Fielding an Expeditionary Prolonged Casualty Care Kit: What We Carry Matters.

Introduction: Prolonged Casualty Care (PCC) is an extension of Tactical Combat Casualty Care (TCCC), which provides prehospital care when evacuation is delayed and care is resource constrained and suboptimal. Current medical rucksacks are designed to maximize medical equipment, without sustainment items like food, clothing, and essential communication equipment. This leaves limited room for PCC expendable supplies and equipment to expand upon existing TCCC loadouts. The multi-day premise of PCC requires both extended medical and general survival items, for which existing medical kits are poorly suited and not optimized. In this study, we sought to systematically create a Prolonged Field Care Kit (PFAK) capable of providing field medics with medications and equipment adjuncts for PCC as well as a specialized long-range medical rucksack (LMR) to house the PFAK, TCCC, and sustainment items.

Materials and methods: Baseline design elements from conventional rucksacks were obtained and modified to address known limitations. Initial prototypes for the PFAK and LMR were created. These were modified following informal discussions with various and multiple end users from both U.S. conventional and Special Operations Forces. Feedback regarding the second iteration prototype was obtained systematically through written surveys regarding strengths, weaknesses, and potential changes that could be made. Qualitative data were analyzed using MAXQDA software.

Results: Using informal feedback, we deduced that the first PFAK prototype lacked internal compartmentalization and could not accommodate the volume of intravenous fluid needed for PCC. Moreover, the LMR was prone to damage by external factors such as rainwater. The second prototype addressed these flaws and written feedback was obtained from medics (n = 10), nurses (n = 11), and medical doctors (n = 3) on its applicability. Positive feedback received on the second prototype included daypack detachability, overall organization, versatility, and design of the LMR and PFAK. However, most survey participants felt that the LMR was too complex and that its heaviness could limit its field use. After the feedback obtained, the finalized PFAK weighed 18 pounds and had a volume of 30 L. The LMR containing the PFAK and other mixed sustainment and TCCC equipment has a length of 30 inches and weighs 110 pounds with all items intact.

Conclusions: PCC will require thoughtful equipping to enable prehospital providers to manage multiple, potentially complex casualties; existing military medical backpacks are not currently optimized for this scenario. Our group created the first-of-its-kind PFAK, as well as the LMR to house it. The final prototypes of our LMR and PFAK are versatile, well organized, and significantly improve upon current backpack options for PCC. However, field testing and further improvement through qualitative analysis are needed.