyond “doctrinal planning time-lines” by a tactical medical practitioner in order to decrease patient mortality and morbidity."[3]

"Prolonged care is provided to casualties if there is likely to be a delay in meeting medical planning timelines"[4]

While the concept itself is well established, since 2012 it has become rapidly codified, with changes in the global political environment and the nature of combat operations around the world.[5] This led to increased research and academia in the area of Prolonged Casualty Care, first in Special operations teams[6] and then more broadly.[7][8][9]

Historical Context

The concept of prolonged casualty care has evolved over time, driven by lessons learned from military conflicts,[10] humanitarian missions, and disaster response efforts. It has become a vital component of prehospital, emergency and military medicine. Prolonged Casualty Care as a subspecialty relies on the transmission and adaptation of guidelines between civilian and military organisations. This can take the form of adapting civilian clinical practices to a military setting,[4] undertaking civilian research to inform military practices[7] or adapting miltiary Prolonged Field Care training for a civilian audience.[11]

Core Capabilities

There are twelve core capabilities of Prolonged Field Care:

  1. Monitor: Possess the capability to acquire, analyze, and comprehend a patient's vital signs, employing a reliable approach for precise documentation of observations.
  2. Resuscitate: Have the equipment and competence to commence suitable fluid resuscitation to enhance patient outcomes, encompassing the administration of whole blood and blood products when necessary.
  3. Ventilate & Oxygenate: Administer positive pressure ventilation while safeguarding the lungs from additional harm.
  4. Airway Management: Gain control of a patient's airway to prevent hypoxia, asphyxiation and aspiration.
  5. Sedation & Pain Control: Use adequate and appropriate pain control. Use sedation to accomplish any procedural tasks.
  6. Physical Exam & Diagnostics: Conduct a thorough physical examination and diagnostics to gather information about the patient's current status and anticipate concealed injuries..
  7. Ongoing (Nursing) Care: Continuously provide nursing care that includes maintaining the patient's warmth, cleanliness, and dryness, managing biological needs, performing wound care, and proactively preventing additional illness.
  8. Advanced (Surgical) Procedures: Undertake advanced procedures essential for preserving life, reducing morbidity and enhancing overall outcomes.
  9. Telemedicine: Establish telemedicine connections with medical providers capable of guiding treatment and effectively communicate the patient's condition.
  10. Prepare for Evacuation: Prepare for safe evacuation by ensuring patient stability during transport and taking measures to prevent further harm.
  11. Logistics: Understand the chain of care and evacuation.
  12. Communication: Establish and maintain reliable communication with operational and medical control.
Special Warfare Medical Group training in prehospital care, this stage would be the "ruck" stage, equipment used must be carried to the patient in a rucksack

The first ten capabilities originates in military practice[12][13] with the last two being later additions for a civilian Each of the core capabilities can then be considered in terms of Minimum, Better, Best in relation to planning to provide a gold standard level of care[14] and in relation to Ruck, Truck, House and Plane[15] to discuss the stages of care and logistical issues which may limit equipment provision.

These stages of care can be further explained as:

  • RUCK: the equipment and medications carried to the furthest point of an expedition or mission. Generally (or conceptually) carried in a rucksack.
  • TRUCK: Additional medications and equipment carried on a transportation medium during an expedition or operation (Four-wheel drive vehicles, boats etc).
  • HOUSE: Equipment and medications available at a team's house, warehouse or other staging post building.
  • PLANE: Plane is used here to represent the formal medical evacuation platform, this will vary but may have the staffing, equipment and capabilities very close to the receiving hosptial.

Core Interventions

There are two acronyms used to prompt the provision of Prolonged Casualty Care, those being HITMAN[16] and SHEEPVOMIT.[17][18]

H: Head to Toe examination; a full secondary survey to identify illnesses or stigmata of disease.

I: Infection

T: Tubes and tidy

M: Medications

A: Administration

N: Nursing care; utilise the SHEEP VOMIT acronym.

