Prolonged Fieldcare Podcast: Recent Episodes
Dennis
This podcast and website is dedicated to the healthcare professional who needs to provide high quality care in a very austere location.
In this episode of the PFC Podcast, Dennis speaks with Justin Ball, a licensed clinical social worker and former Green Beret, about the complexities of combat stress and mental health. They discuss the importance of recognizing maladaptive stress responses, the concept of limbic hijack, and the significance of co-regulation techniques in high-stress situations. Justin introduces the SABRE method for managing stress and emphasizes the impact of home life on mental health. They also explore the challenges of dealing with failure, imposter syndrome, and the importance of daily calm practices, especially during the transition out of military service. The conversation concludes with resources for mental health support within the military community.
Takeaways
Combat stress can lead to maladaptive behaviors.
Limbic hijack can impair decision-making in emergencies.
Co-regulation is essential for managing stress in others.
The SABRE method provides a structured approach to calming techniques.
Daily practices of calm can help maintain mental health.
Retirement can be a challenging transition for veterans.
Understanding personal limits is crucial for mental well-being.
Imposter syndrome affects many in the military community.
Home life stress can significantly impact mental health.
Resources like Soft Network can aid in finding mental health support.
Chapters
00:00 Introduction to Combat Stress and Mental Health
01:21 Justin's Background and Experience
04:50 Recognizing Maladaptive Stress Responses
11:10 Understanding Limbic Hijack and Emotional Responses
17:46 Co-Regulation Techniques in High-Stress Situations
21:50 The SABRE Method for Managing Stress
34:38 Identifying Signs of Emotional Distress
41:31 The Impact of Home Life on Mental Health
49:15 Dealing with Failure and Imposter Syndrome
01:00:59 The Importance of Daily Calm Practices
01:07:10 Navigating Retirement and Transitioning Out
01:38:02 Resources for Mental Health Support
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC podcast, Dennis, Andrew, and Rick delve into the complexities of triage in emergency medicine, particularly in mass casualty situations. They discuss the importance of understanding triage categories, share real-life experiences, and emphasize the role of leadership and resource management in effective triage. The conversation also highlights the need for integrated training that encompasses security and command aspects, as well as the necessity of adapting training scenarios to prepare for the realities of mass casualty events. The episode concludes with reflections on how to improve triage processes and training methodologies.
Takeaways
Triage is chaotic and unpredictable, requiring intuitive methods.
In mass casualty situations, focus on immediate life threats first.
Leadership is crucial in managing triage and patient movement.
Dynamic triage requires continuous reassessment of patient conditions.
Training should include realistic scenarios where not all patients survive.
Effective communication and coordination are essential in triage.
Incorporate security measures in triage training.
Training should align with both medical and non-medical goals.
Utilize available resources efficiently during triage.
Commanders must be involved in triage decision-making processes.
Chapters
00:00 Introduction to Triage and Its Importance
02:27 Understanding Triage Categories
07:11 Real-Life Triage Experiences
09:43 The Role of Leadership in Triage
19:32 Dynamic Triage and Resource Management
29:04 Integrating Security and Command in Triage
38:40 Training for Mass Casualty Scenarios
50:40 Final Thoughts on Triage and Training
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This podcast episode delves into the complexities of irregular warfare in the Indo-Pacific region, featuring insights from Dr. Andrew Maher, a subject matter expert. The discussion covers the definitions and implications of irregular warfare, the rise of proxy warfare, and the challenges faced by allies in understanding and engaging in these conflicts. Medical support and casualty management in tropical regions and urban environments are also explored, alongside lessons learned from recent conflicts like Ukraine. The episode emphasizes the need for preparedness and resilience in the face of potential conflicts.
Andrew Maher | Australian Army Research Centre (AARC)
https://share.google/bs9gh7nLFkJNVGBGW
Takeaways
Irregular warfare is the predominant form of conflict today.
Proxy warfare is on the rise and is a key strategy.
Allies may have different doctrines and approaches to irregular warfare.
Preparedness for unconventional warfare is crucial for allies.
Medical support in tropical regions presents unique challenges.
Urban warfare requires understanding of local healthcare systems.
Lessons from Ukraine highlight the targeting of medical resources.
Humanitarian assistance can enhance resilience and understanding.
Dispersion of forces is necessary in modern conflict.
Understanding local grievances is vital for unconventional warfare.
Chapters
00:00 Introduction to Irregular Warfare in the Pacific
02:48 Understanding Irregular Warfare Concepts
06:10 The Rise of Proxy Warfare
09:07 Allies and Partners in Irregular Warfare
11:50 Unconventional Warfare Preparedness
14:49 Challenges of Medical Support in Irregular Warfare
17:54 Casualty Management in Tropical Regions
20:49 Urban Warfare and Mega Cities
24:08 Lessons from Ukraine and Targeting Medical Resources
27:05 Key Takeaways on Irregular Warfare and Medical Planning
For more content, go to www.prolongedfieldcare.org
Consider joining the Special Operations Medical Association, go to: https://specialoperationsmedicine.org/
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The inaugural episode of the MSIW podcast introduces the critical role of medical support in irregular warfare. The conversation highlights the evolving challenges faced by medical personnel on the battlefield, the need for adaptation in training and technology, and the importance of preparing for future conflicts. The speakers emphasize the necessity of a robust medical trauma system and the integration of lessons learned to enhance military healthcare effectiveness.
Takeaways
The MSIW podcast aims to educate on medical support in irregular warfare.
Medical support must adapt to the fast-moving nature of modern battlefields.
Training for medical personnel needs to include survival tactics in hostile environments.
Technology will play a crucial role in future medical support operations.
A decentralized approach to medical care is essential for battlefield effectiveness.
Lessons learned from past conflicts must be integrated into current practices.
The importance of partnerships in building resilient medical systems is paramount.
Medical personnel must be prepared for resource-limited environments.
The character of warfare is changing rapidly, necessitating new strategies.
Future conflicts may require difficult decisions regarding medical care and triage.
Chapters
00:00 Introduction to the MSIW Podcast
01:04 Understanding Medical Support in Irregular Warfare
04:04 Challenges in Modern Battlefield Medical Care
09:59 The Need for Adaptation in Medical Training
12:29 The Role of Technology in Medical Support
19:34 Future Directions for Medical Support in Warfare
For more content, go to www.prolongedfieldcare.org
Consider joining the MSIW Committee, go to: https://specialoperationsmedicine.org/
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, host Dennis speaks with Steve Schauer, a lieutenant colonel in the US Army and a critical care fellow, about his research on calcium levels in trauma patients. They discuss the importance of understanding calcium derangements, the challenges of correlating civilian and military trauma, and the impact of pre-hospital care on calcium levels. Steve shares insights from his study, including data collection methods, patient enrollment, and the physiological implications of calcium in trauma care. The conversation also covers the prioritization of interventions in trauma management, the role of TXA, and the need for ongoing research in this critical area of medicine.
Takeaways
Calcium derangements are common in trauma patients.
Pre-hospital care can significantly affect calcium levels.
Understanding the correlation between civilian and military trauma is challenging.
Data collection in trauma studies is complex and requires careful planning.
TXA is crucial for preventing the breakdown of clots in trauma patients.
Calcium administration must be approached cautiously in trauma care.
Blood products are the top priority in trauma management.
The physiological role of calcium in coagulation is critical.
Future research is needed to clarify the role of calcium in trauma care.
Medicine is constantly evolving, and practitioners must stay updated.
Chapters
00:00 Introduction to Calcium Study in Trauma
02:48 Understanding Calcium Derangements in Trauma Patients
05:47 Challenges in Correlating Civilian and Military Trauma
08:32 Pre-Hospital Factors Affecting Calcium Levels
11:31 Data Collection and Patient Enrollment
14:29 Retrospective Data Insights on Calcium Levels
17:04 Calcium Administration in Trauma Care
20:16 Prioritizing Interventions in Trauma Management
23:25 The Role of TXA in Trauma Care
26:19 Physiological Implications of Calcium in Trauma
29:17 Final Thoughts and Future Research Directions
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This presentation at SOMSA'25 discusses the analysis of transfusion reactions in trauma patients, focusing on data from military settings. It highlights the importance of blood transfusions in improving survival rates, the rates of transfusion reactions, and the limitations of the current data. The conversation emphasizes the need for further research to understand the implications of transfusion reactions and improve patient outcomes.
Takeaways
Patients who need massive transfusions are likely to develop reactions.
The benefits of transfusions far outweigh the risks.
Transfusion reaction rates are around 1%.
We can't conclude causation from retrospective data.
The rate of transfusion reactions was 23%.
Higher rates of explosive mechanism injuries were noted.
We need more data on transfusion reactions.
The registry is not generating patient data points.
Most reactions occurred on day one of transfusion.
We need to rely on civilian counterparts for data.
Chapters
00:00 Introduction to Transfusion Reactions
02:52 Data Analysis and Findings
05:35 Limitations and Future Directions
For more content, go to www.prolongedfieldcare.org
For CME credit for this presentation, go to: https://specialoperationsmedicine.org/
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Mike Hetzler delve into the intricacies of mission planning, particularly in the context of medical operations in foreign environments. They emphasize the importance of thorough preparation, understanding local medical infrastructures, and the necessity of proactive planning to ensure successful outcomes in high-stakes situations. The conversation covers various aspects of pre-deployment planning, including site surveys, gathering medical intelligence, and the critical need for validation of resources. The speakers share personal experiences and lessons learned, highlighting the importance of communication, collaboration, and attention to detail in military medicine.
Takeaways
Planning and preparation are crucial for success in medical missions.
Assumptions can lead to critical failures in planning.
Validating medical resources on the ground is essential.
Pre-deployment site surveys provide vital information for mission success.
Understanding local medical infrastructure is key to effective operations.
Proactive planning helps mitigate risks in high-stress environments.
Communication with local facilities is necessary for effective patient care.
Rehearsing evacuation plans ensures readiness for emergencies.
Civilian transportation options can complicate medical evacuations.
Attention to detail can make the difference between success and failure.
Chapters
00:00 Introduction to Mission Planning and Preparation
03:00 Understanding the Importance of Pre-Mission Analysis
06:00 Planning for Medical Operations in Foreign Environments
08:55 The Role of Intelligence in Medical Planning
11:37 Navigating Medical Resources and Facilities
14:47 Confirming Medical Assets and Avoiding Assumptions
17:45 Creating a Common Operating Picture for Medical Operations
20:29 The Importance of Communication and Coordination
23:46 Enhancing Host Nation Medical Capabilities
26:40 Utilizing Running Sketches for Effective Planning
27:40 Proactive Risk Mitigation in Medical Operations
29:44 Assessing Medical Facility Capacity
32:18 Understanding Patient Movement Requests
35:47 Navigating Civilian Transportation for Medical Evacuations
40:26 The Importance of Rehearsals and Planning
52:18 Professionalism in Medical Preparedness
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Mike discuss the complexities of providing medical care in austere environments, focusing on the importance of understanding requirements, building relationships, and executing effective educational processes. They emphasize the need for thorough planning, cultural awareness, and continuous assessment to ensure successful outcomes in humanitarian missions.
Takeaways
Understanding the requirement is critical for success.
Building a common language enhances collaboration.
Cultural interpretation is essential in medical missions.
Assessment should be continuous throughout the process.
Planning and preparation account for 80% of success.
Under promise and over deliver to manage expectations.
Engaging with local partners is vital for effective training.
Utilizing local resources can enhance understanding.
Measuring both performance and effectiveness is necessary.
Perfecting the basics is crucial for impactful education.
Chapters
00:00 Introduction to the Podcast and Guest
01:43 Understanding Requirements in Humanitarian Medical Care
05:09 Analyzing the Environment and Common Language
12:14 Building Relationships in Medical Missions
20:15 Executing the Educational Process
38:59 Measuring Success and Effectiveness in Training
49:38 Final Thoughts and Key Takeaways
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Benjamin Ingram discusses the evolving landscape of military medicine, focusing on the challenges and innovations in medical training and care during combat. The conversation highlights the shift from the traditional 'golden hour' concept to a more nuanced understanding of medical capacity in warfare, the development of the Pickles concept for enhanced medical training, and the need for adaptive strategies to address unique injury patterns in modern conflicts. The episode concludes with a call to action for continued innovation and training in combat medicine.
Takeaways
The golden hour concept is becoming outdated in modern warfare.
Military medical capacity is facing unprecedented challenges.
Innovative training programs are essential for effective combat care.
The Pickles concept aims to bridge gaps in medical training.
Understanding unique injury patterns is crucial for improving outcomes.
Collaboration among nations is key to effective medical training.
Rapid response and adaptability are vital in combat situations.
Technology and innovation can enhance medical interventions.
Training must be embedded into operational frameworks.
Future directions in combat medicine require ongoing research and development.
Chapters
00:33 The Concept of the Golden Hour in Medical Care
02:35 Challenges in Military Medical Capacity
05:09 Innovations in Medical Training and Interventions
08:06 The Development of the Pickles Concept
11:04 Evolution of Medical Training Programs
13:46 Addressing Unique Injury Patterns in Modern Warfare
16:39 Improving Patient Outcomes in Combat Situations
19:37 Future Directions in Combat Medicine
22:16 Conclusion and Call to Action
For CME credit for this presentation, go to: https://specialoperationsmedicine.org/
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This conversation explores the advancements in point-of-care ultrasound for combat abdominal trauma, particularly in the context of the ongoing war in Ukraine. The speaker discusses the limitations of traditional ultrasound protocols and introduces innovative approaches to enhance diagnostic accuracy. Through case studies, the importance of timely detection of injuries is emphasized, along with the necessity of training combat medics in ultrasound techniques. The discussion also highlights the challenges faced in modern warfare and the critical role of ultrasound in improving patient outcomes.
Takeaways
Ultrasound is crucial for emergency trauma diagnosis in combat situations.
The FAST protocol is not sufficient for all types of injuries.
Innovative ultrasound techniques can improve diagnosis of colon injuries.
Timely detection of injuries can significantly reduce mortality rates.
Training for combat medics in ultrasound is essential for effective care.
The new FAST-U protocol enhances the standard FAST protocol.
Portable ultrasound devices are vital in combat zones.
Understanding retroperitoneal injuries is key to trauma management.
Collaboration and support are necessary for effective medical training.
Combat medicine education needs more recognition and resources.
Chapters
00:00 Introduction to Combat Ultrasound
00:37 The Importance of Ultrasound in Combat Trauma
02:32 Challenges of Modern Warfare and Trauma
06:07 Innovations in Ultrasound Protocols
12:19 Case Studies and Practical Applications
16:56 Training and Support for Combat Medics
19:02 Understanding Retroperitoneal Injuries
27:20 Enhancing Diagnostic Accuracy with FAST-U
35:02 Future Directions in Combat Medicine
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The conversation delves into the complexities of providing medical care in remote areas, particularly focusing on the challenges faced in replicating hospital procedures. It emphasizes the critical nature of understanding hemorrhagic shock and the importance of timely resuscitation techniques, including blood transfusions, to improve patient outcomes.
Takeaways
There are limitations in replicating hospital care in remote areas.
Non-compressible torso hemorrhage is a significant concern in trauma care.
Many potentially survivable deaths occur due to inadequate resuscitation.
The MARCH algorithm is essential in trauma management.
Recognizing hemorrhagic shock is crucial for effective treatment.
Airway, respiration, and circulation are fundamental in resuscitation.
Starting blood transfusions early can save lives.
Remote medical care requires adaptation of hospital protocols.
Training for remote care must address unique challenges.
Effective communication is key in emergency medical situations.
Chapters
00:00 Introduction to Combat Medicine and Remote Resuscitation
00:52 Innovations in Hemorrhage Control: The ERAPTOR Course
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, discusses the evolving landscape of military medicine, particularly focusing on blood transfusion protocols in combat situations. They emphasize the need for optimizing blood management practices, adapting to dynamic conflict environments, and the potential benefits of implementing type-specific transfusions. The conversation highlights the importance of training medics to be independent thinkers and the necessity for systematic approaches in medical decision-making during deployments.
Takeaways
We see a need for optimizing our blood protocol.
The conflict environment is becoming more dynamic.
Medics need to stabilize patients for longer periods.
Type-specific transfusions can increase available blood supply.
Training medics to be independent thinkers is crucial.
A systematic approach is needed for medical deployments.
The benefits of type-specific transfusions may outweigh risks.
More tools in the toolbox can enhance medical care.
Understanding logistics is vital for blood management.
Research is needed to compare transfusion methods.
Chapters
00:00 Introduction to the Podcast and Speakers
01:56 The Need for Optimizing Blood Protocols
03:47 Understanding the Evolving Conflict Environment
07:48 Tools for Blood Component Management
13:31 Implementing Type-Specific Transfusions
17:05 Conclusions and Takeaway Points
For CME credit for this presentation, go to: https://specialoperationsmedicine.org/For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis interviews Jennifer Gurney, an Army general surgeon specializing in trauma and burn care. They discuss the evolution of burn resuscitation practices, particularly the historical use of plasma and its potential benefits over crystalloid solutions. Gurney emphasizes the importance of plasma in treating burn shock, the timing and dosage of plasma administration, and the challenges faced in burn resuscitation. The conversation highlights the need for a shift back to plasma therapy to improve patient outcomes in burn care.
Takeaways
Burn resuscitation has evolved significantly over the years.
Historical use of plasma in burn care was effective but fell out of favor due to safety concerns.
Current practices often rely too heavily on crystalloid solutions, which can lead to complications.
Plasma therapy can address the plasma deficit seen in burn shock.
The anti-inflammatory properties of plasma can aid in recovery.
Timing of plasma administration is crucial for effective resuscitation.
Monitoring clinical parameters is essential for determining fluid needs.
Dried plasma could revolutionize burn resuscitation in the field.
Over-resuscitation with crystalloid can lead to long-term complications.
A return to plasma therapy may improve outcomes for burn patients.
Chapters
00:00 Introduction to Burn Resuscitation
00:59 Historical Context of Plasma Use
05:11 The Case for Plasma in Burn Resuscitation
11:08 Understanding Resuscitation Endpoints
14:44 Timing and Dosage of Plasma Administration
19:54 Practical Considerations in Burn Care
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Colonel Stacey Shackelford discusses the critical aspects of managing abdominal trauma, particularly in battlefield settings. The conversation covers the statistics of battlefield casualties, current practices in trauma management, innovations in hemorrhage control, surgical techniques, and the challenges faced in trauma care. The discussion also emphasizes the importance of post-operative care and the need for future research in trauma medicine.
Takeaways
90% of casualties died before reaching a surgical hospital.
Two thirds of pre-hospital deaths were from torso hemorrhage.
Advanced pre-hospital care options are limited.
RoboA and other techniques are being explored for hemorrhage control.
Retropartennial packing is primarily for pelvic fractures.
Basic skills in trauma care are essential for success.
Chest tubes may play a larger role in reducing hemorrhage.
Ongoing resuscitation and electrolyte management are critical post-surgery.
Team dynamics are crucial in trauma surgery.
More clinical exposure for medics is necessary for better outcomes.
Chapters
00:00 Introduction to Abdominal Trauma
02:38 Understanding Battlefield Casualties
05:21 Current Practices in Trauma Management
08:42 Innovations in Hemorrhage Control
11:21 Surgical Techniques and Decision Making
14:30 Challenges in Trauma Care
17:14 Post-Operative Care and Complications
20:10 Future Directions in Trauma Research
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This podcast episode features Mike Hetzler discussing NATO's training programs focused on medical support in irregular warfare. He outlines two primary courses: the Advanced Surgical Training Course and the Advanced Medical Concepts Course, emphasizing the need for tailored training to meet the diverse requirements of European nations. The discussion highlights the importance of tactical decision-making, understanding local medical traditions, and preparing for guerrilla warfare scenarios.
Takeaways
NATO training programs are tailored to specific national needs.
The Advanced Surgical Training Course focuses on tactical decision-making.
Understanding local medical traditions is crucial for effective training.
The Advanced Medical Concepts Course emphasizes concept understanding over skills training.
Rehabilitation is a key focus in medical training for guerrilla warfare.
Ultrasound is identified as a critical piece of equipment for medics.
Training includes live tissue and cadaver lab work for practical experience.
Students are encouraged to adapt training to their nation's specific requirements.
The importance of minimizing kit for operational effectiveness is emphasized.
Instructors are selected for both expertise and personality to enhance learning.
Chapters
00:00 Introduction to NATO Training Programs
03:02 Advanced Surgical Training Course Overview
05:53 Advanced Medical Concepts Course
08:42 Guerrilla Warfare Medical Support Training
For CME credit for this presentation, go to: https://specialoperationsmedicine.org/
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Noel discuss the complexities of maritime irregular warfare, drawing on historical insights and personal experiences. They explore the challenges faced in maritime operations, the importance of experience, and the role of innovation and technology in modern warfare. The conversation emphasizes the need for effective communication within command structures and the necessity of preparing the next generation for the unique challenges of maritime IW.
Takeaways
The podcast serves as a platform for storytelling and knowledge sharing.
Historical insights can provide valuable lessons for current operational challenges.
Maritime operations face unique unpredictability due to environmental factors.
Experience is crucial in adapting to the complexities of maritime warfare.
Effective turnover processes are essential for operational continuity.
Innovation should be preemptive rather than reactive during conflicts.
Morale significantly impacts operational effectiveness in combat situations.
Training and iteration are key to identifying gaps in capabilities.
Good decision-making requires a combination of intelligence, knowledge, and context.
Honesty in reporting and communication is vital for future improvements.
Chapters
00:00 Introduction to Maritime Irregular Warfare
00:56 Historical Insights and Lessons Learned
03:51 Challenges of Maritime Operations
09:15 The Role of Experience in Maritime Warfare
11:58 Innovation and Technology in Warfare
17:43 Communication and Command Structure
26:41 Preparing the Next Generation for Maritime IW
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Mikola, a self-medic from a special forces unit, shares his experiences and challenges faced in the medical field during the ongoing conflict in Ukraine. He discusses the complexities of medical evacuation processes, the importance of stabilization points, and the evolving threats posed by enemy tactics, particularly the use of drones. The conversation highlights the need for adaptability, thorough planning, and continuous training to ensure effective medical care in combat situations.
Takeaways
The frontline in Ukraine is over 3,600 kilometers long.
Medical evacuation processes are complex and vary by region.
Stabilization points are crucial but often under-resourced and dangerous.
Drones have changed the dynamics of medical care on the battlefield.
Planning for medical missions must include contingencies for facility destruction.
Training and supply challenges are ongoing issues for medics.
The use of armored transport is essential for casualty evacuation.
Communication and teamwork are vital in high-stress environments.
Casualty numbers can fluctuate dramatically based on enemy activity.
Anticipating enemy tactics is crucial for medics' safety.
Chapters
00:00 Introduction to the PFC Podcast
00:55 Challenges Faced by Medics in Ukraine
06:43 Medical Evacuation Processes Explained
12:01 The Role of Stabilization Points
17:59 Adapting to Evolving Threats
22:50 Training and Supply Challenges
28:55 Conclusion and Reflections on Combat Medicine
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This presentation discusses the significance of electromagnetic warfare in modern military operations, particularly in the context of the ongoing war in Ukraine. It highlights the importance of understanding the electromagnetic spectrum and its implications for medical devices used in combat. A pilot study measuring the electromagnetic signatures of handheld ultrasound systems is presented, revealing that these devices have negligible signatures, which could be crucial for their deployment in forward medical care. The episode concludes with recommendations for best practices in using these medical devices in combat situations.
