Page 96 - JSOM Summer 2025

• TCCC, remote damage control resuscitation, blood far for- civilian nonprofit company Specialized Medical Standards
ward programs, and forward damage control surgery; (SMS), which also oversees that Prolonged Field Care Podcast
• Combining good medicine and good tactics to apply the and website (PFCare.org), has sponsored the International
golden hour concept; Committee for Austere Emergency Care (AEC), which is a new
• Adapting to constraints and challenges inherent in Special continuing education prehospital curriculum built on the best
Operations, with a commitment matrix complex based practices and CPGs of the military. PFC is designed to directly
on tactical complexity, logistical limitations, technical re- support and guide medical care during SOF operations—from
nouncements, and political sensitivity; irregular warfare to crisis response to large-scale combat op-
• Looking for a good balance of high clinical performance erations—and it is being validated for any prehospital care
and minimal footprints. delivered in austere environments. The best references and in-
formation can be found at the following sources:
Medical support must, therefore, be lighter, more mobile, re-
versible, and resilient. 1. The PFC website: PFCare.org (or prolongedfieldcare.org)
2. The PFC Podcast: on most major podcast and social media
Understand the present: As mentioned, the face of conflicts platforms, to include Spotify, iTunes, YouTube.
and war has changed in the last few years, and we must iden- 3. The DeployedMedicine website and app: www.deployed
tify new concepts, such as the militarized gray zone and mul- medicine.com
tidomain operations, but also resurface old concepts such as 4. The SMS website: www.austerecare.org
irregular warfare, near peer conflict, high-intensity combat,
and large-scale combat operations. We need to adapt medical
support, in particular the concept of the golden hour, which Abdominal Aortic and Junctional Tourniquet
is not sustainable, and use golden day or more. Key lessons Dr. Paul Parker (GBR)
of the Ukraine war highlighted challenges, such as persistent he Abdominal Aortic Junctional Tourniquet – Stabilized
drone threats delaying evacuations until the sun goes down T(AAJT-S) (Compression Works Ltd, Birmingham, AL) is
and limiting forward medical interventions. This highlights the an externally applied device that compresses the aorta via the
need to address prolonged evacuation times. Another lesson is inflation of a pneumatic bladder. It has been shown in animal
the deliberate targeting of medical treatment facilities (MTFs), and human cases to be effective at temporizing hemorrhage
which highlights the need for mobility for Role 1/2 and the previously considered ‘noncompressible’ below the renal ves-
need to reduce electronic signature. sels (and to improve physiological parameters). Equivalency
to zone 3 REBOA has been repeatedly demonstrated as well as
Prepare the future: We are working on telemedicine and re- the ability to bridge between an AAJT-S and a REBOA.
mote medical support as well as on drones for delivering prod-
ucts like blood by air and unmanned vehicles for CASEVAC Non-physicians and Combat Medical Technicians have been
on ground. We are also training austere DCR-S teams in both found to be able to effectively apply AAJT-S to healthy hu-
clinical and tactical aspects of missions, including virtual real- mans in just 48 seconds, following a brief training period of
ity and high-fidelity simulation. We would like develop medi- less than 1 hour. The AAJT-S can, of course, be applied both
cal leadership capacity by international scientific and medical junctionally and abdominally. Human case series have shown
networks. In addition, we want to use medicine as an oper- increased rates of return of spontaneous circulation in hypo-
ational effect by improving the medical support partnership volemic trauma cardiac arrest and increased mean arterial
and the development of MED INTEL. We can expect to see the pressure following application with 5/6 patients neurologically
development of technologies such as autonomous evacuation intact at 1 year. We recently also evaluated whether AAJT-S
systems, AI, robotic surgical assistance, health monitoring and could generate enough proximal epigastric compartment pres-
wearable technologies, and also advances in regenerative med- sure to temporize hemorrhaged from celiac trunk branches
icine and biotechnology. and solid organ injuries. We also sought to include the simu-
lated presence of an intraabdominal hemorrhage of 500mL to
Our view is that we must not forget the past but embrace and rule this out as a confounding factor.
adapt to new challenges. The French model presents a real
opportunity in this context. Finally, that we need to find a We reproducibly achieved clinically significant mean epigastric
well-balanced mix of high- and low-technology solutions. proximal compartment pressure increases. This was achieved
both with and without 500mL of simulated intraperitoneal
Prolonged Field Care: Evolution and Updates blood. The threshold of pressure in the epigastric proximal
compartment of 54.38cmH O or 40mmHg was achieved in
2
Sean Keenan, MD; COL (ret.), US Army 5/8 tests, of which 4 were achieved before full AAJT-S infla-
rolonged Field Care (PFC) was first defined at a NATO tion to 250mmHg. In all but one test we saw intraabdominal
PSOF Research Workshop in April 2013. An international pressure increase when 500mL of intraperitoneal fluid was
working group was then formed at the Special Operations added.
Medical Association (SOMA) meeting in December 2013, tak-
ing on the task of further defining and developing the con- Infra-renal occlusion (zone 3) was previously thought to have
cept. Over the past decade, the U.S. Department of Defense’s the potential to increase hemorrhage if bleeding was occurring
Joint Trauma System has developed numerous clinical prac- from the liver or spleen due to increased hydrostatic pressures
tice guidelines (CPGs), and, most recently in 2021, published in arteries that may be produced proximal to the site of occlu-
a set of guidelines for all services called Prolonged Casualty sion. We have now demonstrated that this is clearly not the
Care (PCC). Recently, the JTS published learning objectives case and that it is offset by the abdominal compartment pres-
for PCC, but no military course has yet been developed. The sure increase further stabilizing any zone 1 injury.

94 | JSOM Volume 25, Edition 2 / Summer 2025