{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:13:02Z","timestamp":1790802782295,"version":"4.1.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"7-8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>In current and anticipated future conflicts, including large-scale combat operations, medical teams are tasked to provide prolonged casualty care (PCC) or extended patient care that occurs when delays in evacuation exceed the team\u2019s capabilities. Although the principles of PCC are often taught to military medical providers using simulation, educators rarely dedicate the time to training required to simulate the prolonged nature of these encounters. Therefore, a lack of knowledge exists regarding which aspects of extended care may be lost in an accelerated training scenario.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>To close this knowledge gap within military medical education and training, we modified an existing PCC curriculum at the USU, Operation Gunpowder, to focus on temporal fidelity, extending the length of the simulated encounter to 21\u2009hours. We used a qualitative phenomenological design to explore the students\u2019 experiences and perceptions by closely analyzing their assigned reflection papers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified four themes from the students\u2019 reflection papers: (1) Recognized effects of fatigue, (2) navigated resource limitations, (3) realized the value of teamwork, and (4) noted the importance of communication and documentation. These themes revealed benefits of incorporating temporal fidelity into PCC training, including self-awareness of personal limits and possible strategies to mitigate fatigue when medical or operational mission requirements dictate sleep deprivation. Future studies are needed to determine other training scenarios that would benefit from adherence to temporal fidelity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Wars and disasters require medical providers trained in PCC. Future educational activities aimed at teaching PCC should continue to incorporate temporal fidelity to help teach these valuable lessons.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaf017","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T16:29:09Z","timestamp":1737476949000},"page":"e1727-e1733","source":"Crossref","is-referenced-by-count":3,"title":["Time Is a Tool: Evaluation of a Prolonged Casualty Care Curriculum With a Focus on Temporal Fidelity"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5289-6182","authenticated-orcid":false,"given":"Amy F","family":"Hildreth","sequence":"first","affiliation":[{"name":"Department of Military and Emergency Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2628-8658","authenticated-orcid":false,"given":"Rebekah","family":"Cole","sequence":"additional","affiliation":[{"name":"Department of Military and Emergency Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]},{"name":"Department of Health Professions Education, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Henderson","sequence":"additional","affiliation":[{"name":"Department of Military and Emergency Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9262-3990","authenticated-orcid":false,"given":"Cynthia","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Military and Emergency Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,21]]},"reference":[{"key":"2025070106315548900_R1","article-title":"Clinical practice guideline: prolonged casualty care guidelines","author":"Joint Trauma System"},{"issue":"2","key":"2025070106315548900_R2","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1097\/XCS.0000000000000707","article-title":"Putting medical boots on the ground: lessons from the war in Ukraine and applications for future conflict with near-peer adversaries","volume":"237","author":"Epstein","year":"2023","journal-title":"J Am Coll Surg"},{"key":"2025070106315548900_R3","first-page":"36","article-title":"Medical changes needed for large-scale combat operations: observations from mission command training program warfighter exercises","volume":"100(3)","author":"Fandre","year":"2020","journal-title":"Mil Rev"},{"issue":"1","key":"2025070106315548900_R4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10903127.2021.1907491","article-title":"An analysis of 13 years of prehospital combat casualty care\u2014implications for maintaining a ready medical force","volume":"27","author":"Schauer","year":"2021","journal-title":"Prehosp Emerg Care"},{"key":"2025070106315548900_R5","first-page":"3","article-title":"Descriptive analysis of casualties rapidly returned to the fight after injury: reverse triage implications for large scale combat operations","volume":"(Per 22-04-05-06)","author":"April","year":"2022","journal-title":"Med J (Ft Sam Houst Tex)"},{"issue":"2S Suppl 2","key":"2025070106315548900_R6","doi-asserted-by":"publisher","first-page":"S186","DOI":"10.1097\/TA.0000000000003252","article-title":"Case-control analysis of prehospital death and prolonged field care survival during recent US military combat operations","volume":"91","author":"Shackelford","year":"2021","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"2025070106315548900_R7","doi-asserted-by":"publisher","first-page":"121","DOI":"10.55460\/OAL4-CBRC","article-title":"Review of 54 cases of prolonged field care","volume":"17","author":"DeSoucy","year":"2017","journal-title":"J Spec Oper Med"},{"issue":"2","key":"2025070106315548900_R8","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.wem.2017.02.001","article-title":"Prolonged field care: beyond the \u201cgolden hour","volume":"28","author":"Keenan","year":"2017","journal-title":"Wilderness Environ Med"},{"key":"2025070106315548900_R9","first-page":"10","article-title":"Preparing emergency physicians for the next war: residency capstone training in prolonged casualty care","author":"Elker","year":"2022","journal-title":"Med J (Ft Sam Houst Tex)"},{"key":"2025070106315548900_R10","volume-title":"Healthcare Simulation Dictionary\u2014Second Edition (2.1). 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