Page 88 - Journal of Special Operations Medicine - Fall 2015

Prolonged Field Care Working Group Position Paper

Prolonged Field Care Capabilities

Justin A. Ball, 18Z; Sean Keenan, MD

he Special Operations Command Prolonged Field c. Best: vital signs monitor to provide hands-free vi-
TCare Working Group (SOCOM PFC WG), com- tal signs data at regular intervals
posed of medical-specialty subject matter experts, has 2. Resuscitate the patient beyond crystalloid/colloid
been tasked to evaluate the current training and pre- infusion
paredness of Special Operations Forces (SOF) medics. a. Minimum: field fresh whole blood (FWB) transfu-
The first formal position paper from the working group sion kits
suggests that medical providers consider the following b. Better: maintenance crystalloids also prepared for
list of capabilities when preparing their medical per- a major burn and/or closed head injury resusci-
sonnel to provide prolonged field care (PFC) in austere tation (two to three cases of lactated Ringer’s
settings. It is presented in a “minimum, better, best” for- solution or PlasmaLyte A; hypertonic saline); con-
mat. The intent is to demonstrate those basic skills, with sider adding lyophilized plasma as available; fluid
suggested adjunctive skills and equipment that may be warmer
used when considering PFC training c. Best: maintain a stock of packed red blood cells,
fresh frozen plasma, and have type-specific donors
At first glance, the list may seem somewhat simple, but it identified for immediate FWB draw.
emphasizes basic medical skills that, when put together, 3. Ventilate/oxygenate the patient
allow for a more comprehensive approach to critical pa- a. Minimum: provide positive end-expiratory pres-
tient care in an austere setting. Of note, equipment is sure (PEEP) via bag-valve mask (you cannot
relatively de-emphasized, since medical skills and train- ventilate a patient in the PFC setting [prolonged
ing should be the focus of preparing the SOF provider ventilation] without PEEP or they will be at risk
to give this care. of developing acute respiratory distress syndrome)
b. Better: provide supplemental oxygen (O ) via an
2
PFC requires the following capabilities in at least some oxygen concentrator
capacity. It should be reassuring to the SOF provider c. Best: portable ventilator (i.e., Eagle Impact ven-
that most of the listed capabilities encompass basic med- tilator [Zoll Medical Corp., http://www.impact
ical skills received, at a minimum, in initial training. In instrumentation.com] or similar) with supplemen-
addition, there may be a few that require further study tal O 2
and practice, as well as additional references or equip- 4. Gain definitive control of the patient’s airway with
ment not commonly carried. By focusing study and an inflated cuff in the trachea (and be able to keep
equipment preparation on those capabilities that are less the patient comfortable)
familiar, the SOF provider can be reasonably expected a. Minimum: medic is prepared for a ketamine
to provide PFC. cricothyrotomy
b. Better: add ability to provide long-duration sedation
The 10 capabilities are as follows: c. Best: add a responsible rapid-sequence intubation
capability with subsequent airway maintenance
1. Monitor the patient to create a useful vital signs trend skills, in addition to providing long-term sedation
a. Minimum: blood pressure cuff, stethoscope, pulse (to include suction and paralysis with adequate
oximetry, Foley catheter (measure urine output), sedation)
mental status, and an understanding of vital signs 5. Use sedation/pain control to accomplish the above
interpretation. Use a method to accurately docu- tasks
ment vital signs trends. a. Minimum: provide opiate analgesics titrated
b. Better: add capnometry intravenously

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