Page 151 - Journal of Special Operations Medicine - Spring 2017

clinical judgment and provide the needed decision-mak- and should be noted as an assumption when planning
ing confidence to commit to a treatment plan, as well as for PFC situations.
crucial feedback required to manage unanticipated com-
plications. With the recent implementation of a system- In addition to being rugged, other ideal characteristics
atic solution for telemedicine by the Telemedicine and of PFC equipment must be considered. As weight is
Advanced Technology Research Center, we anticipate often a limiting factor, the ability for a single piece of
increased use for PFC cases in the near future. To be equipment to perform multiple tasks is an exceptional
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proficient, prehospital providers must routinely utilize advantage. An example of such a flexible and multipur-
telemedicine consultation in training as well as during pose device, already available to some PFC providers, is
clinical practice. the Tempus Pro manufactured by Remote Diagnostic
™
Technologies Limited. The development and evolution
Our study showed that a PFC provider was present at the of this device was guided by parallel input from pre-
point of injury in only 40.7% of cases, reinforcing the hospital and Special Operations providers. The current
importance of training both medical and non- medical product incorporates numerous monitoring capabilities,
first responders in both TCCC and PFC. Adaptability ultrasound diagnostics, video laryngoscopy, and tele-
between various modes of transport is also important consultation suitable for extended operations. End-user
since 42.6% of patients required transition between two input and operational scenarios that include PFC should
or more locations or platforms. Patient transport has be considered during the development of future novel
often occurred on non-standard evacuation platforms products. Although technology may enhance the provi-
where the ground prehospital provider is needed to ac- sion of medical care, it is not a suitable alternative to
company and provide en route care to the patient until provider knowledge and experience in these complex
transferred to a higher level of care. True designated and and varied patient scenarios.
dedicated medical evacuation platforms, robust with
medical personnel and equipment capabilities, are lim- Future Research
ited in the current operational environment as global ef- Retrospective reviews of data such as the one presented
forts have widely dispersed military forces in numerous here, as well as future prospective analysis, will prove
locations, most of which are austere in nature. invaluable for identifying and developing training, edu-
cation, and equipment needs that evolve with the PFC
Equipment provider. Studying the factors that contribute to PFC will
Each of the equipment and supply shortfalls identified help to identify the outcomes that may be improved with
by the open-ended questions are also detailed in the PFC better training and equipment. Post hoc surveys are a
capabilities position paper as they are common areas of valuable tool to identify general epidemiologic trends, in-
focus during recommended unit-level PFC exercises. juries, and treatment of PFC patients; however, recall of
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Additionally, the PFC definition incorporates limited re- events will be incomplete. Initial and subsequent patient
sources into its definition and denotes that any medical evaluations (vital signs, Glasgow Coma Scale scores, etc.)
planning and training should anticipate critical short- were requested, but seldom returned with the surveys.
falls and develop contingency plans for continued pa-
tient care in light of limited resources. Similar to that previously described for TCCC care,
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a PFC solution to documentation and data collection
Unique and often hostile environments present multiple would be the combination of both a prospective PFC
challenges when determining appropriate medical per- card along with a retrospective PFC AAR form that can
sonnel, equipment, and supply needs for supporting the ultimately be used to collect, consolidate, and analyze
mission. These challenges are compounded when the data and other information through a central repository
medical component of the mission is unknown. Weight or registry dedicated to PFC. Field care cards like the
and space, and their effect on mobility, are often an issue one developed by the Special Operations Medical As-
with respect to small, specialized response teams. Even sociation Prolonged Field Care Working Group should
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the most basic of resuscitative therapies (e.g., IV fluids be complemented by detailed AARs which comment on
to include blood products) require additional equipment the progression of the PFC event including notes on en-
(needles, tubing, coolers, fluid warmers, etc.) beyond vironmental factors, utilization of equipment and sup-
the products themselves. To remain tactically feasible, plies, and any deficiencies in training or education. The
equipment must be lightweight and compact yet durable combination of these two instruments, deployed with
enough to perform effectively in extremes of environ- US military prehospital providers, would lend more
ment with notable variations in temperature, pressure, clarity to problems encountered by PFC providers. Ad-
vibration, shock, dust, and moisture. Additionally, bat- ditionally, similar to reintegration procedures, post ac-
tery depletion, which was identified in three cases, is tion provider interviews may yield valuable information
a common observation in medical operational reviews that could improve PFC training.

Review of 54 Cases of Prolonged Field Care 127