This post is for the both the PA charged with training medics in the Battalion Aid Station as well as the medic with the initiative to take their medical education into their own hands. I must preface this as my own opinion and experience and not an official recommendation of the Working Group. Something that the working group does officially agree upon is the fact that a medic, and those participating in prolonged field care training, should be extremely competent at Tactical Combat Casualty Care. Master those protocols, found at www.CoTCCC.com, first and then come back here. If you are a medic who meets the previously mentioned requisite of TCCC Mastery, be sure to suggest prolonged field care training in a constructive manner, willing to do the legwork required to make it happen. (Much of it has already been done for you in the folder link below.)
A few weeks ago I was privileged to be invited to the basement of our on-base hospital where some prolonged field care skills training was taking place. This training was unique as I had only known of Special Operates units which were concerned with this problem set. The official definition of prolonged field care even specifies that it is to be practiced by SOCM level medics and higher. The training on this day focused on teaching medics from the 82nd Airborne.
Even after serving as a 68W myself, I had falsely assumed that prolonged field care was a problem only faced by far forward independent duty medics and corpsmen. Infantry Companies are routinely pushed out from the battalion which leaves a Senior Line Medic and 2 or 3 other platoon medics with over 100 soldiers in their charge. Aside from combat injuries the probability of shenanigans resulting in injury is astronomical; falls, rollovers, pouring gas on the burn pit, knife fighting each other… yep that happened.
With 3 or more companies forward deployed per battalion, the line medics may find themselves hours from the next echelon of care in current and future theaters: a Forward Aid Station Team (FAST) consisting of a PA and a couple medics and a truck or the Battalion Aid Station with the Battalion Surgeon, Evac Section, and Treatment Section. Obviously, there are more ways to skin that cat but that’s the configuration I remember most frequently and anticipate encountering in the future. For either the medic working with a Line Company or a PA managing the care of a critically injured patient, prolonged field care principles will apply. Whether or not the medics are familiar and comfortable with applying the principles is a whole other question that could make the difference in the outcome of the patient.
I was initially introduced to Special Operations Medicine was by working a couple mass casualty incidents with numerous patients showing up to our forward aid station in Northern Iraq on our COP where there was no PA or Surgeon present. Other 68Ws and I were directed to which patients we should treat and where to start. It was effective… to a point. Since our “Aid Station” held only 2 patients at a time we were all split up in where we were treating our patients and the 18Ds had to routinely leave their critical patients inside to ensure we were doing the right thing outside by ourselves. Had I known more than rudimentary TCCC at the time (there have been many advancements since then) I could have started trending vital signs, and created a proper problem list which would enable them to have easily filled in a prioritized care plan. None of us had a plan on who to call for a teleconsult should we have reached the end of a protocol. I would certainly want any medical person working with me or for me to be on the same page and understand my priorities.
The vast majority of skills required to provide quality care in austere environments are already common skills tasks for a 68W. Many fit nicely into our 10 Essential Capabilities at the “Minimum” or “Better” category. All we have done is to emphasize certain skills with the prolonged field care concept. A list of the common task skills used is included in the training packet below. While most medics may not be expected to plan a complex austere evacuation across multiple countries, they should absolutely be aware of any evac plan in place and able to assist in its execution or redirection.
The last argument in favor of the 68W learning PFC concepts is that of the deeper understanding by the person putting on the first bandage. This is where the greatest strides will be made in combat medicine in the coming years. It is estimated that up to 25% of combat deaths suffered by US Military troops over the last 15 years were potentially survivable. Over 1000 of our brothers and sisters-in-arms who might have been saved. Getting tourniquets on early, properly packing wounds and keeping airways open saves lives. Prolonged Field Care aims to also reduce the morbidity and improve the quality of life after an incident occurs. If a medic truly understands why they are doing something and what the next echelon of care will be doing, they will have a greater comprehension of the importance of their job and be more adept at the treatments necessary for the patient to go home to their family at the end of the day.
All of the classes in the folder and links below are available courtesy of MAJ James Winstead APA-C, formerly the Senior Physician Assistant of 1st Brigade, 82nd Airborne Division. While not all inclusive it is a start in the right direction ripe for you to customize to your needs.
Click Here for the Google Drive Folder of Classes below
TCCC Guidelines for Medical Personnel 150603
Medical Simulation Reservation
Fluid Therapy Recommendations Dec2014
Acute Kidney Injury (Modified)
Airway Management in PFC (Modified)
Management of Closed Head Injuries in an Austere V2(Modified)
Fillable 10 Essential Capabilities for Planning
Hanging Bag Packing List for PFC
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