Page 152 - Journal of Special Operations Medicine - Spring 2017

Limitations References
Our present study has several limitations. Most of the 1. Butler FK Jr, Blackbourne LH. Battlefield trauma care then
surveys received were not accompanied by a formal and now: a decade of tactical combat casualty care. J Trauma
AAR or patient care card. Surveys based on recorded Acute Care Surg. 2012;73(6 suppl 5):S395–S402.
data were not differentiated from those completed from 2. Kotwal R, Howard J, Orman J, et al. The effect of a golden
the provider’s memory of events. Specific details (ini- hour policy on the morbidity and mortality of combat casual-
ties. JAMA Surg. 2016;151:15-24.
tial and subsequent assessment of vital signs, Glasgow 3. Keenan S. Prolonged Field Care Working Group update. J
Coma Scale, volumes of fluid, number of blood prod- Spec Oper Med. 2016;16(2):105–106.
ucts, and dosage of medications) were often missing or 4. Mohr CJ, Keenan S. Prolonged Field Care Working Group
incomplete from surveys. Even when performing a ret- position paper: operational context for prolonged field care. J
rospective review of a formal AAR, the interpretation Spec Oper Med. 2015;15(3):78–80.
may not be commensurate to what actually transpired 5. Ball JA, Keenan S. Prolonged Field Care Working Group po-
sition paper: prolonged field care capabilities. J Spec Oper
during the PFC event. Post action interviews and patient Med. 2015;15(3):76–77.
care cards obtained on future PFC casualties should de- 6. Keenan S. Deconstructing the definition of prolonged field
crease uncertainty in the data and the data collection care. J Spec Oper Med. 2015;15(4);125.
process. 7. Butler F, Giebner S, McSwain N, Pons P, eds. Prehospital Trauma
Life Support Manual; Eighth Edition—Military Version. Jones
and Bartlett Learning; Burlington, MA, November 2014.
There have been over 59,000 casualties treated in recent 8. http://socmssc.com. Accessed 25 Sep 2016.
operations ; however, it has proven difficult to ascertain 9. Powell D, McLeroy RD, Riesberg J, et al. Telemedicine to
12
the incidence of PFC encounters and the extent to which reduce medical risk in austere medical environments: the Vir-
our study is reflective of the total of PFC cases. We do tual Critical Care Consultation (VC3) service. J Spec Oper
Med. In press.
not know what percentage of providers were surveyed, 10. Kotwal RS, Butler FK, Montgomery HR, et al. The Tacti-
and if any cases were withheld due to security, personal, cal Combat Casualty Care Casualty Card: TCCC guidelines
or other reasons. Only through an exhaustive review of proposed change 1301. J Spec Oper Med 2013;13(2):82–87.
all medical AARs from all US military units would we 11. https://prolongedfieldcare.org/great-reads-checklists-cheat
come close to identifying a true incidence of PFC, and -sheets-and-other-resources-from-external-sites-that-we
-have-found-helpful/. Accessed 25 Sep 2016.
even then we would be missing numerous cases and data 12. https://www.dmdc.osd.mil/dcas/pages/report_sum_reason.
where prehospital documentation did not occur as his- xhtml/. Accessed Sep 27, 2016.
torically this deficiency has already been noted. 10,13,14 13. Eastridge BJ, Mabry RL, Blackbourne LH, et al. We don’t
know what we don’t know: prehospital data in combat casu-
While the focus of this study is analysis of PFC events, alty care. US Army Med Dept J. 2011;Apr–Jun:11–14.
it is important to note that avoidance of these scenarios 14. McGarry AB, Mott JC, Kotwal RS. A study of prehospital
medical documentation by military medical providers during
is preferable. The survey instrument did not identify precombat training. J Spec Oper Med. 2015;15(1):79–84.
which events could have been avoided with improved
mission support and prepositioned assets. Potential for
PFC should be considered during mission planning and
appropriate steps taken to mitigate the risk. Maj DeSoucy, USAF, is a general surgery resident, currently
serving at David Grant Medical Center, Travis AFB, California.
He has deployed twice as flight surgeon and medical director
Conclusion for the 48th Rescue Squadron, Davis-Monthan AFB, Arizona.
E-mail: esdesoucy@ucdavis.edu, erik.desoucy.2@us.af.mil.
PFC, with its unique environmental challenges and of-
ten unpredictable casualty burden, remains as an under- Col Shackelford, USAF, is a trauma surgeon, currently serv-
developed frontier of military medicine. Success in this ing as the chief of performance improvement, Joint Trauma
arena will rely on expanding provider knowledge and System, San Antonio, Texas. She is a member of the Commit-
skillsets that incorporate detailed emergency evaluation, tee on TCCC and has previously deployed as the director of
critical care treatment and resuscitation, and advanced the Joint Theater Trauma System.
nursing care concepts. Carefully selected and adaptable
equipment should enhance care provided by prehospi- Lt Col DuBose, USAF, is a trauma and vascular surgeon
tal personnel without hindering mobility and mission currently serving at David Grant Medical Center, Travis Air
completion. Further research and active collection of Force Base, California. He is a member of the Committee on
PFC event data will help clarify the demands of treating TCCC and has deployed four times in support of OEF, OIF
and Operation Inherent Resolve.
casualties beyond the parameters of TCCC.
SMSgt Zweben, USAF, is a Pararescueman currently serv-
Disclosures ing as the Operations superintendent at the 131st RQS, Mof-
fett Field, Mountain View, California. He has deployed six
The authors have nothing to disclose. times in support of OEF and OIF.

128 Journal of Special Operations Medicine Volume 17, Edition 1/Spring 2017