At the time of writing, R2Ri is the longest standing WMS Affiliate in the UK, the  only Wilderness Medical Society Affiliate headquartered in England and Wales and one of only two WMS Affiliates in the UK - the other being the Faculty of Pre Hospital Care, Royal College of Surgeons (Edinburgh). R2Ri team members have sat on a number of WMS committees including Operational Medicine (military medicine including environmental and PFC), Expedition Medicine and Global Health and Faculty members are peer reviewers of the WMS Wilderness and Expedition Medicine Journal.

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// Prolonged Field Care: 'No help inbound? It's just you. Trained for the Duration?'

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Our civilian expedition emphasis Prolonged field Care specific course is the first of its kind in the UK, possibly globally.  Running for many years now, we know the training works and makes a difference. It has been used in anger in very remote areas and made a difference. We are working with two internationally renowned UK Universities on Prolonged Field Care research, UCL (Institute for Disaster Risk Reduction) and Bangor University (Institute for Human Physiology). Our course was/is part of a world first PhD academic study into Prolonged Field Care, with UCL. The only other entity providing input was the British military, Royal Centre for Defence Medicine. The PhD was focused on how ‘prolonged field care’ can mitigate risks to health in remote environments. The study was published, after 6 years work, in March 2024:

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We have also been involved in work with the UCL Institute for Space Health . This has been the subject of a number of Analogue Space Missions, which have been subject to academic analysis and involve work with the European Space Agency, including the UK's first ever Analogue Space Mission:

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Out of the research with UCL, came our involvement with Space Health Research, in the Prolonged Field Care sphere - relating to Prolonged Field Care in a space setting.

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Our research with Bangor University is grant funded, to cover the costs of the research team and is aimed at supporting outcomes in PFC situations in both expeditionary and disaster response settings in a civilian context.

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Due to the specialist nature of the project, we are very lucky to have appropriate guest lecturers demonstrating specialist, PFC relevant equipment

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Why did we develop a Prolonged Field Care Course?

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Our Director (not a Health Care Professional) was training for a Jungle expedition in 2002/2003 and after the medical training element, delivered by another organisation,  he had strong views that there was a significant element missing from both this and other similar training. Most courses end an exercise with a shiny helicopter arriving promptly and an ATMIST handover to a medic. That was not the reality of our Director's experience or what he was training for. Seeking to mitigate the risks of having to look after a casualty for a long time before rescue arrived, seemed a very obvious gap in training for the real world. It also seemed obvious that a test run in a supportive environment would improve performance outcomes. 

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Discussions with specialist elements indicated that this was not a well developed area outside niche elements of the military and he couldn't find existing, well developed solutions to the training need.

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Planning for subsequent desert and arctic environment expeditions developed this idea/need for a civilian training package. Further discussions with civilian medics deployed to very remote areas, who had not received specialist training in this space, cemented the need. Subsequent discussions with colleagues from specialists military medical backgrounds confirmed the need for more detailed training and the likely benefits of a pre departure exercise. Whilst Prolonged Field Care already existed for many years, within the UK military as a term (Special Forces), mnemonics utilised by the military were not appropriate for a civilian audience.

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Years passed. A subsequent chance meeting and discussion with a military medic  researching the field, crystallised the idea and a multi disciplinary team of military medics (including SF medics), civilian medics, doctors, nurses, paramedics, academics and risk managers worked the idea to develop a programme  that was fit for purpose, for our civilian sectors, without huge amounts of very specialist heavy kit - our clients generally operate out of a back pack with minimal kit.

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The programme has been tried, tested and shown to make a difference in extremis. We have had delegates from all areas, including military (including doctors from very specialist elite units) who have confirmed the value of the training and prolonged pre deployment exercise.

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Prolonged Field Care is primarily a military concept. Great - and extensive work has now been done by pioneers in the military PFC field in the US and later, in the UK. The civilian need for it self evident. Hence our highly regarded, civilian specific training solution.