The second acronym, SHEEP VOMIT, developed by Jason Jarvis and Aebhric O'Kelly, details the nursing care needs of a patient and how best to address these.[19][20]

S: Skin protection

H: Heat regulation

E: Elevate head

E: Exercises

P: Pressure points

V: Vital signs

O: Oral hygiene

M: Massage (DVT prophylaxis)

I: Ins and Outs (diet and fluid)

T: Turn / cough / deep breath

Education

A number of civilian and military Prolonged Casualty Care courses exist. While many follow the core capabilities outlined above some do not. The Austere Emergency Care course aligns closely with the 12 capabilities (as it was designed by one of the authors of the capabilities list). The typical course contents of a typical Austere Emergency Care course includes:

  • TECC/TCCC practical scenarios
  • Four Horsemen of the Apocalypse scenarios (Catastrophic Hemorrhage, Burns, Crush, TBI)
  • Austere nursing care scenarios
  • Austere and prehospital ultrasound (APUS)
  • Disaster response / mass casualty
  • Improvised medicine
  • Austere Critical Care
  • Austere Nursing Care
  • Full-day, immersive exercise

Terminology

A variety of terminology is used for the same concept, this is partly due to the differences between military and civilian practice. The following terms are used fairly interchangeably, but there may be specific differences between the association dogma, guidelines and protocols.

  • Prolonged Prehospital Care - The British Armed Forces utilise this terminology as well as Prolonged Hospital Care.[4]
  • Austere Emergency Care[21][22] - Preferred civilian terminology relating to training and education
  • Prolonged Field Care - Commonly used military term
  • Prolonged Casualty Care - Preferred civilian term

ProlongedFieldCare.org Website

The prolongedfieldcare.org website defines its mission is: "to educate, inform, and advocate for the training of austere emergency medical responders".[23] The website was the brain child of the prolonged field care working group based in the US. Created in 2014 as a one stop shop for prolonged field care resources, the website is now visited over 10,000 times a month and is a valuable resource for special forces, military and civilians medics from around the world.[24] Since 2018 the website has also acted as the host for the US Department of Defence Advanced Virtual Support for Operational Forces (ADVISOR) tele-medicine consultation service, part of the US Army Medical Research and Development department at Fort Detrick.

