The principles and strategies of providing effective prolonged casualty care are meant to help organize the overwhelming amount of critical information into a clear clinical picture and proactive plan regardless of the nature of injury or illness. The following steps can be implemented in any austere environment from dispersed small team operations in permissive environments to large scale combat operations to make the care of a critically ill patient more efficient for the medic and their team. These mimic the systems and processes in typical intensive care units without relying on technology while leaving the ability to add technological adjuncts as they become available. The following checklist is meant to emphasize some of the most important principles in efficient care of the critically ill patient.

1. Perform initial lifesaving care using TCCC guidelines and continue resuscitation. The foundation of good PCC is mastery of TCCC and a strong foundation in clinical medicine.

2. Delineate roles and responsibilities, including naming a team leader. A leader should be appointed who will manage the larger clinical picture while assistants focus on attention intensive tasks.

3. Perform comprehensive physical exam and detailed history with problem list and care plan. After initial care and stabilization of a trauma or medical patient, a detailed physical exam and history should be performed for the purpose of completing a comprehensive problem list and corresponding care plan.

4. Record and trend vital signs. Vital signs trending should be done with the earliest set of vital signs taken and continued at regular intervals so that the baseline values can be compared to present reality on a dedicated trending chart.

5. Perform a teleconsultation. As soon as is feasible, the medic should prepare a teleconsultation by either filling out a preformatted script or by writing down their concerns along with the latest patient information.

6. Create a nursing care plan. Nursing care and environmental considerations should be addressed early to limit any provider-induced iatrogenic injury.

7. Implement team wake, rest, chow plan. The medic and each of their first responders should make all efforts to take care of each other by insisting on short breaks for rest, food, and mental decompression.

8. Anticipate resupply and electrical issues

9. Perform periodic mini rounds assessments. Stepping back from the immediate care of the patient periodically and re-engaging with a mini patient round and review of systems can allow the medic to recognize changes in the condition of the patient and reprioritize interventions.

  • Is the patient stable or unstable?
  • Is the patient sick or not sick?
  • Is the patient getting better or getting worse?
  • How is this assessment different from the last assessment?

10. Obtain and interpret lab studies. When available, labs may be used to augment these trends and physical exam findings to confirm or rule out probable diagnoses.

11. Perform necessary surgical procedures. The decision to perform invasive and surgical interventions should consider both risks and benefit to the patient’s overall outcome and not merely the immediate goal.

12. Prepare for transportation or evacuation care. If the medic is caring for the patient over a long tactical move or strategic evacuation, they should be prepared with ample drugs, fluids, supplies and be ready for all contingencies in flight.

13. Prepare documentation for patient handover. The preparation for transportation and evacuation care should begin immediately upon assuming care for the patient and should include hasty and detailed evacuation requests up both the medical and operational channels with the goal of getting the patient to the proper role of care as soon as possible.

Guideline User Notes

PCC operational context uses the following paradigm for phases of care for different periods of time one is in a PCC scenario:

Where appropriate, a minimum-better-best format is included for situations in which the operational reality precludes optimal care for a given scenario:

  • Minimum: This is the minimum level of care which should be delivered for a specified level of capability
  • Better: When available or practical, this includes treatment strategies or adjuncts that improve outcomes while still not considered the standard of care.
  • Best: This is the optimal medical for a given scenario based on the level of medical expertise of the provider

Expectations of prehospital care, based on TCCC's role-based standard of care, are included within each section:

  • Tier 1: This is the basic medical knowledge for all service-members.
  • Tier 2: Those who have been through approved CLS training are expected to be able to meet the standards at this level of care.
  • Tier 3 (Combat Medics/Corpsmen [CMC]): Those who are trained medics/corpsmen are expected to meet the medical standards for this tier.
  • Tier 4 (Combat Paramedic/Provider [CPP]): This is the highest level of prehospital capability and will have a significantly expanded scope of practice.