 

What is Prolonged Field Care?

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It is NOT simply care in the field - eg hygiene, pro active first aid application/ prevention/awareness of associated conditions arising due to time in the field, although these are relevant.

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'Prolonged Field Care is field medical care applied beyond doctrinal planning timelines until the patient can be delivered to definitive care. PFC is not a defined set of skills or a phase of care. PFC is an operational problem. COL Sean Keenan, a former US Special Forces Group Surgeon, put it “a really [bad] situation to be in”. Prolonged Field Care is “taking care of a patient who you know needs to be somewhere else for much longer than you are comfortable with.”...'

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 “Field medical care, applied beyond ‘doctrinal planning time-lines’ ...in order to decrease patient mortality and morbidity. Utilizes limited resources, and is sustained until the patient arrives at an appropriate level of care.” This definition was developed and adopted by a North Atlantic Treaty Organization (NATO) SOF medical expert panel and reflects the prolonged management of serious casualties in a field or austere setting with limited resources. This approach to complex medical problems mirrors wilderness medicine in its scope and application, and, in fact, has direct application to nonmilitary medical practice.

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In a civilian context, our patient is ill or injured, we are some time/distance away from help and we need to get them to help or get help to us. Assistance is not coming any time soon. PFC fills the gap between primary and then secondary survey and the possible longer terms gap to safe handover to a higher echelon of medical care. We have to do what we can, with what we have available. How do we do this? PFC starts where traditional Pre Hospital Care stops

 

The process includes a Ruck - Truck - Hut approach - ie getting the casualty from in the field, using what med kit you have in a backpack, to transport to a higher echelon of structure/support/ possibly pre inserted kit.

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The course is an introduction to PFC level course, which very much complements and is intended for those who have undertaken previous medical training, such as our Remote Medical Responder: A Wilderness First Responder course or Remote Medic programmes. Those courses cover hygiene to wound care, evacuation necessary ailments and injuries and much more besides. The PFC course does not teach medical skills but provides a framework for care for extended periods, with little help. 

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Importantly, our PFC course includes an extended scenarios overnight. There are pre requisites for the course. The course does not cover initial medical training. It covers PFC protocols and the skills needed to support the casualty in the field, telemedicine and evacuation techniques. The prolonged exercise provides a high fidelity simulation. Importantly, very experienced remote area medics have been through PFC training with us (many are also PHEM educators) and consistently tell us that the overnight scenario was highly beneficial, not only to test their skills but also to give a contextual mental model if such a situation was to happen for real. During the overnight exercise, delegates DO get rest and sleep as they rotate through the night in shifts. A key teaching is that delegates need to work in shifts and secure good sleep, to remain effective and operational. Delegates attend the course fully equipped for the outdoors and work as an expedition team. Each delegate arrives fully equipped with outdoor kit, expedition backpack, cooker, food and tent. Securing quality and sufficient sleep not only mirrors an operational essential but also ensures that delegates are not fatigued and get full benefit from the training. We have only ever had delegates refer to the exercise as a positive and delegates advise that the exercise is highly valued and considered essential - it is, after all, intended to be a simulation for and prepare them for a real world scenario. A number of Health Care Professional delegates have gone on to undertake PFC situations overseas and report back that they found the exercise prepared them exceptionally well for the real thing.

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The course is designed to rapidly introduce delegates to this subject, provide a real world hands on scenario and allow the delegates to go away from the course, well equipped to consider how they can improve their performance on the next occasion and prepare for a real life PFC scenario. Delegates get a mental model and context in case they ever have to do it for real.

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We know the training works - we have received case studies and positive feedback from both military (very remote non tactical, adventurous activity expedition teams) and civilian attendees.

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We also deliver follow on training for those wanting to study these skills over a longer period in more depth. 

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Hugely relevant to Civilian Organisations.

