Prolonged Field Care is what happens when the helicopter isn't coming. Your MEDEVAC request is denied, weather has the birds grounded, or the tactical situation prevents extraction. You have a casualty who needs a hospital, but the hospital is 12, 24, or 72 hours away. Now what?
PFC is the bridge between point-of-injury TCCC and definitive surgical care. It turns a combat medic into a field nurse running a one-patient ICU with whatever supplies fit in a rucksack. It's the hardest thing a tactical medical provider does, and it's the least trained skill in most units.
When PFC happens
The doctrinal planning factor for MEDEVAC in a conventional fight is under 60 minutes. In reality, especially in austere environments, special operations, maritime, or large-scale combat operations, evacuation can take hours to days. Any time the evacuation timeline exceeds what the casualty's injuries can tolerate without further intervention, you're in PFC.
The shift from TCCC to PFC isn't a clean handoff. It's a gradual realization that you're going to be managing this casualty for a while and the interventions that stabilized them initially need to be sustained, monitored, and adjusted.
The PFC checklist
The Prolonged Field Care Working Group published the PFC Casualty Card (currently version 25) that structures the transition from TCCC to PFC. The priorities in order:
Complete initial life-saving TCCC first. Don't skip ahead to PFC tasks while the patient still has unaddressed MARCH problems.
Perform a comprehensive exam and history. You were focused on life threats during TCCC. Now do a full head-to-toe assessment. Document everything. Make a problem list.
Chart and trend vital signs. Serial vitals over time tell you if your patient is getting better, staying the same, or circling the drain. A single set of vitals is a snapshot. Trending vitals is a movie.
Perform a telemedical consult. If you have any form of communication, get a physician on the line. BATDOK, satellite phone, HF radio, whatever you have. A remote physician can talk you through procedures and medication decisions you might not be comfortable making alone.
Create a nursing care plan. This includes serial assessments (HEENT, respiratory, integumentary, GI), pain management, sedation, ins and outs, and a wake/rest/chow plan for both the patient and the care team.
Monitoring in PFC
You're trending vitals at regular intervals. At minimum: heart rate, blood pressure, respiratory rate, SpO2, temperature, mental status (GCS or AVPU), urine output, and pain score.
Calculate MAP (mean arterial pressure) and Shock Index (heart rate divided by systolic BP). A Shock Index over 0.9 is concerning. Over 1.0 in a trauma patient strongly suggests hemodynamic instability even if the blood pressure looks acceptable.
Track fluid input and urine output meticulously. Urine output should be at least 0.5 ml/kg/hour. If it's dropping, your patient needs volume or their kidneys are failing. Either way, you need to know.
Medications in PFC
Pain management in PFC goes beyond the initial ketamine push during TCCC. You're setting up a drip or scheduled dosing regimen. Ketamine drip for analgesia, midazolam or propofol if you need procedural sedation, antibiotics for open wounds (ceftriaxone 2g IV daily per Change 25-1), and potentially pressors if you're dealing with distributive shock.
Document every medication: drug name, dose, route, and time. Every single one. When you hand this patient off to a surgical team, they need to know exactly what's been given.
The nursing care piece
This is where PFC separates from TCCC. You're not just keeping someone alive for 20 minutes until the bird lands. You're providing nursing care for hours or days.
Turn and reposition the patient every 2 hours to prevent pressure injuries. Clean and redress wounds. Manage the airway (suction, reposition, adjust ventilator settings if you have one). Monitor urinary catheter output. Provide nutrition if the patient can tolerate it. Manage the patient's temperature continuously.
Don't forget about yourself and your team. Establish a watch schedule. Make sure everyone eats and rests. A fatigued medic making decisions at hour 18 is a danger to the patient.
The PFC card
We built an interactive PFC Casualty Card at medeor.app that digitizes the v25 card. It walks through every section: patient information, MIST report, medical history, tourniquet tracking, medication administration, lab values, burn assessment with auto-calculated Parkland formula, a full treatment checklist with timestamps, expanded vital signs with GCS, MAP, Shock Index, AVPU, and I/O tracking, ventilator settings, nursing care reminders, and a problems/plans/goals section.
Everything persists on your device. Nothing is lost if you switch tabs or close the browser. When you're done, hit Export and it generates a PDF you can hand off to the surgical team or upload to the patient's medical record.
It's the PFC card, but usable on a phone, in the dark, with gloves on. Free, no login, works offline.