This week, Dr Sean Keenan gives the keynote address for the Medicine in the Mediterranean 2025 conference held last week in Malta. He discusses the evolution and current practices of Prolonged Field Care (PFC) in military and austere environments. Dr Sean Keenan discusses the importance of adapting medical practices to meet the challenges of remote and resource-limited settings, emphasising the need for comprehensive training and guidelines. The discussion highlights the difficulties with transitioning from Tactical Combat Casualty Care to Prolonged Field Care, the significance of clinical practice guidelines, and the ongoing efforts to improve emergency medical response in various contexts. This conversation delves into the development and implementation of Prolonged Casualty Care guidelines, focusing on the challenges faced in training and the importance of mastering basic medical skills. The discussion highlights the need for effective logistics, the significance of the golden hour in trauma care, and the evolving nature of warfare that impacts medical practices. The speaker emphasises the importance of continuous education and adapting to operational needs while maintaining sound medical principles. Takeaways Prolonged Field Care has evolved significantly over the past decade. The importance of audience participation in understanding medical terms. Learning from past experiences is crucial in medical practices. The Joint Trauma System collects data to improve best practices. Pre-hospital care is often overlooked in trauma literature. Human physiology remains constant regardless of the environment. Prolonged Field Care addresses the gaps in emergency medical response. Training and equipping personnel is essential for effective care. The transition from Tactical Combat Casualty Care to Prolonged Field Care is vital. Understanding the context of care is key to effective medical response. Prolonged Casualty Care guidelines are evolving to meet modern warfare needs. Curriculum development requires feedback from experienced practitioners. Basic medical skills are crucial for effective, prolonged field care. The golden hour is critical for reducing mortality in trauma cases. Logistics play a significant role in successful medical interventions. Training must adapt to the realities of current combat situations. Understanding human physiology is essential for effective medical care. Expecting casualty care is a new concept that needs training. Continuous education is vital for paramedics and medical personnel. Operational needs drive the development of medical guidelines. Chapters 00:00 Introduction to Prolonged Field Care 07:03 The Evolution of Prolonged Field Care 29:04 Current Practices and Guidelines in Prolonged Field Care 31:55 Prolonged Casualty Care Guidelines Overview 35:49 Curriculum Development and Feedback Process 40:12 Challenges in Prolonged Field Care Training 44:01 Extending the Golden Hour in Trauma Care 49:34 Current Practices and Future Directions in Prolonged Field Care 54:44 Mastering the Basics of Prolonged Field Care 01:00:42 Future Warfare and Operational Considerations

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