Development of a prolonged field care kit using a modified Delphi survey approach

BACKGROUND: Prolonged Casualty Care (PCC) is a military adaptation of Tactical Combat Casualty Care providing up to 72 hours of prehospital care in delayed extrication. However, providing PCC is challenging because of recommended medications outweighing size/weight restrictions during dismounted operations. We sought to narrow down the medication and supply items required for 72 hours of PCC to create a standardized and effective prolonged field care kit (PFAK) with a weight limitation of 20 lbs. METHODS: Joint Trauma Systems Clinical Practice Guidelines were reviewed to generate a list of potential contents for the PFAK. A two-step Delphi survey that included various PCC subgroups was performed. The Delphi results were subjected to an expert panel (containing military and civilian medical personnel) survey to finalize the choices. Participant responses were analyzed using mean rank scores and finalized using expert consensus to determine the final components of the PFAK. RESULTS: Eleven Joint Trauma Systems Clinical Practice Guidelines relevant to PCC were selected, encompassing 47 potential medications and 5 adjuncts to PCC. The Delphi surveys were distributed to 100 participants (response rates of 57% and 65% for the two rounds, respectively). A total of 18 medications were shortlisted after the second Delphi survey. Finally, following the expert panel survey, 14 medications and 4 equipment were shortlisted for the PCC. The total weight of the PFAK with medications and adjuncts was under 20 lbs. CONCLUSION: Providing efficient PCC is limited by the size and weight restrictions in military dismounted operations. Using a Delphi survey approach, we have shortlisted the optimal medications and adjuncts that can be used to deliver effective PCC.