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  #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

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?

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 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

Podcast Episode 69: Hot Weather Injury

Hot weather injuries are an issue medics have to account for even when not deployed. Proper planning, recognition and treatment can greatly reduce frequency and severity of these patients and their outcomes. Before you listen to podcasts, let's go over some talking points as a little pop quiz or a refresher to stay humble and … Continue reading Podcast Episode 69: Hot Weather Injury