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ur Fall Then and Now looks at the past 20 years of
prolonged field care development. Providing some in- PROLONGED FIELD CARE ARTICLES, THEN
Osight, LTC Jamie Riesberg, COL (Ret) Sean Keenan,
and SFC Paul Loos explain: 2001;1(3):9–10
The birth of prolonged field care (PFC) as we know Biomedical Research and Development Update Mr. Robert
it today can be traced to a NATO Special Operations Clayton, SVERDRUP
workshop in April 2013. At this gathering of 37 par- EXCERPTS: ORAL FLUOROQUINOLONE PROPHYLAXIS
ticipants from 10 different nations, the attendees set IN COMBAT TRAUMA. A number of potential issues for
to the task of “preparing for future conflicts in less improving battlefield care for combat casualties were raised
asset rich environments and operating environs of following Mogadishu. One of these issues was the need for
Special Operations.” While the wars in Iraq and Af- antibiotics to be administered as soon as possible after wound-
ghanistan created the greatest combat medical treat- ing. This was not done in Mogadishu and there was a high
ment and evacuation system the world had yet seen, incidence of wound infection that followed the prolonged
wary thinkers refused to grow complacent with what evacuation time for the casualties in this engagement. The flu-
had become status quo. Golden Hour surgical care oroquinolone class of antibiotics offers the advantage of good
that provided exceptionally good outcomes for even bioavailability following oral administration combined with
the most seriously combat wounded was accepted as excellent spectrum of action. This study will make specific rec-
“the norm,” but what would happen in less mature ommendations regarding the use of oral fluoroquinolones in
combat theaters or against a peer enemy where free- both penetrating abdominal trauma and penetrating extremity
dom of aerial movement was denied? The NATO trauma with associated fracture
group defined PFC as “field medical care, applied
beyond doctrinal planning timelines by a [NSOCM TREATMENT STANDARDS FOR DECOMPRESSION SICK-
NATO] Special Operations Combat Medic, in order NESS/ARTERIAL GAS EMBOLISM DCS/AGE. Special Op-
to decrease patient mortality and morbidity. It uti- erations are often conducted in remote areas where there may
lizes limited resources, and is sustained until the pa- be a significant delay in access to recompression facilities
tient arrives at the next appropriate level of care.” A for the victims of decompression sickness and gas embolism
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movement was born among Special Operations per- (DCS/AGE), with an accordingly higher probability of severe
sonnel who knew first-hand that the amazing medi- or refractory disease as a result. This study forms a standing
cal system of the present would not be the system of Undersea Hyperbaric Medical Society (UHMS) committee to
tomorrow. review the literature on treatment of decompression sickness
and gas embolism and make recommendations for therapy
Shortly after the NATO workshop which defined based on the best clinical series, case reports, and animal stud-
PFC, a grassroots movement among medics, corps- ies available. Special emphasis in this review will be placed
men, and SOF providers began. Starting with an al- on the pre-recompression phase of treatment, which may be
most uncanny agreement that the problem was real, prolonged in Special Operations and recommendations for
and in near future, volunteers began collaborating on specific animal trials that will study the most promising new
best methods to train and mitigate the risk of PFC. treatment modalities or otherwise enhance SOF ability to treat
Early collaboration in 2014 yielded the now well- dysbaric disorders will be provided.
known “10 PFC Capabilities” by Justin Ball and
Sean Keenan and the prolongedfieldcare.org website 2001;1(3): 24–40
started by US 18D Paul Loos. This was followed by United States Army Rangers in Somalia: An Analysis of Com-
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a rapid increase in PFC thinker-doers, who by now bat Casualties on an Urban Battlefield Robert L. Mabry, MD,
embraced the newly proposed “Ruck, Truck, House, John B. Holcomb, MD, Andrew M. Baker, MD, Clifford C.
Plane” operational context that would enable medics Cloonan, MD, John M. Uhorchak, MD, Denver E. Perkins,
and planners to prepare for PFC within their mis- MD, Anthony J. Canfield, MD, John H. Hagmann, MD
sions’ tactical resources. At the Special Operations
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Medical Association conference in Tampa, FL, in This article was previously published in the Journal of Trauma.
2014, PFC made its strong public debut in the form Permission to reprint in the JSOM was granted by Lippincott,
of a pre-conference lab where attendees were invited Williams & Wilkins.
to explore the 10 capabilities while caring for no- EXCERPT 1: Delayed evacuation is typical in urban con-
tional patients after Tactical Combat Casualty Care flicts. Buildings and the close proximity of combatants make
scenarios. The movement now caught fire, with ev- helicopter evacuation difficult, if not impossible. In cities, ar-
eryone from industry to unit surgeons realizing the mored vehicles are vulnerable to ambush with antitank rockets
potential problem of future conflict, and the need for and RPGs along narrow streets and alleys. Crossing exposed
a different paradigm to address the future. streets and moving through rubble with casualties on litters is

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