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PFC is a new emerging field. It is very widely recognised that PFC is hugely relevant to civilian expedition as well as remote area operations and more. In fact, articles have featured in medical press regarding the relevance of many of these skills in dealing with casualties in an urban setting prior to ambulances arriving, e.g. a casualty lying on a rugby pitch in the rain for 6 hours.

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Academic research by civilian researchers (see PhD above) and military experts extol the huge benefits and relevance of PFC to civilian wilderness/ remote medicine settings. However, there are very few organisations with the experience and knowledge to fill this training gap. That is no criticism of other organisations at all. It simply an acknowledgement of the fact that this subject is fairly new in military spheres and very new in civilian spheres. The fact that the subject has been referenced for the first time in the Oxford Expedition and Wilderness Medical Handbooks shows that it is considered relevant by subject matter experts and editors, as well as being new as a defined concept.

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Importantly, we have NGO organisations, Disaster Response organisations coming to us for their training as well as expedition medics, expedition leaders and more. They all tell us that this is new to them, that their organisations do not have PFC systems and protocols in place and highly value the training.

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Surely civilian organisations that deploy to remote areas already have systems in place for Prolonged Field Care? Not in our extensive experience of the sector. Organisations come to us for training and individuals come to us for training to take back to their organisation.

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PFC is a new emerging field. It has come from the military but has direct applicability to civilian context (see definition below). Delegates have come from expedition teams, Government Agencies, all branches of the UK military, Army, Navy, Air Force, Royal Marines, Special Forces Medics, research scientists, expedition leaders, ex UK Special Forces Medics, expedition  medics, expedition leaders and many more. All gave exceptional feedback and would recommend the course. Importantly, outside Special Forces, most organisations do NOT have procedures in place for Prolonged Field Care. The subject is a hot topic as future conflicts are anticipated to be near peer - and so PFC is a new topic even for many regular armies. 

 

PFC is an emergency speciality in the civilian world. It is both relevant and essential for those that work in remote areas. The fact that organisations do NOT commonly provide training on or have set procedures for Prolonged Field Care is why they come to us for training. This has been emphasised by all of the organisations coming to us for training. This includes expedition companies, disaster response organisations and NGO's. Protocols simply finish after primary and secondary surveys and anticipate swift medical response and an ATMIST handover.

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Our course was in fact incepted by our Director who, having run multiple expeditions and having received training from multiple, highly regarded training organisations, for expeditions and having worked for a leading expedition company, as well as representing the expedition sector at the Institute of outdoor Learning review of pre hospital care training for non health care professionals, couldn't get a clear answer on what to do in a medical situation, if the expedition team was a long way from help and external assistance was delayed or would tale a long time to arrive. Traditional training simply doesn't cover this.

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Who is the course for? /Pre requisites.

 

The course is suitable for both Health Care Professionals (Doctor, Nurse, Paramedic, Military Medic) with suitable remote area medical training and non health care professionals who have undergone suitable training (such as our 7 day  Remote Medical Responder course or FREC 4 with additional remote area medical training).

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Course format

 

The course is run over two days at the National Outdoor Centre, Plas y Brenin. Both streams (medic and non medic) are run together (the reality is that an expedition team has to deal with a problem as a whole and will me made up of varied skill sets and looking after a casualty for a prolonged period of time in an expeditionary setting takes a LOT of resources). The course involves lectures and skill stations, introducing delegates to a formula to undertake Prolonged Field Care post incident and to practice these skills as well as gain experience in a friendly, supportive environment - culminating in an overnight exercise, treating, monitoring and caring for the patient in an outdoor setting, with minimal (expedition typical only kit), utilising telemedicine and more. The exercise culminates in an evacuation to an intended Helicopter Landing Site. 

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Delegates are taught that team work is essential and work in shifts. Delegates will NOT be fatigued as they will sleep in an expeditionary camp setting during the exercise. It is important that the exercise does not impact the educational value. This has been tested an evaluated with many many delegates and the appropriate balance struck. All delegates feed back that the actual simulation is of huge value.

