No.

Medics and Corpsmen have not always done Prolonged Field Care or Prolonged Casualty Care.

While it is true that combat medical providers have always taken care of patients for longer than anticipated, we did not have a set of dedicated principles on which to fall back and guidelines to follow. Since the dawn of battlefield medicine, Medics have always had to contend with the contingency of caring for patients for longer than they should be due to the negligence of commanders and planners or overwhelming enemy action. History is filled with accounts of litter bearers, Corpsmen and Medics caring for patients for extended periods of time trapped in shell holes, beach heads, ships, and urban settings such as Mogadishu. There are even detailed case reports and data from the modern GWOT when evacuation timelines were not adhered to despite mandates to the contrary.

If not using the MARCH algorithm for battlefield care, is it still considered TCCC? If you purposely disregard the CoTCCC guidelines, are you still doing TCCC? We may be stuck in a PFC situation but not be doing PFC just like it is possible to do medicine in combat without doing TCCC.

Just like Medics have only had the unique algorithms of TCCC for a few short decades, the modern principles of prolonged care aren’t even 10 years old and still being perfected for unique environments and patient challenges. PFC was a term coined by NATO in 2013/14 as the working group was first forming. Prior to that there were many terms such as extended care or simply austere care. Once agreeing on this term, our working group rapidly developed principles help organize allllll of the complex information being thrown at or hiding from a medic to help them figure out what is going on with a complicated illness or injury. It gives us a simple way to prioritize the immense amount of work required.

Some may consider the little bit of nursing care that they did as prolonged casualty care. While performing prolonged casualty care will likely involve some nursing care it also goes beyond that and involves forming differential diagnoses, creating problem lists and treatment plans, incorporating telemedicine, tailoring extended analgesia and sedation strategies just to start. Having a palliative care strategy is also an unfortunate part of failing to meet evacuation requirements. Simply moving an expectant patient around a corner is not a realistic strategy for managing a dignified death. Mastering these low-tech, analog principles requires reps on realistic (and real) patients and training scenarios in accurately austere environments. For more info on the principles, search this website or check out page 7 of the newest PCC clinical practice guidelines on the

The RAVINES mnemonic was created as a way for medics to prioritize interventions after completing traditional TCCC in the form of the MARCH PAWS algorithm, or after completing an initial history and physical exam as part of a clinical encounter.

Resuscitating a hypovolemic casualty with the appropriate type and volume of fluids is an important step. This is often started in TCCC or during the initial interventions of a life threatening clinical case. Resuscitation strategies vary widely depending on the etiology such as utilizing whole blood for a casualty in hemorrhagic shock, or utilizing crystalloid solutions to the proper hemodynamic goals in the case of burn, crush or sepsis.

The R in RAVINES also stands, secondarily for Reducing or Replacing tourniquets as a reminder that if not done at this point it will likely have to be completed soon to avoid complications prolonged replacement or conversion.

Airway is next in the PFC priorities as it easily correlates with what has already been done in MARCH. If a definitive airway has already been established in Tactical Field Care, often it is done hastily and should be reassessed to ensure that it is still effective via capnography, inserted to the correct depth, secured, cleaned, that a Heat, Moisture Exchanger (HME) has been applied, and that adequate suctioning is occurring.

Ventilation and oxygenation adequacy should be assessed utilizing the MOVE mnemonic developed by Wayne Trainer at Ragged Edge with our MOVE assessment tool available in our documentation packet.

Initiating telemedicine early and often (when available) is an important part of this process and was included in this algorithm as a way to remind medics and those providing austere care that external consultation is expected and not seen as a sign of weakness. The telemedical consultation script was designed to be utilized in conjunction with out PFC Flowsheet and other documentation resources on this website.

Nursing care is next in our algorithm and an important part of PFC and may incorporate other nursing care mnemonics such as HITMAN, or SHEEPVOMIT, or others. The use of a dedicated nursing care checklist, such as is provided in our Nursing Care Clinical Practice Guideline either on this site or that of the Joint Trauma Service’s.

Environmental considerations are often forgotten or not addressed in traditional nursing care due to the normal, in-hospital environment where nursing is usually performed. It is therefore emphasized here to remind the clinician or medic to address these environmentally specific needs of the patient. Some examples include applying shade or sunscreen where shade is not possible such as in an open back truck, applying mosquito netting or bug spray in malaria endemic locations, or chapstick and eye drops in extremely dry locations. Unconscious patients being transported in loud, rotary wing aircraft should be shielded from the noise and debris with appropriate ear and eye protection. The bottom line is, if a medic does it for themself, they should do it for the patient as well.

Surgical procedures are last in this mnemonic as every effort should be made to avoid additional potential iatrogenic complications via an unnecessary or ill advised surgical procedure. Sometimes, however, there is no other choice but to perform a timely invasive intervention. Our Austere Anesthesia and Surgical checklist should help the medic and their team plan, prepare and perform some surgical interventions on affected extremities as described in the many free resources provided by the International Committee of the Red Cross.

If the RAVINES mnemonic is not utilized, other systematic tools should be considered to help prioritize interventions in order of importance by the small team with limited manpower.

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