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Prolonged Casualty Care Guidelines (CPG ID:91)*
The Prolonged Casualty Care (PCC) guidelines are a consolidated list of
casualty-centric knowledge, skills, and best practices intended to serve as the SECTION 1
DoD baseline clinical practice guidance to guide casualty management over
a prolonged amount of time in austere, remote, or expeditionary settings,
and/or during long-distance movements.
*Guideline Only/Not a Substitute for Clinical Judgment
PROLONGED CASUALTY CARE BACKGROUND

Prolonged Casualty Care (PCC): The need to provide patient care for extended periods
of time when evacuation or mission requirements surpass available capabilities and/or
capacity to provide that care.
The PCC guidelines are a consolidated list of casualty-centric knowledge, skills, abil-
ities, and best practices intended to serve as the DoD baseline clinical practice guidance
(CPG) to direct casualty management over a prolonged period of time in austere, remote, or
expeditionary settings, and/or during long-distance movements. These PCC guidelines build
upon the DoD standard of care for non-medical and medical first responders as established
by the Committee on Tactical Combat Casualty Care (CoTCCC), outlined in the Tactical
Combat Casualty Care (TCCC) guidelines, and in accordance with (IAW) DoDI 1322.24.
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The guidelines were developed by the PCC Work Group (PCC WG). The PCC WG
is chartered under the Defense Committee on Trauma (DCoT) to provide subject matter
expertise supporting the Joint Trauma System (JTS) mission to improve trauma readiness
and outcomes through evidence-driven performance improvement. The PCC WG is re-
sponsible for reviewing, assessing, and providing solutions for PCC-related shortfalls and
requirements as outlined in DoD Instruction (DoDI) 1322.24, Medical Readiness Training,
16 Mar 2018, under the authority of the JTS as the DoD Center of Excellence pursuant to
DoDI 6040.47, JTS, 05 Aug 2018.
Operational and medical planning should seek to avoid categorizing PCC as a primary
medical support capability or control factor during deliberate risk assessment; however, an
effective medical plan always includes PCC as a contingency. Ideally, forward surgical and
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critical care should be provided as close to casualties as possible to optimize survivability.
DoD units must be prepared for medical capacity to be overwhelmed, or for medical evacu-
ation to be delayed or compromised. When contingencies arise, commanders’ casualty
response plans during PCC situations are likely to be complex and challenging. Therefore,
PCC planning, training, equipping, and sustainment strategies must be completed prior to
a PCC event. The following evidence-driven PCC guidelines are designed to establish a
systematic framework to synchronize critical medical decisions points into an executable
PCC strategy, regardless of the nature of injury or illness, to effectively manage a complex
patient and to advise commanders of associated risks.
PB SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 21