Prolonged Holding (Zinc 48)
Mission
Prolonged Holding receives casualties whose evacuation is delayed beyond the standard 48-hour Holding window. The mission shifts from “stabilize and transport” to “sustain physiology and clinical condition without imminent transport,” integrating JTS Prolonged Casualty Care (PCC) doctrine.
The “Zinc 48” designator refers to the prolonged holding state.
Personnel & Task Organization
The same Holding team continues, but with explicit attention to crew rest and rotation. Sustained operations require deliberate planning for sleep, food, and time away from the bedside. Cross-training widens — every team member becomes more general because individual specialization is unsustainable across days and weeks.
Mental health considerations apply to both casualties and providers; pre-planned check-ins and command-aware indicators of distress matter.
Equipment & Logistics
Sustainment-oriented:
- Pharmacy resupply lines with longer planning horizons.
- Oxygen generation or large stored supplies.
- Nutrition planning (enteral feeding capability; parenteral where available).
- Pressure-ulcer prevention (turning protocols; pressure-redistributing surfaces).
- Wound care supplies for extended periods.
- Mental health support resources for casualties (and providers).
- Communication with the receiving facility for ongoing care planning.
Doctrinal References
- JTS CPG: Prolonged Casualty Care Guidelines (foundational reference, 21 Dec 2021)
- MCRP 3-40A.7 (formerly MCRP 4-11.1G, Jul 2013)
- JTS CPG: Damage Control Resuscitation in PFC (01 Oct 2018)
- JTS CPG: Analgesia and Sedation Management during PFC (11 May 2017)
- JTS CPG: Wound Management PFC (24 Jul 2017)
- JTS CPG: Traumatic Brain Injury PFC (06 Dec 2017)
- JTS CPG: Sepsis Management PFC (28 Oct 2020)
- JTS CPG: Burn Management PFC (13 Jan 2017)
- JTS CPG: Crush Syndrome PFC (28 Dec 2016)
- JTS CPG: Mechanical Ventilation Basics (09 Apr 2025)
- JTS CPG: Telemedicine in a Deployed Setting (19 Sep 2023)
- JTS CPG: Nutritional Support Using Enteral and Parenteral Methods (04 Aug 2016)
- JTS CPG: Acute Mental Health Conditions by Non-specialty Medical Personnel (26 Mar 2026)
- JTS CPG: Wound Management (PFC, 24 Jul 2017)
Clinical Practice Guidelines
The full PCC bundle anchors practice. Re-evaluate every patient against PCC criteria daily — what would change if evacuation became available now versus 24 more hours.
Decision Points
| Decision | Trigger | Outcome |
|---|---|---|
| Transition from Silver to Zinc | Evac delay confirmed beyond 48 hours | Engage PCC framework |
| Sustainment thresholds | Resource consumption versus sustainment capacity | Re-prioritize; consider expectant for non-recoverable patients under MASCAL |
| Provider rotation | Approaching duty-cycle limits | Planned hand-off; structured AAR |
| Family/command notification | As policy and operational security permit | Coordinate per current policy |
| Recognize “this is changing the mission” | Sustained PCC operations meaningfully degrading the team’s primary mission | Communicate to Command; consider augmentation request |
Linked ELOs
| TLO | ELO | Primary or Secondary |
|---|---|---|
| Prepare to Receive | PR-6 (individual patient management) | Primary |
| Prepare to Receive | PR-7 (extended holding plan) | Primary |
| Clinical Ops | CO-11 (narcotics management — sustainment) | Primary |
| Clinical Ops | CO-14 (clinical decision-making) | Primary |
| Team Development | TD-8 (resilience under sustained operations) | Primary |
| Team Development | TD-7 (ethics — expectant in prolonged context) | Primary |
Forms & Documentation
- Prolonged-care handoff template.
- Rotation/duty schedule.
- Sustainment status board.
- Daily PCC re-evaluation note.
- PCC Nursing Care Tracker.
- Prolonged Field Care Card Worksheet.
Reference Imagery
Educational Resources
Presentations:
- Prolonged Casualty Care: First 72 Hours — primary unit deck
- Tele-consultation & Autonomous Decision-Making
SOPs: Holding / PCC SOP
⚠️ Gap: Telemedicine CPG references the DoD telemedicine program but no public platform link was identified. JTS CPG ID94 is the primary reference. ⚠️ Gap: Crush syndrome and burn wound PFC CPGs — no Deployed Medicine educational module found for these topics.
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