Operational Implementation of Prolonged Field Care Kits for Large-Scale Combat Operations

Prolonged Casualty Care (PCC) has become an increasing focus of military medicine as the Joint Force prepares for Large-Scale Combat Operations (LSCO) with mass casualties, contested logistics, and prolonged evacuation timelines. Existing Role 1 medical equipment was largely developed around assumptions of reliable evacuation and permissive resupply and is poorly suited for prolonged casualty holding in highly contested environments. We previously collaborated with the Joint Trauma System (JTS) under a Department of Defense-funded effort to develop the first Prolonged Field Care Kits (PFAKs), including Delphi-based generation of candidate medications and equipment aligned with PCC Clinical Practice Guidelines (CPGs). However, the resulting content recommendations exceeded 50 lbs and 80 L, rendering them operationally impractical for distributed Role 1 operations (defined as providers organic to combat arms units, from line medical personnel up to the Battalion Aid Station level) during LSCO. To translate PCC guidance into fieldable systems, a multidisciplinary working group with extensive operational experience refined the survey-derived candidate contents using repeated tabletop exercises, field testing, and end-user feedback. Design priorities included reduction of weight, volume, administration burden, cognitive burden, and logistical footprint while maintaining adherence to PCC CPG intent. This process resulted in 2 complementary systems: the PFAK Basic for typical Role 1 PCC and the PFAK Advanced for teams capable of mechanical ventilation. Representative design tradeoffs included simplification of medication strategies, minimization of sharps use, and emphasis on oral and enteral alternatives to reduce reliance on intravenous administration. The PFAKs represent the first standardized PCC equipment configurations specifically designed for conventional forces operating under LSCO assumptions. Their development demonstrates a practical framework for translating PCC guidelines into distributed, scalable, and tactically survivable Role 1 capabilities. The concept is now being operationally implemented within the 1st Marine Division through an Improvised PFAK loadout fielded alongside a PCC course and handbook, demonstrating that conventional formations can begin to generate standardized PCC capabilities using existing organizational structures and inventories while dedicated procurement pathways are developed.