See Also

References

  1. ^ Smith, Michael; Johnston, K.; Withnall, R. (2021-04-01). "Systematic approach to delivering prolonged field care in a prehospital care environment". BMJ Mil Health. 167 (2): 93–98. doi:10.1136/jramc-2019-001224. ISSN 2633-3767. PMID 32111674. S2CID 211564442.
  2. ^ Keenan, Sean (2016). "Deconstructing the Definition of Prolonged Field Care" (PDF). Prolonged Field Care.
  3. ^ Dolan, Connor P.; Valerio, Michael S.; Lee Childers, W.; Goldman, Stephen M.; Dearth, Christopher L. (2021-02-04). "Prolonged field care for traumatic extremity injuries: defining a role for biologically focused technologies". npj Regenerative Medicine. 6 (1): 6. doi:10.1038/s41536-020-00117-9. ISSN 2057-3995. PMC 7862384. PMID 33542235.
  4. ^ a b c Allied Joint Publication-4.10: Allied Joint Doctrine for Medical Support (PDF) (Edition C Version 1 ed.). NATO STANDARDIZATION OFFICE (NSO). 2019. {{cite book}}: Unknown parameter |agency= ignored (help)
  5. ^ MD, Brad Kinney (2022-01-25). "Prolonged Field Care". KINNETIC MEDICINE. Retrieved 2023-09-03.
  6. ^ Keenan, Sean; Riesberg, Jamie C. (June 2017). "Prolonged Field Care: Beyond the "Golden Hour"". Wilderness & Environmental Medicine. 28 (2): S135 – S139. doi:10.1016/j.wem.2017.02.001. ISSN 1080-6032. PMID 28601206.
  7. ^ a b Mould-Millman, Nee-Kofi; Dixon, Julia M.; Lategan, Hendrick J.; Beaty, Brenda; Fosdick, Bailey; Fleischer, Chelsie; de Vries, Shaheem; Schauer, Steven G.; Steyn, Elmin; Verster, Janette; Hodsdon, Lesley; Mukonkole, Suzan; Doubell, Karlien; Stassen, Willem; Keenan, Sean (August 2023). "Feasibility of conducting a military-relevant multicenter cohort study to assess outcomes of early trauma resuscitative interventions in a prolonged care civilian setting". Journal of Trauma and Acute Care Surgery. 95 (2S): S88 – S98. doi:10.1097/TA.0000000000004066. ISSN 2163-0763. PMC 10389497. PMID 37212617.
  8. ^ Suresh, Krithika; Dixon, Julia M.; Patel, Chandni; Beaty, Brenda; del Junco, Deborah J.; de Vries, Shaheem; Lategan, Hendrick J.; Steyn, Elmin; Verster, Janette; Schauer, Steven G.; Becker, Tyson E.; Cunningham, Cord; Keenan, Sean; Moore, Ernest E.; Wallis, Lee A. (2022-10-17). "The epidemiology and outcomes of prolonged trauma care (EpiC) study: methodology of a prospective multicenter observational study in the Western Cape of South Africa". Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 30 (1): 55. doi:10.1186/s13049-022-01041-1. ISSN 1757-7241. PMC 9574798. PMID 36253865.
  9. ^ Mould-Millman, Nee-Kofi; Baidwan, Navneet Kaur; Beaty, Brenda; Suresh, Krithika; Dixon, Julia M.; Patel, Chandni; de Vries, Shaheem; Lategan, Hendrick J.; Steyn, Elmin; Verster, Janette; Schauer, Steven G.; Becker, Tyson E.; Cunningham, Cord; Keenan, Sean; Moore, Ernest E. (August 2022). "Prolonged casualty care: Extrapolating civilian data to the military context". Journal of Trauma and Acute Care Surgery. 93 (2S): S78 – S85. doi:10.1097/TA.0000000000003675. ISSN 2163-0763. PMC 9323558. PMID 35546736.
  10. ^ "Review of 54 Cases of Prolonged Field Care" (PDF).
  11. ^ Keenan, Sean (2020). "AUSTERE EMERGENCY CARE CAPABILITIES – Specialized Medical Standards". specializedmedicalstandards.org. Retrieved 2023-09-03.
  12. ^ "Prolonged Field Care for the Combat Medic". Next Generation Combat Medic. 2017-06-15. Retrieved 2023-09-03.
  13. ^ "Position Paper – 10 Essential Core Capabilities for Prolonged Field Care". ProlongedFieldCare.org. 2015-02-10. Retrieved 2023-09-03.
  14. ^ "Prolonged Field Care: Beyond the "Golden Hour" – MED-TAC International Corp". tactical-medicine.com. 2019-07-07. Retrieved 2023-09-03.
  15. ^ Mohr, Christopher; Keenan, Sean (2015). "Prolonged Field Care Working Group Position Paper: Operational Context for Prolonged Field Care" (PDF). Journal of Special Operations Medicine : A Peer Reviewed Journal for Sof Medical Professionals. 15 (3): 78–80. PMID 26360359.
  16. ^ Smith, Michael; Johnston, K.; Withnall, R. (2021-04-01). "Systematic approach to delivering prolonged field care in a prehospital care environment". BMJ Mil Health. 167 (2): 93–98. doi:10.1136/jramc-2019-001224. ISSN 2633-3767. PMID 32111674. S2CID 211564442.
  17. ^ Development, PodBean. "Eric Pirie - Prolonged Care in the Field | BASICS Scotland Podcast". basicsscotland.podbean.com. Retrieved 2023-09-03.
  18. ^ "Nursing mnemonic SHEEP VOMIT" (PDF). 2018.
  19. ^ O'Kelly, Aebhric; Jarvis, Jason. Remote and Offshore Medicine: Field Guide for Practitioners (2nd ed.). College of Remote and Offshore Medicine. ISBN 9789995791308.
  20. ^ "AUSTERE Nursing Care". EURMED podcast. 2023.
  21. ^ "Austere Emergency Care – CoROM". Retrieved 2023-09-03.
  22. ^ "Austere Emergency Care – Anyone Not Ready". Retrieved 2023-09-03.
  23. ^ "About". ProlongedFieldCare.org. 2011-09-27. Retrieved 2023-09-08.
  24. ^ "Prolonged Field Care". Next Generation Combat Medic. 2017-03-30. Retrieved 2023-09-08.
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