Page 120 - JSOM Summer 2019

Prolonged Field Care
and the Capabilities Offered by Technology

Dimitrios Sardianos, NSOCM*; Josh Boland, NSOCM

ABSTRACT
Technology has become a necessity in modern society, provid- Advanced Monitoring Capabilities in PFC
ing capabilities that have never been experienced before. The
integration of such capabilities arms today’s Special Opera- Monitoring a casualty or patient in the field was a privilege
tions medic with abilities that can make a vast difference to the for well-established medical facilities at the best of times;
survivability rate of an ill or injured patient. Taking advantage however, it was more commonly considered unfeasible at the
of new technological capabilities such as advanced monitoring SOCM level. Advanced monitoring was feasible only for the
and diagnostics and portable ultrasound also plays a key role; expensive, dedicated medical evacuation (MEDEVAC) assets
together with the evolution in modern communication. or in higher-level medical treatment facilities. The SOCM, in
most instances, was provided with minimal equipment in his
arsenal, such as a stethoscope, a manual sphygmomanometer,
Keywords: technology; awareness; ultrasound; telemedicine; and a pulse oximeter, which, of course, were very helpful but
NATO; Special Operations Combat medic; NSOCM
had their difficulties in the austere, remote operational envi-
ronment of SOF, where they were intractable and distractive.
Imagine the difficulties faced by a Combat Medic when trying
Introduction to treat a casualty in the confined space of a moving armored
personnel carrier. The reason at that time for such basic equip-
The North Atlantic Treaty Organization (NATO) definition ment was that electronic monitoring devices were too large for
of prolonged field care (PFC) is “Field medical care applied the vehicles and their power consumption required permanent
beyond ‘doctrinal planning time-lines’, by a Special Opera- and complicated installation, which was unfeasible for non-
tions Combat Medic (SOCM) or higher, in order to decrease a MEDEVAC assets.
patient’s mortality and morbidity. Utilizing limited resources,
and is sustained until the patient arrives at an appropriate level As technology has evolved, the size and the power consump-
of care.” 1 tion of those kinds of electronic monitoring devices have been
reduced. The modern devices are portable, more compact, and
Prolonged evacuation times and, in many circumstances, the can fit in the confined space of a non-MEDEVAC vehicle with-
lack of evacuation capabilities in the operational environment out the need for permanent installation modifications, because
have created the need for PFC and its four steps, known as they are battery operated (Figure 1).
Ruck, Truck, House and Plane. In some theaters in which
Special Operations Forces (SOF) operate, the golden hour of SOCMs now have the capabilities to be aware of traumatic
prehospital life support is extremely difficult or impossible to brain injury or a casualty’s end-tidal CO , using portable cap-
2
2
achieve, requiring new techniques and capabilities integrated nography devices; or to check if the patient’s cricothyroid tube
with PFC care. New advanced technology can fill the gap is in place, by using the same device (portable capnography
between extended evacuation times and the quality of treat- devices are small enough to fit in the SOCM’s assault medic
ment given in the early stages of care, offering better situation bag). At the same time, the SOCM can perform the casualty
awareness through the whole chain of treatment. This technol- evacuation (CASEVAC) using their trucks’ equipment, which
ogy can provide the NATO SOCM with diagnostics capabili- may include a portable monitor for advanced monitoring of
ties that a few years ago were considered a privilege to have in vital signs and a portable ventilator to support the casualty’s
the emergency department of a civilian or military hospital. By respiration. The SOCM has these capabilities starting from the
taking advantage of modern communication devices to con- point of injury and the CASEVAC transport to the facility of
duct telemedicine, the SOCM can add this, the latest weapon, the next level of care facility, through the whole evacuation

to their ever-increasing, sophisticated arsenal. The combina- and treatment chain, to the final, definitive level of care.
tion of Tactical Combat Casualty Care and such capabilities
in the early stages of PFC will help SOF medical personnel Situational awareness throughout the whole evacuation chain
reduce mortality and morbidity rates, reinforcing the evidence is very important for the SOCM and the casualty’s survivabil-
that advanced technology devices and capabilities should fit in ity. Advanced monitoring aids organizing a better treatment
the chain of treatment as early as feasible before and during plan, because all the data are concentrated on one monitor.
transport to definitive care facilities. Data also can be forwarded to the next level of treatment,

*Correspondence to sardi064@gmail.com
Mr Sardianos and Mr Boland are currently students at the University College Cork, Cork, Ireland.

118