Prolonged Casualty Care for all
The wait is over…
The Role 1 Prolonged Casualty Care Guidelines for the entire DoD are now available here and on the Joint Trauma System website!
This was a monumental undertaking from the beginning and required countless hours of research, writing, deliberations, and editing from subject matter experts, volunteering from each service and academia. The baseline for these guidelines were the previous clinical practice guidelines written by members of our legacy prolonged field care working group. Where those guidelines did not meet the requirements of one of the services, the members of this new Committee on Prolonged Casualty Care came together to ensure the verbiage met those unique needs while not taking away from the underlying principle. They ain’t perfect but fill a gap which has been hanging over our heads for years. They are version 1.0 with updates already being considered. In the future, concerned parties will be able to present evidence in the same change paper format used by the other official Defense Committees on Trauma such as CoTCCC and we can update it on the official JTS website quickly and efficiently. Aside from the work done by each of the listed authors an inordinate amount of work was done by MSG Mike Remley to edit and push them through the JTS process. It would have been another 6 months or more with him. COL Jamie Riesberg led this group from the beginning while juggling his day job which has almost nothing to do with the writing and editing of guidelines. He did this out of his never-satisfied sense of Service. They both certainly have my respect for embracing the challenge when I was much more skeptical. Another unsung hero stepped up in the final quarter was Dr. Dan Mosley. There is no question that all of us were spinning our wheels and hitting all the walls when he stepped up to do the hard, unenviable and tedious work, combing through each section and editing the minutia before handing it off to Mike and the JTS team for final approval and technical writing under COL Gurney and Col Shackleford.
Thank you to all involved in these guidelines and to those who paved the way from the beginning. Now back to work.
The PCC guidelines are a consolidated list of casualty-centric knowledge, skills, abilities, and best practices intended to serve as the DoD baseline clinical practice guidance (CPG) to direct casualty management over a prolonged period of time in austere, remote, or expeditionary settings, and/or during long-distance movements. These PCC guidelines build upon the DoD standard of care for non- medical and medical first responders as established by the Committee on Tactical Combat Casualty Care (CoTCCC), outlined in the Tactical Combat Casualty Care (TCCC) guidelines,1 and in accordance with (IAW) DoDI 1322.24.
The guidelines were developed by the PCC Work Group (PCC WG). The PCC WG is chartered under the Defense Committee on Trauma (DCoT) to provide subject matter expertise supporting the Joint Trauma System (JTS) mission to improve trauma readiness and outcomes through evidence-driven performance improvement. The PCC WG is responsible for reviewing, assessing, and providing solutions forPCC-related shortfalls and requirements as outlined in DoD Instruction (DoDI) 1322.24, Medical Readiness Training, 16 Mar 2018, under the authority of the JTS as the DoD Center of Excellence pursuant to DoDI 6040.47, JTS, 05 Aug 2018.
Operational and medical planning should seek to avoid categorizing PCC as a primary medical support capability or control factor during deliberate risk assessment; however, an effective medical plan always
includes PCC as a contingency. Ideally, forward surgical and critical care should be provided as close to
casualties as possible to optimize survivability.
2 DoD units must be prepared for medical capacity to be overwhelmed, or for medical evacuation to be delayed or compromised. When contingencies arise, commanders’ casualty response plans during PCC situations are likely to be complex and challenging. Therefore, PCC planning, training, equipping, and sustainment strategies must be completed prior to a PCC event. The following evidence-driven PCC guidelines are designed to establish a systematic framework to synchronize critical medical decisions points into an executable PCC strategy, regardless of the nature of injury or illness, to effectively manage a complex patient and to advise commanders of associated risks. The guidelines build upon the accepted TCCC categories framed in the novel MARC2 H3-PAWS-L treatment algorithm, (Massive Hemorrhage/MASCAL, Airway, Respirations, Circulation,
Communications, Hypo/Hyperthermia and Head Injuries, Pain
Control, Antibiotics, Wounds (including Nursing and Burns),
The PCC guidelines prepare the Service Member for “what to
consider next” after all TCCC interventions have been effectively
performed and should only be trained after having mastering the
principles and techniques of TCCC.
The guidelines are a consolidated list of casualty-centric knowledge, skills, abilities, and best practices are the proposed standard of care for developing and sustaining DoD programs required to enhance confidence, interoperability, and common trust among all PCC-adept personal across the Joint force. The JTS CPGs are foundational to the PCC guidelines and will be referenced throughout this document in an effort to keep these guidelines concise. General information on the Joint Trauma System is available
on the JTS website (https://jts.amedd.army.mil) and links to all of the CPGs are also available by usingthe following link: https://jts.amedd.army.mil/index.cfm/PI_CPGs/cpgs. The TCCC guidelines are included in these guidelines as an attachment because they are foundational AND prerequisite to effective PCC.
Remember, the primary goal in PCC is to get out of PCC!!!