Takeaways
The electromagnetic spectrum is crucial in modern warfare.
Electromagnetic warfare can control or attack the enemy's spectrum.
Ukraine's war shows a significant uptick in electromagnetic spectrum use.
Portable handheld ultrasounds are essential for advanced critical care.
The electromagnetic signature of handheld ultrasounds is negligible.
Best practices include minimizing the time devices are on.
Electromagnetic signature measurement is vital for medical equipment procurement.
No medical unit should deploy without knowing device signatures.
The study found no significant difference in signatures when devices are used.
Future testing is necessary to ensure safety and effectiveness.
Chapters
00:00 Introduction to Electromagnetic Warfare
02:38 The Role of Electromagnetic Spectrum in Modern Warfare
05:22 Measuring Electromagnetic Signatures of Medical Devices
08:21 Pilot Study on Handheld Ultrasound Systems
11:08 Results and Implications of the Study
13:38 Best Practices and Future Recommendations
For CME credit for this presentation, go to: https://specialoperationsmedicine.org/
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis interviews Jessica, known as the Combat Midwife, who shares her extensive experience in both paramedicine and midwifery. The conversation delves into the critical issues surrounding postpartum hemorrhage, the mismanagement of obstetrics, and the importance of proper labor management. Jessica emphasizes the need for understanding the physiological process of birth and the risks associated with unnecessary interventions. She also discusses the significance of positioning during labor, the delivery of the placenta, and the risks of infection postpartum. Additionally, Jessica introduces the resources available for further education in maternal care.
Takeaways
Jessica is both a paramedic and a midwife.
Postpartum hemorrhage is a leading cause of maternal death.
Mismanagement in obstetrics often leads to complications.
Birth is a natural physiological process that should not be micromanaged.
Less than 10% of births require medical intervention.
Proper positioning during labor is crucial for a successful delivery.
The delivery of the placenta should be handled with care to avoid complications.
Postpartum care is essential to prevent infections and other issues.
The Combat Midwives Emergency OB Kit is designed for use in austere environments.
Education and resources are available for those interested in maternal care.
Chapters
00:00 Introduction to the Combat Midwife
01:28 Understanding Postpartum Hemorrhage
04:37 The Mismanagement of Obstetrics
06:14 Categories of Postpartum Hemorrhage
15:13 Advice for Managing Labor
19:11 The Importance of Positioning During Labor
21:03 Delivery of the Placenta
27:34 Postpartum Care and Infection Risks
36:06 Addressing Postpartum Hemorrhage and Infection
45:42 The Combat Midwife's Emergency OB Kit
48:41 Resources and Courses for Further Learning
For more information Connect with The Combat Midwife™:
Email: ask@combatmidwife.com
Website: https://combatmidwife.com
Classes & Kits: Workshops & Kits
Instagram: @CombatMidwife
YouTube: Combat Midwife on YouTube
Facebook: Combat Midwife on Facebook
X: @CombatMidwife
Discount Code for your followers: PFC
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Kevin dive deep into the complexities of ketamine, exploring its pharmacodynamics, pharmacokinetics, and practical applications in emergency medicine. They discuss the drug's disassociative properties, its analgesic effects, and the importance of individualized dosing based on patient physiology. The conversation also touches on the risks of catecholamine depletion and the management of side effects, particularly in trauma patients. Throughout the discussion, Kevin shares valuable insights and practical advice for medics and healthcare professionals using ketamine in real-life scenarios.
Takeaways
Ketamine is an NMDA receptor antagonist with various effects on the body.
It can cause profound analgesia and disassociation at different doses.
S-ketamine is preferred for its more intense analgesic effects and quicker recovery.
Dosing should be individualized based on patient condition and physiology.
Ketamine can lead to catecholamine depletion, especially in trauma patients.
Smaller doses are safer for patients with compromised vital signs.
Analgesic effects can be achieved without full disassociation at lower doses.
Managing side effects is crucial, especially in the 'party zone' of ketamine use.
Always have a plan for potential complications when using ketamine.
Refer to clinical practice guidelines (CPGs) for best practices.
Chapters
00:00 Understanding Ketamine: Basics and Mechanisms
09:17 Pharmacokinetics of Ketamine: How It Works
15:58 Dosing Ketamine: Individualized Approaches
25:23 Analgesic Properties of Ketamine: Beyond Disassociation
31:39 Managing Side Effects: The Party Zone and Hallucinations
39:19 Catecholamine Depletion: Risks and Considerations
43:05 Practical Advice for Medics: Using Ketamine Safely
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Noel discusses the complexities and challenges of maritime medicine, emphasizing the importance of training, knowledge, and operational flexibility. He shares insights from his extensive experience, highlighting the unpredictable nature of the ocean and the necessity of effective communication and integration with host nation partners. Noel advocates for a focus on practical training and the need for a forward-thinking approach to tackle operational challenges in a collaborative manner.
Takeaways
Courage in the absence of fear is stupidity.
Training should focus on knowledge, not just equipment.
The ocean's unpredictability complicates operations.
Effective communication is crucial in maritime environments.
Over-planning can lead to operational failures.
Training is essential for operational success.
Integrating with host nation partners enhances effectiveness.
Technology should be a last resort solution.
Operational flexibility is key in dynamic environments.
A joint effort is necessary for tackling complex challenges.
Chapters
00:00 Introduction and Context of the Mission
02:53 Challenges in Maritime Operations
05:38 Operational Planning and Flexibility
08:30 Communication Strategies in Maritime Environments
11:15 Training and Integration with Host Nation Partners
14:12 Operational Autonomy and Cross-Training
16:50 Emphasizing Training Over Technology
19:25 Conclusion and Call to Action
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Max discuss the evolving landscape of modern combat injuries, focusing on neck and upper chest injuries. They delve into the anatomy of the neck, the importance of understanding different zones for surgical intervention, and effective hemorrhage control techniques. The conversation emphasizes the critical role of teamwork in trauma care and the necessity of airway management in emergency situations. A case study of a traumatic incident illustrates the practical application of these concepts in real-world scenarios.
Link to Video Kentucky Ballistics: https://www.youtube.com/watch?v=1449kJKxlMQ&t=983s
Takeaways
Modern combat injuries have evolved, necessitating updated medical responses.
Neck and upper chest injuries present unique challenges in trauma care.
Understanding the anatomy of the neck is crucial for effective treatment.
Zone classification helps determine surgical approaches to neck injuries.
Upper extremity junctional injuries are particularly difficult to manage.
Effective hemorrhage control requires teamwork and quick decision-making.
Airway management is critical in trauma situations, especially with neck injuries.
Hands-on techniques, such as packing and suturing, are essential skills for medics.
Training and preparation are key to successful trauma interventions.
Real-world case studies highlight the importance of timely medical responses.
Chapters
00:00 Introduction to Modern Combat Injuries
02:43 Understanding Neck and Upper Chest Injuries
05:38 Anatomy of the Neck: Zones and Surgical Considerations
09:50 Upper Extremity Junctional Injuries
15:36 Management of Hemorrhage in Neck Injuries
21:37 Airway Management in Trauma
26:24 Effective Hemorrhage Control Techniques
30:35 The Importance of Teamwork in Trauma Care
36:22 Surgical Interventions and Techniques
42:25 Case Study: Kentucky Ballistics Incident
48:27 Conclusion and Key Takeaways
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This podcast episode explores the innovative use of maggot therapy in wound care, discussing its historical context, benefits, and applications in various medical settings, particularly in austere environments. The conversation highlights the importance of maggot therapy as a cost-effective and efficient treatment option, especially in the face of rising antimicrobial resistance. The speakers emphasize the need for proper sourcing, preparation, and application techniques for maggot therapy, as well as the potential for integrating this method into modern medical practices.
Takeaways
Maggot therapy has historical roots dating back thousands of years.
Maggots effectively debride wounds and promote healing.
Maggot therapy is cost-effective, especially in low-resource settings.
Chronic wounds often develop biofilms that resist antibiotics; maggots can help.
Maggots can be used in both chronic and acute wounds, including burns.
Maggot therapy can be implemented in austere environments with proper training.
Specific fly species are required for effective maggot therapy.
Maggots can be sourced locally in various environments.
Maggot therapy can be a sustainable alternative to antibiotics in combat situations.
Documentation and sharing of experiences are crucial for advancing maggot therapy.
Chapters
00:00 Introduction to Maggot Therapy
01:16 Historical Context of Maggot Therapy
04:41 Benefits of Maggot Therapy
08:39 Application in Various Wound Types
11:14 Maggot Therapy in Austere Environments
15:32 Sourcing and Preparing Maggots
23:33 Application Techniques for Maggot Therapy
29:32 Patient Management and Treatment Regimens
35:06 Future of Maggot Therapy in Medicine
43:51 Conclusion and Call to Action
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, the speaker discusses the Ridge Healer exercise, a tactical training program designed for small surgical and resuscitation teams operating in unconventional warfare environments. The conversation covers various aspects of the exercise, including operational challenges, team dynamics, communication strategies, patient care during transport, and the importance of adapting to non-battle injuries. The speaker emphasizes the need for effective decision-making, cross-training, and cultural awareness in high-stress medical situations.
Takeaways
Ridge Healer is a tactical training program for small teams.
Decision-making is crucial in the IW environment.
Surgeons should not be team leaders during operations.
Communication should be clear and concise to reduce cognitive load.
Medivac should focus on improving patient condition, not just transport.
Hypothermia management is critical in cold environments.
Non-battle injuries are common and require attention.
Post-operative care is essential for patient recovery.
Cultural awareness is important in military operations.
Rehearsing procedures is vital for effective execution.
Chapters
00:00 Introduction to Ridge Healer Exercise
00:52 Understanding the Ridge Healer Program
02:16 Operational Challenges in IW Environment
04:08 Team Dynamics and Roles
06:29 Communication and Decision-Making
10:17 Patient Care During Transport
12:48 Managing Hypothermia and Patient Comfort
15:26 Adapting to Non-Battle Injuries
16:52 Post-Operative Care and Monitoring
19:12 Basic Soldiering Skills and Cultural Awareness
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Alex delve into the topic of forced vital capacity in the context of chest trauma. They discuss a research paper that explores the assessment of forced vital capacity for risk stratification of blunt chest trauma patients in emergency settings. The conversation covers the importance of understanding chest wall injuries, clinical guidelines for treatment, challenges in diagnosing rib fractures, and the implications of the study's findings on patient outcomes and resource allocation in military medicine.
Takeaways
Forced vital capacity is crucial for assessing chest trauma.
Chest wall injuries can significantly impact patient outcomes.
Pain management is a key component of treatment strategies.
Clinical guidelines help in managing chest injuries effectively.
Risk stratification is essential for resource allocation in trauma care.
The study highlights the importance of forced vital capacity measurements.
Understanding patient dispositions is vital in emergency settings.
Challenges exist in diagnosing rib fractures in the field.
The study's methodology raises questions about its applicability.
Future research is needed to refine treatment approaches for chest trauma.
Chapters
00:00 Introduction to the Podcast
00:30 Exploring Forced Vital Capacity
02:02 Understanding Chest Trauma
04:56 The Importance of Chest Wall Injuries
08:37 Clinical Guidelines and Treatment Algorithms
10:21 Challenges in Diagnosing Rib Fractures
12:33 Pain Management and Treatment Strategies
16:25 Dispositions and Resource Allocation
19:02 Risk Stratification in Chest Injuries
22:39 Forced Vital Capacity and Its Relevance
27:16 Study Overview and Methodology
32:29 Outcomes and Implications of the Study
36:41 Critical Analysis of the Research
46:38 Reflections on the Study's Impact
52:12 Conclusion and Future Directions
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Doug discuss the critical aspects of analgesia and sedation in emergency and critical care settings. They emphasize the importance of patient safety, comfort, and effective communication among medical teams. The conversation covers decision-making processes for sedation, the types of medications used, and the significance of sedation wake-up trials to assess patient status. The hosts also address the management of over-sedation and the need for clear communication in patient assessments.
Takeaways
Keep the patient alive as the top priority.
Sedation may be necessary for patient safety.
Decision-making for sedation involves assessing comfort and safety.
Different medications serve specific purposes in sedation and analgesia.
Light to moderate sedation can help minimize PTSD risks.
Daily sedation wake-up trials are essential in critical care.
Communication using standardized scales aids in patient assessment.
Over-sedation management requires a systematic approach.
Medazolam and Propofol are preferred sedatives in critical care.
Start sedation at lower doses and adjust based on patient response.
Chapters
00:00 Priorities in Analgesia and Sedation
04:16 Decision-Making for Sedation Needs
07:47 Understanding Sedative Medications
14:32 Guiding Sedation Management in Critical Care
20:49 Sedation Wake-Up Trials
26:46 Communication and Neuro Exam in Sedation
31:25 Managing Over-Sedation and Emergencies
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This podcast episode discusses the challenges and strategies for sustaining distributed medics in denied environments, focusing on unconventional warfare and the importance of medical support as a force multiplier. It explores historical lessons from World War II, modern resupply techniques, and innovative delivery systems for medical supplies, emphasizing the need for sustainability and recycling in medical logistics.
Takeaways
Medical is not the mission; it supports the mission.
Medical support is crucial for building resistance forces.
Unconventional warfare requires strong medical logistics training.
Historical lessons from World War II can inform modern strategies.
Innovative delivery systems are essential for medical supplies.
Sustainability in medical logistics is critical for long-term operations.
Combat feeding is important for maintaining troop health.
Recycling medical supplies can extend operational capabilities.
Advanced manufacturing could revolutionize medical supply chains.
Understanding the environment is key to effective resupply.
Chapters
00:00 Introduction to Distributed Medics in Denied Environments
02:52 Understanding Unconventional Warfare and Medical Support
05:44 Planning Considerations for Unconventional Warfare Resupply
08:29 Historical Context: Lessons from World War II
11:49 Modern Techniques and Technologies for Resupply
14:36 Innovative Delivery Systems for Medical Supplies
17:33 Future of Medical Logistics in Combat
20:32 Sustainability and Resource Management in Warfare
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dr. John Holcomb discusses the management of traumatic brain injury (TBI) and the innovative use of plasma as a treatment option. He emphasizes the importance of understanding the glycocalyx and its role in preventing edema and managing intracranial pressure (ICP). The conversation also highlights the limitations of current guidelines in TBI treatment and the need for practical considerations in administering plasma. Dr. Holcomb advocates for a shift in practice towards using plasma early in the treatment process to improve patient outcomes.
Takeaways
- Plasma is used as a drug to prevent edema in TBI patients.
- The glycocalyx plays a crucial role in brain injury management.
- Preventing increased ICP is more effective than treating it.
- Current guidelines often lag behind clinical practice.
- Understanding the physiology behind treatments is essential for medics.
- Monitoring blood pressure is critical in TBI management.
- Plasma can repair the blood-brain barrier and reduce edema.
- Practical considerations are necessary for administering plasma in the field.
- The outcomes of TBI treatment should focus on functional recovery.
- Future directions in TBI management include more research on plasma use.
Chapters
00:00 Introduction to TBI Management and Plasma Use
03:04 Understanding Plasma as a Drug for TBI
05:39 The Role of Glycocalyx in Brain Injury
08:47 Preventing Edema and Managing ICP
11:31 Guidelines and Their Limitations in TBI Treatment
14:33 Practical Considerations for Administering Plasma
17:29 The Importance of Patient Monitoring and Judgment
20:44 Outcomes and Future Directions in TBI Management
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Jeff delve into the complexities of anoxic brain injury, discussing its causes, recovery processes, and prevention strategies in tactical environments. They emphasize the importance of maintaining oxygen levels, effective airway management, and addressing hypotension and hypoxia. The conversation highlights the critical role of preventing secondary brain injuries and the significance of basic medical interventions in saving lives.
Takeaways
Anoxic brain injury is caused by a lack of oxygen to the brain.
The brain requires oxygen to function, and deprivation leads to cell death.
Recovery from brain injuries can take time and various therapies.
Prevention strategies in tactical environments are crucial to avoid anoxic brain injury.
Monitoring oxygen levels is vital in emergency situations.
Airway management decisions should be based on the patient's condition and available skills.
Hypotension and hypoxia must be addressed promptly to prevent further injury.
Secondary brain injuries can be prevented with proper care and monitoring.
Treating pain and agitation is important to reduce intracranial pressure.
Basic medical interventions can save lives in critical situations.
Chapters
00:00 Understanding Anoxic Brain Injury
02:56 Recovery and Rehabilitation Process
05:27 Prevention Strategies in Tactical Environments
10:09 Monitoring and Maintaining Oxygen Levels
16:48 Airway Management Decisions
20:01 Addressing Hypotension and Hypoxia
26:56 Preventing Secondary Brain Injuries
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, the speakers discuss their experiences during a mission in Syria, focusing on the challenges and lessons learned from managing mass casualty operations. They emphasize the importance of planning, teamwork, and effective communication in high-stress environments, particularly in the context of medical support for both U.S. and host nation forces. The conversation highlights the critical role of walking blood banks, logistical challenges, and the necessity of building relationships with local partners to enhance operational effectiveness.
Takeaways
The views and opinions expressed are personal and not official.
Empowering individuals at all levels is crucial for success.
Planning and rehearsals are essential for effective mass casualty response.
Walking Blood Banks are vital in resource-limited environments.
Understanding blood accountability is critical for patient care.
The best-laid plans may not hold under stress; flexibility is key.
Building relationships with local forces enhances operational success.
Incorporating linguists into operations is essential for communication.
Logistical planning is as important as medical planning.
Success in operations often comes from teamwork and collaboration.
Chapters
00:00 Introduction to the Podcast and Speakers
00:54 Overview of the Mission in Syria
04:57 Planning and Execution of Mass Casualty Operations
11:10 Importance of Walking Blood Bank Operations
11:40 Challenges and Logistics in Medical Operations
24:39 Lessons Learned from the Deployment
33:18 Conclusion and Acknowledgments
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis interviews Dr. John Aho, a general surgeon and emergency medicine expert, discussing the critical topic of needle decompression and the confirmation of placement in cases of tension pneumothorax. Dr. Aho shares his insights on assessing the need for decompression, the techniques and sites for needle placement, and the challenges faced in pre-hospital settings. He introduces the CapNoSpot device, which aids in confirming the correct placement of the needle, and emphasizes the importance of training and understanding vital signs in emergency situations. The conversation highlights the complexities of treating tension pneumothorax and the need for effective tools and protocols in emergency medicine.
Takeaways
Needle decompression is a critical procedure in emergency medicine.
Assessing the mechanism of injury is key to determining the need for decompression.
Tracheal deviation is a late sign of tension pneumothorax.
Subcutaneous emphysema can indicate significant trachea or bronchial trauma.
Placement location and depth are crucial for successful needle decompression.
The CapNoSpot device can help confirm correct needle placement.
Vital signs can change after decompression, but monitoring is essential.
Ultrasound technology could enhance pre-hospital care if properly trained.
Training and experience are vital for effective use of emergency procedures.
Pre-hospital decompression can save lives, but under-treatment is common.
Chapters
00:00 Introduction to Needle Decompression and Confirmation of Placement
01:39 Assessing the Need for Decompression
09:47 Techniques and Sites for Needle Decompression
14:56 Confirming Placement of Needle Decompression
18:49 Monitoring Vital Signs Post-Decompression
24:46 The Role of Ultrasound in Decompression
29:31 CapNoSpot: A New Tool for Confirmation
34:33 Challenges in Pre-Hospital Settings
39:31 Final Thoughts on Needle Decompression
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and John discuss the complexities of chest trauma management, focusing on the use of chest seals, the importance of patient assessment, and the evolving guidelines in tactical medicine. They explore the debate surrounding the March algorithm, the role of blood transfusions, and the techniques for needle decompression and finger thoracotomy. The conversation emphasizes the need for a systematic approach to trauma care and the importance of adapting medical practices based on real-world experiences and outcomes.
Takeaways
Chest seals can be overused and may cause harm.
Patient assessment is crucial before applying interventions.
The March algorithm may need reevaluation based on new data.
Blood transfusion should be prioritized in trauma care.
Needle decompression and finger thoracotomy have distinct roles.
Effective thoracotomy techniques can improve patient outcomes.
Managing hemothorax and pneumothorax requires careful consideration.
Guidelines for chest trauma are evolving based on practical experiences.
Training should reflect realistic scenarios in trauma care.
Continuous assessment is key in trauma management.
Chapters
00:00 Introduction to Chest Trauma Management
02:56 Understanding Chest Seals and Their Use
05:53 The Debate on Chest Seal Application
08:31 The Importance of Patient Assessment
11:37 Revisiting the March Algorithm
14:33 The Role of Blood Transfusion in Trauma
17:15 Needle Decompression vs. Finger Thoracotomy
20:09 Techniques for Effective Thoracotomy
23:16 Managing Hemothorax and Pneumothorax
26:01 The Future of Chest Trauma Guidelines
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This conversation highlights a harrowing experience of combat medics during a mission, detailing the challenges faced during a life-threatening incident. The speakers share their personal accounts of injury, rescue, and the critical medical response that followed. They emphasize the importance of teamwork, humor, and training in high-stress situations, as well as the emotional and physical toll of such experiences. The discussion also touches on lessons learned for future operations and the significance of mental health in recovery.
Takeaways
The importance of highlighting the care delivered by medics in combat.
Humor can be a vital tool in high-stress medical situations.
Immediate response and teamwork are crucial in life-threatening scenarios.
Training and preparedness can significantly impact outcomes in emergencies.
The emotional toll of trauma affects both patients and medics.
Effective communication is essential during medical emergencies.
Cross-training among team members enhances operational effectiveness.
Understanding the patient's perspective can improve care.
The role of advocacy and support in recovery is critical.
Future training should focus on pain management and patient comfort.
Chapters
00:00 Introduction to Heroism in Combat Medicine
02:46 The Incident: A Life-Altering Explosion
05:00 Immediate Response: Rescue and Treatment
08:06 The Journey to Safety: Evacuation Challenges
10:52 Reflections on Pain and Recovery
13:50 Lessons Learned: Training and Preparedness
16:39 The Role of Humor in High-Stress Situations
19:39 Final Thoughts and Future Improvements
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, host Dennis interviews Jeff Ory, a recent medical graduate and former infantryman, discussing the critical topic of tension pneumothorax and the techniques for needle decompression. They explore the historical data on tension pneumothorax mortality, the effectiveness of different decompression sites, and the risks associated with the procedure. The conversation also delves into the importance of ongoing training for medics, the debate over who should be trained in needle decompression, and the best practices for chest tube placement. The episode concludes with thoughts on the future of trauma care and the need for continuous improvement in medical training.
Takeaways
Tension pneumothorax is primarily a blood flow issue, not a respiratory one.
The fifth intercostal space is often preferred for needle decompression due to safety and accuracy.
Hubbing a needle during decompression poses significant risks.
Many patients do not show objective improvement after needle decompression.
Training in emergency procedures must be continuous to maintain skills.
The placement of chest tubes is debated, with various opinions on the best approach.
Most patients with pneumothorax also have other injuries that complicate treatment.
Emergency procedures should be simplified for better retention and execution.
