Category Archives: FAQ

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. However, much of it may be a waste of money, space, and weight without proper consideration, training, and integration. 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.

The stethoscope was invented and perfected in the early 19th century. Before the turn of the century the sphygmomanometer, or BP cuff, was invented. Both of these analog technologies have aided in the bedside diagnosis and treatment of an untold number of patients and are still mainstays of many loadouts . Our modern clinical practice guidelines routinely rely on numbers gathered by the use of technology to guide our decisions and treatment plans. A wristwatch helps this process, another piece of technology. If any one of these 3 pieces of equipment were purposely left behind or disregarded, most medical providers might be considered negligent. Opting to not incorporate some way to record vital signs may also be considered irresponsible.

The ability to record and transmit writing could be considered to be one of the most transformative of early technologies. The TCCC card is a great way to record the first few sets of vitals for a short, doctrinal evacuation. The PFC card and vitals chart can help if caring for a patient for a much longer time without technology. It also should help a weary medic interpret patterns and notice subtle changes over time.

“Yeah, but what about real, digital technology?” Like a Pulse Ox or Emma? Both have been ubiquitous pieces of technology used by modern medics over the course of the GWOT and numerous other non-combat deployments. They are immensely helpful, take up a small amount of space and weigh almost nothing. Like anything else, they may have a small downside depending on the model. A small increase in the electromagnetic signature. Both emit different types and amounts of light. If equipped and switched on, Bluetooth may also be a consideration. In the proper setting, wirelessly monitoring multiple patients via a single device could be hugely beneficial.

Now for the more contentious tech… The vent and the cell phone. As equipment increases in complexity, and/or connectivity, the consideration of electromagnetic signature should be a part of the planning process. This includes all aspects of training: initial and sustainment. An “Autonomous” piece of medical equipment like a SAVE2 bag-valve device that runs at a certain setting, once set, still requires considerable attention by a thoroughly trained and equipped provider. This should include advanced analgesia and sedation training and experience. Just buying the equipment doesn’t cut it. (This may sound obvious but is routinely the case, unfortunately.) You can’t just set it and forget it. It may actually make your job more difficult if you are not ready to manage a vented patient and all of the possible complications.

As ATAK and net warrior proliferate and JMEDIC3 goes through the wickets, clinicians should be familiar with BATDOK and other emerging technologies. If for nothing else, being informed can help steer R&D, acquisition, and training. I have been a huge fan of BATDOK since I first got my hands on an early version in 2015. Despite the potential, here we are almost 8 years later and it is still not implemented across the force. I’ll do another post on that another time. It is googleable though.

Since the majority of deployments are outside combat zones, the use of technology may greatly enhance the quality of care given beyond TCCC and basic sick-call in other austere environments. The 2022 NDAA directs the Secretary of Defense to review “current electromagnetic spectrum emissions control tactics, techniques, and procedures across the joint force.” talk to your S2 and S6 and they may just tell you not to use whatever it is you want to use. Talk to the Air Force and the thing you bought off the shelf may not be considered airworthy. Even if it is blessed off for use in a permissive training environment, take into account these concerns if ever activated into a near-peer LSCO fight.

I’m definitely not recommending to not use technology. Rather realistic integration that begins with adequate training. That means if you are using technology, incorporate the failure of said equipment. This will reduce the reliance on power-hungry or cyber susceptible tech and increase the confidence of the medic in any eventuality, whether telemedicine is available and safe to use or not.

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.