Category Archives: Due outs

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.

Click to access Prolonged_Casualty_Care_Guidelines_21_Dec_2021_ID91.pdf

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),
Splinting, Logistics).
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!!!

Standard Prolonged Field Care Training Curriculum Crowdsource Project

It has been our experience that high quality prolonged field care training takes time, resources and expertise by dedicated trainers well versed and experienced in critical care concepts. That being said we also believe that there are fundamental principles which can help

Continue reading Standard Prolonged Field Care Training Curriculum Crowdsource Project

New JTS AAR Submission Forms for Data Collection Trauma Registry

Stories and experiences can sometimes bring relevancy to a situation you are in or to a point you are trying to make while instructing. These singular stories are called anecdotes and while powerful and personal do not represent similar patient outcomes even in similar situations. They are not science. They do not take into account the vast number of variables that were present in that particular situation. Often these stories can mislead and misinform medical practice by inexperienced medics and practitioners due to that powerful personal experience clouding that person’s own judgment.

Continue reading New JTS AAR Submission Forms for Data Collection Trauma Registry

Podcast 23: Clinical Practice Guidelines for the SOF Medic

While at the 2017 Remote Damage Control Resuscitation(RDCR) conference put on by the Tactical Hemostasis, Oxygenation and Resuscitation(THOR) network in Norway, Sean took the time to corner Dr. Shackleford to get her thoughts on the Joint Trauma System Clinical Practice Guidelines. Continue reading Podcast 23: Clinical Practice Guidelines for the SOF Medic

CALL FOR CASES!

JTS_Operational_Cycle

The U.S. Institute Of Surgical Research Joint Trauma Service and PFC Working Group need your help:

The JTS is working to conduct a retrospective case review relating to PFC in order to conduct an aggregate analysis.

We are currently collecting as many cases as we can obtain relating to prolonged role 1 care (anything greater than 4 hours) both trauma and non-trauma. We are accepting unclassified AAR’s, medical records, powerpoint summaries from meeting presentations, or even just personal memory/war stories. If the medic is available, we would like to interview them if possible. As there is really no database of such cases, many of the cases will be identified by word of mouth, although we are also searching the trauma registry, SOMA and SOCMSSC databases.

The results of our analysis will include the epidemiology of PFC cases and aggregate lessons learned. The report will be returned to the PFC working group and  operational communities and published (likely in JSOM).

Thank you for any assistance you can provide to help identify these cases and the medics who provided such care. Cases may be submitted to usarmy.jbsa.medcom-aisr.list.jts-prehospital@mail.mil

Click here to download the AAR Form


Once you open the PDF, click
Once you open the PDF, click “Fill and Sign” then “Add Text” to fill out as much as you can.

Telemedicine Issues

Who should medics call for help while managing a critical patient for prolonged periods of time?  Different aspects of this have been discussed via different forums such as the SOMSA lunchtime working sessions and email chain.  We are posting it here in order to reach a wider knowledge base including those who it affects directly such as the medics on the ground.

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Recommended Research?

What research would help Medics on the ground provide better care to sick patients in an austere, environment today?  Has anyone ever told you any dogma that you hear but question and can’t find studies for such as; less than 8 intubate, trendelenberg position for hypovolemic patients, etc.?  We have the opportunity to make some of this research happen and use real science to find the best practice for our patients.  We simply need ideas and suggestions for research to be conducted.

Topics for Prolonged Field Care Training wanted

Here is a message from one of our brothers serving in Germany. I copy and pasted verbatim so that you don’t miss any nuances. My thoughts will be pasted as a new comment after the post to get some discussion going.  Please speak up and let us know what we forgot!

Continue reading Topics for Prolonged Field Care Training wanted

What is a Cuff Manometer and should we be using it? (Yes)

During a break from the lectures at the last SOMSA one of the first issues identified was the lack of knowledge of PEEP and the absence of PEEP valves on BVMs.  Within a few weeks the paper Why we need PEEP valves on BVMs was written, edited and posted for distribution.  Our unit ordered the extremely inexpensive valves and they were distributed down to the medics.  It is now standard to be using PEEP valves and considered less-than-best practice without.

Continue reading What is a Cuff Manometer and should we be using it? (Yes)