Ruck - Litter - House - Wagon: how we got to prolonged field care (original) (raw)
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Journal of Military, Veteran and Family Health
LAY SUMMARY As a result of the unpredictable nature of warfare, military medics deployed on missions may be required to manage seriously ill or injured patients for longer than expected. Because this type of care is not typically the focus of a military medic’s training or mandate, core skills and knowledge gaps were, not surprisingly, identified. For this reason, specialized training was developed, and the term prolonged field care (PFC) was coined. PFC takes on concepts associated with traditional hospital care and translates them into austere military medical environments with limited resources, including supplies, equipment, and trained medical providers to manage critically ill or wounded patients. This training program helps medics maximize their ability to save lives and improve outcomes for those who are ill or injured. This article discusses how PFC originated both internationally and within the Canadian Special Operations Forces Command and core concepts and applications f...
Review of 54 Cases of Prolonged Field Care
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
Prolonged field care (PFC) is field medical care applied beyond doctrinal planning time-lines. As current and future medical operations must include deliberate and contingency planning for such events, data are lacking to support efforts. A case review was conducted to define the epidemiology, environment, and operational factors that affect PFC outcomes. A survey distributed to US military medical providers solicited details of PFC encounters lasting more than 4 hours and included patient demographics, environmental descriptors, provider training, modes of transportation, injuries, mechanism of injury, vital signs, treatments, equipment and resources used, duration of PFC, and morbidity and mortality status on delivery to the next level of care. Descriptive statistics were used to analyze survey responses. Surveys from 54 patients treated during 41 missions were analyzed. The PFC provider was on scene at time of injury or illness for 40.7% (22/54) of cases. The environment was desc...
Canadian journal of surgery. Journal canadien de chirurgie, 2015
Medical support to deployed field forces is increasingly becoming a shared responsibility among allied nations. National military medical planners face several key challenges, including fiscal restraints, raised expectations of standards of care in the field and a shortage of appropriately trained specialists. Even so, medical services are now in high demand, and the availability of medical support may become the limiting factor that determines how and where combat units can deploy. The influence of medical factors on operational decisions is therefore leading to an increasing requirement for multinational medical solutions. Nations must agree on the common standards that govern the care of the wounded. These standards will always need to take into account increased public expectations regarding the quality of care. The purpose of this article is to both review North Atlantic Treaty Organization (NATO) policies that govern multinational medical missions and to discuss how recent sci...
Medical support of military operations in Iraq and Afghanistan
International maritime health
The system of medical support in the territory of military operations in Iraq and Afghanistan is based on four levels of medical treatment. Level 4 is organized outside the war theatre, in the territories of the countries that are a part of the stabilization forces of international organizations (NATO). Both the tasks and the structure of medical support are adjusted to fit the requirements of the U.S. Forces. The same tasks and structure are also recognized by medical services of other NATO countries participating in military operations in Iraq and Afghanistan. Each subsequent level of medical support is progressively more highly specialized and capable of providing more advanced medical treatment in comparison to the preceding level. Medical evacuation is executed either by air or overland depending on the type of illness or injury as well as the tactical situation prevailing in the combat zone. The aim of this paper is to present the planning, challenges, and problems of medical assistance in the contemporary battlefield.
Sustaining Clinical Readiness for Combat Casualty Care
Military Medicine, 2021
We read with interest the article of Richards et al. titled "Review of a Role 2 in Afghanistan: Understanding the Data on Medical and Surgical Volumes in a Deployed Setting." The authors' deployment experience highlights the urgency to ensure clinical surgical readiness, and their concerns are well-founded. We believe that the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program, developed at the Department of Surgery at the USU and operationalized within the Defense Health Agency (DHA) Combat Support Agency, addresses the authors' concerns. Since the cessation of major direct combat operations in Iraq and Afghanistan, we began a period during which we still continue to provide surgical combat casualty care support across large geographic regions but to fewer deployed service members mainly in an assistance role with far fewer combat injuries. As the authors note, this presents a dilemma for trauma system resource utilization, risk management decisions, and clinical readiness. Regarding the issue of clinical readiness for surgeons, we believe that there are 2 pieces to consider for expeditionary scope of practice readiness. The first involves sustainment to ensure acceptable proficiency in expeditionary surgical skills upon deployment. The second involves the question of skill decay during deployments, in particular for those with few or even zero combat casualties. We would like to describe how the KSA Clinical Readiness Program is addressing this critical issue and which is the Defense Health Agency's enterprise solution. The U.S. Military Health System is unique in that it must provide expertise both in stateside hospitals and across the globe in support of military operations. The Military Health System sustains the clinical readiness of its providers through routine medical practice, particularly in the military treatment
PsycEXTRA Dataset
Operations other than war (OOTW) and combat scenarios differ in doctrinal, cultural, political, personnel, and logistical aspects. Relying on the parameters of combat scenarios to plan medical requirements for OOTW missions might result in overstocking of some supplies and equipment while underestimating the requirements for others. Objective The goal of this study was to identify those diseases and injuries that occur during OOTW but not during combat operations, and to link them to corresponding treatment tasks and supply requirements. The ultimate objective of this research effort was to add an OOTW component to the Estimating Supplies Program (ESP), thus enhancing its value as a planning tool. Approach A literature search was conducted to find published disease and injury statistics representing a variety of OOTW scenarios, and this information was organized to form a database. Researchers compared the OOTW diagnoses with diseases and injuries that were already defined in the ESP model. The OOTW diagnoses that could not be matched to established codes were determined to be unique to OOTW. Researchers defined treatment protocols for these unique OOTW diagnoses. Medical subject matter experts were consulted for more-complex treatments. The clinical tasks that would be performed during treatment and the supplies required to accomplish these tasks for each OOTW patient condition (PC) were identified. Results The literature search produced 19 sources that included disease and injury information for OOTW. To organize these statistics, PCs used in ESP were identified either as trauma or nontrauma. The trauma PCs were divided into 18 categories, while the nontrauma PCs formed 20 categories. There were 15 OOTW diagnoses that did not match already-existing PCs, and all of them were nontraumatic. In addition, 22 new clinical tasks were introduced. Five of the tasks require no supplies, and six require no new supplies. Eight of the tasks introduce a total of 15 new items to the supply database. The three tasks related to eye surgery require extensive, specialized consumable supplies and equipment that are suggested as a supplement to the operating room setup that is already in place. Discussion Determining OOTW PCs and linking them to the clinical tasks and supply requirements that comprise treatment protocols is the basis for creating a planning module for ESP. To continue the process, a patient stream must be developed. In this report, the diagnoses were classified by type rather than by frequency to determine which diseases and injuries are unique to OOTW. Additional research is needed to quantify populations at risk and to calculate rates of occurrence for humanitarian assistance, disaster relief, and peacekeeping.
Triage of American Combat Casualties: The Need for Change
Military Medicine, 1994
United States military medical planning must reevaluate the practices of combat casualty resuscitation, transportation, and triage to secondary echelon care. Analysis of the experiences of other medical commands, such as that of the Israeli Defense Force, offers insight into improvements in equipment and training that are achievable with minimal cost. Training programs must involve formal instruction in Advanced Trauma Life Support for the combat corpsman, and ongoing experience in trauma surgery for personnel who are placed in the role of military surgeons. Today in military medicine there exists a major deficiency of expertise in trauma care, arising through a near total lack of involvement in active trauma surgery on the part of military medical training facilities. Civilian trauma centers offer an abundance of opportunity for military-like casualty management, and successful efforts at our command have integrated active duty personnel into this experience.