Page 113 - JSOM Summer 2024

Committee on Tactical Combat Casualty Care (CoTCCC)

Position Statement on Prolonged Casualty Care (PCC)

01 May 2024

Michael A. Remley, NRP; Dan Mosely, MD; Sean Keenan, MD; Travis Deaton, MD;
Harold Montgomery, ATP; Russ Kotwal, MD; George Barbee, PA; Lanny Littlejohn, MD;
Justin Wilson, SOIDC; Curtis Hall, MSOM; Paul Loos, 18D; John Holcomb, MD; Jennifer Gurney, MD

“REMEMBER, THE GOAL OF PCC IS TO GET OUT OF PCC!”

Background
In 2009, Secretary of Defense Robert M. Gates mandated that all casualties receive rapid handoff to a surgical team within 60
minutes of injury. In addition to tourniquets and blood transfusion, this Golden Hour mandate and subsequent reduction of
1
transport time contributed to historically low case fatality rates and increased survival rates for U.S. military personnel during
the low-intensity conflicts in Afghanistan and Iraq. The Golden Hour may prove challenging in large-scale combat operations
2
(LSCOs) without air superiority. Although the military departments recognize that high casualty numbers and delayed casualty
transport may occur during LSCOs, contingency planning and preparation for this eventuality has been difficult. The delayed
3
evacuation of casualties during LSCOs will force Role 1 (prehospital) responders to contend with the medical, logistical, and
operational challenges associated with providing Prolonged Casualty Care (PCC). This may result in an increase in the percent-
age of casualties killed in action (KIA; prehospital deaths). To mitigate an increase in casualties KIA, substantial time and effort
4
should be spent on PCC. 5
PCC is defined as:
“The need to provide Role 1 casualty care for extended periods of time when the tactical situation may limit or prevent
prompt and/or optimal medical care.”

PCC is care provided by any responder to non-regulated casualties in the Role 1 environment. PCC ends when the casualty
is evacuated to a medical system under medical mission command within a medically regulated environment. Therefore, PCC
solutions across all Joint capabilities and development system domains (doctrine, organizational, training, material, leadership/
education, personnel, facilities, and policy) must be focused on Role 1 care. In contrast, prolonged care begins when the planned
evacuation of a medically regulated casualty is delayed, resulting in the need for a non-doctrinal increase in patient holding
capacity. 6

The willingness to adopt PCC across the full range of military operations demonstrates an unwavering commitment to continu-
ally improve battlefield survivability for our force and unwillingness to accept any gaps in the continuum of care. Furthermore,
the DoD’s clinical and research communities have recognized the need to improve PCC capabilities; however, there remain sub-
stantial shortfalls and misconceptions among framed PCC problems. As such, the DoD must continue to develop Joint capable
solutions for the delivery of PCC across all force development domains and institutionalize PCC best practice principles outlined
within the Joint Trauma System’s (JTS) PCC guidelines. 7
The PCC guidelines are a consolidated list of casualty-centric best practices that provide all Servicemembers with “what to con-
sider next” after all Tactical Combat Casualty Care (TCCC) interventions have been effectively performed. The PCC guidelines
were developed to inform DoD education and training programs that build confidence, interoperability, and common trust
among those caring for casualties in a PCC environment. However, PCC should only be trained after mastering the principles
and techniques of TCCC.

Facts and Principles
• Nonmedical responders will likely provide a substantial portion of PCC interventions and assist with care.
• Once a Role 1 casualty becomes medically regulated (at the next role of care), returned to duty, or die they are no longer
in PCC.

111