Prolonged Field Care

Ok so you are not deployed to some remote region in Afghanistan or some other part of the world, and 99% of the time evac is not delayed. So why train on prolonged field care? And if we did train how would we do it. 

As a 68W in the Army prolonged field care was a skill (art) I trained on regularly. Evac times varied during deployments, they were dependent on the  mission, location, weather, enemy, assets etc. So being unprepared was never an option.

Move over to civilian life. As a tactical medic, 99% of the time evac is not delayed. Pew, pew, pew (yes i just said pew, pew, pew) you go in do your initial treatment bring in the Evac (ambulance) team then you load and go. Too easy right. So why add prolonged field care to our training? Why add the countless hours and supplies you will spend training on something that you hardly ever encounter?…

Well i’m glad you asked, anyone who tells you that it’s a waste of time and resources should really re-evaluate their role as a tactical medic. Our job as tactical medics is to save lives, primarily those of our operators, bystanders, and others involved.

First lets start with what is Prolonged Field Care…

The NATO definition of Prolonged Field Care (PFC) is:

Field medical care, applied beyond ‘doctrinal planning time-lines’ by an NSOCM (NATO Special Operations Combat Medic), in order to decrease patient mortality and morbidity. Utilizes limited resources, and is sustained until the patient arrives at the next appropriate level of care. (In short, spending a long time with your patient(s) with limited supplies).

So yes this is a rare occasion stateside, that being said we as tactical medics should always strive to better ourselves, be better prepared for those “rare” instances when we find ourselves with a patient(s) for a prolonged amount of time. Those situations many believe “won’t ever happen here”. You may find yourself placed in a hostage situation caring for a patient or multiple patients during a long and stressful negotiation process, or in some secluded area without communications. The list goes on.

Don’t be “that guy” the one that wasn’t ready for a situation because of the “it could never happen here” mentality, or the “how hard could it be” guy.

So how are we going to train on this? It’s not just a matter of throwing a few simulated patients on the ground and spending all day treating them. Before we get started on things you can do in training there are a few things that need to be done. (Note this is not a substitute for taking a recognized PFC class, SOMA has an excellent program that I believe is the GOLD standard for PFC. This should just serve as information and a small step forward in developing your PFC capabilities). 

First we need to change our mindsets, change the way we approach patient care. Think about why we do what we do as far as treatments go, we need to really know what effect those treatments will have on the body, not just giving fluids without worrying about output, or applying tourniquets without understanding how they effect your body after 2 hours.

Mastering the basics is a must. Know your TCCC guidelines, know your treatments and the effects they have on the body. If you are carrying a piece of equipment know it inside and out, know it’s capabilities and limitations, can it be modified? Does it have multiple applications? What else can I use should this fail? And know how to trouble shoot mechanical or electrical equipment. If you carry meds you should know them inside and out, know how it will effect the pt down the road (if you carry them you should know already).

Planning in advance is imperative. Radio Failure protocols are not enough. Have a plan of action in place for patient care in the event of no communication capabilities. Every scenario is different and there is no way of planning for every scenario, go and do some rotations in ICU and CCU so you know what right looks like further on in patient care.  Knowing what a patient on the road to recovery looks like. Don’t forget in extreme cases you may be with your patient for days.

Those are just 3 of the things you should start with. Now for training i’m a firm believer in “train as you fight” so if you are going to train in PFC then you better clear your schedule and get a couple training days approved (as in full 24 hour days). Start small maybe start with 2 hour patient care and work your way up to 48 hours.

Now I know not all agencies are created equal as far as budgets, supplies, and training aides. So for the purpose of this training we will go with low budget ie. no fancy mannequins that are computerized.

Training should be formative, meaning the training is a teaching/learning experience. Initial training should be the medic and a critical patient and later evolve to multiple patients and the entire team. Keep in mind PFC is a stressful situation for all involved. The patient feels as “why am I not in a hospital, i’m going to die here”, the medic has the stressors of keeping the patient alive with his/her skill set and limited equipment, and the tactical commander has the stress of the entire situation. So training should be stressful but not to stressful where the participants cant retain the information.

Make sure that a training objective is set and later hopefully met. Scenarios should be scripted well prior to the training. This includes vital signs and treatment goals. Your role players should know how to portray the pre-determined injuries and how to react to initial and later treatments during the different stages. Make sure that the medic only has the equipment they would normally bring with them on a mission. So no boxes of supplies set in the room (that’s cheating) this will help them understand the importance of rationing supplies. Once everything is set up run through scenarios over and over again. After each evolution conduct an After Action Review and learn from them.

This a very condensed version of training for PFC.  There are entire books and manuals written on this subject. I just want to give you a sliver of insight on this because I know it’s importance and I also know how overlooked this matter is stateside. Go and run through some scenarios and let me know how they went. If you have any questions let me know.

“Complacency in training, has deadly real world consequences”.                                                                                       Jose Ortiz (Me)




Categories Austere Medicine, Prolonged Field Care, SWAT, Tactical Medics, TCCCTags

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