The risk of injury from needle decompression is a significant concern.
Emergent decompression is crucial for patient survival in trauma situations.
Chapters
00:00 Introduction to the Podcast and Guest
01:08 Understanding Tension Pneumothorax
07:04 Needle Decompression Techniques and Efficacy
12:20 Risks and Complications of Needle Decompression
20:03 Training and Skill Retention in Emergency Medicine
30:44 Debate on Needle Decompression in Military Training
39:04 Chest Tube Placement and Techniques
49:22 Conclusion and Future Directions in Trauma Care
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Alex Drum discuss the Massimo EMMA device, focusing on its functions, calibration, and clinical applications. They explore the importance of understanding waveforms, interpreting end-tidal CO2 values, and the significance of training and familiarity with medical equipment. The conversation emphasizes the need for proper monitoring techniques and troubleshooting common issues, ultimately highlighting the value of the EMMA device in emergency medicine.
Takeaways
The EMMA device is essential for monitoring end-tidal CO2 in patients.
Calibration is crucial for accurate readings and should be done before use.
Understanding waveforms can provide valuable insights into patient status.
End-tidal CO2 values can indicate patient responsiveness and fluid status.
The EMMA device can be used for airway confirmation and monitoring during transport.
Training on the device is important for effective use in critical situations.
Common issues include leaks in the circuit that can affect readings.
Setting alarm variables can help manage patient care more effectively.
Familiarity with normal values is key to recognizing abnormalities.
The EMMA device is a valuable tool in both civilian and military medical settings.
Chapters
00:00 Introduction to Massimo and the EMMA Device
02:51 Basic Functions and Calibration of the EMMA
05:37 Understanding Waveforms and Monitoring
08:21 Clinical Applications of Capnography
11:39 Interpreting End-Tidal CO2 Values
14:35 Advanced Monitoring Techniques and Patient Assessment
17:20 Common Issues and Troubleshooting
20:08 The Importance of Training and Familiarity
23:02 Conclusion and Resources
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Paul discusses the evolving landscape of medical support in irregular warfare, emphasizing the importance of training non-medics and leveraging technology like AI to enhance medical training and support. He shares insights from his extensive experience in military medicine and highlights the need for comprehensive education and collaboration among medical professionals in the field.
Takeaways
The conversation emphasizes the importance of medical support in irregular warfare.
Paul shares his personal experiences and insights from over 20 years in military service.
There is a significant need for a medical annex to the resistance operating concept.
Collaboration among subject matter experts is crucial for developing effective medical training resources.
Non-medics play a vital role in supporting medics during operations.
Training programs for Special Forces are evolving to meet the demands of modern warfare.
The integration of AI in medical training can enhance learning and support.
Sustainability of medical training programs is a challenge that needs addressing.
The importance of preparing for unknown and uncertain environments in military operations.
Paul encourages open access to medical resources and knowledge sharing.
Chapters
00:00 Introduction and Context
03:52 Medical Support in Irregular Warfare
09:45 Training and Capability Gaps
19:38 Innovations in Medical Training and AI
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The conversation delves into the complexities of end of life care in combat settings, emphasizing the need for palliative care discussions among military medical personnel. It highlights the challenges faced in recognizing non-survivable injuries, the decision-making process in resuscitation efforts, and the importance of compassionate care for both patients and their loved ones. The discussion also touches on the role of opioids in managing pain and anxiety during end of life care, advocating for a shift in focus from aggressive treatment to comfort and dignity for the patient.
Takeaways
End of life care is a critical conversation in military medicine.
Palliative care is often overlooked in combat settings.
Recognizing non-survivable injuries is essential for effective care.
Decision-making in resuscitation requires courage and leadership.
Compassionate care benefits both the patient and their loved ones.
Opioids play a significant role in managing pain in palliative care.
Transitioning to palliative care is a necessary step in certain cases.
Medical providers must educate themselves on end of life care.
Patient autonomy should be respected in decision-making.
Compassionate care can alleviate the emotional burden on medical providers.
Chapters
00:00 Introduction to End of Life Care in Combat
02:34 The Challenges of Palliative Care in Military Settings
09:57 Recognizing Non-Survivable Injuries
19:08 Decision-Making in Resuscitation Efforts
35:49 Transitioning to Palliative Care
43:03 The Role of Opioids in Palliative Care
53:18 Compassionate Care and Patient Autonomy
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This podcast episode discusses the evolution and current state of battlefield medicine, focusing on the Tactical Combat Casualty Care (TCCC) guidelines, training tiers, and the importance of evidence-based practices. The conversation highlights the challenges faced in implementing these guidelines and the ongoing efforts to improve trauma care in combat situations. Key updates to the TCCC curriculum and the logistics of providing medical care in the field are also addressed, emphasizing the need for continuous improvement and adaptation in military medicine.
Listen ad-free with a premium membership on Spotify, Apple Podcast, or Patreon.
Takeaways
- The majority of casualties occur in the pre-MTF environment due to hemorrhage.
- Improvements in battlefield trauma care have led to increased survival rates.
- Evidence-based medicine is crucial for developing TCCC guidelines.
- The TCCC curriculum consists of four training tiers for different levels of medical personnel.
- Recent updates to TCCC guidelines focus on airway management and TBI care.
- Logistics remain a significant challenge in providing timely medical care in combat.
- The committee emphasizes the importance of adapting guidelines based on new evidence.
- Training for combat medics must prioritize effective interventions for hemorrhagic shock.
- There is a need for consensus on triage methods in mass casualty situations.
- Continuous updates and training resources are essential for maintaining high standards in military medicine.
Chapters
00:00 Introduction to Battlefield Medicine
02:40 Guidelines and Evidence-Based Practices
04:55 TCCC Curriculum and Training Tiers
07:47 Updates and Changes in TCCC Guidelines
10:21 Current Challenges and Future Directions
13:05 TCCC and Evidence Grading
15:42 Logistics and Implementation Challenges
17:58 Conclusion and Resources
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dr. Givens discusses the importance of civilian involvement in medical emergencies, particularly in conflict and disaster situations. He shares the origin of a new medical initiative aimed at training laypeople to respond effectively to trauma care. The conversation highlights the need for accessible medical resources and the development of a user-friendly guide designed for non-medical individuals. Dr. Givens emphasizes the significance of empowering communities to take action in medical emergencies and the collaborative efforts behind creating this resource.
Takeaways
The initiative was inspired by a trip to Lithuania.
Civilians play a crucial role in medical emergencies.
Training laypeople can significantly improve trauma outcomes.
Current medical infrastructure is vulnerable in crises.
Historical examples show the need for civilian preparedness.
Bystander training is feasible and impactful.
The new book is designed for a civilian audience.
The guide is written in simple language for easy understanding.
Open access publication aims to reach those in need.
Community involvement is essential for effective emergency response.
Chapters
00:00 Introduction to the Podcast and Its Purpose
00:54 The Origin of the Medical Initiative
03:23 The Role of Civilians in Medical Emergencies
05:43 Training Laypeople for Medical Response
08:33 Developing Accessible Medical Resources
10:57 Conclusion and Call to Action
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Kateryna discuss the complexities of trauma care in Ukraine, focusing on a specific case study involving a soldier injured by a drone explosion. They explore the challenges faced in medical response, including the importance of training, communication, and the need for standardized procedures. The conversation highlights the lessons learned from past mistakes and emphasizes the necessity for ongoing education and adaptation in combat medicine.
Takeaways
The importance of learning from mistakes in medical response.
Training should be proactive, not reactive to emergencies.
Communication is critical in medical evacuations.
Standard Operating Procedures (SOPs) are essential for effective care.
Medical competence varies widely among personnel in conflict zones.
Telemedicine can enhance communication and decision-making in emergencies.
Equipment must be accessible and understood by all medical personnel.
The need for continuous education and training in trauma care.
Understanding the difference between civilian and combat medical practices is crucial.
Lessons learned from current conflicts should inform future medical training.
Chapters
00:00 Introduction and Overview of the Workshop
02:53 Case Study: Injury Patterns and Medical Response
06:00 Challenges in Medical Competence and Training
09:06 Communication and Coordination in Medical Evacuations
11:53 The Importance of Standard Operating Procedures
15:02 Lessons Learned and Future Improvements
17:58 Conclusion and Final Thoughts
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dr. Givens discusses the complexities of dealing with CBRNE patients in the field, emphasizing the need for a methodical approach to treatment. He introduces the March concept, which integrates CBRNE protocols into tactical care, and outlines the importance of agent identification and treatment protocols. The conversation covers the management of CBRNE patients across different zones, the specific challenges posed by nerve agents and cyanide, and the necessity of supportive care for chemical exposures. Dr. Givens concludes with key takeaways for medical professionals working in high-stress environments.
Takeaways
CBRNE is a significant concern in military medicine.
A methodical approach is essential for managing CBRNE patients.
The March concept can be adapted for CBRNE scenarios.
Agent identification is crucial for effective treatment.
Understanding the hot, warm, and cold zones is key to patient management.
Nerve agents and cyanide require specific treatment protocols.
Supportive care is vital for patients exposed to chemicals.
Training and practice are necessary for effective response.
Communication and teamwork are critical in high-stress situations.
Basic skills in chemical exposure management are essential for all medical personnel.
Chapters
00:00 Introduction to CBRNE and Its Challenges
02:53 Understanding CBRNE: A Methodical Approach
05:38 The March Concept: Integrating CBRNE into Tactical Care
08:47 Agent Identification and Treatment Protocols
11:35 Managing CBRNEPatients: Hot, Warm, and Cold Zones
14:48 Specific Agents: Nerve Agents and Cyanide
17:30 Supportive Care for Chemical Exposures
20:28 Key Takeaways and Final Thoughts
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Brock shares his journey into critical care medicine, emphasizing the importance of mentorship, essential knowledge for paramedics, and the challenges faced in the field. He discusses the rigorous training and experiences required to excel in flight medicine, the significance of the FPC certification, and the learning curve associated with transitioning from military to civilian roles. Brock also highlights the value of community involvement and the lessons learned throughout his career, providing insights for aspiring medics.
Takeaways
This presentation is for guys on active duty.
I want to impart on y'all, this is giving me a very good opportunity to be a mentor.
The FPC is a foundation for your practice.
You have to have three years experience as a paramedic.
The big thing in critical care medicine, they're very heavy on airway management.
Every interview I have done, they've all been different.
There is no shortcuts to the three-year requirement or patient contacts.
I wanted a very diverse resume.
We are side of these patients that are extremely sick with sepsis.
I would absolutely go to a college and take the class.
Chapters
00:00 Introduction to Critical Care Medicine
02:31 Pathway to Becoming a Critical Care Medic
05:09 Essential Knowledge for Critical Care
07:48 Flight Interview Process and Expectations
10:50 Post-Hire Experiences and Learning Curve
13:27 Challenges in Critical Care and Patient Management
15:51 Mentorship and Community Involvement
18:32 Lessons Learned and Future Directions
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Ethan discuss the complexities of managing chest trauma in pre-hospital settings, focusing on the controversial topic of finger thoracostomy versus needle decompression. They explore the challenges of existing protocols, the importance of training and diagnostics, and the need for better data collection to improve outcomes in trauma care. The conversation emphasizes the significance of context in decision-making and the balance between equipment and training in emergency medical situations.
Listen to this podcast AD-Free with premium membership on Spotify or Apple Podcast.
Takeaways
The conversation around chest trauma protocols is ongoing and complex.
Finger thoracostomy is not universally applicable; context matters.
Training and assessment are crucial in pre-hospital care.
Infection risks must be considered with invasive procedures.
Data collection in trauma care is often inadequate.
Diagnostic techniques like ultrasound can improve decision-making.
The effectiveness of procedures can vary based on patient condition.
Equipment should complement, not replace, proper training.
Understanding the nuances of trauma can lead to better outcomes.
Protocols should be adaptable to different scenarios and providers.
Chapters
00:00 Introduction and Controversial Post
02:04 Understanding Chest Trauma Protocols
04:59 Exploring the IDF Trauma Registry Study
09:54 Infection Risks and Protocol Considerations
12:34 Training and Assessment in Pre-Hospital Care
15:06 Diagnostic Techniques and Their Importance
19:36 Evaluating the Effectiveness of Procedures
23:29 The Role of Equipment vs. Training
29:22 Data Collection for Better Outcomes
35:29 Conclusion and Future Considerations
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This podcast discusses the evolution and importance of telemedicine in operational environments, particularly in military settings. It highlights case studies that demonstrate the need for telemedical support during prolonged field care, the challenges faced by medical teams, and the current solutions available. The conversation emphasizes the significance of training, effective communication, and the integration of technology to enhance patient care in remote and challenging environments.
Listen to this podcast AD FREE with premium Membership on Spotify, Apple Podcast, and Patreon
Takeaways
Telemedicine is rapidly evolving to support operational environments.
Case studies illustrate the critical need for telemedical support.
Challenges exist in current medical support systems, particularly in remote areas.
Prolonged field care requires innovative solutions like telemedicine.
Telemedicine is defined as remote evaluation and consultation using technology.
Current telemedical solutions have limitations that need addressing.
Future innovations in telemedicine may include AI and robotics.
Training is essential for effective telemedical consultations.
Asking for help through telemedicine is a sign of strength, not weakness.
Technology must be reliable, convenient, and adaptable to various situations.
Chapters
00:00 Introduction to Telemedicine in Operational Environments
02:43 Case Studies Highlighting Telemedical Support
05:56 Challenges in Current Medical Support Systems
08:35 The Need for Telemedicine in Prolonged Field Care
11:53 Defining Telemedicine and Its Importance
14:45 Current Telemedical Solutions and Their Limitations
17:44 Future Directions and Innovations in Telemedicine
20:35 Operational Telemedicine: Best Practices and Recommendations
23:24 Q&A Session: Addressing Concerns and Future Growth
26:35 Conclusion and Final Thoughts on Telemedicine
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Ramey Wilson discusses the evolving landscape of Global Health Engagement (GHE) and its critical role in military medicine. He emphasizes the importance of interoperability in crisis standards of care, sharing real-world examples of medical collaboration in operational settings. The conversation highlights the need for a framework that addresses crisis capability gaps and the psychological protection of medical personnel in challenging situations. Ramey also explores future directions for medical engagement and the importance of preparing for various operational contexts.
Takeaways
Global Health Engagement is evolving and critical for military operations.
Interoperability is essential for effective crisis response.
Crisis standards of care must be established for operational readiness.
Understanding partner capabilities is vital for effective medical support.
Real-world examples illustrate the importance of collaboration in medical care.
Psychological protection for medical personnel is crucial in crisis situations.
Future medical engagement should focus on sustainable practices.
Risk assessment is a key component of medical decision-making.
Training must align with the operational context and partner capabilities.
Crisis standards of care can enhance the effectiveness of medical operations.
Chapters
00:00 Introduction to Global Health Engagement
02:38 Interoperability in Crisis Standards of Care
05:42 The Role of Global Health Engagement
09:02 Crisis Capability Gap and Medical Support
11:51 Real-World Examples of Medical Collaboration
14:41 Crisis Standards of Care and Ethical Considerations
17:57 Framework for Crisis Standards of Care
20:46 Future Directions in Global Health Engagement
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis and Michael discuss the critical role of hemostatic agents in hemorrhage control. Michael, a clinical education manager at Celox Medical, shares his extensive experience as a Navy corpsman and firefighter, emphasizing the importance of understanding the mechanisms of hemostatic agents, the necessity of pressure in controlling bleeding, and the impact of coagulopathy on treatment effectiveness. They also explore practical tips for effective wound packing, the significance of anatomy knowledge, and advancements in hemostatic technology. The conversation highlights the need for continuous training and understanding of medical products to ensure effective trauma care.
Listen to this podcast AD-FREE with membership.
Takeaways
Hemostatic agents provide advantages in controlling bleeding.
Pressure is essential for effective hemorrhage control.
Understanding anatomy is crucial for effective wound packing.
Coagulopathy can significantly affect the effectiveness of hemostatic agents.
Different hemostatic agents have varying activation times.
Experience and practice are vital for effective hemorrhage management.
Advancements in hemostatic technology improve treatment outcomes.
Knowledge of product deployment is critical in emergency situations.
Training should focus on practical skills and unconscious competence.
Continuous education is necessary for all medical professionals.
Chapters
00:00 Introduction to Hemostatic Agents
03:08 Understanding the Need for Hemostatic Agents
06:03 Mechanisms of Action in Hemostatic Agents
09:05 The Importance of Pressure in Hemorrhage Control
11:56 Activation Times and Their Significance
14:56 Impact of Coagulopathy on Hemostatic Agents
18:01 Practical Tips for Effective Wound Packing
21:06 Understanding Anatomy for Effective Hemorrhage Control
23:52 The Role of Experience in Hemorrhage Management
27:05 Advancements in Hemostatic Technology
30:11 Conclusion and Final Thoughts on Hemostatic Agents
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, the hosts discuss the critical importance of team dynamics in emergency medical situations, particularly when dealing with critically injured patients. They explore the challenges teams face when individuals work in isolation rather than collaboratively, emphasizing the need for effective communication and organization. The conversation highlights the role of a team leader in overseeing the resuscitation process, the necessity of training as a cohesive unit, and strategies for adapting these concepts in solo medic scenarios. The episode concludes with insights on training for mass casualty situations and empowering team members to take initiative during emergencies.
Listen to this podcast AD-Free with membership.
Takeaways
Team dynamics are crucial in critical care situations.
Effective communication can prevent missed injuries during resuscitation.
A well-organized team can significantly improve patient outcomes.
The team leader's role is to maintain oversight and ensure all tasks are completed.
Training as a cohesive unit is essential for effective emergency response.
Solo medics should utilize checklists to ensure comprehensive care.
Mass casualty training should include triage and stabilization protocols.
Empowering all team members enhances situational awareness and response.
Repetitive training improves team performance in real-life scenarios.
Mentored training fosters confidence and cohesiveness within the team.
Chapters
00:00 Understanding Team Dynamics in Critical Care
04:52 Effective Team Organization in Trauma Situations
11:14 The Role of the Team Leader in Resuscitation
13:38 Adapting Team Concepts for Solo Medics
17:00 Training for Mass Casualty Scenarios
20:35 Empowering the Team for Better Outcomes
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The conversation revolves around a complex trauma case involving a 26-year-old male who suffered severe injuries from a live round during a training exercise. The discussion covers the patient's initial assessment, the challenges faced during his treatment, the surgical interventions performed, and the lessons learned from the case. The speakers emphasize the importance of timely interventions, effective communication, and the need for continuous improvement in emergency medical practices.
Takeaways
The patient was a 26-year-old male with severe injuries.
Initial assessment showed signs of shock despite normal blood pressure.
CT scans revealed significant internal bleeding.
Surgical interventions were complicated by the patient's deteriorating condition.
Massive transfusion protocol was activated due to significant blood loss.
Lessons learned include the importance of timely blood product administration.
Pre-hospital care plays a crucial role in patient outcomes.
Effective communication among medical teams is essential.
The case highlights the need for continuous training and preparedness.
The patient ultimately required extensive rehabilitation after his injuries.
Chapters
00:00 Introduction to the Case
02:52 Patient Arrival and Initial Assessment
06:05 CT Scan and Deterioration
08:50 Surgical Interventions and Challenges
11:58 Massive Transfusion Protocol and Outcomes
14:58 Lessons Learned from the Case
18:00 Discussion on Pre-Hospital and In-Hospital Care
20:48 Final Thoughts and Reflections
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC podcast, Dennis interviews Jason, a seasoned surgeon with extensive military experience. They discuss the challenges and adaptations required for surgical practices in austere environments, the importance of mindset in trauma care, and the need for effective training in both military and civilian contexts. Jason shares insights from his combat deployments and humanitarian work, emphasizing the necessity of flexibility and resourcefulness in providing care under challenging conditions. The conversation also touches on the differences between definitive care and damage control surgery, and offers advice for new providers looking to work in austere settings.
Takeaways
Jason has extensive experience in military and humanitarian surgical care.
Adapting to limited resources is crucial in austere environments.
Training in military settings provides invaluable experience for trauma care.
Definitive care may be necessary when follow-up is uncertain.
Surgical practices must be flexible to accommodate different environments.
Understanding the context of care is essential for effective treatment.
Courage and basic principles are key for new providers in austere medicine.
Experience helps in determining what surgical tools are truly necessary.
The global surgical capacity is insufficient for the growing population.
Effective communication with local partners is vital for successful operations.
Chapters
00:00 Introduction to the Podcast and Guest
01:14 Military Experience and Surgical Training
05:27 Adapting Surgical Practices in Austere Environments
13:27 Challenges in Military and Civilian Surgical Training
22:13 Definitive Care vs. Damage Control Surgery
37:24 Advice for New Providers in Austere Medicine
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, host Dennis interviews Nate, a Special Forces Detachment Commander, who shares his unique perspective on the integration of medical training within military operations. Nate discusses his journey into the medical side of Special Forces, the challenges of establishing effective Standard Operating Procedures (SOPs), and the importance of realistic training and communication of medical capabilities to commanders. The conversation emphasizes the need for curiosity and problem-solving in medical training, as well as the value of community feedback in improving medical practices in austere environments.
Listen ad-free with membership
Takeaways
Nate's background is not in medicine, but he has a strong interest in improving medical capabilities.
The importance of hands-on experience in medical training for Special Forces.
Creating effective SOPs is crucial for operational success in medical scenarios.
Testing and validating medical plans is essential to ensure effectiveness.
Training standards in medicine should be as rigorous as in other military skills.
Communication of medical capabilities to commanders is vital for mission success.
Curiosity about medicine can enhance team dynamics and operational effectiveness.
Problem-solving is a key aspect of medical training and should be embraced.
Feedback from the community can help improve medical practices in the field.
Establishing a culture of honesty about medical capabilities is necessary for effective planning.
Chapters
00:00 Introduction to the Podcast and Guest
01:02 Nate's Journey into Medical Training
03:38 Establishing Standard Operating Procedures (SOPs)
06:12 Testing and Validating Medical Plans
09:33 The Importance of Training Standards in Medicine
12:44 Planning and Realistic Medical Training
16:51 Communicating Medical Capabilities to Commanders
20:07 The Role of Curiosity in Medical Training
23:18 Seeking Community Feedback on Clinic Setup
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-
This conversation focuses on the implementation of a cold blood protocol for military training, emphasizing the importance of whole blood transfusions in preventing deaths from hemorrhagic shock. The discussion covers the logistics of blood availability, the challenges of storage and transportation, and the establishment of a pilot program for blood donation. The speakers highlight the collaboration with blood banks and the regulatory hurdles faced, while also outlining future directions for expanding the program to enhance medical support during training events.
Takeaways
Hemorrhage is the leading cause of preventable death on the battlefield.
Whole blood is recognized as the superior resuscitation fluid.
Logistics and availability of blood during training are critical issues.
Cold blood storage can be effectively implemented in training environments.
A pilot program for blood donation has been established to support training needs.
Collaboration with blood banks is essential for successful blood storage and use.
Regulatory challenges complicate blood storage and transportation.
Training medics to use cold stored blood is a priority.
Future expansion of the program is necessary to meet training demands.
Increased knowledge of blood protocols enhances medic preparedness.
