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TABLE 1 Characteristics of Definitive Field Care (DFC)
Operationally… Providers will have… Resources and equipment…
• Required when movement is restricted • Less diagnostic certainty • Likely must be sourced from local economy
• Tactical and political factors are largest • Less assets available • Consider couriers or drones if kit needs imported
driving force • No guarantee of resupply or relief • Maybe cached
• Pivoting from PFC/PCC to DFC will • Language and cultural barriers • Must be recycled
occur • To work with little supervision • Must be re-sterilized
• To master small team dynamics • Must be multipurpose
• To broaden their scope of practice • Must work if there is no running water or
• Non-Western outcomes electricity

Historically, providers in armed conflicts over the last 20 years years, with more than twenty-five combat deployments serv-
have maintained predominately specialty driven lanes. This ing across the entire medical support spectrum for combat
mindset must change as providers must be able to treat a broad operations. Additionally, all the authors have cumulatively
range of clinical pathologies from trauma to infectious disease performed almost two dozen humanitarian aid missions in
to endemic disease. Treatment algorithms are often simplified austere environments in nineteen different countries across
due to local resources and environmental restrictions. Ideally, Africa, Asia and South America. Based on our combined ex-
an individual will have worked and trained to achieve clinical perience in both military and humanitarian missions, we have
experience and confidence in a well-supported location prior realized there is a lack of definition for this type of mission
to engaging in such austere settings. in which patients will not leave the area of operation. These
views are our own and not of the Department of Defense, De-
The lack of proper mindset applies not only to the individ- partment of the Army, or any other entity.
ual, but also to the system that supports the providers. For a
system this is more accurately described as culture. A system Disclosures
culture should be in place that embraces and insulates the men The authors have nothing to disclose.
and women who practice in such environments. Research to
determine the best possible care for these settings, device de- Funding
velopment for less sophisticated but reliable equipment, and No funding was received for this work.
accurate outcome expectations are all part of an ideal system
culture. Sending a team into these environments is costly with References
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tics of such missions may be a concern for stakeholders. With franja/franja-partisan-hospital-1943-1945/
the right system culture DFC teams can operate and improve. 2. Hirst JW. An account of the medical services of the National
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fined or studied as a distinct strategy (Table 1). Unlike PFC or 6. Bhatnagar MK, Smith GS. Trauma in the Afghan guerrilla war:
PCC, where echelons of care remain functional, DFC represents effects of lack of access to care. Surgery. 1989; 105(6):699–705.
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field surgery during war. Injury. 1992;23(6):401–4. doi: 10.1016/
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11. World Population Review. Countries currently at war. World
Population Review. Published 2025. Accessed March 8, 2025.
Author Contributions https://worldpopulationreview.com/country-rankings/countries-
JH and AG conceived of this study and wrote the protocol. JH, currently-at-war
AG, LH and DH orchestrated all approvals for field observa- 12. Post P. Not a world war but a world at war. The Atlantic. Pub-
tions. JH, AG, LH, and DH collected and analyzed data. JH lished November 17, 2023. Accessed March 8, 2025. https://www.
and AG wrote the first draft of this paper. All authors served as theatlantic.com/international/archive/2023/11/conflicts-around-
medical experts during the data analysis process. All authors the-world-peak/676029/
read and approved the final manuscript.
PMID: 40997279; DOI: 10.55460/NPPC-CLHM
Disclaimer
Three of the authors have the AMEDD Special Operations
designator and a combined military service greater than sixty

118 | JSOM Volume 25, Edition 3 / Fall 2025