Prolonged Casualty Care

Prolonged Casualty Care (PCC) is the delivery of advanced medical care when evacuation to definitive treatment is significantly delayed or unavailable. It focuses on sustaining critically ill or injured patients beyond the traditional timelines of prehospital care by applying evidence-based critical care principles in austere, remote, and resource-limited environments. PCC acknowledges that conventional assumptions regarding evacuation, personnel, equipment, and medical resources may no longer apply, requiring clinicians to adapt their assessment, treatment, and resource management to maintain patient survival until transfer to an appropriate level of care becomes possible.

During the Special Operations Medical Association’s symposium in 2013, a group of SOF medics met to discuss the need to redirect the focus of the current operational concentration on a short aeromedical evacuation that was the norm. With the drawdown of troops in the Middle East, the medics were aware of the skills which seemed to fade from the original focus of operating in remote, austere and resource-limited environments. Medical evacuation was no longer a twenty-minute event. 

Medical professionals had to stabilise and manage their critical casualties for extended periods. Many medics were treating casualties for days at a time. The skills and medical knowledge needed to be enhanced to meet this new necessity. Dr Sean Keenan was the Theater Special Operations Surgeon for Special Operations Command, Europe (SOCEUR). 

He started the Prolonged Field Care Working group along with Paul Loos and colleagues from all branches and specialities in Special Operations. Dr Keenan has been a guest lecturer for our College, and both Dennis Jarema (Prolonged Fieldcare podcast) and Paul are currently enrolled on our MSc Austere Critical Care programme.

• Principles of Prolonged Casualty Care
  • PCC concepts and doctrine
  • Extended evacuation timelines
  • Austere and resource-limited medicine
  • Clinical priorities during prolonged care
  • Human factors and decision-making
• Extended Patient Assessment and Monitoring
  • Primary and secondary survey review
  • Serial patient assessments
  • Vital sign trending
  • Documentation and handover
  • Clinical deterioration recognition
• Airway, Breathing and Ventilation
  • Oxygen therapy
  • Advanced airway management
  • Mechanical ventilation principles
  • ETCO₂ monitoring
  • Chest injury management
  • Troubleshooting respiratory failure
• Haemorrhage Control and Resuscitation
  • Damage control resuscitation
  • Whole blood and blood products
  • Fluid therapy
  • Tranexamic acid
  • Shock recognition
  • Permissive hypotension
• Critical Care Nursing in the Field
  • Pressure area care
  • Hygiene and infection prevention
  • Temperature management
  • Eye, skin and oral care
  • Urinary catheter management
  • Long-duration patient positioning
• Analgesia, Sedation and Pharmacology
  • Multimodal pain management
  • Sedation strategies
  • Antibiotic therapy
  • Medication administration in austere settings
  • Drug storage and logistics
  • Medication safety
• Diagnostics and Critical Care Monitoring
  • Point-of-care ultrasound
  • ECG interpretation
  • Blood glucose
  • Lactate monitoring
  • Capnography
  • Clinical laboratory alternatives
• Prolonged Management of Common Critical Conditions
  • Traumatic brain injury
  • Thoracic trauma
  • Abdominal injuries
  • Crush syndrome
  • Burns
  • Sepsis and medical emergencies
• Evacuation Planning and Resource Management
  • Evacuation decision-making
  • Packaging for prolonged transport
  • Equipment conservation
  • Team workload management
  • Communications and telemedicine
  • Documentation for transfer of care
• Integrated Simulation and Team Training
  • Long-duration casualty scenarios
  • Clinical leadership
  • Team communication
  • Dynamic reassessment
  • Resource prioritisation
  • Complex prolonged casualty care simulations
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Part 1: Online training

(8 hours)

There are quite a few online video lectures to review before arriving for classroom training. These lectures will review the Prolonged Casualty Care content and cover some of the additional lectures offered during this programme.

Part 2: Classroom training

(16 hours)

Once you have completed and passed the online training, you come to Malta for two days of extensive classroom experience. Most of the time is hands-on with some lectures that will review the essential topics learned during the online training.  Once you register for the programme, we will send you a free copy of our digital Field Guide

The PCC course includes hands-on experience with live casualty scenarios with special effects makeup.