Chapters
00:00 Introduction to Cold Blood Protocol
03:02 Understanding Hemorrhagic Shock and Blood Transfusion
06:07 Logistics of Blood Availability in Training
08:55 Implementing Cold Blood Storage in Training Environments
12:11 Pilot Program for Blood Donation and Storage
14:50 Collaboration with Blood Banks and Regulatory Challenges
18:14 Future Directions and Program Expansion
20:58 Conclusion and Key Takeaways
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis interviews John Dominguez, a veteran with extensive experience in the Special Operations Medical Association (SOMA). They discuss the origins of SOMA, its evolution into a global organization, and its impact on interoperability among special operations forces. John emphasizes the importance of networking, professional development, and learning from failures in medical training for medics. The conversation highlights how SOMA serves as a platform for sharing experiences and knowledge among medical professionals in the military and beyond. The conversation delves into the importance of experiential learning in medical training, particularly through SOMA's various labs and courses. It highlights the challenges faced in organizing medical conferences, the professional development opportunities available through SOMA, and the significance of leveraging technology for enhanced learning. The discussion also emphasizes the importance of early engagement and membership in SOMA for career advancement and knowledge sharing.
Listen to this episode ad-free with our membership.
Takeaways
SOMA was established to improve interoperability among special operations medics.
The organization has grown to include international representation from over 30 countries.
Networking at SOMA events fosters relationships and collaboration among medics.
SOMA provides a platform for professional development and training for medics.
Learning from failures is crucial in medical practice, especially in high-stakes environments. Experiential learning enhances the connection between theory and practice.
SOMA offers various labs that provide hands-on experience in medical training.
Attendees can gain different perspectives through international training opportunities.
The organization of medical conferences faces unique challenges, especially in funding and logistics.
SOMA's growth in attendance reflects its importance in the medical community.
Vendors play a crucial role in funding and supporting SOMA events.
Professional development opportunities are available for those interested in advancing their careers.
Mentorship is a key component of SOMA, aiding in career guidance and development.
Technology is increasingly important in medical education and training.
Engagement in SOMA can lead to leadership opportunities and influence in the field.
Chapters
00:00 Introduction to SOMA and Its Origins
07:49 The Evolution of SOMA and Its Global Impact
14:53 Networking and Interoperability in Special Operations
21:59 Training and Professional Development for Medics
26:59 Learning from Failures and Sharing Experiences
33:54 Experiential Learning in Medical Training
41:06 Challenges in Organizing Medical Conferences
47:40 SOMA's Professional Development Opportunities
55:30 Leveraging Technology for Enhanced Learning
01:01:28 Engagement and Membership in SOMA
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This podcast episode delves into the complexities of unconventional warfare (UW) and the evolution of medical support within Special Forces. Rocky Farr discusses historical examples of guerrilla warfare, the critical role of medics, and the challenges faced in providing timely medical care during combat operations. He emphasizes the importance of adapting medical practices to the realities of modern warfare and the need for ongoing training and support for Special Forces medics. The conversation culminates in reflections on the future of combat medicine and the necessity of questioning established norms.
Takeaways
The Army has historically struggled with the concept of unconventional warfare (UW).
Medical support is a crucial component of Special Forces operations, comprising 20% of their structure.
Historical examples of guerrilla warfare highlight the importance of medical care in sustaining operations.
The evolution of medics in Special Forces reflects changing military needs and strategies.
The golden hour is a critical factor in trauma care, but its application can vary in different combat scenarios.
Future conflicts may see a return to smaller, more agile Special Forces teams with limited medical support.
There is a need to question traditional medical practices and adapt to the realities of combat medicine.
Training in unconventional warfare must be reinvigorated within Special Operations Forces (SOF).
The 1961 edition of FM 31-21 is a valuable resource for understanding guerrilla warfare tactics.
The podcast emphasizes the importance of integrating medical capabilities into military operations effectively.
Chapters
00:00 Introduction to the Podcast and Overview of Topics
01:18 Understanding Unconventional Warfare (UW) and Its Historical Context
03:44 Guerrilla Warfare: Historical Examples and Medical Support
07:32 The Evolution of Medical Support in Special Forces
12:02 The Role of Medics in Special Forces Operations
16:26 The Golden Hour: Challenges and Realities in Combat Medicine
20:51 Future of Medical Support in Unconventional Warfare
25:09 Conclusion and Reflections on Combat Medicine
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Victor, a former Ranger medic, shares his experiences and lessons learned from a mass casualty event during a humanitarian mission in Burma. He discusses the historical context of the conflict, the challenges faced in providing medical support, and the innovative solutions developed in a denied environment. The conversation emphasizes the importance of training, adaptability, and building sustainable medical practices to empower local medics in future conflicts.
Listen to this episode ad free with membership.
Takeaways
Victor shares his experiences as a former Ranger medic.
The humanitarian mission in Burma faced severe challenges.
The conflict in Burma has historical roots dating back to World War II.
Training focused on hemorrhage control and casualty extraction techniques.
Two casualty collection points were established during the operation.
The team had to adapt to carrying casualties over long distances.
Blood transfusions were successfully conducted in the field for the first time.
Building sustainable medical practices is crucial for future operations.
Empowering local medics is essential for effective care.
The mission was guided by a sense of love and purpose.
Chapter
00:00 Introduction to the Humanitarian Mission
02:54 The Conflict in Burma: Historical Context
05:52 Training the Rangers: Preparing for Combat
08:55 The Medical Support Operation: Initial Challenges
11:49 Casualty Management: Triage and Evacuation
14:55 Adapting to the Battlefield: Lessons Learned
17:54 Blood Transfusions in the Field: A New Capability
20:45 Building Sustainable Medical Practices
23:48 Empowering Local Medics: The Future of Care
26:58 Conclusion: A Call to Action
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Master Sergeant Dan McGarra discuss the evolving role of females in combat and the challenges faced in medical treatment for female casualties. They explore discrepancies in medical protocols, cultural implications, and the need for gender-neutral approaches in military medicine. The conversation highlights the importance of understanding physiological differences and social dynamics that affect treatment outcomes, as well as the necessity for training that prepares medics for real-world scenarios involving female patients. Dan proposes solutions to improve medical protocols and training to ensure that all soldiers receive appropriate care, regardless of gender.
Listen ad free with membership.
Takeaways
The percentage of females in the military is increasing, necessitating discussions on their treatment in combat.
Studies show discrepancies in trauma treatment between genders, affecting outcomes for female casualties.
Cultural and social factors influence how medics respond to female patients in emergencies.
Training scenarios often fail to prepare medics for the realities of treating female casualties.
Gender biases can lead to inappropriate prioritization in triage situations.
Medical protocols need to be updated to reflect the physiological differences between genders.
There is a need for gender-neutral training in military medical education.
International military practices can provide insights into better treatment for female soldiers.
The Sharp training program must include medical emergency protocols to protect both patients and medics.
Open discussions about gender and medical treatment are essential for improving care in the military.
Chapters
00:00 Introduction to Female Participation in Combat
02:48 Challenges in Medical Treatment for Female Casualties
06:06 Discrepancies in Medical Protocols and Gender Bias
09:56 Cultural and Social Implications in Medical Emergencies
17:01 Learning from Global Military Practices
21:12 Addressing the Sharp Training and Medical Protocols
28:46 Proposed Solutions for Gender Neutral Medical Treatment
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, host Dennis engages with Andy Fisher to discuss the controversial topic of needle decompression in Individual First Aid Kits (IFACs). They explore the historical context of IFAC contents, the effectiveness of needle decompression, and the challenges in identifying tension pneumothorax in the pre-hospital setting. The conversation also delves into the training and decision-making processes in combat medicine, assessment techniques for pneumothorax, and potential alternatives to needle decompression. In this conversation, the speakers delve into the evolving perspectives on thoracostomy and its application in pre-hospital settings, particularly in combat medicine. They discuss the implications of tension physiology in hemothorax and the prevalence of massive hemothorax in recent years. The conversation also revisits treatment protocols for chest injuries, emphasizing the need for a shift towards simple thoracostomy over needle decompression. Finally, they evaluate the use of pigtail catheters versus traditional chest tubes, weighing the pros and cons of each in emergency situations.
Takeaways
Needle decompression is debated in the context of IFACs.
Historical context shows that needle decompression was not originally included in official DOD lists.
Hemorrhage is the leading cause of mortality in trauma cases.
Tension pneumothorax is rare, occurring in only 1.1% of cases.
Identifying tension pneumothorax in pre-hospital settings is challenging.
Medics should rely on objective data for decision-making.
Training often prioritizes speed over thorough assessment.
Prophylactic interventions for tension pneumothorax may not be effective.
Chest tubes are not always life-saving interventions.
Exploring alternatives like finger thoracostomy may be beneficial. Evolving views on thoracostomy emphasize its selective use.
Needle decompression may be overused in practice.
Tension physiology can occur with blood accumulation in the chest.
Massive hemothorax is increasingly recognized in trauma cases.
Up to 49% of combat casualties require chest tubes.
Simple thoracostomy should be prioritized over needle decompression.
Patient monitoring is crucial in pre-hospital settings.
Pigtail catheters may not be suitable for pre-hospital use.
Chest tubes are preferred for their reliability in emergencies.
Comfort for the patient is important but should not compromise urgent care.
Chapters
00:00 Introduction to the Podcast and Guest
01:01 Debate on Needle Decompression in IFACs
03:20 Historical Context of IFAC Contents
06:40 Effectiveness of Needle Decompression
09:09 Challenges in Identifying Tension Pneumothorax
12:00 Training and Decision-Making in Combat Medicine
16:21 Assessment Techniques for Pneumothorax
21:29 Interventions for Tension Pneumothorax
25:19 Exploring Alternatives to Needle Decompression
25:50 Evolving Perspectives on Thoracostomy
31:38 Understanding Tension Physiology in Hemothorax
36:41 Revisiting Treatment Protocols for Chest Injuries
43:12 Evaluating Pigtail Catheters vs. Chest Tubes
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dan McGraw discusses the critical need for gender-specific medical training in military settings, drawing from personal experiences and extensive research. He highlights the disparities in treatment outcomes between male and female patients, the physiological differences that affect trauma care, and the cultural challenges faced by medical personnel when treating patients of the opposite sex. Through case studies and real-life scenarios, Dan emphasizes the importance of understanding these differences to improve survival rates and ensure equitable treatment for all service members.
Takeaways
Dan shares a personal story about losing a friend due to medical negligence.
The importance of gender-specific medical training is emphasized.
Research shows that female casualties have different treatment needs.
Physiological differences between genders affect trauma care.
Cultural challenges hinder effective medical response to female patients.
Case studies reveal biases in treatment during emergencies.
Medical errors often occur due to gender biases in treatment protocols.
Training must address the discomfort of treating opposite genders.
The military must adapt to increasing numbers of female service members.
Future training programs need to incorporate gender-specific considerations.
Chapters
00:00 Introduction and Personal Story
02:57 The Importance of Gender-Specific Medical Training
06:11 Research Findings on Female Casualties
08:54 Physiological Differences in Trauma Treatment
12:06 Cultural and Training Challenges in Medical Response
15:08 Case Studies and Real-Life Scenarios
18:07 Addressing Medical Errors and Gender Bias
21:03 The Future of Gender-Inclusive Medical Training
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis and Ryan Maves delve into the complex world of hemorrhagic fevers, discussing various viral infections such as Ebola, Lassa fever, and dengue. They explore the symptoms, diagnosis, and treatment options available for these dangerous pathogens, emphasizing the importance of supportive care and proper waste management. The discussion also highlights the challenges faced in resource-limited settings and the need for medical intelligence and preparedness when dealing with potential outbreaks.
Takeaways
Viral hemorrhagic fevers are highly dangerous pathogens.
Ebola is a prototype for understanding these diseases.
Symptoms often start as nonspecific febrile illnesses.
Diagnosis can be challenging due to overlapping symptoms.
Supportive care is crucial for patient survival.
Fluid management is a key aspect of treatment.
Preventative measures are essential in endemic areas.
Waste management is critical in handling infected materials.
Medical intelligence plays a vital role in outbreak preparedness.
Expertise and resources are available for managing these diseases.
Chapters
00:00 Introduction to Hemorrhagic Fevers
03:07 Understanding Viral Hemorrhagic Fevers
05:48 Symptoms and Diagnosis of Hemorrhagic Fevers
14:46 Treatment and Supportive Care
24:01 Preventative Measures and Waste Management
32:00 Expertise and Resources for Care
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, hosts Dennis, John, and Paul delve into the development and application of the Abdominal Aortic Junctional Tourniquet (AAJT). John shares his background as an ER doctor and military medic, explaining the need for a device to control pelvic hemorrhage in trauma cases. Paul discusses the first applications of the AAJT in combat situations, highlighting successful case studies. The conversation also covers research findings on the device's efficacy, application techniques, and user experiences, emphasizing its importance in modern trauma care. This conversation delves into the application and implications of medical devices in emergency situations, particularly focusing on ventilation, prolonged application challenges, reperfusion injury, and the comparative effectiveness of RABOA and AJT. The discussion highlights the importance of rapid intervention in traumatic cardiac arrest and the need for ongoing research to improve outcomes in combat and emergency medicine.
Takeaways
The AAJT was developed to address junctional hemorrhage in trauma cases.
John's experience in military medicine influenced the design of the AAJT.
The device aims to control blood flow to the pelvis effectively.
Initial applications of the AAJT have shown promising results in saving lives.
Research indicates that the AAJT can be safely applied for up to two hours.
Studies have shown that the AAJT is effective in controlling hemorrhage in combat situations.
User experience suggests that the AAJT is less painful than traditional tourniquets.
The device's design allows for easy application without extensive medical training.
Ongoing research is exploring the potential for extended application times.
The AAJT has been adopted by multiple military units and allied nations. Ventilation can be maintained even with device application.
Prolonged application of medical devices can be challenging.
Preparedness is crucial in emergency situations.
Every minute of delay in hemorrhage control increases mortality.
RABOA has shown to cause harm in some studies.
The AJT device offers a promising alternative for hemorrhage control.
Research is ongoing to validate the effectiveness of AJT.
Traumatic cardiac arrest requires immediate and effective intervention.
The future of emergency medicine must adapt to new challenges.
Understanding the risks and benefits of interventions is essential.
Chapters
00:00 Introduction to the AAJT and Its Creators
05:09 The Development and Purpose of the AAJT
09:59 First Applications and Case Studies
14:47 Research and Study Data on the AAJT
20:03 Application Techniques and Pressure Management
25:09 Practical Demonstration and User Experience
26:35 Ventilation and Device Application
29:15 Challenges of Prolonged Application
32:13 Reperfusion Injury and Monitoring
36:59 Risk-Benefit Analysis in Emergency Interventions
39:41 RABOA vs. AJT: A Comparative Discussion
42:09 Research Insights on AJT Effectiveness
45:53 Future of Non-Compressible Torso Hemorrhage Treatment
50:03 Traumatic Cardiac Arrest and New Approaches
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Rick Caldwell, a seasoned sof medic, discusses the critical foundations of medical education and training for combat medics. He emphasizes the importance of quality over quantity in medic training, the need for a solid understanding of both combat and humanitarian support, and the challenges faced in modern combat medicine, particularly in prolonged field care scenarios. Caldwell advocates for a shift from mere training to comprehensive teaching that fosters critical thinking and adaptability among medics. He concludes with a call to action for improving medical education to better prepare medics for the realities of combat situations.TakeawaysHumans are more important than hardware.Quality is better than quantity in medic training.Medics cannot be mass produced; quality is essential.Combat medics must provide both combat and humanitarian support.Good medicine is the foundation of T-Tricy.Training should focus on teaching critical thinking skills.Most patients evacuated are DNBI, not just trauma cases.Current training methods may set medics up to fail.Medicine is fundamentally a logistics function.Medical education must evolve to meet modern combat challenges.Chapters00:00 Introduction to Combat Medicine03:06 The Role of Combat Medics05:55 Training vs. Teaching in Medical Education08:47 Challenges in Modern Combat Medicine11:56 The Importance of Critical Thinking15:13 Principles Over Procedures in Medical Training17:56 Conclusions and Future DirectionsThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Kevin discuss the intricacies of waking patients after sedation, focusing on procedural sedation techniques, managing emergence delirium, and the challenges of airway management. They share insights from real-world experiences, particularly in combat and austere environments, emphasizing the importance of monitoring and patient safety during the awakening process. The conversation also covers extubation strategies, the differences between Cric and ET tube management, and the significance of having a well-thought-out emergence plan from the start of anesthesia.
Takeaways
Waking a patient requires careful monitoring and reorientation.
Emergence delirium can occur with ketamine; vigilance is key.
Communication with the patient is crucial during awakening.
Airway management is critical, especially in trauma cases.
TIVA can complicate the emergence process; planning is essential.
Extubation should be based on patient readiness and safety.
Cric tubes may be better tolerated than ET tubes.
Ventilation support may be necessary during the emergence phase.
Understanding the patient's history aids in sedation decisions.
Always be prepared for unexpected airway challenges.
Chapters
00:00 Introduction to Patient Awakening
01:16 Procedural Sedation Techniques
06:24 Managing Emergence Delirium
10:40 Airway Management in Sedation
15:27 Waking Up After Long Procedures
24:23 Extubation Strategies and Considerations
30:29 Cric vs. ET Tube Management
39:06 Ventilation and Monitoring During Emergence
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Ethan discuss the critical role of patient positioning in emergency and prolonged field care. They explore various aspects of patient positioning, including its importance for TBI management, ventilation, and airway management. The conversation also addresses the risks associated with changing patient positions, the need for a safety net in patient care, and the operational considerations for medics in the field. They emphasize the significance of training and cultural factors in reducing preventable deaths in combat situations, concluding with a call to focus on the basics of patient care.
Takeaways
Patient positioning is often overlooked but crucial in care.
Elevating the head of the bed can help with TBI.
Ventilation improves with proper patient positioning.
Patients can manage their airways better when allowed to position themselves.
Reassess interventions after changing patient positions.
Improvisation is key in resource-limited environments.
Equipment design can enhance patient care in the field.
Cultural factors in military medicine impact patient outcomes.
Training in patient positioning is essential for medics.
Mastering the basics can significantly reduce preventable deaths.
Chapters
00:00 Introduction to Patient Positioning
02:21 The Importance of Patient Positioning
06:01 Patient Positioning for TBI and Ventilation
09:20 Airway Management and Patient Positioning
14:25 Risks and Downsides of Changing Patient Position
19:18 Building a Safety Net in Patient Care
20:22 Operational Considerations for Patient Positioning
24:29 Improvisation and Equipment in Patient Care
27:46 Positioning in Prolonged Field Care
30:03 Cultural Factors in Reducing Preventable Deaths
36:40 Conclusion and Key Takeaways
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This presentation explores the challenges and needs of military operations in the Arctic, particularly focusing on cold-weather medicine and the stability of medications in extreme conditions. Emily emphasizes the urgency of improving medic training and resources, the lack of solid data on medication efficacy in cold environments, and the need for innovative solutions to ensure medics can operate effectively. She calls for collaboration and data sharing among partner nations to enhance medical care in extreme cold environments.
Sorry, if you would like to see the slides, you'll have to become a paid member. Takeaways
We don't have a whole lot of military presence above the Arctic Circle.
Cold is the enemy; we need to get used to it.
The greatest need is initial care at the point of injury.
We need to improve the ability of our medics to operate efficiently in cold environments.
Most medication stability data is from controlled environments, not extreme conditions.
We need to test medications in field environments to understand their stability.
Base layer transport is a promising method for carrying medications in cold weather.
We need actual inventions that work for medics in the field.
Siloing up information is not the answer; we need collaboration.
Identifying high-priority medications is crucial for effective cold-weather operations.
Chapters
00:00 The Arctic Military Landscape
02:47 Challenges of Cold Weather Medicine
05:59 Medication Stability in Extreme Conditions
08:54 Innovative Solutions for Cold Weather Operations
11:52 Data Collection and Research Needs
15:04 Practical Tips for Medics in Cold Environments
18:02 Future Directions in Cold Weather Medical Care
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Since the vast majority of you guys couldn't go to SOMSA '25, I'm bringing SOMSA '25 to you. Paul and I got our steps in this year and recorded a ton of presentations. These presentations with slides will only be available for subscription members...Enjoy
In this episode of the PFC Podcast, Dr. Jason Hiles discusses the challenges and strategies of providing medical care in unconventional warfare environments. He shares insights from his experiences in Southeast Asia, focusing on the importance of adaptability, community engagement, and training local medics to ensure sustainable healthcare practices in resource-limited settings. The conversation covers various surgical techniques, trauma management, and the significance of building trust within the communities served.
Takeaways
The need for trained personnel in war zones is critical.
Adaptability in surgical techniques is essential in resource-limited environments.
Community engagement fosters trust and improves healthcare access.
Surgical care must be tailored to the specific needs of the environment.
Triage and evacuation strategies are vital in managing war wounds.
Training local medics ensures continuity of care after foreign personnel leave.
Simplicity in medical kits can enhance operational efficiency.
Understanding local customs and languages improves patient care.
The impact of war on civilian health requires innovative solutions.
Building relationships with local communities can lead to better health outcomes.
Chapters
00:00 Introduction to Unconventional Warfare Medicine
03:12 Operational Challenges in Resource-Limited Environments
06:07 Surgical Techniques and Patient Care in Conflict Zones
09:00 Managing War Wounds and Trauma
11:55 Triage and Evacuation Strategies
15:10 Community Engagement and Building Trust
18:14 Training Local Medics and Sustainable Practices
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast from last year, Dennis interviews Victor, a former Ranger and current tactical medicine program manager, who shares his experiences in Burma with the Free Burma Rangers. Victor discusses the evolving situation on the ground, his transition from military to humanitarian work, and the challenges of training indigenous forces in combat medicine. He emphasizes the importance of basic medical techniques, the complexities of blood collection and transfusion, and the management of mass casualties in a combat environment. Throughout the conversation, Victor reflects on the lessons learned from his experiences and the realities of operating in a conflict zone. In this conversation, the speaker shares their experiences and insights from operations in Burma, focusing on air operations, reconnaissance techniques, and the challenges of medical planning in hostile environments. They discuss the importance of movement discipline, ground reconnaissance, and resource management in ensuring the safety and effectiveness of their operations. The conversation highlights the complexities of providing medical care in combat situations and the need for adaptability and strategic planning.
Takeaways
Victor transitioned from military service to humanitarian work.
The situation in Burma is rapidly changing with ethnic forces gaining ground.
Training indigenous forces requires cultural understanding and respect.
Basic medical techniques are crucial in combat medicine training.
Blood collection and transfusion present significant challenges in the field.
Managing mass casualties requires effective triage and resource allocation.
Training local medics can lead to successful outcomes in emergencies.
Logistics and communication are vital in combat scenarios.
The experience highlighted the importance of adaptability in medical training.
Victor learned to appreciate the resources available in military medicine. The Burma army utilizes advanced air operations for reconnaissance and strikes.
Movement and noise discipline are critical in combat situations.
Ground reconnaissance is essential for safe movement and operational success.
Medical planning must account for the capabilities of local hospitals.
Prolonged field care requires careful consideration of resources and logistics.
Effective communication and teamwork are vital during operations.
Understanding enemy tactics can enhance operational planning.
Pre-packing medical supplies can save time during emergencies.
Adaptability is key in unpredictable combat environments.
Continuous learning and preparation are necessary for effective field care.
