Prolonged Casualty Care – “Not the Plan, But Needs a Plan”

In military and tactical medicine, Prolonged Casualty Care (PCC) is a prime example of something that isn’t the plan but needs a plan. The standard protocol in combat medicine follows the MARCH algorithm and the Tactical Evacuation (TACEVAC) process, ensuring casualties are stabilized and rapidly evacuated to a higher echelon of care. However, in austere environments, evacuation might be delayed or impossible due to terrain, weather, enemy threats, or logistical failures.

PCC isn’t part of the intended medical plan because the expectation is rapid evacuation but since delays are a known possibility, a plan must exist to handle extended care in the field.

Key Elements of PCC Planning

1. Resource Management:  Since standard medical resupply isn’t guaranteed, planning must include rationing fluids, medications, oxygen, and blood products.

2. Patient Monitoring & Deterioration Prevention:  Extended field care requires tracking vitals, managing infections, and preventing secondary injuries.

3. Prolonged Pain Management & Sedation:  Casualties may need extended analgesia, sedation, or even ventilatory support.

4. Field-Expedient Interventions:  Improvising solutions for issues like wound care, nutrition, and hypothermia prevention.

5. Decision-Making on Movement vs. Staying Put:  Teams must plan whether to hold their position or attempt a self-evacuation.

Conclusion

PCC is a contingency rather than the primary goal, yet it requires its own protocols, training, and preparation. Failing to plan for PCC means hoping for the best instead of preparing for the worst, a dangerous mindset in operational medicine.

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