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... Read the rest at ProlongedFieldCare.org #postandghost #fourforfour #prolongedfieldcare #prolongedcasualtycare #prolongedcare #sfms #soidc #socm #sarc #sofacc #combatmedic #soma #somsa #jsom #corpsman #idmt #IWMed #UWMed
PFC and The Surgical Team Deficit
The vast majority of SOF deployments occur outside combat zones where the SOF Medic is expected to care for the entire team without a credentialed provider. Faced with a low level of risk, Commanders opt to accept it. The team also willingly accepts it due to the confidence that they have in us. Medics and Corpsmen bear the burden of the risk assumed by the Commander. There is no Doc. No PA. No dentist or Vet. No surgical team or MEDEVAC standing by. What can be done? Hint... Its training #postandghost #prolongedfieldcare #prolongedcasualtycare #prolongedcare #sfms #soidc #socm #sarc #sofacc #combatmedic #soma #somsa #jsom #corpsman #idmt #irregularwarfaremedicine #IWMed #UWMed
Prolonged Care and Technology: A PFC Op-Ed
Prolonged Care and Technology: A PFC Op-Ed
If trained sufficiently, integrated responsibly, and not relied upon, some technology may enhance the awareness of a task-saturated medic dealing with a critically ill patient. R&D dollars should be spent on training, relevant knowledge, and only on equipment that has a good chance of both improving patient outcomes and actually making it into the aid bag or equipment set.
Read the rest of this Op-Ed at ProlongedFieldCare.org
#prolongedfieldcare #prolongedcasualtycare #prolongedcare #sfms #soidc #socm #sarc #sofacc #combatmedic #soma #somsa #jsom #corpsman #idmt #IWMed #UWMed #irregularwarfaremedicine
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(when available), 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. #prolongedfieldcare #prolongedcasualtycare #prolongedcare #sfms #soidc #socm #sarc #sofacc #combatmedic #soma #somsa #jsom #corpsman #idmt #irregularwarfaremedicine #IWMed #UWMed #postandghost
Ukraine: Podcast Episode 101
Dennis had the honor of interviewing Dr. John Quinn who's on the ground working Role 1 medical operations for an NGO somewhere in Ukraine. The lessons being learned by John and others during the early days of this conflict and the past 8 years can be used to help those on the ground now and … Continue reading Ukraine: Podcast Episode 101
Joint Trauma System Newsletter Update
The Joint Trauma System and Defense Committees on Trauma are made up of several committees including the Committee on Tactical Combat Casualty Care (CoTCCC), the Committee on EnRoute Combat Casualty Care (CoERCCC) and the Committee on Surgical Combat Casualty Care (CoSCCC). These committees, along with the other branches of the JTS, strive to share lessons learned, data, research and form recommendations to DoD medical communities.
Improvised Field Medicine Shopping List for the Austere Clinician
From tourniquets to chest seals, our community has been at the forefront of innovating, problem solving and improvising when not able to get a commercially tested and manufactured device. A purpose-made, evidence-based solution should always be primary in the PACE plan. After the primary manufactured and evaluated product is exhausted, what then?
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
Medical Support to Resistance: Special Warfare Article
This article first appeared in the Jul-Sep 2019 Special Warfare Magazine which can be found open-source at soc.mil. SURVIVABILITY MEDICAL SUPPORT TO RESISTANCE BY SERGEANT FIRST CLASS JAKE HICKMAN, U.S. ARMY; COLONEL JAY BAKER, U.S. ARMY; AND LIEUTENANT COLONEL ELIZABETH ERICKSON, U.S. AIR FORCE Hope is a primary driver of resistance movements, and the best … Continue reading Medical Support to Resistance: Special Warfare Article
A Practical Approach to Care after SMARCH-E-PAWS-B: RAVINES
The RAVINES Mnemonic was created to help the medical provider on the ground in an austere environment with a very sick patient. Most medics will do a decent TCCC SMARCH survey and when they get to the end of that, get vital signs to begin trending and repeat the MARCH sequence while adding E-PAWS-B... E … Continue reading A Practical Approach to Care after SMARCH-E-PAWS-B: RAVINES