Background: US Air Force (USAF) pararescuemen (PJs) perform long-range ocean rescue missions for ill or injured civilians when advanced care and transport are not available. The purpose of this case series is to examine the details of these missions, review patient treatments and outcomes, and describe common tactics, techniques, and procedures for these missions. Methods: Cases in which the USAF PJs preformed long-range ocean rescue for critically ill or injured civilians between 2011 and 2018 were identified. Case information was obtained, including patient demographics, location, infiltration/exfiltration methods, diagnoses, treatments, duration of patient care, patient outcome, and lessons learned. Results: A total of 14 pararescue missions involving 22 civilians were identified for analysis. Of the 22 patients, 10 (45%) suffered burns, six (27%) had abdominal issues, four (18%) had musculoskeletal injuries, one had a traumatic brain injury, and one had a necrotizing soft-tissue infection. Medical care of these patients included intravenous fluid and blood product resuscitation, antibiotics, analgesics, airway management, and escharotomy. The median duration of patient care was 51 hours. Conclusion: This case series illustrates the complex transportation requirements, patient and gear logistical challenges, austere medicine, and prolonged field care (PFC) unique to USAF PJ open-water response.
This Role 1, prolonged field care (PFC) clinical practice guideline (CPG) is intended to be used after Tactical Combat Casualty Care (TCCC) Guidelines, when evacuation to higher level of care is not immediately possible. A provider must first and foremost be an expert in TCCC, the Department of Defense standard of care for first responders. The intent of this PFC CPG is to provide evidence and experience-based solutions to those who manage airways in an austere environment. An emphasis is placed on utilizing the tools and adjuncts most familiar to a Role 1 provider. The PFC capability of airway is addressed to reflect the reality of managing an airway in a Role 1 resource-constrained environment. A separate Joint Trauma System CPG will address mechanical ventilation. This PFC CPG also introduces an acronym to assist providers and their teams in preparing for advanced procedures, to include airway management.