PROLONGED CASUALTY CARE BACKGROUND

#### Prolonged Casualty Care (PCC)

The need to provide patient care for extended periods of time when evacuation or mission requirements surpass available capabilities and/or capacity to provide that care.

The PCC guidelines are a consolidated list of casualty-centric knowledge, skills, abilities, and best practices intended to serve as the DoD baseline clinical practice guidance (CPG) to direct casualty management over a prolonged period of time in austere, remote, or expeditionary settings, and/or during long-distance movements. These PCC guidelines build upon the DoD standard of care for non-medical and medical first responders as established by the Committee on Tactical Combat Casualty Care (CoTCCC), outlined in the Tactical Combat Casualty Care (TCCC) guidelines,1 and in accordance with (IAW) DoDI 1322.24.

The guidelines were developed by the PCC Work Group (PCC WG). The PCC WG is chartered under the Defense Committee on Trauma (DCoT) to provide subject matter expertise supporting the Joint Trauma System (JTS) mission to improve trauma readiness and outcomes through evidence-driven performance improvement. The PCC WG is responsible for reviewing, assessing, and providing solutions for PCC-related shortfalls and requirements as outlined in DoD Instruction (DoDI) 1322.24, Medical Readiness Training, 16 Mar 2018, under the authority of the JTS as the DoD Center of Excellence pursuant to DoDI 6040.47, JTS, 05 Aug 2018.

Operational and medical planning should seek to avoid categorizing PCC as a primary medical support capability or control factor during deliberate risk assessment; however, an effective medical plan always includes PCC as a contingency. Ideally, forward surgical and critical care should be provided as close to casualties as possible to optimize survivability.2 DoD units must be prepared for medical capacity to be overwhelmed, or for medical evacuation to be delayed or compromised. When contingencies arise, commanders’ casualty response plans during PCC situations are likely to be complex and challenging. Therefore, PCC planning, training, equipping, and sustainment strategies must be completed prior to a PCC event. The following evidence-driven PCC guidelines are designed to establish a systematic framework to synchronize critical medical decisions points into an executable PCC strategy, regardless of the nature of injury or illness, to effectively manage a complex patient and to advise commanders of associated risks.

The guidelines build upon the accepted TCCC categories framed in the novel MARC2H3-PAWS-L treatment algorithm, (Massive Hemorrhage/MASCAL, Airway, Respirations, Circulation, Communications, Hypo/Hyperthermia and Head Injuries, Pain Control, Antibiotics, Wounds (including Nursing and Burns), Splinting, Logistics).

The PCC guidelines prepare the Service Member for “what to consider next” after all TCCC interventions have been effectively performed and should only be trained after having mastering the principles and techniques of TCCC.

The guidelines are a consolidated list of casualty-centric knowledge, skills, abilities, and best practices are the proposed standard of care for developing and sustaining DoD programs required to enhance confidence, interoperability, and common trust among all PCC-adept personnel across the Joint force.

The JTS CPGs are foundational to the PCC guidelines and will be referenced throughout this document in an effort to keep these guidelines concise. General information on the Joint Trauma System is available on the JTS website (https://jts.health.mil) and links to all of the CPGs are also available by using the following link: https://jts.health.mil/index.cfm/PI_CPGs/cpgs.

The TCCC guidelines are included in these guidelines as an attachment because they are foundational AND prerequisite to effective PCC. Remember, the primary goal in PCC is to get out of PCC!!!