Chapters
00:00 Introduction to Victor's Journey
01:57 The Situation in Burma
04:08 Transitioning from Military to Humanitarian Work
05:50 Training Indigenous Forces in Combat Medicine
12:07 Implementing Medical Techniques in the Field
19:47 Challenges of Blood Collection and Transfusion
28:03 Managing Mass Casualties in Combat
39:48 Lessons Learned from the Experience
41:58 Air Operations and Reconnaissance Techniques
47:12 Engaging with the Enemy: Capturing Prisoners
50:16 Ground Reconnaissance and Movement Discipline
55:29 Medical Planning in Hostile Environments
01:01:40 Challenges of Prolonged Field Care
01:07:13 Logistical Considerations and Resource Management
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Doug delve into the complexities of bradyarrhythmias, discussing their recognition, causes, and treatment options. They explore the importance of vital signs, differential diagnosis, and the various pharmacological and electrical interventions available for managing bradycardia. The conversation also touches on the implications of overdoses and the long-term management of patients with bradyarrhythmias, emphasizing the need for a comprehensive approach in emergency medicine.
Takeaways
Recognizing bradycardia involves checking vital signs and symptoms.
Not all bradycardias are the same; context matters.
Altered mental status can indicate shock in bradycardia cases.
Lyme disease is a significant cause of bradycardia in younger populations.
Narcotic overdose can lead to bradycardia and requires immediate attention.
Atropine is a quick and handy treatment for bradycardia.
Transcutaneous pacing is a common emergency intervention.
Dopamine is preferred for its targeting of heart rate in bradycardia.
Glucagon is an expensive but necessary treatment for beta-blocker overdose.
Treating hypoxia is crucial before addressing bradycardia.
Chapters
00:00 Introduction to Bradyarrhythmias
03:01 Recognizing Bradycardia and Its Symptoms
06:14 Causes of Bradycardia
09:02 Differential Diagnosis in Bradycardia
11:57 Stabilization and Treatment Approaches
14:46 Pharmacological Interventions for Bradycardia
17:59 Electrical Interventions: Pacing Techniques
20:55 Managing Overdoses and Bradycardia
23:48 Long-term Management and Follow-up
26:54 Conclusion and Key Takeaways
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-228-DImE-e32aek2
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Ian Wedmore, an expert in high altitude medicine, discusses the newly released Clinical Practice Guidelines (CPG) for altitude-related illnesses. The conversation covers the pathophysiology of acute mountain sickness, high altitude pulmonary edema, and high altitude cerebral edema, as well as their diagnosis and treatment protocols. Ian emphasizes the importance of understanding the symptoms, utilizing technology, and implementing prevention strategies to effectively manage altitude illnesses in military and wilderness settings.
Takeaways
The new CPG for altitude medicine is a significant advancement.
Acute mountain sickness occurs when the body ascends too quickly without acclimatization.
Diagnosis of altitude sickness relies heavily on symptom scoring systems.
Vital signs are crucial for diagnosing high altitude pulmonary edema.
Dexamethasone is essential for treating high altitude cerebral edema.
Pre-exposure prophylaxis can reduce the risk of altitude sickness.
Acetazolamide is the primary medication for preventing acute mountain sickness.
Understanding the pathophysiology of altitude illnesses is key for treatment.
Good hydration and nutrition are critical for acclimatization.
Data collection through medic encounter forms will improve altitude care.
Chapters
00:00 Introduction to High Altitude Medicine
02:51 Understanding Acute Mountain Sickness
06:13 Diagnosing and Differentiating Altitude Illnesses
08:56 Pathophysiology of High Altitude Pulmonary and Cerebral Edema
12:04 Treatment Protocols for Altitude Illnesses
15:08 Utilizing Technology in Altitude Medicine
18:00 Prevention and Prophylaxis Strategies
20:45 The Role of Medications in Altitude Care
24:13 Future Directions in Altitude Medicine
27:01 Conclusion and Key Takeaways
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-228-DImE-e32aek2
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Help with what they actually need. Having a long-term view will bring lasting success.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-228-DImE-e32aek2
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis speaks with Dr. Jim Czarnik, a retired Army officer with extensive experience in military medicine and operations. They discuss the complexities of military medicine, the importance of communication between medical and operational personnel, and the challenges of adapting to future conflicts, particularly in the context of large-scale combat operations (LISCO). Jim emphasizes the need for honest discussions about the role of medicine in the military and the moral dilemmas faced in battlefield situations. The conversation also touches on the integration of technology in tactical medicine and the necessity of training for real-world scenarios. In this conversation, the speakers delve into the complexities of military operations, focusing on the moral dilemmas faced by medics, the importance of understanding diplomatic language, and the necessity of being well-informed about national interests when engaging in foreign nations. They emphasize the need for courageous vulnerability in communication and the importance of preparation and information gathering to ensure successful missions. This conversation delves into the complexities of military operations, particularly focusing on the importance of resource management, the necessity of basic medical skills in prolonged field care, and the critical role of clinical judgment in medical training. The speakers emphasize the need for cultural sensitivity and effective patient interaction in combat situations, as well as the importance of strategic engagement and long-term planning in military medicine. They discuss the challenges faced by medics in adapting to different environments and the need for a collaborative approach to healthcare in military operations.
Takeaways
Medicine exists to serve the line, highlighting its role in military operations.
There is often a lack of understanding between medical and operational personnel.
Training for LISCO requires adapting to the environment, not just changing it.
Time is a critical factor in military operations and training.
Moral dilemmas in battlefield medicine need to be addressed beforehand.
Technology can enhance tactical medicine, but must be integrated thoughtfully.
Honest discussions about roles and expectations are crucial in military settings.
The complexity of military medicine requires a balance between operational needs and medical capabilities.
Future conflicts will demand innovative approaches to medical care on the battlefield. It's not just about the mission; it's about the relationships.
Engagement with foreign nations requires understanding their systems.
Courageous vulnerability is essential in military interactions.
Clinical judgment is often lacking in medical training.
The command element must prioritize medical training.
Long-term planning is necessary for successful military engagement.
Chapters
02:51 Winning in a Complex World: Insights from Jim
19:32 The Role of Technology in Tactical Medicine
27:15 Adapting to Future Conflicts: LISCO and Beyond
42:51 Warrior's Will and Moral Dilemmas
45:07 Understanding the Medic's Role in Military Operations
47:20 Navigating Diplomatic and Military Language
52:00 Engagement Strategies in Foreign Nations
01:01:11 Understanding National Interests and Engagement Plans
01:07:57 Information Gathering and Preparation
01:12:43 Courageous Vulnerability in Military Engagements
01:20:26 The Future of Military Operations and Resource Management
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Medicine is no different. You either adapt to the environment or you will fail.
Posting tomorrow..
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This conversation delves into the critical aspects of tourniquet management in trauma care, focusing on the distinction between tourniquet conversion and replacement, the importance of resuscitation, and the physiological implications of prolonged tourniquet use. The speakers discuss techniques for safe conversion, the challenges faced in the field, and the assessment of limb salvageability, emphasizing the need for preparedness and patient assessment in high-stress environments. This conversation delves into the complexities of patient care in trauma situations, focusing on the challenges faced by medics in making critical decisions about limb salvage, managing acidosis, and understanding reperfusion injury. The speakers emphasize the importance of resuscitation, the need for adequate resources, and the moral dilemmas that arise in emergency medical situations. They provide practical advice for medics on how to navigate these challenges effectively while ensuring patient safety and care quality.
Takeaways
Tourniquet conversion is essential in trauma care.
Understanding the difference between conversion and replacement is crucial.
Resuscitation is a key factor before converting a tourniquet.
The two-hour mark for tourniquet use is based on physiological considerations.
Prolonged tourniquet time can lead to significant metabolic issues.
Be prepared for reperfusion injury when converting a tourniquet.
Confidence in tourniquet conversion skills is often lacking among providers.
Patient assessment is critical before converting a tourniquet.
Limb salvageability can vary and should be assessed carefully.
The decision to convert a tourniquet should prioritize patient stability. Imperfect situations require difficult decisions in patient care.
Triage decisions are crucial when resources are limited.
Resuscitation is the primary goal in trauma care.
Understanding reperfusion injury is essential for medics.
Managing acidosis can significantly impact patient outcomes.
Blood transfusions are critical in trauma situations.
Medics must be prepared for potential complications.
Always monitor and assess the patient's condition continuously.
Reading medication labels is vital for safe practice.
Confidence in converting tourniquets is essential for medics.
Chapters
00:00 Introduction to Tourniquet Management
02:56 Understanding Tourniquet Conversion vs. Replacement
06:10 Resuscitation Goals and Tourniquet Timing
08:58 Physiological Implications of Prolonged Tourniquet Use
11:47 Techniques for Safe Tourniquet Conversion
15:09 Challenges in Tourniquet Management
17:53 Assessing Limb Salvageability and Patient Stability
25:44 Navigating Imperfect Situations in Patient Care
30:32 Triage Decisions: When to Save a Limb
31:03 Understanding Reperfusion Injury and Its Challenges
35:43 Managing Acidosis in Trauma Patients
46:34 Advice for Medics: The Importance of Conversion
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The hardest thing in medicine is to dial back a treatment.
Link to full podcast:
https://spotifycreators-web.app.link/e/06Azb81cTSb
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
We know the right answer, but we still don't follow it!
Link to full podcast:
https://spotifycreators-web.app.link/e/06Azb81cTSb
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Alex delve into the complexities of burn resuscitation, discussing recent advancements in fluid management and the importance of urine output monitoring. They explore the historical context of burn care, the role of glycocalyx in fluid dynamics, and evaluate various resuscitation protocols. The conversation emphasizes the need for careful fluid management to avoid complications and improve patient outcomes, particularly in emergency and military settings.
Takeaways
- Burn injuries require specialized and intensive care.
- Fluid management is critical in burn resuscitation.
- The glycocalyx plays a significant role in fluid dynamics.
- Urine output is a key indicator of patient status.
- Over-resuscitation can lead to severe complications.
- Plasma therapy shows promise in improving outcomes.
- Historical protocols may need reevaluation based on new evidence.
- Monitoring urine output is essential for adjusting fluid therapy.
- Collaboration with burn centers is crucial in managing severe cases.
- Understanding the physiological changes in burn patients is vital.
Chapters
00:00 Introduction to Burn Resuscitation
03:09 Understanding Burn Injuries and Their Management
06:00 Fluid Management in Burn Patients
09:05 The Role of Glycocalyx in Fluid Dynamics
12:04 Evaluating Burn Resuscitation Protocols
15:08 Comparing Fluid Resuscitation Strategies
17:51 The Importance of Urine Output Monitoring
20:47 Outcomes of Different Resuscitation Approaches
24:01 Recommendations for Burn Care in the Field
26:59 Final Thoughts on Burn Resuscitation
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Hint...It has nothing to do with the formula.
Posting tomorrow.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, trauma surgeon Dr. Mark Shapiro discusses advanced trauma care techniques, including Roboa, hemorrhage control methods, and the importance of decision-making in high-stakes environments. He emphasizes the need for ongoing training and collaboration between civilian and military medical professionals to improve patient outcomes in trauma situations. The conversation also touches on the role of telemedicine in providing guidance for advanced procedures in austere settings.
Takeaways
- Roboa is a controversial procedure with mixed reviews.
- Decision-making in trauma surgery is critical and complex.
- Training and practice are essential for proficiency in advanced procedures.
- Telemedicine can enhance trauma care by providing expert guidance.
- Collaboration between civilian and military trauma care is vital.
- Alternative hemorrhage control techniques are limited but evolving.
- The consequences of surgical decisions can be life or death.
- Regular training refreshers are necessary for trauma medics.
- Understanding the environment is crucial for effective trauma care.
- Patient outcomes can improve with better training and experience.
Chapters
00:00 Introduction to Advanced Trauma Care
02:51 Understanding Roboa and Its Implications
06:11 Decision-Making in Trauma Surgery
09:03 Exploring Alternative Hemorrhage Control Techniques
12:03 The Role of Training and Practice in Trauma Procedures
15:04 Shunts and Limb Reperfusion in Trauma
18:04 Thrombectomy and Its Challenges
21:03 Telemedicine in Trauma Care
24:11 Collaboration Between Civilian and Military Trauma Care
27:13 Recruiting and Training for Advanced Trauma Procedures
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The same standard doesn't equal the same approach.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-226-Training-Feedback-e31lvbn
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Real feedback can't be cookie-cutter.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-226-Training-Feedback-e31lvbn
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis and Justin explore the nuances of providing feedback in educational settings, particularly in medical training. They discuss the importance of tailoring feedback to different learner levels, the concept of training to failure, and the significance of creating a safe environment for feedback. The conversation also delves into assessing learner needs, setting expectations, and the balance between giving constructive criticism and managing personal egos. Overall, the discussion emphasizes the art of effective teaching and the complexities involved in delivering feedback that fosters growth and learning. In this conversation, Justin Doroshenko and Dennis discuss the intricacies of medical education, focusing on the importance of addressing learner anxiety, facilitating self-discovery, and the significance of process-oriented learning. They explore the concept of training to failure, the design of effective training scenarios, and the necessity of establishing clear learning outcomes. Additionally, they emphasize the recognition and addressing of training scars that can hinder a learner's development.takeaways
- Tailoring feedback is essential for different learner levels.
- Training to failure can enhance learning experiences.
- Feedback should be task-oriented for beginners.
- Creating a safe environment for feedback is crucial.
- Setting clear expectations helps learners prepare for feedback.
- Experienced providers may not always be effective teachers.
- Feedback can resonate differently with each individual.
- Understanding the learning spectrum aids in providing effective feedback.
- Balancing feedback with personal ego is important for educators.
- Feedback is a gift that can lead to growth or resistance. New learners often panic when faced with criticism.
- Understanding the thought process behind decisions is crucial.
- Facilitating self-discovery enhances learning outcomes.
- Training to failure can be a valuable educational tool.
- Creating realistic training scenarios is essential.
- Establishing clear learning outcomes guides the educational process.
- Feedback should focus on the thought process, not just outcomes.
- Recognizing training scars can improve teaching effectiveness.
- Peer feedback can be less intimidating for learners.
- Teaching judgment is more complex than teaching facts.
Chapters
00:00 Tailoring Feedback for Different Learners
02:57 Training to Failure in Education
05:57 Understanding the Learning Spectrum
08:55 Assessing Learner Needs
11:59 Creating a Safe Feedback Environment
14:59 The Importance of Setting Expectations
17:46 Navigating the Feedback Process
20:47 The Gift of Feedback
24:00 The Role of Experience in Teaching
27:05 Balancing Feedback and Ego
35:00 Navigating Learner Anxiety in Medical Education
37:50 Facilitating Self-Discovery in Learning
40:55 The Importance of Process Over Outcome
43:55 Pushing Boundaries: Training to Failure
48:48 Designing Effective Training Scenarios
54:10 Establishing Clear Learning Outcomes
57:55 Recognizing and Addressing Training Scars
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Training guys to the edge of their capabilities.
Posting tomorrow...
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Experience is only gained by experience. Find a way to actually use (legally) the narcotics you're issued.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-S-Ketamine-e31etbb
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Not every drug works well with trauma patients.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-S-Ketamine-e31etbb
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Pac delve into the intricacies of ketamine and esketamine, exploring their applications in military medicine, particularly in battlefield scenarios. Pac shares his extensive experience as an anesthetist and military medical officer, discussing the evolution of ketamine, its effectiveness in pain management, and the cultural differences in pain perception. The conversation emphasizes the importance of proper training and planning in administering these drugs, as well as the role of regional anesthesia in enhancing patient care. This conversation delves into the various aspects of ketamine administration, including routes, dosages, and the importance of experience in emergency medicine. The speakers discuss the nuances of managing pain, the significance of understanding pharmacology, and the practicalities of using ketamine in hemodynamically unstable patients. They also touch on the importance of teaching and preparing for emergencies, as well as the value of gaining hands-on experience in different environments.takeaways
- Esketamine is often viewed as a superior alternative to traditional ketamine.
- Cultural perceptions of pain can significantly influence patient responses to anesthesia.
- Proper training in drug administration is essential for medical personnel.
- Ketamine has a high tolerance for side effects, making it safer in emergency situations.
- Regional anesthesia can complement ketamine use for better pain management.
- The effectiveness of ketamine in battlefield scenarios is well-documented.
- Dosage and administration techniques are crucial for achieving desired effects with ketamine.
- Understanding patient responses is key to effective pain management.
- The evolution of ketamine reflects ongoing advancements in medical practices.
- A comprehensive plan is necessary when using ketamine for sedation or analgesia. Different routes of administration for ketamine have varying bioavailabilities.
- Dosage adjustments are crucial when switching between IV and IM routes.
- Experience in drug administration can significantly impact patient outcomes.
- Managing adverse effects requires patience and a clear plan.
- Planning for patient transport is essential in emergency situations.
- Teaching pharmacology should focus on techniques applicable to all narcotics.
- Ketamine is effective for hemodynamically unstable patients.
- Ketamine can be used in managing refractory seizures.
- Hands-on experience is invaluable for medical professionals.
- Utilizing local knowledge can enhance treatment effectiveness.
Chapters
00:00 Introduction to the Podcast and Guests
01:10 Exploring Esketamine: A Medical Perspective
03:51 The Evolution of Ketamine in Medicine
07:14 Practical Applications of Ketamine in Military Medicine
11:06 Cultural Differences in Pain Perception
13:19 Dosage and Administration of Esketamine
16:12 Comparing Ketamine and Morphine in Battlefield Analgesia
18:59 The Role of Regional Anesthesia in Pain Management
22:16 Training Challenges in Medical Personnel
25:14 Assessing Pain Management Effectiveness
27:59 Exploring Routes of Administration for Ketamine
30:57 Understanding Dosage and Onset Times
32:20 The Importance of Experience in Drug Administration
34:27 Managing Adverse Effects and Overdoses
36:14 Planning for Patient Transport and Sedation
39:10 Teaching Pharmacology and Emergency Preparedness
41:03 Ketamine in Hemodynamically Unstable Patients
45:11 Ketamine's Role in Seizure Management
48:22 Gaining Practical Experience with Ketamine
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Posting tomorrow...
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Nobody can run this alone; Unit buy-in is essential.
Link to full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-care-Podcast-225-Mastering-Triage-e31er64
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
MASCALs are not solely a medical problem.
Link to full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-care-Podcast-225-Mastering-Triage-e31er64
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Start with the basics...Like REAL basic.
Link to full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-care-Podcast-225-Mastering-Triage-e31er64
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC podcast, Dennis, Andrew, and Rick delve into the critical topic of triage in emergency medicine. They explore the complexities of triage during mass casualty situations, emphasizing the importance of quick decision-making and prioritization of patient care. Andrew shares his experiences as an emergency medicine physician, highlighting the chaotic nature of triage and the necessity of using intuitive methods to assess patients effectively. The conversation covers various triage categories, techniques, and the significance of clinical judgment in determining patient needs during emergencies. This conversation delves into the complexities of triage in emergency medical situations, emphasizing the importance of decision-making under pressure, the role of medical leadership, and the integration of security measures. The speakers discuss the dynamic nature of triage, the ethical dilemmas faced in resource allocation, and the necessity of effective communication and collaboration among medical teams and command structures during mass casualty events. This conversation delves into the complexities of triage in high-pressure medical situations, particularly in military contexts. The speakers discuss the importance of effective training, the management of mass casualty scenarios, and the need for a comprehensive approach that includes both medical and non-medical personnel. They emphasize the necessity of adapting training to reflect real-world challenges and the importance of leadership in ensuring successful outcomes during emergencies.
Takeaways
- Triage is never perfect; it's chaotic and unpredictable.
- Use the simplest methods for triage in emergencies.
- Identify who is dying now versus who is stable.
- Focus on life-saving interventions first.
- Triage is a continuous process, not a one-time event.
- Utilize all available resources during a mass casualty.
- Clinical judgment is crucial in triage decisions.
- Trust your instincts when assessing patient urgency.
- Most patients in mass casualty scenarios are routine or priority.
- Effective communication and organization are key in triage situations. Triage decisions must be made quickly and efficiently under pressure.
- Assessing patient stability is crucial for effective resource allocation.
- Medical leaders must maintain situational awareness during triage.
- Communication between medical and non-medical leaders is essential.
- Security measures must be integrated into medical response plans.
- Triage is a dynamic process that requires constant reassessment.
- Ethical dilemmas arise when deciding how to allocate limited resources.
- Collaboration with surgical teams is vital for patient outcomes.
- Training should address both medical and security aspects of triage.
- Effective management of patient flow can improve overall care during crises. Triage in high-volume situations requires strategic patient distribution.
Chapters
00:00 Introduction to Triage and Its Importance
03:05 Understanding Triage Categories
09:01 Triage Techniques and Strategies
11:59 Evacuation Categories and Decision Making
14:59 Clinical Judgment in Triage
21:20 Assessing Patient Stability and Resource Allocation
25:19 Security Considerations in Mass Casualty Events
29:27 Integrating Security and Medical Response
38:50 Triage in High-Volume Situations
41:53 Managing Mass Casualty Scenarios
44:48 Command and Control in Triage
45:57 Defining Success in Mass Casualty Training
51:05 Improving Triage Processes
57:59 Final Thoughts on Triage and Training
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Posting tomorrow...
If everything is going well...it's probably not a MASCAL.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
What your units expect from you.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-What-is-a-SOF-Medic-e317vq9
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
It's not just your boss you have to work with.
Link to full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-What-is-a-SOF-Medic-e317vq9
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This podcast episode delves into the roles and responsibilities of various special operations medics, including Ranger medics, SOIDCs, and SEAL medics. The discussion highlights the unique training, skills, and challenges these medics face in the field, emphasizing the importance of trust, communication, and continuous learning in military healthcare. The speakers share their experiences and insights on the evolution of medic training and the critical nature of their roles in combat situations. This conversation delves into the intricate dynamics between medics and PAs within military teams, highlighting the importance of intimate relationships, expectations from new medical personnel, and the necessity of building trust and rapport. The discussion emphasizes the value of field experience for medical providers and the critical role of advocacy and support for medics to enhance their effectiveness in the field. The speakers share insights on how to foster better communication and collaboration within medical teams to ultimately improve patient care and outcomes.
Takeaways
- Ranger medics focus on TCCC and basic skills.
- SOIDCs have unique provider roles within the Navy.
- SEAL medics are expanding their capabilities in various environments.
- Trust and communication are vital for effective medical care.
- New providers must understand the diverse experiences of medics.
- Medic training is evolving to include prolonged field care.
- Relationships between medics and providers shape career paths.
- Continuous learning is essential for maintaining clinical skills.
- The operational environment influences medic training and practice.
- Team dynamics play a crucial role in medical effectiveness. The relationship between medics and IDCs is crucial for effective teamwork.
- PAs play a significant role in supporting medics during operations.
- Building rapport is essential for successful medical practice in military settings.
- Field experience is vital for medical providers to understand operational challenges.
- Trust between medics and doctors enhances patient care and team effectiveness.
- Advocacy for medics' needs is necessary for optimal performance.
- Medical personnel should be proactive in seeking knowledge and training.
- Understanding the unique challenges faced by medics is key for providers.
- Effective communication can bridge gaps between different roles in medical teams.
- Support from leadership can significantly impact the morale and performance of medics.
