• Amy F Hildreth, Rebekah Cole, Jonathan Henderson, and Cynthia Shen.
• Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD 20814, USA.
• Mil Med. 2025 Jan 21.

IntroductionIn 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's 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.Materials And MethodsTo 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 hours. We used a qualitative phenomenological design to explore the students' experiences and perceptions by closely analyzing their assigned reflection papers.ResultsWe identified four themes from the students' 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.ConclusionsWars 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.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2025. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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