Systematic approach to delivering prolonged field care in a prehospital care environment

Abstract

BackgroundThis article describes a novel patient care algorithm which provides a Role 1 (R1) medic with a structured approach to delivering prolonged field care (PFC) in a resource-limited environment. PFC is a vital component of the operational patient care pathway providing the continuum of care from completion of a primary survey to the delivery to hospital care. Future operational environments are likely to have more fragile or extended lines of communication, potentially delaying evacuation to hospital care. This delay may lead to increases in patient morbidity and mortality. Effective PFC offers an opportunity to improve patient outcomes and help mitigate against this risk.MethodsAn initial prototype model of a PFC care process was developed using existing hospital-based guidance. A series of medical and trauma vignettes and best available evidence were used to refine the algorithm.ResultsThe algorithm has been designed be used in conjunction with patient specific clinical guidance making the approach generalisable for all patient groups. For UK military, clinical guidance is provided by clinical guidelines for operations. The algorithm can be downloaded into a convenient format to be used on mobile devices or printed as an aide memoire.

How should the Defence Medical Services prepare for an Article 5 NATO collective defence operation with the prospect of high volumes of combat casualties?

“…It was possible to meet this timeline in Afghanistan because British forces in Afghanistan, as part of ISAF, benefitted from air superiority over the enemy, and an area of operations confined to Helmand Province 12. If this timeline cannot be met, prolonged care of the patient in the prehospital environment known as PFC must occur 13…”

“…DMS has an algorithm for the delivery of PFC, which aims to provide a Combat Medical Technician with a structured approach to PFC 13. However, in the event of 500 casualties requiring PFC for up to 3 months, the deployed medical team is likely to be overwhelmed without additional support.…”

Review of enteral nutrition practices in critically ill adults in resource-limited environments

“…Therefore, developing a low cost, highly sustainable enteral nutrition for critically ill patients, may be of benefit when treating local nationals or when providing prolonged field care. [30,31] Previous UK military operations have required local nationals to be transferred to other local facilities when stable, therefore an added advantage of developing locally sourced enteral nutrition regimens may allow continuing in care.…”

“…While this approach may provide expert technical advice for humanitarian and military organisations deployed in a range of settings, access to a continuous supply of commercial feeds may be a challenge. Therefore, developing a low-cost, highly sustainable EN for critically ill patients may be of benefit when treating local nationals or when providing prolonged field care 30 31. Previous UK military operations have required local nationals to be transferred to other local facilities when stable; therefore, an added advantage of developing locally sourced EN regimens may allow continuity of care.…”

Delivering medicine in a cold weather environment

“…Tentage must be large enough to provide a thermally insulated facility for stabilised T2 casualties, as there is a high likelihood of prolonged field care being needed. Several aspects of the HITMAN algorithm1 will be difficult to deliver, such as prevention of hypothermia and hydrating patients with warm fluids. Similarly, medical gases, intravenous medications2 and intravenous fluids are all vulnerable to cold, and can be rendered unserviceable if allowed to deviate outside an appropriate temperature range.…”