Chapters
00:00 Introduction to Special Operations Medics
02:59 Roles and Responsibilities of Ranger Medics
05:47 Understanding the SOIDC and Navy Medics
08:56 The Role of SEAL Medics
11:48 Comparative Analysis of SOF Medics
15:01 The Importance of Trust and Communication
18:04 Challenges Faced by New Providers
20:57 The Evolution of Medic Training
24:14 Conclusion and Final Thoughts
39:33 The Role of Medics and PAs in Team Dynamics
42:24 Expectations from New Medical Personnel
49:17 Building Rapport and Trust in Medical Teams
51:55 The Importance of Field Experience for Providers
52:28 Advocacy and Support for Medics
01:01:19 Final Thoughts on Enhancing Medical Support
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
AI is helpful for relevant suggestions, but you're the provider.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-224-AI-in-Austere-Medicine-e3152uk
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
AI is not the crutch you're looking for.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-224-AI-in-Austere-Medicine-e3152uk
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Can we put that much faith in the information given, to make a medical decision based on AI?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-224-AI-in-Austere-Medicine-e3152uk
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis and Steven Blocker discuss the integration of AI in healthcare, particularly in emergency medicine. They explore the capabilities and limitations of various AI models, including large language models and natural language processing, and their applications in diagnostics, patient care, and education. The conversation also touches on the ethical considerations and accountability surrounding AI usage in medical settings, emphasizing the importance of understanding the technology's boundaries and ensuring patient safety. In this conversation, Steven Blocker and Dennis discuss the evolving role of AI in healthcare, emphasizing the importance of medical protocols, the responsibilities of healthcare providers, and the limitations of AI in clinical decision-making. They explore the potential for AI to assist in surgical procedures, the future of AI in medicine, and the need for AI to adapt to changing medical practices. The discussion highlights the necessity of human oversight in medical decisions and the importance of using AI as a tool to enhance, rather than replace, the clinician's expertise.
Takeaways
- AI has been around for a long time, but its recent popularity is notable.
- Understanding the bounds of AI is crucial for effective use.
- AI cannot be used offline, especially on mobile devices.
- Large language models provide answers with confidence but lack true understanding.
- Always fact-check AI outputs, as they may contain inaccuracies.
- AI can assist in triage processes but requires tailored software.
- Ethical considerations in AI usage are paramount in healthcare.
- AI can enhance education and training for medical professionals.
- The quality of AI-generated information must be critically evaluated.
- Accountability in AI usage is essential to prevent liability issues. It's crucial to adhere to medical protocols to avoid blame.
- Healthcare providers are ultimately responsible for patient decisions.
- AI should augment medical decision-making, not replace it.
- The effectiveness of AI in surgery depends on the data it is trained on.
- AI can assist medics but cannot replace their experience.
- AI needs sufficient data to make informed decisions.
- The future of AI in healthcare is promising but uncertain.
- AI must adapt to evolving medical practices and protocols.
- Using AI effectively requires understanding its limitations.
- AI can help summarize and analyze patient data efficiently.
Chapters
00:00 Introduction to AI in Medicine
02:54 Understanding AI Models and Their Applications
05:46 The Role of AI in Patient Care
09:08 AI in Diagnostics and Decision Support
12:05 AI in Education and Training
15:08 Challenges and Limitations of AI in Medicine
18:10 Ethics and Accountability in AI Usage
20:50 Future of AI in Healthcare
27:00 Navigating Medical Protocols and Responsibilities
30:02 The Role of AI in Medical Decision-Making
33:13 AI in Surgical Procedures: Potential and Limitations
38:57 The Future of AI in Healthcare
43:05 Adapting AI to Evolving Medical Practices
48:08 Maximizing AI's Utility in Clinical Settings
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Posting tomorrow..
Finally....something to do my thinking for me?
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Benzo reversal has it's own consequences.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Versed-and-Sedation-Mastery-e30s38g
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
It is harder to get right than analgesia and the consequences are just as bad.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Versed-and-Sedation-Mastery-e30s38g
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, the discussion revolves around patient positioning during procedural sedation, the pharmacology and application of Versed (Midazolam), and the nuances of dosing in various clinical scenarios. The speakers emphasize the importance of having a plan for airway management, the physiological implications of patient positioning, and the amnestic effects of Versed in trauma and surgical settings. They share insights from their experiences in austere environments, highlighting the need for adaptability and careful consideration of patient responses to sedation. In this conversation, the speakers delve into the complexities of IV amnestics, particularly focusing on Propofol and Midazolam, and the challenges faced during sedation in anesthesia. They discuss the importance of monitoring patient comfort, the nuances of sedation versus analgesia, and the implications of using drugs like Ketamine and Versed. The conversation highlights the critical nature of assessing patient responses and the difficulties in managing sedation effectively, emphasizing that sedation is often more challenging than general anesthesia.
Takeaways
- Patient positioning is crucial during procedural sedation.
- Recovery position may enhance airway protection during sedation.
- Always have a plan for airway management in different positions.
- Versed is a GABA agonist that promotes sedation and amnesia.
- Dosing of Versed varies significantly based on patient condition.
- In trauma cases, lower doses of sedatives may be necessary.
- Communication with the patient is key when administering sedatives.
- Understanding the pharmacodynamics of Versed aids in effective use.
- Amnestic effects of Versed can be dose-dependent.
- Clinical experience plays a significant role in medication administration. IV amnestics like Propofol and Midazolam do not have a guaranteed amnestic dose.
- Sedation is one of the most challenging aspects of anesthesia.
- Monitoring vital signs is crucial during sedation to assess patient comfort.
- The physiological state of the patient significantly affects drug dosing.
- Ketamine is not considered an amnestic drug by some providers.
- Patient comfort is paramount, and sedation must be carefully managed.
- The use of narcotics can help manage discomfort during sedation.
- Understanding the patient's history, such as alcohol use, is important for dosing.
- Sedation requires constant assessment and adjustment of medications.
- The complexities of sedation often make it more difficult than general anesthesia.
Chapters
00:00 Introduction to Patient Positioning in Procedural Sedation
09:57 Understanding Versed: Mechanism and Usage
19:54 Dosing Strategies for Versed in Different Patient Scenarios
29:54 Amnestic Effects and Clinical Considerations of Versed
35:05 Understanding IV Amnestics: Propofol and Midazolam
39:01 The Challenges of Sedation in Anesthesia
45:26 Monitoring and Assessing Patient Comfort During Sedation
51:27 Navigating the Complexities of Sedation and Analgesia
57:55 The Role of Versed and Ketamine in Anesthesia
01:01:39 Final Thoughts on Sedation Practices and Patient Safety
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content, go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
We all say it "I'll consider my H's and T's". How do you actually consider, assess, and DO SOMETHING ABOUT IT.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-223-Cardiac-Arrest-e30k73l
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
We'll keep going till our arms fall off, but when DO YOU STOP CPR?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-223-Cardiac-Arrest-e30k73l
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
You haven't won yet. You still have to respond to ROSC.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-223-Cardiac-Arrest-e30k73l
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Doug dive deep into Advanced Cardiac Life Support (ACLS) focusing on Pulseless Ventricular Tachycardia (VTAC) and Ventricular Fibrillation (V-Fib). They discuss the challenges of performing CPR in military settings, the roles and responsibilities during resuscitation, and the importance of understanding H's and T's in improving patient outcomes. The conversation also covers post-resuscitation care, the difficult decision of when to call it, and the role of telemedicine in ACLS. The episode emphasizes the need for teamwork, effective communication, and the importance of being prepared for unexpected situations in emergency care.Takeaways
- Continuous high-quality CPR is crucial for survivability.
- In military settings, situational awareness is key for effective CPR.
- One knowledgeable person can lead a resuscitation effort.
- BLS is the foundation for any good ACLS.
- Timekeeping during CPR is essential for effective management.
- H's and T's are critical in identifying reversible causes during resuscitation.
- Post-resuscitation care is vital to prevent relapse.
- Telemedicine can provide valuable support during ACLS.
- Witnessed cardiac arrests have better outcomes than unwitnessed ones.
- Effective communication with the team is essential during resuscitation efforts.
Chapters
00:00 Introduction to ACLS and VTAC
02:58 Challenges of CPR in Military Settings
06:02 Roles and Responsibilities in ACLS
09:01 Understanding H's and T's in Resuscitation
12:08 Post-Resuscitation Care and Considerations
17:54 Deciding When to Call It
24:11 The Role of Telemedicine in ACLS
30:00 Conclusion and Final Thoughts
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Posting tommorow
When was the last time you ran through a cardiac arrest scenario? Not common for us, but it does happen.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
You need to have survival skills to work in the austere environment.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Ground-Truth-in-Ukraine-e30hg2h
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
While documentation is difficult on/near the X, it is so vitally important.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Ground-Truth-in-Ukraine-e30hg2h
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The podcast was recorded in the days following the invasion of Ukraine. Hopefully, this war will end soon, but it's always smart to remember how it started.
In this episode of the PFC Podcast, Dr. John Quinn provides an in-depth update on the medical response to the ongoing conflict in Ukraine. He discusses the evolution of medical training, the challenges faced in providing care, and the surprising developments in clinical practices amidst the war. The conversation highlights the logistical difficulties, the nature of injuries sustained, and the principles of casualty care that have emerged from the experience of prolonged field care in a conflict zone. In this conversation, the speakers discuss critical aspects of managing catastrophic bleeding, airway challenges, and the importance of preparation for transport in medical emergencies. They emphasize the risks associated with humanitarian work in Ukraine, the need for NGOs to engage with local needs, and advancements in blood management practices. The discussion also highlights the significance of sharing lessons learned from the ongoing conflict and the essential training topics for medical practitioners working in such environments.Takeaways
- The conflict has led to significant changes in medical training and practices.
- There has been a focus on prolonged field care due to extended evacuation times.
- Logistical challenges are a major issue in providing medical care.
- The quality of clinical care in Ukraine is impressive despite resource limitations.
- Injuries from modern warfare present unique challenges for medical responders.
- Scene safety is a critical principle in casualty care.
- Documentation of care is essential but challenging in conflict zones.
- Training and adherence to clinical guidelines have improved outcomes.
- Prolonged field care requires careful preparation and assessment before transport. Put a tourniquet on a patient with controlled hemorrhage.
- Prepare for transport by creating a problem list.
- Understand the severe risks of humanitarian work in Ukraine.
- Engage with local authorities to understand healthcare needs.
- Advocate for best practices in blood management and resuscitation.
- Share lessons learned from the conflict to improve future care.
- Anticipate challenges during transport to enhance patient outcomes.
- Traumatic brain injury is a growing concern in conflict zones.
- Utilize telemedicine for better communication and resource allocation.
- Focus on training for non-specialist surgeons in trauma care.
Chapters
00:00 Introduction to the Conflict and Medical Response
02:07 Evolution of Medical Training in Ukraine
05:14 Challenges and Improvements in Medical Care
10:41 Surprising Developments in Clinical Care
15:28 Logistical Challenges and Wound Patterns
20:20 Prolonged Field Care and Evacuation Times
25:29 Core Principles of Casualty Care
34:04 Managing Catastrophic Bleeding and Airway Challenges
39:51 Preparing for Transport: Anticipating Challenges
44:35 Understanding the Risks of Humanitarian Work in Ukraine
49:31 Engaging with Local Needs: Best Practices for NGOs
51:52 Advancements in Blood Management and Resuscitation
54:06 Sharing Lessons Learned from the Conflict
58:45 Essential Training Topics for Medical Practitioners
01:05:11 Closing Thoughts and Future Directions
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Individuals have the responsibility to hone their craft and leaders have the responsibility to ensure they have the time and equipment to do that.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-222-Command-Perspective-e30gafs
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Want to know what the command thinks about you?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-222-Command-Perspective-e30gafs
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Getting medics ready for the future of combat medicine.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-222-Command-Perspective-e30gafs
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, the discussion revolves around the critical role of medics in Special Operations Forces (SOF), their training, and the importance of effective communication between operational and medical teams. The speakers share personal experiences from combat, emphasizing the need for thorough mission planning that incorporates medical considerations. They also address the challenges faced in maintaining medical skills and the necessity of cross-training within teams to ensure readiness for various scenarios. The conversation highlights the evolution of medic training and the ongoing efforts to enhance operational effectiveness in the field. This conversation delves into the evolving role of medics in special operations, highlighting the balance between training and team responsibilities, the differences between Navy and Army medic models, and the importance of critical thinking and adaptability in combat medicine. Personal experiences shape perspectives on the value of medics, emphasizing the need for continuous training and collaboration between medics and doctors. The discussion also addresses the complexities of future battlefields and the necessity of preventive medicine.Takeaways
- The role of medics is crucial in SOF operations.
- Effective communication between medics and operational teams is essential.
- Mission planning must include medical considerations to ensure team safety.
- Training and preparedness are vital for medics and operational personnel.
- Real combat experiences shape the understanding of medical capabilities.
- Cross-training enhances team dynamics and operational readiness.
- Maintaining medical skills is a continuous challenge for medics.
- The basics of medical training should be practiced regularly.
- Institutional support is necessary for medic training and skill maintenance.
- Future training should focus on integrating clinical experience with operational needs. Each MPT rotation provided valuable learning experiences.
- Balancing medic training with team responsibilities is crucial.
- The Navy's model for medics may offer insights for the Army.
- Medics are expected to perform under increasingly complex conditions.
- Personal experiences can deepen respect for medics' roles.
- Leadership in medical training is essential for operational success.
- Collaboration between medics and doctors enhances care.
- Battalion docs play a vital role in supporting medics.
- Understanding the medic's scope of practice is key for providers.
- Preparing for future battlefield challenges requires adaptability.
Chapters
02:07 Understanding the Role of Medics in SOF
06:05 Mission Planning and Medical Considerations
10:04 The Importance of Training and Preparedness
15:08 Experiences in Combat and Medical Response
20:06 Challenges in Medic Training and Skill Maintenance
25:12 Cross-Training and Team Dynamics
30:06 Future of Medic Training and Operational Readiness
34:47 Balancing Medic Training and Team Responsibilities
37:04 Navy vs. Army Medic Models
38:55 The Evolving Role of Medics in Combat
40:21 Personal Experiences Shaping Medical Perspectives
43:40 The Importance of Medical Training in Leadership
46:06 Collaboration Between Medics and Doctors
48:40 The Role of Battalion Docs in Special Forces
51:14 Understanding the Medic's Scope of Practice
54:30 Preparing for Future Battlefield Complexities
57:44 The Importance of Basics in Medic Training
01:01:40 Adapting to New Battlefield Realities
01:05:33 The Role of Preventive Medicine
01:09:12 Training for Unique Battlefield Challenges
01:12:18 Encouraging Critical Thinking in Medical Training
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Hint....It's not just MEDPROS.
Posting Tomorrow.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
You have to do the legwork. Nobody will do it for you.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Adding-Meds-to-the-Formulary-e306cur
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Jamie discuss the challenges faced by medics in adding new drugs to their formulary. They explore the roles of medics and doctors, the importance of training and experience, and how to effectively communicate the need for new medications. The conversation emphasizes the need for trust and collaboration between medics and doctors, as well as the importance of understanding local drug availability in future operational environments.
Takeaways
The requirement for new drugs must be justified by a clear capability gap.
Medics should master the basics before seeking new medications.
Safety and operational appropriateness of drugs are critical considerations.
Experience with a drug is essential for medics to advocate for its use.
Building trust with doctors is crucial for medics to gain support for new drugs.
Training and experience are necessary to prove competency with new medications.
Communication is key in discussing drug needs with providers.
Medics should use stories and data to support their requests for more medication.
Understanding local pharmacology is important for future missions.
A full pace plan should include locally available agents.
Chapters
00:00 Introduction to the Podcast and Guest
01:04 Understanding the Role of Medics and Doctors
03:08 Evaluating New Drugs for Medic Use
06:53 Bridging the Gap Between Medics and Doctors
11:00 Training and Experience for Medics
20:51 The Process of Adding New Drugs
24:34 Proving the Need for More Medication
28:10 Building Trust and Communication with Providers
30:40 Future Considerations for Medic Formulary
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
"Who's going to tell me something about me that I didn't know?"
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-221-Trauma-to-Recovery-e305kcj
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
If you treat the conversation as a "check the block", you will get a "check the block" answer.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-221-Trauma-to-Recovery-e305kcj
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Modern transportation is great, but is coming home from a warzone quickly, the right thing?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-221-Trauma-to-Recovery-e305kcj
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Max delve into the complexities of recovery and behavioral health following traumatic experiences in combat. Max shares his personal journey from the whirlwind of returning home after a helicopter crash to the challenges of processing trauma and the importance of support systems. The conversation highlights the need for better medical evacuation processes and the critical role of behavioral health in recovery, emphasizing the significance of brotherhood and professional support in navigating the aftermath of trauma. In this conversation, the speaker shares their profound journey through trauma, mental health challenges, and the importance of coping mechanisms and therapy. They discuss the experience of feeling detached from reality, the role of unpredictability in healing, and the significance of EMDR therapy in processing traumatic memories. The conversation also emphasizes the need for leaders to recognize mental health issues in their peers and the importance of supporting one another in the healing process. Ultimately, the speaker highlights personal growth through adversity and the ongoing commitment to mental health as a lifelong journey.
Takeaways
The rapid return home after combat can disrupt mental processing.
Brotherhood among soldiers is crucial for emotional recovery.
Experiences in medical facilities can vary greatly in quality.
Decompression time is essential for transitioning from combat to home.
Seeing traumatic events on video can trigger intense emotional responses.
Psychotic breaks can occur when processing trauma is rushed.
Support systems need to be more humanized and effective.
Behavioral health can lead to stronger outcomes if managed well.
Professional therapists play a vital role in recovery.
Recovery is an ongoing process, similar to physical rehabilitation. The mind can create a simulation of reality, leading to feelings of detachment.
Unpredictable experiences can help ground individuals in reality.
Coping mechanisms, like doing unpredictable actions, can aid in mental health recovery.
Therapy can lead to significant improvements in mental health over time.
Trauma can manifest in various ways, including PTSD and depression.
EMDR therapy can help individuals process traumatic memories effectively.
Leaders have a responsibility to recognize and address mental health issues in their teams.
Mental health should be treated with the same seriousness as physical health.
Personal growth often comes from facing and overcoming adversity.
Supporting one another is crucial in the journey of healing.
Chapters
00:00 Introduction to Recovery and Behavioral Health
03:02 The Whirlwind of Returning Home
05:56 The Importance of Brotherhood in Recovery
08:59 Experiences in Germany: A Mixed Bag
11:50 The Need for Decompression After Combat
14:48 The Transition to Walter Reed
18:07 The Emotional Rollercoaster of Homecoming
20:50 The Struggles of Processing Trauma
24:07 The Impact of Seeing the Crash Video
26:58 The Psychotic Break: A New Reality
29:48 The Need for Better Support Systems
32:49 Revamping the Medical Evacuation Process
36:13 The Role of Behavioral Health in Recovery
39:09 The Importance of Professional Support
41:52 Conclusion: Moving Forward with Hope
48:46 Navigating the Simulation of Life
51:23 Coping Mechanisms and Unpredictability
54:12 The Journey to Normalcy
56:04 Understanding Trauma and Its Effects
01:02:29 EMDR and Healing from Trauma
01:10:05 Leadership and Mental Health Awareness
01:18:56 Growth Through Adversity
01:29:42 Supporting Each Other in Healing
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Posting tomorrow...
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Seconds count with administration of epi.
Link to full podcast:
https://spotifycreators-web.app.link/e/rWP5Wo0oJRb
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.comFor more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-
How to recognize anaphylaxis before its catastrophic.
Link to full podcast:
https://spotifycreators-web.app.link/e/rWP5Wo0oJRb
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.comFor more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, host Dennis speaks with Eric Bauer from FlightBridge ED about the critical topic of anaphylaxis. They explore the importance of understanding anaphylaxis through real-life scenarios, the initial assessment and response required in emergency situations, and the underlying pathophysiology of allergic reactions. The conversation emphasizes the urgency of treatment protocols, particularly the use of epinephrine, and discusses advanced management strategies for patients experiencing anaphylaxis. This episode serves as an essential guide for emergency medical professionals and anyone interested in critical care. This conversation delves into advanced airway management, IV access, and medication protocols in the context of anaphylaxis treatment. The speakers discuss the importance of proactive decision-making, fluid resuscitation strategies, and the need for careful monitoring and adjustment of treatment. They also touch on Kuhn's syndrome, a condition that can complicate anaphylaxis cases, and emphasize the importance of seeking help when needed in critical care situations.TakeawaysAnaphylaxis is a lower frequency type of call in EMS.Initial assessment should focus on the patient's airway and breathing.Respiratory involvement indicates a more severe allergic reaction.Benadryl is not the first-line treatment for anaphylaxis.Epinephrine should be administered promptly in anaphylactic cases.Timing of treatment is crucial; reactions can escalate quickly.Advanced airway management may be necessary in severe cases.Patient positioning and PEEP can aid in respiratory distress.Understanding the pathophysiology of anaphylaxis is essential for effective treatment.Continuous reassessment is key in managing anaphylactic patients. Advanced airway management is crucial in critical situations.Proactive decision-making is essential in emergency care.Fluid resuscitation strategies must be tailored to the patient's condition.Medication protocols should include timely administration of epinephrine and steroids.Monitoring patient response is vital for adjusting treatment plans.Kuhn's syndrome can mimic myocardial infarction in young patients.It's important to be aware of the potential for rebound responses in anaphylaxis.Healthcare providers should be comfortable adjusting medications as needed.Telemedicine can provide valuable support in critical care situations.Continuous education and self-awareness are key in emergency medicine.Chapters00:00 Introduction to Anaphylaxis and Its Importance02:56 Understanding Anaphylaxis Through a Scenario05:50 Initial Assessment and Response to Anaphylaxis09:07 The Pathophysiology of Anaphylaxis11:51 Timing and Severity of Anaphylactic Reactions15:00 Treatment Protocols for Anaphylaxis18:11 Advanced Management Strategies in Anaphylaxis23:20 Advanced Airway Management in Critical Situations26:04 IV Access and Pressor Administration28:58 Fluid Resuscitation Strategies32:02 Medication Protocols in Anaphylaxis36:03 Monitoring and Adjusting Treatment41:27 Understanding Kuhn's Syndrome45:48 Final Thoughts on Anaphylaxis ManagementThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.comFor more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
You should know how to use all of the tools in your toolbox.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-220-Long-Acting-Opioids-e2vojfb
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Brad explains why ketamine replaced morphine as the drug of choice for combat medicine.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-220-Long-Acting-Opioids-e2vojfb
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Transitioning from ketamine to a long-acting opioid can be a great technique to spare your (very short-acting) ketamine.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-220-Long-Acting-Opioids-e2vojfb
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
When teaching a technique, it's super important to make sure the students understand the context.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-220-Long-Acting-Opioids-e2vojfb
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis and Brad discuss the evolving landscape of pain management, particularly focusing on the apprehension surrounding the use of opioids like morphine and hydromorphone. They explore the historical context of opioid use, the introduction of ketamine, and the importance of transitioning between different pain management techniques. The discussion emphasizes the need for a strategic approach to pain management, considering factors such as respiratory rate and the context of the patient's condition. In this conversation, Brad and Dennis discuss the complexities of pain management in medical settings, particularly during recovery and transport. They emphasize the importance of monitoring vital signs, effective communication with patients, and the careful selection of medications to manage pain while minimizing side effects. The discussion also highlights the need for thorough training and preparation to handle emergency situations effectively.
