Let’s jump right in. No one wants to be in a prolonged care situation. It is a contingency like a MASCAL. Maybe even a subset of a MASCAL: Being overwhelmed with the complexity and severity of a single, critically ill or injured patient vs being overwhelmed by many patients. As discussed in yesterday’s post,
Commanders assume the risk to force for this contingency. They do this more readily for SOF Medics than for conventional units. PFC was initially created to shore up some of the deficiencies that remained in the training and experience provided to SOF Medics and Corpsmen even after 9+ months of training and hospital rotations. Some of the PFC JTS guidelines and our other recommendations reflect this in the acknowledgment of the increased scope of practice and increased frequency in which SOF Medics are placed in these situations where evacuation timelines are extended beyond doctrine and policy.
The conventional military medical system, starting with the ground medic, is designed to treat and evac quicker and adhere to the doctrinal timeline. Yes. Commanders can still assume risk and push an element past this but likely and rightfully so, with greater career and political consequences. As a prior 68w, I did this multiple times as a scout or infantry medic while deployed. Commanders were aware and informed. We mitigated risk as much as possible and kept the exposure to a minimum with several mitigation strategies.
Once the conventional Army planners and senior medical leaders contemplated potential contingencies and future conflict models and saw what we were doing they wanted in. Aside from some of the advanced skills, the scope of practice provided at Fort Sam covered the minimum category of the 10 essential PFC capabilities. Max Dodge wrote a great article on the topic in the Next Generation Combat Medic Blog:
We did the same in 2016 based on training being done by the 82nd for 68Ws in 1st Brigade.
From this, the Prolonged Casualty Care working group was formed along with a parallel effort to create a Prolonged Field Care curriculum per DoDi 1322.24.
The Navy, realizing their vulnerabilities, also wanted in but felt that their sailors did not work in the field so we dropped "field" and replaced it with "casualty" to be more inclusive. You're welcome Navy. The Navy does have different constraints and so some recommendations were shifted and included things like ventilators and other meds that fit easily on a ship with "endless" power that would be more prohibitive in a field setting. NATO and SOF still utilize the term PFC, for now.
The PCC working group is composed of members from all services and kept the tiered paradigm utilized by CoTCCC and the TCCC guidelines. Members from the original SOF working group and CoTCCC are represented to coordinate the recommendations as much as possible. As described by HR Montgomery at SOMSA last year, the PCC working group will likely get folded under the CoTCCC. We will remain here and n SOF to act as a hub for innovation and share lessons learned and emerging TTPs where they can then be better refined and studied for possible inclusion into official recommendations.
Some erroneously believe that PCC can somehow replace TCCC. That is ridiculous in that PCC/PFC are both built on the foundations of TCCC. Training should reflect this. Until mastery of TCCC, no one should be training PCC. That does not mean that no one should ever train on PCC though. Like training for a MASCAL response for a large number of patients, PCC training can help organize the chaos of a single complex patient until they can be evacuated to an appropriate facility and role of care.
The problem with PCC is that the breadth and depth are so wide and deep, training for PCC takes more time. Blunt trauma, burns, crush, TBI, tropical disease, envenomations, electrocutions, environmental injuries… The list goes on. Hitting the basics of each takes more than an afternoon like ironing out and rehearing a MASCAL response would. If time is very limited and TCCC is proficient, training should focus on the principles of PCC and ensure that references are readily available. Training can and should continue while deployed. Some of the best PFC podcasts that were never recorded were conversations had while deployed.
Just to throw a complete monkey wrench into the works, why not ditch both and call it prolonged patient care since the patient is the focus. Once they move out of the acute phase they are more of a patient in the traditional sense than a casualty at that point.
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