Page 145 - Journal of Special Operations Medicine - Spring 2017

Review of 54 Cases of Prolonged Field Care

Erik DeSoucy, DO; Stacy Shackelford, MD; Joseph Dubose, MD;
Seth Zweben, NREMT-P; Stephen C. Rush, MD; Russ S. Kotwal, MD, MPH;
Harold R. Montgomery, SO-ATP; Sean Keenan, MD

ABSTRACT
Background: Prolonged field care (PFC) is field medical tactical medical providers who must hold and manage
care applied beyond doctrinal planning time-lines. As patients when transport to higher levels of care is not im-
current and future medical operations must include delib- mediately possible. Much of the first responder medical
erate and contingency planning for such events, data are training over the past decade has focused primarily on
lacking to support efforts. A case review was conducted the initial stabilization of traumatically wounded casual-
1,2
to define the epidemiology, environment, and opera- ties in preparation for rapid transport to surgical care.
tional factors that affect PFC outcomes. Methods: A sur- As our military forces continue to encounter novel and
vey distributed to US military medical providers solicited challenging casualty care scenarios in undeveloped coun-
details of PFC encounters lasting more than 4 hours and tries and immature theaters of operation, it has become
included patient demographics, environmental descrip- apparent that there is currently a strategic and tactical
tors, provider training, modes of transportation, injuries, gap in training, planning, and providing for prolonged
mechanism of injury, vital signs, treatments, equipment care in situations where evacuation may be delayed.
and resources used, duration of PFC, and morbidity and
mortality status on delivery to the next level of care. De- The United States Special Operations Command has
scriptive statistics were used to analyze survey responses. recognized the challenge of PFC as innate to Special Op-
Results: Surveys from 54 patients treated during 41 mis- erations missions and as such has sponsored the estab-
sions were analyzed. The PFC provider was on scene lishment of the PFC Working Group. This group has
at time of injury or illness for 40.7% (22/54) of cases. worked to advance training and knowledge in this com-
3–5
The environment was described as remote or austere for plex area of care. As efforts evolve, this group remains
96.3% (52/54) of cases. Enemy activity or weather also cognizant of the fact that PFC situations may arise on
contributed to need for PFC in 37.0% (20/54) of cases. any mission, in any environment, within developed and
Care was provided primarily outdoors (37.0%; 20/54) undeveloped countries, mature and immature theaters
and in hardened nonmedical structures (37.0%; 20/54) of operation, on land and at sea.
with 42.6% (23/54) of cases managed in two or more
locations or transport platforms. Teleconsultation was PFC has been described as “field medical care, applied
obtained in 14.8% (8/54) of cases. The prehospital time beyond doctrinal planning time-lines” culminating in
6
of care ranged from 4 to 120 hours (median 10 hours), evacuation to a higher level of care. For trauma, PFC
and five (9.3%) patients died prior to transport to next may be thought of as an extension or follow-on treat-
7
level of care. Conclusion: PFC in the prehospital setting ment to Tactical Combat Casualty Care (TCCC) when
is a vital area of military medicine about which data are evacuation is delayed and providers are forced to ad-
sparse. This review was a novel initial analysis of recent dress the patient’s needs beyond the initial resuscitation
US military PFC experiences, with descriptive findings and preparation for transport. In addition to traumatic
that should prove helpful for future efforts to include battle and nonbattle injuries, PFC also includes treat-
defining unique skillsets and capabilities needed to effec- ment of medical and surgical illnesses.
tively respond to a variety of PFC contingencies.
In anticipation of requirements for training, planning,
Keywords: prolonged field care; after action review; mili- and equipment and supplies tailored to support PFC,
tary medicine; prehospital; medical evacuation we sought to further describe the recent US military ex-
perience through a series of PFC cases. The goal of this
review of worldwide PFC cases is to define the epidemiol-
ogy, environment, and operational factors that affect PFC
Introduction
outcomes. This collective experience will prove helpful in
Ongoing worldwide military operations have revived and guiding training and planning efforts needed to optimize
heightened the awareness of medical challenges faced by management of casualties beyond initial stabilization.

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