• Comment: Not enough independent, significant coverage. Reads like an essay. WikiOriginal-9 (talk) 06:55, 5 November 2023 (UTC)

• Comment: Interesting article however seems somewhat promotional in tone, (I did a few edits, but it needs further work) thank you Ozzie10aaaa (talk) 22:50, 14 October 2023 (UTC)

Prolonged Casualty Care refers to the specialized medical care provided to individuals who have sustained injuries or illnesses in situations where immediate evacuation to a medical facility or next tier of healthcare provision is delayed, challenging, or not feasible.^[1][2]

This concept is applicable in various contexts, including military operations, wilderness emergencies, and disaster response scenarios.^[2] Definitions may exhibit slight variations, but they generally convey the same fundamental meaning:

"Field medical care, applied beyond doctrinal planning time-lines"^[3]

"Field medical care that is applied beyond “doctrinal planning time-lines” by a tactical medical practitioner in order to decrease patient mortality and morbidity."^[4]

"Prolonged care is provided to casualties if there is likely to be a delay in meeting medical planning timelines"^[5]

While the concept itself is well established, since 2012 it has become rapidly codified, with changes in the global political environment and the nature of combat operations around the world.^[6] This led to increased research and academia in the area of Prolonged Casualty Care, first in Special operations teams^[7] and then more broadly.^[8][9][10]

History

The concept of prolonged casualty care has evolved over time, driven by lessons learned from military conflicts,^[11] humanitarian missions,^[12] and disaster response efforts. It has become a vital component of prehospital, emergency and military medicine. Prolonged Casualty Care as a subspecialty relies on the transmission and adaptation of guidelines between civilian and military organisations. This can take the form of adapting civilian clinical practices to a military setting,^[5] undertaking civilian research to inform military practices^[8] or adapting miltiary Prolonged Field Care training for a civilian audience.^[13]

Core capabilities

There are twelve core capabilities of Prolonged Field Care:^[2]

1. Monitor: Possess the capability to acquire, analyze, and comprehend a patient's vital signs, employing a reliable approach for precise documentation of observations.
2. Resuscitate: Have the equipment and competence to commence suitable fluid resuscitation to enhance patient outcomes, encompassing the administration of whole blood and blood products when necessary.
3. Ventilate & Oxygenate: Administer positive pressure ventilation while safeguarding the lungs from additional harm.
4. Airway Management: Gain control of a patient's airway to prevent hypoxia, asphyxiation and aspiration.
5. Sedation & Pain Control: Use adequate and appropriate pain control. Use sedation to accomplish any procedural tasks.
6. Physical Exam & Diagnostics: Conduct a thorough physical examination and diagnostics to gather information about the patient's current status and anticipate concealed injuries..
7. Ongoing (Nursing) Care: Continuously provide nursing care that includes maintaining the patient's warmth, cleanliness, and dryness, managing biological needs, performing wound care, and proactively preventing additional illness.
8. Advanced (Surgical) Procedures: Undertake advanced procedures essential for preserving life, reducing morbidity and enhancing overall outcomes.
9. Telemedicine: Establish telemedicine connections with medical providers capable of guiding treatment and effectively communicate the patient's condition.
10. Prepare for Evacuation: Prepare for safe evacuation by ensuring patient stability during transport and taking measures to prevent further harm.
11. Logistics: Understand the chain of care and evacuation.
12. Communication: Establish and maintain reliable communication with operational and medical control.

The first ten capabilities originates in military practice^[14][15] with the last two being later additions for a civilian Each of the core capabilities can then be considered in terms of Minimum, Better, Best in relation to planning to provide a gold standard level of care^[16] and in relation to Ruck, Truck, House and Plane^[17] to discuss the stages of care and logistical issues which may limit equipment provision.

These stages of care can be further explained as:

• RUCK: the equipment and medications carried to the furthest point of an expedition or mission. Generally (or conceptually) carried in a rucksack.
• TRUCK: Additional medications and equipment carried on a transportation medium during an expedition or operation (Four-wheel drive vehicles, boats etc).
• HOUSE: Equipment and medications available at a team's house, warehouse or other staging post building.
• PLANE: Plane is used here to represent the formal medical evacuation platform, this will vary but may have the staffing, equipment and capabilities very close to the receiving hosptial.

Core interventions

There are two acronyms used to prompt the provision of Prolonged Casualty Care after completing a Primary and Secondary Survey, those being HITMAN^[18][19] and SHEEPVOMIT.^[20][21]

H: Head to Toe examination; a full secondary survey to identify illnesses or stigmata of disease.

I: Infection

T: Tubes and tidy

M: Medications

A: Administration

N: Nursing care; utilise the SHEEP VOMIT acronym.^[22]

The second acronym, SHEEP VOMIT details the nursing care needs of a patient and how best to address these.^[23][24]

S: Skin protection

H: Heat regulation

E: Elevate head

E: Exercises

P: Pressure points

V: Vital signs

O: Oral hygiene

M: Massage (DVT prophylaxis)

I: Ins and Outs (diet and fluid)

T: Turn / cough / deep breath

Education

A number of civilian and military Prolonged Casualty Care courses exist. While many follow the core capabilities outlined above some do not. As an example, the Austere Emergency Care course aligns closely with the 12 capabilities (as it was designed by one of the authors of the capabilities list). The typical course contents of a typical Austere Emergency Care course includes:

• TECC/TCCC practical scenarios
• Four Horsemen of the Apocalypse scenarios (Catastrophic Hemorrhage, Burns, Crush, TBI)
• Austere nursing care scenarios
• Austere and prehospital ultrasound (APUS)
• Disaster response / mass casualty
• Improvised medicine
• Austere Critical Care
• Austere Nursing Care
• Full-day, immersive exercise

Terminology

A variety of terminology is used for the same concept, this is partly due to the differences between military and civilian practice. The following terms are used fairly interchangeably, but there may be specific differences between the association dogma, guidelines and protocols.

• Prolonged Prehospital Care - The British Armed Forces utilise this terminology as well as Prolonged Hospital Care.^[5]
• Austere Emergency Care - Preferred civilian terminology relating to training and education^[2]
• Prolonged Field Care - Commonly used military term
• Prolonged Casualty Care - Preferred civilian term