Page 117 - JSOM Fall 2025

An Ongoing Series

Definitive Field Care

The Modern Application of a Historical Strategy

Jason M. Hiles, MD *; Luke J. Hofmann, DO ;
1
2
April A. Grant, MD ; R. David Hardin, MD 4
3

ABSTRACT

Definitive Field Care (DFC) is a medical strategy required may necessitate a different approach, particularly in uncon-
when evacuation is impossible due to tactical, environmental, ventional warfare settings among resistance groups, displaced
or political constraints. Unlike Prolonged Field Care (PFC) or indigenous populations, or even prisoners of war (Figure 1).
Prolonged Casualty Care (PCC), which assume eventual evac- In these situations, a different medical approach is needed.
uation, DFC places full responsibility for definitive treatment The providers embedded within these groups are the definitive
on the initial provider. Historical examples, such as the Yugo- plan of care. We define this medical strategy as Definitive Field
slavian Partisans in World War II and Afghan resistance fight- Care (DFC).
ers during the Soviet invasion, highlight the necessity of DFC
in austere, high-risk environments. Key considerations include FIGURE 1 Relationship between Special Operations and irregular
warfare (Joint Publication 3-05, Special Operations, 16 July 2014).
operational constraints, risk tolerance, and provider mindset.
Without evacuation, medical priorities shift, requiring difficult
decisions. Providers must adapt to scarce resources, hostile
conditions, and the absence of Geneva Convention protec-
tions. The mindset required demands resilience, adaptability,
and acceptance of non-Western medical standards. As irreg-
ular warfare becomes more prevalent, formally recognizing,
studying, and integrating DFC into military and humanitarian
medical planning is essential. Training personnel for DFC will
enhance operational effectiveness and improve survival rates
in extreme conditions.

Keywords: field care; austere surgery; irregular warfare;
PFC; PCC

Introduction
While the concept of DFC is not new, it has not been formally
Over the past two decades, a substantial body of literature has defined, nor has it been adequately considered in the context
emerged on Prolonged Field Care (PFC) and Prolonged Ca- of future near-peer conflicts. This paper aims to define DFC,
sualty Care (PCC). These strategies are employed in environ- place it in historical context, and explore the conditions and
ments where movement into and out of the area of operations requirements for its implementation. Three key considerations
is restricted, delaying medical evacuation but not precluding it in discussing DFC are operational conditions, risk tolerance,
entirely. PFC and PCC emphasize damage control resuscitation and mindset.
with procedures such as cricothyroidotomy, thoracostomy, and
basic wound care; however, they lack a true surgical component. Background
Throughout history, official state militaries, resistance groups,
There are, however, environments where medical evacuation and isolated populations have practiced DFC, albeit without
is never an option. Tactical, environmental, or political factors formally recognizing it as a strategy. One notable example
*Correspondence to jason@4wguild.org
1 COL (Ret.) Jason M. Hiles is affiliated with the Four Winds Professional Guild, El Paso, TX. COL (Ret.) Luke J. Hofmann is affiliated with the
2
United States Army, Fort Sam, Houston, TX. Dr. April A. Grant is affiliated with the Four Winds Professional Guild, El Paso, TX and the St. Al-
3
phonsus Regional Medical Center, Acute Care Surgery, Boise, ID. COL R. David Hardin is affiliated with the United States Army, Fort Bragg, NC.
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