Takeaways
Medics are increasingly fearful of using longer-acting opioids.
Ketamine has become a preferred option over traditional opioids.
Morphine and hydromorphone still have a place in pain management.
Understanding the context of drug use is crucial for effective treatment.
Transitioning from rapid-acting to long-acting agents requires careful monitoring.
Respiratory rate is a key indicator of patient comfort and need for medication.
Historical perspectives on drug use can influence current practices.
Education and experience play significant roles in drug administration confidence.
The evolution of pain management reflects changing medical practices and perceptions.
Effective pain management requires a balance of various medications. Respiratory rate is a critical indicator for pain management.
Patients often have cultural expectations about pain levels.
Effective communication can significantly improve patient care.
Medications should be administered based on patient stability.
Ketamine can be a beneficial option for pain relief.
Understanding individual responses to medications is essential.
Training and practice are vital for emergency preparedness.
Developing a strategy for pain management is crucial.
Monitoring vital signs helps determine medication needs.
Practicing scenarios can reduce mistakes in real situations.
Chapters
00:00 Understanding the Fear of Opioids
08:18 The Evolution of Pain Management
14:57 Transitioning Between Pain Management Techniques
25:34 Practical Application of Opioid Dosing
31:31 Understanding Pain Management in Recovery
39:02 The Role of Communication in Patient Care
47:09 Managing Side Effects of Pain Medications
57:04 The Importance of Training and Preparation in Emergency Care
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
You've used your ketamine..how to transition safely to a long acting opioid? Posting tomorrow.
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Burjor delve into the intricacies of maxillofacial surgery, focusing on trauma management in austere environments. They discuss the importance of hemorrhage control, various techniques for managing facial injuries, and the critical aspects of airway management in trauma situations. The conversation emphasizes practical approaches and innovative techniques that can be employed in emergency scenarios, highlighting the need for preparedness and adaptability in medical practice. This conversation delves into the complexities of managing facial trauma, particularly focusing on airway management, mid-face fractures, and hemorrhage control techniques. The speakers discuss their differing comfort levels and approaches to treatment, emphasizing the importance of thorough evaluations and timely interventions. They also touch on the significance of recognizing signs of head injuries and the role of humanitarian efforts in providing medical care in remote areas.
Takeaways
Maxillofacial surgery requires a deep understanding of hemorrhage control.
Facial injuries can lead to significant blood loss, necessitating immediate action.
Techniques for managing scalp lacerations include direct and indirect pressure.
Ear and cheek injuries require specific dressing techniques to avoid obstruction.
Neck injuries can be managed with packing and pressure techniques.
Bone bleeds from jaw fractures can often be controlled by approximation.
Airway management is crucial in trauma cases, especially with facial injuries.
Definitive airway techniques may vary based on the operator's experience and available resources.
Using basic materials creatively can effectively manage complex injuries.
Preparation and adaptability are key in emergency medical situations. Airway management is prioritized over mid-face splinting in emergencies.
Comfort levels in handling trauma vary among medical professionals.
Facial injuries can distract from more critical injuries.
Timely intervention is crucial in managing hemorrhage.
Understanding the anatomy is key to treating facial fractures.
Visual acuity tests are essential in assessing eye injuries.
Bilateral bruising often indicates more severe facial fractures.
Mid-face fractures require careful evaluation and management.
Humanitarian medical efforts are vital in underserved areas.
Training local populations enhances medical care in remote regions.
Chapters
00:00 Introduction to Maxillofacial Surgery
03:03 Hemorrhage Control in Facial Injuries
06:02 Techniques for Managing Scalp Lacerations
09:09 Addressing Ear and Cheek Injuries
12:04 Managing Neck Injuries
14:50 Bone Bleeds and Jaw Fractures
18:14 Airway Management in Trauma
20:59 Definitive Airway Techniques
28:34 Airway Management vs. Mid-Face Fractures
33:11 Techniques for Hemorrhage Control
38:02 Understanding Facial Fractures
45:59 Signs of Head Injuries
49:47 Addressing Mid-Face Fractures
52:31 Team 5 Medical Foundation and Humanitarian Efforts
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This is not a death sentence, but it definitely can't be ignored.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-219-Tuberculosis-e2v7m50
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Ryan Maves and Dennis discuss various aspects of tuberculosis, including recent outbreaks, public health implications, and treatment protocols. They delve into the complexities of managing tuberculosis in different contexts, particularly within military settings, and highlight the importance of public health initiatives like PEPFAR. The discussion also touches on the challenges posed by drug-resistant tuberculosis and the evolving landscape of health policy. In this conversation, Ryan Maves discusses the complexities of tuberculosis (TB), including its historical significance, transmission methods, diagnosis, treatment protocols, and the challenges posed by drug resistance. He emphasizes the importance of public health measures in managing TB outbreaks and reassures that most individuals with TB can recover with appropriate treatment. The discussion also highlights the role of good ventilation in reducing transmission risk and the need for awareness and screening in military and public health settings.
Takeaways
Tuberculosis outbreaks can be slow and complex, not immediate crises.
Public health interventions are crucial for effective tuberculosis management.
PEPFAR has saved millions of lives and is a significant achievement in global health.
Drug-resistant tuberculosis presents unique challenges in treatment.
Telemedicine can enhance the management of tuberculosis in remote settings.
Understanding the transmission dynamics of tuberculosis is essential for prevention.
Good ventilation and treatment protocols can mitigate tuberculosis risks.
Public health policies can significantly impact disease control efforts.
Collaboration and open dialogue are necessary for effective health policy.
The importance of recognizing the long-term nature of tuberculosis management. Tuberculosis is a significant global health issue that has been impacted by the COVID-19 pandemic.
HIV and tuberculosis have a close interaction, affecting incidence and outcomes.
Active screening for tuberculosis is crucial, especially in military settings.
Good ventilation and sunlight can significantly reduce the risk of TB transmission.
Latent TB infection can progress to active disease if not treated promptly.
The classic treatment regimen for active TB involves a combination of four drugs.
Multi-drug resistant TB (MDR-TB) is a growing concern, particularly in certain regions.
Rifampin is a key drug in TB treatment but has notable drug interactions.
Most people with TB can recover with effective therapy, and treatment is often satisfying for healthcare providers.
Public health measures are essential in managing TB outbreaks and ensuring community safety.
Chapters
00:00 Introduction and Personal Updates
03:11 Understanding Tuberculosis Outbreaks
06:00 Public Health and Policy Implications
08:54 PEPFAR and Global Health Initiatives
12:00 Tuberculosis in Military Contexts
14:58 Diagnosis and Treatment of Tuberculosis
18:01 Drug-Resistant Tuberculosis
23:15 Understanding Tuberculosis: A Global Perspective
27:43 Transmission and Infection: How TB Spreads
33:31 Diagnosis and Screening: Identifying TB Cases
41:41 Treatment Protocols: Managing Active and Latent TB
51:29 Challenges of Drug Resistance in TB
58:03 Public Health Response: Reporting and Managing Outbreaks
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Medicine in the military is a bit different than in the civilian world.
Link to full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Military-Medic-Transition-to-Civilian-Workforce-e2v7ju5
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Nobody else will do it for you. Take charge of your own destiny.
Link to full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Military-Medic-Transition-to-Civilian-Workforce-e2v7ju5
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This conversation explores the transition of military medics into civilian healthcare roles, discussing the strengths and challenges they face. The speakers highlight the quality of training military medics receive, the differences in medical practice between military and civilian settings, and the importance of humility and confidence during the transition. They also address the need for bridge courses and continued education to ensure successful integration into civilian roles, while emphasizing the unique skills and insights that military medics bring to the healthcare field. This conversation delves into the transition of veterans, particularly special operations medics, into civilian roles. It discusses the value these veterans bring to various professions, the responsibility of the Department of Defense (DOD) in facilitating this transition, and the importance of utilizing available resources. The dialogue also emphasizes the need for certifications and ongoing medical training to ensure that veterans remain competent in their skills as they move into civilian healthcare roles. The discussion concludes with thoughts on enhancing medical proficiency training programs to better prepare veterans for their future careers.
Takeaways
Military medics have excellent training but lack breadth in patient exposure.
The transition from military to civilian medicine requires adaptation to different contexts.
Humility and confidence are crucial for a successful transition.
Military medics often excel in leadership roles in civilian healthcare.
Bridge courses can help military medics adjust to civilian medical practices.
Continued education is essential for maintaining skills in civilian roles.
Military medics bring unique insights that can enhance team dynamics.
The transition experience varies based on individual backgrounds and roles.
Understanding the civilian healthcare environment is key for military medics.
Data on the outcomes of military medics in civilian roles is needed. Veterans possess valuable skills that can benefit civilian roles.
The DOD has a moral responsibility to assist veterans in transitioning.
Many veterans are unaware of the resources available to them.
Certifications can enhance the employability of military medics.
There is a need for better education on career options for veterans.
Utilizing DOD programs is crucial for a seamless transition.
Veterans should be proactive in seeking out opportunities.
Community hospitals can provide valuable training experiences for medics.
The future of military medicine requires adaptation and collaboration with civilian institutions.
Improving medical proficiency training can better prepare medics for civilian roles.
Chapters
00:00 Introduction to Military Medics' Transition
02:51 Training and Experience of Military Medics
05:45 Contextual Differences in Military and Civilian Medicine
08:48 The Transition Experience of Military Medics
12:03 The Role of Humility and Confidence in Transition
14:47 Bridging the Gap: Military Medics in Civilian Roles
18:06 Challenges in Transitioning to Civilian Medicine
20:59 The Need for Bridge Courses and Continued Education
23:51 Evaluating Outcomes of Military Medics in Civilian Roles
26:47 Conclusion: The Value of Military Medics in Healthcare
31:01 The Value of Veterans in Civilian Roles
35:19 DOD's Responsibility in Transitioning Veterans
39:01 Utilizing DOD Resources for Career Transition
43:28 The Importance of Certifications for Medics
46:57 Future of Military Medicine and Training
51:29 Enhancing Medical Proficiency Training Programs
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Carrying the weight of your past experiences and not talking about it, is going to catch up with you.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-218-Neuroplastic-Syndromes-e2v3r5d
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Can PTSD manifest as chronic pain syndromes? Likewise, can seeking help alleviate symptoms?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-218-Neuroplastic-Syndromes-e2v3r5d
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Talking to your patient can make a world of difference.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-218-Neuroplastic-Syndromes-e2v3r5d
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dr. David Clarke discusses the complexities of chronic pain, emphasizing the mind-body connection and the role of stress and trauma in physical symptoms. He shares insights from his extensive experience treating patients with pain that lacks a clear physical cause, highlighting the importance of understanding psychological factors and the need for a comprehensive treatment approach. Dr. Clarke also addresses the long-term impacts of childhood trauma and offers practical steps for managing chronic pain, including self-care and recognition of one's own struggles.TakeawaysChronic pain can exist without a physical cause.The mind can generate real pain through stress and trauma.Patients often carry more stress than they realize.Understanding the source of stress is crucial for treatment.Psychological factors play a significant role in chronic pain.Self-recognition and self-care are essential for healing.Childhood trauma can have lasting effects on health.Writing about stressors can help in processing emotions.Treatment should address both physical and psychological aspects.Support resources are available for those suffering from chronic pain.Chapters00:00 Introduction to Chronic Pain and Its Misunderstandings03:07 The Mind-Body Connection in Chronic Pain06:13 Understanding Stress and Trauma in Pain Syndromes09:11 Patient Assessment and Identifying Stressors12:02 The Role of Psychological Factors in Chronic Pain14:57 Treatment Approaches for Chronic Pain17:54 The Importance of Self-Recognition and Care20:48 Long-Term Impacts of Childhood Trauma24:13 Practical Steps for Managing Chronic Pain27:13 Resources and Support for Patients29:58 Final Thoughts and ConclusionThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.comFor more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Can current or past stressors be the cause of pain?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-218-Neuroplastic-Syndromes-e2v3r5d
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
How to remap our thought process to increase survivability.Link to full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-PSNOT-e2uuqqdThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Good medicine gives the warfighter or even the first responders the confidence to go into harm's way.Link to full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-PSNOT-e2uuqqdThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Alex discuss the evolving framework of Prolonged Field Care (PFC) and the importance of structured phases of care. They introduce the PeaceKnot framework, which emphasizes preparation, stabilization, normalization, observation, and transportation. The conversation highlights the significance of training, humility, and collaboration in enhancing medical capabilities in operational settings. They also touch on the need for continuous learning and adapting to the complexities of modern conflicts, advocating for a proactive approach to medical training and community engagement.TakeawaysThe PeaceKnot framework provides a structured approach to PFC.Preparation and logistics are crucial for successful patient care.Observation periods can vary significantly in duration.Humility is essential for effective medical practice.Training opportunities are vital for operational medics.Collaboration enhances medical capabilities in the field.Understanding patient disposition is key in critical care.Experience is necessary to manage critically ill patients effectively.Engagement with community and partners fosters better outcomes.Continuous learning is essential in evolving medical practices.Chapters00:00 Introduction to Prolonged Field Care02:54 Defining Phases of Care in PFC06:08 The PeaceKnot Framework09:06 Observation and Patient Disposition11:54 Training and Experience in Critical Care14:56 The Importance of Humility in Medicine18:03 Collaboration and Learning in Medical Practice20:50 Field to Table: Bridging Gaps in Care23:48 Conclusion and Call to ActionThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
They have to have a pulse long enough to FIX the Problem.
Link to the full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-217-Calcium-for-Hyperkalemia-e2ustm4
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
We're told NEVER do CPR in the field, but when would you?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-217-Calcium-for-Hyperkalemia-e2ustm4
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Hopefully, SM titles push you to read the actual research papers.
Link to the full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-217-Calcium-for-Hyperkalemia-e2ustm4
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC podcast, Dennis and Alex delve into the complexities of scientific article reviews, particularly focusing on a study related to hyperkalemia and its implications in CPR. They discuss the importance of critical thinking in medicine, the gray areas of clinical practice, and the physiological mechanisms behind calcium and sodium bicarbonate use during cardiac arrest. The conversation emphasizes the need for a thorough understanding of research outcomes, limitations, and the application of clinical guidelines in emergency medicine.
Takeaways
The knowledge translation window in medicine is about 17 years.
Critical thinking is essential when evaluating medical literature.
Medicine often presents gray areas rather than black and white answers.
Understanding the physiological mechanisms of treatments is crucial.
The outcome of studies should be relevant to clinical practice.
Calcium and sodium bicarbonate have specific roles in managing hyperkalemia during CPR.
Assessing patients requires more than just looking for classic signs.
Confounders in studies can significantly impact outcomes.
Clinical practice guidelines provide valuable insights for treatment.
Continuous research and questioning are vital for medical advancement.
Chapters
00:00 Introduction to Scientific Article Review
04:14 The Importance of Critical Thinking in Medicine
10:41 Understanding Hyperkalemia in CPR
11:07 PICO Framework for Research Analysis
16:19 Evaluating Study Outcomes and Limitations
22:15 Physiological Mechanisms of Calcium and Sodium Bicarbonate
28:53 Clinical Practice Guidelines for Hyperkalemia
34:07 Conclusions and Future Directions
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Without an ECG, what can you use to assess for hyperkalemia?
Full podcast posting tomorrow.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis speaks with Brett and Sean about the Arctic Medic course designed to train medics in cold weather environments. They discuss the unique challenges posed by the Arctic, including cold weather injuries, hypothermia management, and the importance of survival skills. The conversation also covers the course structure, objectives, and the necessity of knowledge and experience in extreme conditions.
Takeaways
The Arctic Medic course is essential for training medics in cold weather environments.
Cold weather injuries like frostbite and trench foot are significant concerns.
Preventative measures and knowledge are key to reducing cold weather injuries.
Airway management in extreme conditions poses unique challenges.
Hypothermia management requires innovative techniques and equipment.
Survival skills are critical for operating in the Arctic.
Shelter is a top priority for survival in extreme cold.
Experience in the Arctic environment is invaluable for medics.
The course aims to create routine and repetition in training.
Future iterations of the course will be nested in the Northern Warfare Training Center.
Chapters
00:00 Introduction to Arctic Medic Course
04:02 Course Structure and Objectives
10:00 Cold Weather Injuries and Prevention
13:56 Airway Management in Extreme Conditions
19:57 Hypothermia Management Techniques
23:48 Survival Skills in the Arctic
30:05 Preparing for Arctic Operations
33:55 Course Overview and Future Plans
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Supplements and medications can exacerbate liver damage from heat injury or shock. Know your guys and what they are taking.
Link to full podcast:
https://spotifycreators-web.app.link/e/BE5xGzqaPQb
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Knowing the physiology of the liver will reveal major clues of dysfunction.
Link to full podcast:
https://spotifycreators-web.app.link/e/BE5xGzqaPQb
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Management of Liver failure in shock.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-216-Acute-Liver-Failure-e2ujj0q
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode, Dennis and Doug discuss acute liver injury, its causes, recognition, and management. They explore the liver's vital functions, the implications of liver injury in shock situations, and the importance of early recognition and treatment. The conversation also touches on the role of supplements and heat injury in exacerbating liver issues, emphasizing the liver's resilience and the need for vigilant care in critical situations.
Takeaways
The liver plays a crucial role in toxin clearance and blood metabolism.
Acute liver injury can result from hypoxia, heat stroke, and toxins like acetaminophen.
Recognizing signs of liver injury early can significantly impact patient outcomes.
Supportive care for liver injury includes maintaining glucose levels and managing coagulopathy.
The timeline for liver injury can vary, often showing signs later than other organ failures.
Preventing acute liver injury involves early recognition and treatment of shock.
Supplements can increase the risk of liver injury, especially in heat-related cases.
The liver's resilience allows it to withstand significant damage before showing dysfunction.
Monitoring lactate and glucose levels can help in diagnosing liver injury.
Effective resuscitation is key to preventing progression to severe liver injury.
Chapters
00:00 Introduction to Acute Liver Injury
02:58 Understanding Liver Functions and Injury
06:04 Recognizing Acute Liver Injury
08:57 Supportive Care for Liver Injury
11:47 Challenges in Managing Acute Liver Injury
15:04 The Timeline of Liver Injury
17:47 Preventing Acute Liver Injury
21:13 The Role of Supplements and Heat Injury
24:07 Conclusion and Key Takeaways
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Throughout history, cold weather injury has been a major attritor of combat effectiveness.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Cold-Weather-Injury-e2ua5i8
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis, Paul, and Ian discuss the critical topic of cold weather injuries, focusing on frostbite and trench foot. Ian shares his extensive experience in wilderness medicine and military contexts, providing historical insights into the impact of these injuries in warfare. The conversation covers prevention strategies, treatment protocols, and the importance of buddy checks in cold environments. Ian explains the pathophysiology of frostbite, the classification of injuries, and the role of thrombolytics in treatment. The episode concludes with a discussion on trench foot, emphasizing the need for proper foot care and hydration to prevent these injuries.
Takeaways
Frostbite and trench foot have significant historical military implications.
Prevention is key in avoiding cold weather injuries.
Buddy checks can help identify early signs of frostbite.
Rapid rewarming in warm water is the best treatment for frostbite.
Thrombolytics can help reduce tissue loss if administered early.
Trench foot requires slow, dry rewarming and careful monitoring.
Frostbite classification helps determine treatment and prognosis.
Hydration and keeping feet dry are crucial for preventing trench foot.
Avoid using active heat sources for rewarming frostbite.
Rubbing frostbite with snow is a dangerous myth.
Chapters
00:00 Introduction to Cold Weather Injuries
01:49 Historical Context of Cold Weather Injuries
03:14 Understanding Frostbite and Non-Freezing Cold Injuries
05:51 Prevention Strategies for Cold Weather Injuries
09:06 Buddy Checks and Hydration
10:58 Pathophysiology of Frostbite
14:01 Treatment Protocols for Frostbite
20:03 Evacuation Considerations for Frostbite
24:42 Assessment and Classification of Frostbite
30:25 Thrombolytics and Their Role in Treatment
36:11 Trench Foot: Understanding and Treatment
45:39 Conclusion and Key Takeaways
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Ketamine is a great drug for pain control and procedural sedation, but you can screw it up.Link to full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-215-Surviving-Chaos-e2u00kkThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
You gotta know when the treatment is NEEDED and when is just part of the algorithm. Don't waste time doing stuff for the sake of doing stuff.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-215-Surviving-Chaos-e2u00kk
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This story is crazy, but it's just the beginning.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-215-Surviving-Chaos-e2u00kk
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this gripping conversation, trauma surgeon Max Sirkin MD shares his harrowing experience of being a patient in a mass casualty situation following a helicopter crash. He recounts the chaos of the event, the physical and emotional trauma he endured, and the profound lessons learned about resilience, brotherhood, and the importance of being present for others in crisis. Sirkin's narrative highlights the stark realities of military medicine and the bonds formed in the face of adversity. In this conversation, Max shares his harrowing experience in the trauma bay after a serious injury, reflecting on feelings of inadequacy and failure in the face of trauma. He discusses the psychological impact of moral injury and the importance of behavioral health in recovery. The conversation emphasizes the principle of 'less is more' in trauma care, highlighting the need for careful decision-making in chaotic situations. Max also recounts his experience with ketamine during treatment, illustrating the limited situational awareness of patients in trauma. Finally, he underscores the significance of camaraderie and support among peers in the recovery process. In this conversation, Max Sirkin shares his harrowing experiences in a life-threatening situation, emphasizing the importance of training and preparation in chaotic medical environments. He discusses the critical role of behavioral health in recovery from trauma and the necessity of learning from failures in medical practice. The dialogue highlights the need for teamwork, effective communication, and continuous training to ensure readiness in emergency situations.
Takeaways
He shares his unique perspective as a patient in a mass casualty situation.
The chaos of a mass casualty requires quick and effective decision-making.
Surviving a helicopter crash was a life-altering experience for Sirkin.
The importance of brotherhood and support in crisis situations is paramount.
Sirkin emphasizes the need for medical professionals to be present for their patients.
He reflects on the emotional toll of being unable to help others in distress.
The narrative illustrates the unpredictability of trauma care in combat zones.
Sirkin's story serves as a reminder of the resilience of the human spirit.
The conversation sheds light on the realities faced by military medical personnel. It's hard to face the reality of failure in trauma situations.
Moral injury can be as impactful as physical injuries.
Behavioral health is crucial for recovery after trauma.
Less intervention can sometimes lead to better outcomes.
Situational awareness is limited when you're a patient.
Keeping injured individuals together can aid in recovery.
The importance of communication in chaotic medical situations.
Ketamine can provide pain relief but also alter perception.
Understanding the dynamics of trauma care is essential for providers.
Camaraderie among peers is vital for emotional support. Training is essential for managing chaos in medical emergencies.
Behavioral health is crucial for recovery from trauma.
Surgeons should not consider themselves special; everyone is vulnerable.
Daily medical practice is necessary for readiness.
Teaching non-medical personnel basic medical skills saves lives.
Failure in medicine is inevitable; learning from it is essential.
Hope alone is not a strategy in critical care.
