Constructing a prolonged field care echeloned system for interrupted casualty evacuation chains

Introduction/Objective. To analyze the evolution of modern combat casualty care from the Golden Hour and Tactical Combat Casualty Care (TCCC) to Prolonged Field Care (PFC) and Prolonged Casualty Care (PCC), and to construct an Echelon P model for situations in which casualty evacuation is delayed or interrupted. Methods. A structured literature analysis, conceptual differentiation, and model-construction approach was used. Foreign military guidelines, position statements, operational reports, and peer-reviewed studies on prolonged casualty care were reviewed, with priority given to literature from 2022 to 2026. PFC and PCC were compared by origin, target users, operational scenario, capability requirements, time frame, and interface with traditional echelons of care. Results. The evidence indicates a shift from evacuation-dependent care toward sustained forward care under contested conditions. PFC is primarily a clinical continuation of TCCC by advanced-trained personnel, whereas PCC is a system-level framework for all Role 1 responders when timely evacuation is limited or denied. The proposed Echelon P model includes activation triggers, P0-P3 capability tiers, and medical, blood/resuscitation, data, and command interfaces. Conclusion. Institutionalizing prolonged care as an independent capability layer may improve medical resilience in future high-intensity operations. Implementation should focus on doctrine, training, equipment modularization, telemedicine-enabled support, documentation, and quality assessment