Page 90 - Journal of Special Operations Medicine - Fall 2015

Prolonged Field Care Working Group Position Paper

Operational Context for Prolonged Field Care

Christopher J. Mohr, 18Z; Sean Keenan, MD

e propose a universal approach to operational Example 1: A unit conducting foot patrols, supported
Wplanning and logistical preparation for prolonged by gun trucks, with a team house at a local national
field care (PFC) missions, in the form of four stages. We base and with access to a helipad. In this case, while
have been accustomed to view missions in terms of pa- dismounted, the medic carries what makes sense to him
tient treatment stages, such as seen in Tactical Combat (RUCK). He has access to larger equipment and resup-
Casualty Care (TCCC). This is less useful when planning ply in the mission support vehicles (TRUCK). The team
for PFC because of the more comprehensive list of ca- house stores the balance of medical equipment he could
pabilities needed to consider across a wider spectrum of not feasibly carry forward, and this represents his high-
operational realities. Instead of echelons of patient care, est organic level of care (HOUSE). The team will have
we propose to use a system of mission or evacuation planned for use of the helicopter landing zone to po-
stages to simplify and standardize our language, using tentially transport patients to higher care or fixed-wing
the following terminology: RUCK-TRUCK-HOUSE- evacuation (PLANE).
PLANE (RTHP). We believe that the RUCK-TRUCK-
HOUSE-PLANE format is useful, being simple as well However, the RTHP formula can just as easily be used
as easily transferable and relatable, across all branches for any other mission.
of service.
Example 2: A unit operating out of their vehicles on an
The stages are explained as follows: extended desert mission may not have any higher level
of organic care than that which is contained on their
RUCK: the gear carried to the furthest point on a trucks. They may not operate out of a fixed facility or
mission, generally carried by medical personnel team house. The larger trucks, therefore, would repre-
dismounted. sent the highest level of capability the unit has organic
TRUCK: whatever additional equipment will be to them (HOUSE). However, when they split up into pa-
carried in mission-specific transportation, whether trols, the smaller vehicles on each patrol will normally be
that is trucks, boats, all-terrain vehicle, kayaks, and stocked with resupply bags, and perhaps heavier medical
so forth. equipment, such as oxygen bottles. These patrol vehicles
HOUSE: gear available to the medic, but which now represent the TRUCK stage. The most specialized
is only feasible to be maintained at a team house, capabilities may only be retained by the command and
firebase, or other mission support site. It represents control element, or mission support site, representing
the highest level of care the operational element has HOUSE. The individual medic and the equipment on
organic to it. his person represent RUCK (Figure 1).
PLANE: planning stage included to allow the medical
providers to consider how they will move patients on The point of Figure 1 is the flexibility of the language to
aircraft, whether medical evacuation (MEDEVAC) describe operational context of care. It should be noted
aircraft (those designated and equipped to move ca- these stages are always defined according to assets avail-
sualties as a primary mission) or casualty evacuation able, mission, and unit. There is no expectation that a
(CASEVAC) (preplanned nonmedical mission sup- “TRUCK” or “HOUSE” is strictly defined across differ-
port aircraft, opportunity or “slick”) aircraft. ent mission sets.

These stages are conceptual and not necessarily linear, A useful operational planning diagram would be the
but should be used as guidelines only. Two examples development of a matrix with four horizontal rows la-
follow. beled with the four operational stages, and the vertical

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