 

The practical phase of the course concludes at lunch time of day 2, followed by hot showers, lunch, debrief and then running the course to conclusion.

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The course is complemented by post course resources including wipe clean, PFC specific field aide memoires.

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The Medic and Non Medic streams are run in Parallel with each aimed at the skill set of the respective group.

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Course content:

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The course will take delegates through a systematic approach to PFC including with memorable Mnemonics - assisted by our field proof flow charts and aide memoires.

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Delegates will also be taught a framework - relevant to their skill levels - to enable them to implement PFC in the field and introduced to lightweight, real world kit, that you would have with you on expedition/ in the field.

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• What is Prolonged Field Care?

• The problem - loss of the Golden Hour

• The solution

• Case Study examples

• The history of the PFC Algorithm - from primary survey to pain assessment and control, assassins to social observations, ravine to nursing care, unwell ruminants to telemedicine, packaging, transport and handover. 

• Equipment and improvisation .

• Introduction to field documentation 

• Skill stations

• Communications and power in the field

• Telemedicine

• Evacuation ladder

• Patient Packaging

• Stretcher Systems 

• Local evacuation

• Working with Helicopters

• Handover

• International Evacuation and Insurance

• Practical exercise

• Post course CPD

• Further learning/experience options

• Academic PFC case study capture

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Who teaches on the course? A unique and broad church of medics with significant experience in remote areas & experience of PFC.

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The R2Ri team are experienced remote area medics. The team includes those experienced in Prolonged field care from both military and civilian operations - whether terrestrial or ship board PFC experience, prolonged evacuations and more. The team also includes University lecturers and academics. We have combined the expertise of team members with Masters Degrees focusing on Prolonged Field and Nursing Care (now undertaking a PhD in Prolonged Field Care), with military and civilian experience.

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We have an unparalleled, multi disciplinary Faculty in the UK to deliver PFC training: Several ex British Antarctic Survey Doctors (trusted to undertake prolonged care in the field as the only medic), holders of the Diploma in Mountain Medicine, PGCE in Global Health,  Anaesthetists, Doctors with experience in intensive care, Ex Special Forces Paramedic, Military Doctor, Experienced Remote Area Paramedics, Military Paramedics, Military Nurse, two Nursing Lecturers (University degree lecturers), Off Shore Medics, Telemedicine and Repatriation expert Doctors. This is a very broad church, covering all aspects of PFC.

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Importantly, the course instructors are have been in positions where they were the medics trusted to undertake PFC in a remote area setting. Having been in that situation, they are appropriate to teach delegates on our PFC course. Almost all have undertaken and completed Ofqual regulated adult teaching qualifications and training.

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Course Dates:

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Our next PFC courses are:

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07/08 April 2025. Bookings open.​ Note that this course is a 2 day, stand alone course but is immediately preceded by our 7 day Remote Medical Responder: A Wilderness First Responder course, for those who would like to undergo a comprehensive 9 day programme. If you have already submitted a booking form and are awaiting joining instructions and an invoice, the next batch are scheduled to go out on 20 March 2025.

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13/14 September 2025. Bookings open 5 July 2025. We are happy to accept expressions of interest now. We will contact you once bookings open and will hold a place for you for 7 days once bookings open, pending receipt of a booking form. 

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Venue: The National Outdoor Centre, Plas y Brenin, Snowdonia.

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Cost: 2 day £350.00

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Accommodation and food are not included as clients tell us that they want flexibility and we wish to be as inclusive as possible. Inexpensive accommodation can be booked at the venue itself. Note that the end of day 1 sees delegates go up in to the hills for an overnight exercise using their own tents.

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How to book:

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Click the link below to access the booking course pack for the course dates you are interested in. Download the pack, save it your computer and you can complete the booking form electronically and email to us. The booking form is editable. Alternatively, print off the pack, complete and scan the booking form back to us. Terms and Conditions can be found in the booking pack and any booking form submitted to us is subject to these booking terms and conditions (including cancellation charges).

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