Prolonged Casualty Care (PCC) - The need to provide Role 1 casualty care for extended periods of time when the tactical situation may limit or prevent prompt and/or optimal medical care.

Prolonged Field Care (PFC) is a continuation of PCC, conducted by advanced trained personnel, that continues until a casualty arrives at the appropriate level of care. PFC is addressed in a later section of this guideline.

The PCC guidelines are designed to guide nonmedical and medical responders to plan, prepare, and perform casualty care that immediately follows Tactical Combat Casualty Care (TCCC) management when evacuation to a higher role of care is delayed or denied due to operational constraints or limitations. PCC is focused on the casualty regardless of the environment, location, or setting. PCC conceptually replaces the Joint Trauma Lexicon definition for prolonged field care (PFC) in that the PCC guidelines apply to all Role 1 non-medical and medical responders across the Joint force’s full range of military operations. A provider of PCC must first be proficient in all aspects of TCCC. The intent of this guideline is to provide Role 1 non-medical and medical responders, who encounter delayed, denied, or prolonged casualty evacuation with an evidence-based and expert-based approach for assessing, managing, and monitoring injured or ill casualties to optimize medical and operational outcomes. Pursuant to the PCC guidelines, this nursing intervention, wound care, and splint management, this CPG recommends actions and resource utilization following the “minimum, better, best” format that provides alternate or improvised methods of delivering PCC when more ideal treatment options are unavailable.

Nursing interventions, wound care, and splint management may be the most important, yet overlooked, capabilities PCC responders can and must develop. Critically injured and ill casualties are at higher risk for complications such as pressure sores and wound infections that can lead to unfavorable outcomes, potentially increasing morbidity and mortality. Nursing interventions, wound care, and splint management are core principles of PCC because they reduce the risk of preventable complications without requiring costly or burdensome equipment. All providers of PCC must practice nursing care skills to help maintain proficiency.

In PCC, a casualty’s basic activities of daily living can become impaired or nonexistent depending on the severity of their wounds. Simple tasks such as oral hygiene, hydration, skin care, moving extremities, and turning become impossible for an injured or unconscious casualty. Thus, the casualty requires regular assessments and interventions to monitor the condition and prevent the development of further acute or chronic complications. The PCC flowsheet, Appendix A, can be used to track vital signs, medications, and other interventions. Using a nursing care checklist assists with developing a schedule of ongoing and future actions for performing appropriate assessments and interventions. See Appendix B for a sample nursing care checklist.

Non-medical to medical responder ratios vary in any operational unit, but generally non-medical responders vastly outnumber their medical counterparts within the Role 1 environment. Fortunately, many of the PCC tasks and skills recommended in this CPG can be successfully performed by non-medical responders, allowing medical responders to focus on the myriad of medical tasks and skills they are trained to provide. Cross-training all team members on these recommended PCC interventions prior to deployment will ultimately optimize outcomes, especially when responders are forced to manage multiple casualties.

*Important Note: The authors acknowledge that not everything discussed in this CPG will be applicable to all providers and care settings. These are recommendations taken from best practices with consideration given to a resource-limited environment.