Erik DeSoucy, DO1, Seth Zweben, NREMTP2, Stacy Shackelford, MD3, Joseph J DuBose, MD1, Russ S Kotwal, MD, MPH3, Harold R Montgomery, SOATP3, Sean Keenan, MD4, Stephen C Rush, MD2. 1David Grant Medical Center, 2U.S. Air Force Pararescue, 3Joint Trauma System, 4Special Operations Command, Europe
Introduction: United States Air Force Pararescue is an elite special operations force specifically organized, trained, equipped, and postured to perform both combat and civil search and rescue across the globe. Prolonged field care (PFC), described as “field medical care, applied beyond ‘doctrinal planning time-lines’” is particularly pertinent to these medics who may infiltrate by parachute followed by an extended time awaiting exfiltration. PFC has been described on individual Pararescue missions, however the frequency and nature of these events has not been reviewed. Each PFC scenario presents unique environmental, operational and resource challenges which affect the patient and provider during transition to the next level of care. By categorizing PFC events and collecting lessons learned from a spectrum of missions, we hope to inform future Pararescue training and equipment requirements.
Methods: A survey distributed to U.S. military medical providers solicited details of PFC encounters lasting more than 4 hours and included patient demographics, environmental descriptors, provider training, modes of transportation, injuries, mechanism of injury, vital signs, treatments, equipment and resources used, duration of PFC, and mortality status upon delivery to the next level of care. From these surveys, we selected PFC encounters where a Pararescueman (PJ) was the primary provider. Descriptive statistics were used to analyze survey responses.
Results: From 54 surveys we identified 20 patients where a PJ was the PFC provider ranging from December 2001 to June 2016. All cases were remote with a mix of mountainous (9/20, 45%) and maritime (8/20, 40%) environments and most occurred in the U.S. Pacific Command (14/20, 70%). Most patients had life threatening injuries or illnesses (19/20, 95%) with a mix of non-battle injury, medical illness, and battle injury (50%, 40% and 10% respectively). PFC was provided primarily aboard ships (8/20, 40%), outdoors (5/20, 255), in hardened non-medical structures (7/20, 35%) and aboard aircraft (5/20, 25%). Teleconsultation was used in three cases (15%). The average PFC time was 29 hours (IQR 6-39, max 120) and one patient died prior to arriving at the next level of care.
Discussion: Though PFC is a rare event, PJs have had a broad experience in a variety of settings, particularly in the U.S. Pacific Command where future conflicts may test the “tyranny of distance.” The lessons learned during these missions are invaluable and reinforce the need for prospective data collection and a rapid means to share data with Pararescue and others within the special operations forces community.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86903
Program Number: MSS12
Presentation Session: Full-Day Military Surgical Symposium – Trauma/Critical Care Presentations
Presentation Type: MSSPodium