Haven’t we always done PFC?

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 littered 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 Joint Trauma System Website.

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