"Field medical care, applied beyond doctrinal planning time-lines"[3]
"Field medical care that is applied beyond 'doctrinal planning time-lines' by a tactical
medical practitioner in order to decrease patient mortality and morbidity."[4]
"Prolonged care is provided to
casualties if there is likely to be a delay in meeting medical planning
timelines"[5]
While the concept itself is well established, since 2012 it has become rapidly codified, with changes in the global political environment and the nature of combat operations around the world.[6] This had led to increased
research and
academia in the area of prolonged field care, first in
Special operations teams[7] and then more broadly.[8][9][10]
There are twelve core capabilities of Prolonged Field Care:[1]
Monitor: Possess the capability to acquire, analyze, and comprehend a patient's
vital signs, employing a reliable approach for precise documentation of observations.
Resuscitate: Have the equipment and competence to commence suitable
fluid resuscitation to enhance patient outcomes, encompassing the administration of whole blood and blood products when necessary.
Ventilate & Oxygenate: Administer positive pressure ventilation while safeguarding the
lungs from additional harm.
Airway Management: Gain control of a patient's airway to prevent
hypoxia,
asphyxiation and aspiration.
Sedation & Pain Control: Use adequate and appropriate pain control. Use
sedation to accomplish any procedural tasks.
Physical Exam & Diagnostics: Conduct a thorough physical examination and diagnostics to gather information about the patient's current status and anticipate concealed injuries..
Ongoing (Nursing) Care: Continuously provide nursing care that includes maintaining the patient's warmth, cleanliness, and dryness, managing biological needs, performing wound care, and proactively preventing additional illness.
Advanced (Surgical) Procedures: Undertake advanced procedures essential for preserving life, reducing morbidity and enhancing overall outcomes.
Telemedicine: Establish telemedicine connections with medical providers capable of guiding treatment and effectively communicate the patient's condition.
Prepare for Evacuation: Prepare for safe evacuation by ensuring patient stability during transport and taking measures to prevent further harm.
Logistics: Understand the chain of care and evacuation.
Communication: Establish and maintain reliable communication with operational and medical control.
The first ten capabilities originates in military practice[14][15] with the last two being later additions for a civilian audience. Each of the core capabilities can be considered in terms of Minimum, Better, Best in relation to aiming to provide a high standard level of care,[16] and in relation to Ruck, Truck, House and Plane[17] to discuss the stages of care and logistical issues which may limit equipment provision.
These stages of care can be further explained as:
RUCK: the equipment and medications carried to the furthest point of an expedition or mission. Generally (or conceptually) carried in a
rucksack.
TRUCK: Additional medications and equipment carried on a transportation medium during an expedition or operation (
Four-wheel drive vehicles, boats etc).
HOUSE: Equipment and medications available at a team's house, warehouse or other staging post building.
PLANE: Plane is used here to represent the formal
medical evacuation platform, this will vary but may have the staffing, equipment and capabilities very close to the receiving hospital.
Core interventions
There are two
acronyms used to prompt the provision of prolonged field care after completing a
Primary and Secondary Survey, those being HITMAN coined by the
UK Military[18][19] and SHEEPVOMIT created by the then Dean of the College of Remote and Offshore Medicine.[20][21]
H
Head to Toe examination; a full secondary survey to identify illnesses or stigmata of disease.
A number of civilian and military prolonged field care courses exist. While many follow the core capabilities outlined above some do not. Many prolonged field care courses align closely with the 12 capabilities. Typical course contents may include:
A variety of
terminology is used for the same concept, this is partly due to the differences between military and civilian practice. The following terms are used fairly interchangeably, but there may be specific differences between the association
dogma, guidelines and protocols.
Prolonged Casualty Care - A preferred civilian term
Austere Emergency Care - A preferred civilian terminology relating to training and education[1]
Prolonged Field Care - A commonly used military term
Prolonged Prehospital Care - Terminology used by the
British Armed Forces in addition to Prolonged Hospital Care.[5]
^O'Kelly, Aebhric; Jarvis, Jason. Remote and Offshore Medicine: Field Guide for Practitioners (2nd ed.). College of Remote and Offshore Medicine.
ISBN9789995791308.