End-of-Life Care in the Austere Military Environment

Area of Science:

• Military Medicine
• Palliative Care
• Austere Medicine

Background:

• Global War on Terror (GWOT) advanced military medical care in austere settings.
• Future Large Scale Combat Operations (LSCO) will involve high casualties and limited resources.
• Increased 'expectant' casualties necessitate new approaches to end-of-life care.

Purpose of the Study:

• Provide guidance for medical and non-medical leaders on end-of-life care in LSCO.
• Address recognition, triage, and management of imminently dying patients.
• Integrate palliative care principles into military doctrine and training.

Main Methods:

• Narrative review of military doctrine, palliative care literature, and austere medicine.
• Integration of guidance from Tactical Combat Casualty Care (TCCC) and Prolonged Casualty Care (PCC).
• Exploration of shifting from curative to comfort-focused care in resource-limited settings.

Main Results:

• End-of-life care must be a doctrinally supported component of military medicine.
• Clinical recognition of imminent death is critical in resource-limited settings.
• Psychological support is vital for providers, units, and families to reduce moral injury.

Conclusions:

• End-of-life care in austere military environments is a mission-critical capability.
• Gaps in doctrine, training, and command understanding require urgent attention.
• Integration of palliative care into planning and training is essential for future conflicts.