Page 137 - Journal of Special Operations Medicine - Winter 2015

Deconstructing the Definition of

Prolonged Field Care

Sean Keenan, MD

hat is this PFC thing exactly? The accepted defini- A key point in understanding PFC principles is the con-
Wtion is “field medical care, applied beyond ‘doctri- cept of reduction in morbidity. We know that some
nal planning time-lines’ by a SOCM (Special Operations patients are at risk for such complications as sepsis,
Combat Medic) or higher, in order to decrease patient multiorgan system failure, respiratory compromise, and
mortality and morbidity. Utilizes limited resources, and other serious conditions. Contrast this with Tactical
is sustained until the patient arrives at an appropriate Combat Casualty Care (TCCC), where the protocols
level of care.” are aimed primarily at preventing mortality in the first
hours of treatment, prior to arrival at surgical resusci-
This definition necessarily assumes that the care is deliv- tative care. PFC patient management necessarily begins
ered in an austere or field environment. It also acknowl- with the sound principles of TCCC, but in situations
edges that the care is provided outside the planning where care is extended over hours or days, we must
guidance of usual military medical doctrine; therefore, evaluate and reevaluate all treatments, being diligent to
the usual medical force structure and related assump- minimize the morbidity of potentially harmful interven-
tions cannot be relied on. tions and prevent, recognize, and treat medical condi-
tions that may develop over time.
When we consider time factors, operational situations
vary greatly. It has been said by some in Special Op- Last, medics most likely will prepare for CASEVAC on
erations Forces (SOF) medicine that “an 18D can take a diverse array of potential platforms, whether land,
care of a patient for 72 hours,” and still others have sea, or air. The continued movement to an appropriate
used this as strict operational planning guidance. The referral center presents a level of operational challenge
experienced medical practitioner, however, will quickly not experienced in static patient care scenarios. Only
dispel this myth, having managed patients who may live through practice, reviewing basic patient care capabili-
for many weeks with serious injuries and illness and ties, and continuous learning will SOF medics be ready
still others who quickly exhaust a full Forward Surgi- to provide medical coverage in the diverse and austere
cal Team in only hours. Instead, the community should situations found in today’s global medicine challenges.
accept the operational reality of military operations in
austere locations and instead focus on the preparation For these difficult patient care situations, the SOCOM
and training of those tasked to provide comprehensive PFC Working Group is working to identify needs and
medical care in these difficult situations. knowledge gaps. Additionally, our goal is to provide
educational tools and references to meet the challenges
It should be acknowledged that PFC focuses on a rela- of managing the most complex patients, in the most aus-
tively small subset of patient care. It specifically is meant tere environments.
to include only the most serious and critical casualties.
Additionally, PFC assumes the patients are US or part- Please join the discussion at prolongedfieldcare.org.
ner military forces and that the end-state is evacuation
to higher-level medical treatment facilities.

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