Prolonged Casualty Care for the Layperson - Best Practices for Teaching Civilian Non-medical Personnel

Introduction: Prolonged Casualty Care (PCC) is the US military’s system for managing casualties after field stabilization. Traditionally focused on military medical personnel, the PCC for the Layperson project aims to train Civilian Non-medical Personnel (CNP) to provide prolonged care in unconventional warfare, large-scale combat operations (LSCO), and natural disaster scenarios. This initiative is developing just-in-time training resources, skills checklists, and guidance for conducting PCC in these environments. Its significance grows in conflicts where the "Golden Hour" for casualty evacuation is unachievable. This project aims to bridge gaps in military-civilian medical engagement, offering resources adaptable to diverse crises.

Methods: Using the Scale for the Assessment of Narrative Review Articles (SANRA), a literature review across Embase, PubMed, CINAHL, and Web of Science yielded 5,179 results. Search terms included PCC, CPR, Stop the Bleed, Golden Hour, online training modalities, and telemedicine. Studies were selected using a modified-delphi method with experts consisting of prior Special Operations medics and Emergency Physicians who have deployed to combat theaters. Studies prioritizing civilian training methods were analyzed to inform best practices for PCC training in austere environments. A manual search was conducted to ensure thoroughness with relevant supplements.

Results: The review identified three primary modalities for training CNPs in PCC: in-person, hybrid, and online approaches. Hybrid and online methods provide scalability and accessibility, but require frequent retraining, standardized grading, and robust quality control mechanisms, such as teleconferencing, to maintain efficacy. Evidence from BLS and Stop the Bleed demonstrates the effectiveness of video-based instruction in building confidence to conduct basic medical tasks. Military telemedicine models, such as Virtual Critical Care Consult (VC3), extend training and real-time support to diverse populations. Barriers such as language, socioeconomic status, and age underscore the need for inclusive and adaptable training strategies.

Discussion: Findings indicate critical opportunities for CNP interventions. Trained CNPs can reduce preventable deaths and sustain care during prolonged evacuation timelines. Scalable training supported by telemedicine and tailored platforms can enhance efficacy and expand capabilities in resource-limited environments.

Conclusion: Scalable hybrid and virtual training methods, combined with telemedicine, represent promising avenues for further research into effective PCC instruction in austere and crisis environments.