Understanding trauma can lead to better coping mechanisms.
Team dynamics and communication are vital in emergency situations.
Every medical provider should be prepared for the unexpected.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
MASCALs are always crazy...Trying being a patient in one. I had a great conversation with Max about his experience.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
You know the indications, but have you made a plan? Have you thought about "What will I do in THIS situation?"...Maybe you should
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Airway-Decisions-e2u0juk
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
What should be a straightforward decision...isn't.
Link to the full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Airway-Decisions-e2u0juk
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC podcast, Dr. Jim DeCanto, an experienced anesthesiologist, discusses the critical aspects of airway management in emergency situations. He emphasizes the importance of decision-making processes, assessing neurological status, and the necessity of proper planning and preparation for airway interventions. The conversation highlights the challenges faced in both hospital and pre-hospital settings, the significance of having the right equipment, and the need for practitioners to be confident in their skills. Dr. DeCanto shares valuable insights and advice for new practitioners in the field, stressing the importance of thorough assessments and timely interventions to ensure patient safety.
Takeaways
Airway management is a critical skill for anesthesiologists.
Decision-making in emergencies can be complex and requires a plan.
Assessing neurological status is crucial before airway interventions.
Proper planning and preparation can enhance confidence in emergency situations.
Communication with patients, even when unconscious, is important.
Practitioners must be ready to act when necessary, as no one else may be available.
Understanding the tools and techniques for airway management is essential.
Experience and continuous learning are key to improving skills in airway management.
Practitioners should not hesitate to perform necessary procedures when indicated.
Physical exams and clinical judgment are vital in emergency medicine.
Chapters
00:00 Introduction to Airway Management
03:05 Decision-Making in Emergency Situations
12:29 Assessing Neurological Status
20:40 Planning and Preparing for Airway Management
30:50 Clinical Decision-Making in Airway Management
41:21 Advice for New Practitioners
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
A successful MASCAL depends on your ability to Triage effectively.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-214-TCCC-Updates-e2to67f
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Major changes coming soon to TCCC.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-214-TCCC-Updates-e2to67f
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Why are they changing MARCH to Resus before managing the Chest?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-214-TCCC-Updates-e2to67f
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and John discuss the ongoing updates and changes within the Tactical Combat Casualty Care (TCCC) guidelines. They delve into the role of the TTC Committee, the importance of literature reviews in developing algorithms for trauma care, and the proposed changes to the March algorithm, emphasizing the need for resuscitation before decompression. The conversation also covers the overhaul of the analgesic section, the recommendations for antibiotics, and the role of TXA in treating hemorrhagic shock. Additionally, they touch on the significance of triage in mass casualty situations and the future directions of the committee's work.
Takeaways
TCCC is continuously updated to reflect new research.
Resuscitation should be prioritized over decompression in trauma care.
The March algorithm may undergo significant changes to improve outcomes.
Analgesic options are being re-evaluated due to supply issues.
Rocephin is being recommended as a primary antibiotic.
TXA is crucial for managing hemorrhagic shock in trauma patients.
Triage protocols are essential for effective mass casualty management.
The committee is open to innovative ideas and solutions.
Training and education are vital for implementing new guidelines.
Future meetings will focus on finalizing and voting on proposed changes.
Chapters
00:00 Introduction to the PFC Podcast
02:46 Understanding the TTC Committee and Its Role
06:06 Literature Review and Algorithm Development
09:00 Resuscitation vs. Decompression in Trauma Care
12:07 Proposed Changes to the March Algorithm
15:06 Analgesic Section Overhaul and Alternatives
18:09 Antibiotic Recommendations and Changes
20:54 TXA and Its Role in Hemorrhagic Shock
23:51 Triage in Mass Casualty Situations
26:45 Future Directions and Upcoming Votes
30:06 Conclusion and Final Thoughts
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Posting tomorrow...John gives us a behind the curtain look at upcoming TCCC updates. Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Knowing the basics and how to apply them rapidly, will allow you to help far more people.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Rethinking-Triage-e2tljum
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
How do you prepare for something of this scale?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Rethinking-Triage-e2tljum
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis, Stacy Shackelford, and Doc Rush discuss the critical topic of triage in emergency medical situations, particularly in military contexts. They explore the current challenges in triage practices, emphasizing the need for a shift in thinking towards large-scale events and the importance of adapting strategies based on the number of casualties. The conversation highlights the significance of immediate actions in the first hour post-injury and the necessity of training medics to handle chaotic situations effectively. The episode concludes with a call for a more standardized approach to triage that prioritizes population health over individual patient categorization. This conversation delves into the complexities of tactical medicine in combat situations, emphasizing the importance of prioritizing tactics over medicine, the necessity of clinical experience for medics, and the psychological challenges faced in high-stress environments. The discussion also covers the decision-making process in evacuation scenarios, the identification of surgical needs, and the training required for mass casualty incidents. The speakers advocate for a simplified approach to triage and the need for ongoing training to prepare medics for the realities of their roles.
Takeaways
Triage practices need to evolve with changing conflict scenarios.
Current triage systems are not standardized and often ineffective.
Immediate actions in the first hour post-injury are crucial.
Training should focus on large-scale event responses, not just individual cases.
The first pass actions should prioritize stopping bleeding and ensuring airway clearance.
Medics should be prepared for chaotic situations and make quick decisions.
Understanding the scale of an event is essential for effective triage.
The concept of treating the population rather than individuals is vital.
Preparation and rehearsal are key to effective triage in emergencies.
Triage decisions should be offloaded to allow for rapid response. Tactics often take precedence over medical interventions in combat.
Medics should have regular clinical rotations to enhance their skills.
Risk management in evacuation decisions is crucial for team leaders.
Psychological preparation is essential for medics facing trauma.
Identifying surgical needs should focus on unstable patients.
Basic principles of triage should guide decision-making in emergencies.
Training for mass casualty scenarios is vital for operational readiness.
Medics must be prepared for the reality of not saving every patient.
Experience and pattern recognition are key to effective triage.
Simplicity in approach can lead to better outcomes in chaotic situations.
Chapters
00:00 Introduction to Triage and Its Importance
07:00 Current Challenges in Triage Practices
14:13 Revising Triage Approaches for Large-Scale Events
19:55 Practical Strategies for Effective Triage
30:12 Conclusion and Future Directions in Triage
31:13 Understanding Tactical Medicine in Combat Situations
36:00 The Importance of Clinical Experience for Medics
39:42 Risk Management in Evacuation Decisions
43:03 Preparing Medics for Psychological Challenges
46:07 Identifying Surgical Needs in Critical Care
49:54 The Role of Basic Principles in Triage
52:44 Training for Mass Casualty Scenarios
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Imagine dealing with a 50+ patient MASCAL....where to even begin. Posting tomorrow
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Quick rundown of basic management of Dengue fever.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-213-Dengue-Fever-e2tgiksThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Every fluid has its purpose as well as its effects. Stick to the isotonic fluids to maintain your patient.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-213-Dengue-Fever-e2tgiksThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Resource constraints (within reason) can lead to innovation and ultimately better medicine.
Links to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-213-Dengue-Fever-e2tgiksThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis speaks with Dr. Ryan Maves, an infectious disease physician, about dengue fever, a significant tropical disease. They discuss the epidemiology, clinical presentation, management, and prevention strategies for dengue, emphasizing the importance of recognizing warning signs and providing supportive care. Dr. Maves shares insights from his extensive experience in tropical medicine, particularly during his time in the Navy and in Peru, where he conducted research on dengue and other vector-borne diseases. The conversation highlights the increasing relevance of dengue in both civilian and military contexts, especially in light of climate change and urbanization.
Takeaways
Dengue fever is part of the flavivirus family, which includes Zika and chikungunya.
The disease is primarily transmitted by the Aedes aegypti mosquito, which thrives in urban areas.
Dengue can cause severe morbidity, particularly in non-endemic populations.
Management of dengue is largely supportive, with a focus on fluid resuscitation.
Warning signs of severe dengue include persistent vomiting, abdominal pain, and altered mental status.
Preventive measures include using insect repellent and controlling standing water.
Dengue is endemic in many tropical regions, including parts of Latin America and Southeast Asia.
Vaccines for dengue exist but are not widely available for adults.
Dengue can present with a wide spectrum of symptoms, making diagnosis challenging.
Public health strategies are crucial in controlling dengue outbreaks.
Chapters
00:00 Introduction to Tropical Medicine and Dengue Fever
03:12 Understanding Dengue Fever: Background and Epidemiology
06:03 Clinical Presentation and Diagnosis of Dengue Fever
08:56 Management and Treatment of Dengue Fever
11:54 Warning Signs and Severe Dengue
15:13 Preventive Measures and Public Health Strategies
18:01 Final Thoughts on Dengue and Tropical Medicine
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In operational/tactical EMS situation, you have to put security of the remaining personnel over the medicine. It's counter intuitive to our medical training, but incredilily important.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Tactical-Time-out-e2tcbcdThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
When patients complain of feeling sick....That doesn't help that much. Knowing what questions to ask will lead you to the correct treatment. Posting tomorrow...
Link to the full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-213-Dengue-Fever-e2tgiks
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
As always, we as medics are part of the tactical situation. We must inform the ground commander of the medical situation and based on his determination, plan on how to best help our patients.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Tactical-Time-out-e2tcbcd
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis, Casper, and Paul discuss the concept of Tactical Timeout, a leadership tool designed to enhance communication and operational effectiveness in medical scenarios, particularly in military contexts. They explore the importance of security, operational considerations, and effective patient care, emphasizing the need for clear communication and teamwork. The conversation highlights the significance of understanding the operational environment, managing shift changes, and ensuring that all team members are informed and prepared for any changes in patient status or operational conditions.
Takeaways
Tactical Timeout enhances team communication and cohesion.
Security is paramount in medical operations.
Understanding the operational environment is crucial for effective care.
Shift changes require clear communication about patient status.
Regular patient updates are essential for team awareness.
Pain management should be proactive, not reactive.
Encouraging team members to speak up fosters a supportive environment.
Contingency planning is vital for unexpected situations.
Essential supplies should be organized for quick access.
Tactical Timeout can be used to clarify uncertainties among team members.
Chapters
00:00 Introduction to Tactical Timeout
02:54 Understanding Tactical Timeout in Medical Context
05:48 Importance of Security in Medical Operations
09:13 Operational Considerations for Medical Teams
11:58 Shift Changes and Administrative Updates
14:55 Patient Updates and Communication
17:50 Managing Pain and Patient Care
21:12 Team Dynamics and Communication
24:03 Final Thoughts on Tactical Timeout
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Hypotension has been mentioned repeatedly in literature, but is it really a thing.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-212-TXA-e2sss55Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Can TXA cause seizures and hypotension...Always read the insert.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-212-TXA-e2sss55Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Bleeding patient outside the 3 hr window...Can I redose TXA?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-212-TXA-e2sss55Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Does TXA cause hypotension or is it just correlated due to the types of trauma patients it's indicated for?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-212-TXA-e2sss55
In this episode of the PFC Podcast, Dennis speaks with John McClellan, a military trauma surgeon, about the use of Tranexamic Acid (TXA) in trauma care. They discuss the mechanism of TXA, its applications in pre-hospital settings, potential complications, and evolving dosing strategies. John emphasizes the importance of TXA in managing hemorrhage and the need for standardized protocols in trauma care, especially for medics in the field.
Takeaways
TXA is a lysine analog that helps stabilize clots.
The ideal patient for TXA is anyone suspected of needing massive transfusion.
TXA is considered a low-risk drug for trauma patients.
Pre-hospital administration of TXA is crucial for patient outcomes.
Complications from TXA are not increasing significantly.
Current dosing strategies for TXA are evolving towards higher initial doses.
Preloading TXA can save time in emergency situations.
TXA has solidified its role in trauma care over the years.
Understanding the pharmacokinetics of TXA is essential for effective use.
Standardized protocols are vital for medics in the field.
Chapters
00:00 Introduction to TXA and Trauma Care
03:12 Understanding TXA: Mechanism and Applications
05:53 Pre-Hospital Administration of TXA
08:48 Complications and Concerns with TXA
12:06 Dosing Strategies and Evolving Guidelines
15:02 Practical Considerations for Medics
17:57 The Future of TXA in Trauma Care
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Posting tomorrow...Down and dirty chat with John on TXA and Trauma.
Link to full episode:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-212-TXA-e2sss55
Controlling chaos both the environment we're working...and ourselves.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-MASCAL-Lessons-Learned-e2t1hd7
A MASCAL will humble anyone. It's always better to learn from other mistakes.
Link to the full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-MASCAL-Lessons-Learned-e2t1hd7
Considering recent events, I thought it would be a good time to push this info back out. In this episode of the PFC Podcast, Dennis and Rick discuss critical lessons learned from military operations, particularly focusing on mass casualty situations. Rick shares his extensive experience as a senior medic in the Special Forces, detailing the complexities of managing casualties in combat, the importance of realistic training, and the challenges of communication and coordination during crises. The conversation emphasizes the need for adaptability, accountability, and principle-driven medicine in the field, as well as the resilience of soldiers in the face of adversity. In this conversation, Dennis shares his experiences and insights as a combat medic during a mass casualty event. He discusses the challenges of managing equipment and space, the importance of airway management, and the emotional toll of making critical medical decisions. Dennis emphasizes the need for effective communication, leadership, and the ability to manage chaos in high-pressure situations. He reflects on the lessons learned from his experiences and the importance of advocating for team members' health and well-being.
Takeaways
Mass casualty situations require a different mindset and approach.
Understanding the tactical implications of casualties is crucial.
Realistic training scenarios prepare medics for actual combat situations.
Communication and coordination are vital during crises.
Documenting patient information is essential for effective care.
Survival in combat can depend on factors beyond medical intervention.
Principle-driven medicine is necessary in unpredictable environments.
Adaptability is key when plans change unexpectedly.
Accountability in casualty management is critical for success.
Resilience among soldiers can lead to unexpected recoveries. Managing equipment effectively is crucial in crisis situations.
Airway management can be severely impacted by equipment damage.
Quick release systems are essential for efficient casualty management.
Senior medics must focus on managing the scene rather than individual patients.
Emotional detachment can aid in making difficult medical decisions.
Advocating for expectant patients is a challenging but necessary task.
Creative solutions are often required for successful evacuations.
Post-mission reflections can lead to valuable lessons learned.
Communication is key in managing chaos during medical emergencies.
Understanding the mission and appropriate equipment is vital for medics.
Chapters
00:00 Introduction to Lessons Learned
03:02 Understanding Mass Casualty Situations
05:54 Planning and Execution of Operations
09:01 Adapting to Changing Situations
11:59 The Impact of Explosions and Casualties
14:54 Managing Casualties in Combat
17:48 Training Realism and Preparedness
21:09 Communication and Coordination in Crisis
24:04 Lessons on Accountability and Documentation
27:00 Survival and Resilience in Combat
29:46 Principle-Driven Medicine in the Field
32:57 Navigating Medevac Challenges
35:58 Final Thoughts and Reflections
44:42 Managing Equipment and Space in Crisis
45:39 Airway Management Challenges
46:06 The Importance of Quick Release Systems
47:31 Lessons from Casualty Management
48:46 The Emotional Toll of Medical Decisions
50:51 The Role of Senior Medics in Crisis
52:11 Expectant Patients and Difficult Decisions
54:35 Creative Solutions for Evacuation
56:33 Post-Mission Reflections and Lessons Learned
01:00:03 Advocating for Team Members' Health
01:02:14 The Aftermath of Combat and Team Dynamics
01:04:17 Managing Chaos in Medical Situations
01:06:14 Communication and Leadership in Crisis
01:09:09 Final Thoughts on Mass Casualty Events
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
It's very easy to be overwhelmed with events. Having your organization pre-planned, will help out immensely.
Link to the full podcast posting tomorrow:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-MASCAL-Lessons-Learned-e2t1hd7
We all use Walk, Crawl, Run..But what does that actually mean and how does training change?
Link to full podcast: https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-211-Training-Scars-e2sq2n3
Patients die...That's a fact of life, but how do you train for that without crushing the medics' confidence?
Link to full podcast: https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-211-Training-Scars-e2sq2n3
Doing a good AAR or debrief is not as easy as it looks. There are definite right and wrongs when giving feedback.
Link to full podcast: https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-211-Training-Scars-e2sq2n3
All students are different and need different approaches to get them were they need to be.
Link to full podcast: https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-211-Training-Scars-e2sq2n3
Welcome Back...Let's kick 2025 off with another training discussion.
In this conversation, Dennis and John discuss the current state of medical training, particularly in military contexts. They explore the shortcomings of existing training methodologies, emphasizing the need for a foundational knowledge base and a structured approach to skill acquisition. John introduces the concept of cognitive load theory and advocates for a gradual progression in training stressors to enhance learning outcomes. The discussion also touches on cultural challenges within training environments and the importance of engaging experienced learners effectively. In this conversation, Dennis discusses the intricacies of training in operational medicine, emphasizing the importance of establishing a solid training framework, the need for skill development, and the role of effective instructors. He highlights the significance of providing immediate and actionable feedback to build confidence in trainees while avoiding no-win scenarios that can negatively impact learning. The discussion also touches on the cultural aspects of training and the necessity for instructors to adapt their methods based on the audience's experience and needs.
Link to Paper: https://nextgencombatmedic.com/2024/09/16/a-lost-opportunity/
Takeaways
Training needs a refocus on foundational knowledge.
Skill atrophy occurs quickly without regular practice.
Repetition is crucial for skill mastery in medical training.
Cognitive load theory helps optimize training effectiveness.
Gradual progression in stress is essential for learning.
Cultural issues can hinder effective training.
Experienced learners require different engagement strategies.
Training should have clear objectives and outcomes.
Effective training must balance quality and quantity of practice.
Understanding the audience is key to successful instruction. Establish a clear training framework to guide instruction.
Skill development should be prioritized over complex scenarios.
Instructors must adapt their teaching methods based on audience experience.
Immediate feedback is crucial for effective learning.
Avoid no-win scenarios that can demoralize trainees.
Confidence building is a key goal of training.
Cultural issues can impact training effectiveness.
Deliberate practice is essential for instructor improvement.
Training scenarios should be relevant and realistic.
Instructors should focus on actionable feedback to enhance learning.
Chapters
00:00 Introduction to Training Philosophy
05:09 Identifying Issues in Current Training Methods
09:52 The Importance of Foundational Knowledge
15:11 Cognitive Load Theory in Training
19:55 Gradual Progression in Stress Training
24:53 Cultural Challenges in Training
29:48 Engaging Experienced Learners
33:46 Establishing a Training Framework
39:46 The Importance of Skill Development
44:50 Creating Effective Instructors
50:39 Feedback and Confidence Building
58:12 Avoiding No-Win Scenarios in Training
What are we doing wrong with medical scenarios? Dennis chats with Jon from Next Generation Combat Medics on Training Scars.
Link to full podcast: https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-211-Training-Scars-e2sq2n3
In this episode of the PFC Podcast, Dennis and Alex discuss the complexities of trauma surgery, particularly focusing on pelvic injuries and the use of pelvic binders. They explore the subjective nature of truth in medical practice, the importance of research and evidence in trauma care, and the anatomy and physiology related to pelvic injuries. The conversation delves into injury patterns, damage control surgery, and the challenges faced in operational environments. They also engage in a debate about the efficacy of pelvic binders, weighing the evidence and risks involved in their use during trauma care. In this conversation, Dennis discusses the critical importance of evidence-based practice in combat medicine, particularly regarding the use of pelvic binders. He emphasizes the need for medical professionals to understand the nuances of pelvic injuries, especially in a combat environment, and how these injuries differ from civilian cases. The discussion also covers the structured approach to prolonged field care, the management of blood transfusions, and the challenges of imaging in trauma assessment. Dennis advocates for clinical decision-making that prioritizes patient safety and effective care, while also acknowledging the emotional weight of these decisions in high-stakes environments.
Takeaways
Truth is subjective and varies by perception.
Disagreement in medical practice can lead to better patient care.
Understanding research quality is crucial in medical decisions.
Venous bleeding is more common in pelvic injuries than arterial.
Damage control surgery involves multiple phases of patient management.
Operational environments present unique challenges for trauma care.
Pelvic binders are debated in their effectiveness and necessity.
Surgical decision-making requires weighing risks and benefits.
Evidence-based medicine is essential but often lacking in operational settings.
The role of pelvic binders in trauma care remains contentious. Evidence is crucial in medical practice to avoid misinformation.
Dismounted IED blasts result in unique injury patterns.
Understanding research and statistics is essential for medical professionals.
Pelvic binders may not always be beneficial in every injury case.
Timely blood transfusions are critical in managing trauma patients.
Imaging plays a vital role in assessing pelvic injuries.
Clinical decision-making should be based on patient stability and evidence.
Prolonged field care requires a structured approach to patient management.
Team collaboration is essential in making difficult medical decisions.
Continuous education and training are vital for operational medics.
Chapters
00:00 Introduction to the Podcast and Guest
02:58 Understanding Trauma Surgery and Pelvic Injuries
06:13 Research and Evidence in Trauma Care
09:06 Anatomy and Physiology of Pelvic Injuries
12:04 Injury Patterns and Their Implications
14:53 Damage Control Surgery and Patient Management
17:48 Operational Environment Challenges
21:03 The Role of Pelvic Binders in Trauma Care
23:52 Debate on Pelvic Binders and Evidence
26:51 Surgical Decision Making in Trauma
29:47 Conclusion and Final Thoughts
45:19 The Importance of Evidence in Medical Practice
52:34 Understanding Pelvic Injuries in Combat
53:59 Prolonged Field Care: A Structured Approach
01:00:03 Managing Blood Transfusions in Critical Care
01:10:06 The Role of Imaging in Trauma Assessment
01:18:00 Clinical Decision-Making in Prolonged Field Care
For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Here's another great podcast from early '24. This was a great presentation at SOMSA 24 and finished the year at #2.This podcast episode discusses the challenges and trends in Special Operations Medicine, focusing on the training and evaluation of medics. The speakers share insights from their experiences at the Joint Special Operations Medical Training Center, highlighting the importance of regular training, data collection, and critical thinking in medical scenarios. They also address common challenges faced by medics, including equipment access and the need for realistic training feedback. The episode concludes with recommendations for improving medic training at the unit level.
Takeaways
Not all medics are underperforming, but some are.
Regular training significantly improves medic performance.
Data collection is essential for understanding training outcomes.
Critical thinking is crucial in medical scenarios.
Pass rates indicate the effectiveness of training programs.
Equipment access is a major challenge for medics.
Feedback during training is vital for skill improvement.
Units that conduct regular medical training perform better.
Understanding drug administration is critical for medics.
More robust training at the unit level is necessary.
Chapters
00:00 Introduction to Special Operations Medicine
03:17 Understanding Medic Training and Trends
06:37 Overview of Sustainment Courses
10:51 Evaluating Medic Proficiency
15:42 Pass Rates and Observations
19:05 Identifying Common Medic Challenges
25:40 Equipment and Training Gaps
31:57 Recommendations for Improved Training
37:20 Closing Remarks and Future Directions
For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Here's another great podcast from early '24. This was a great conversation and finished the year at #3.
In this episode of the PFC podcast, Dennis and Doug delve into the complexities of crush syndrome, discussing the importance of scene safety, initial assessment, and the management of casualties in dynamic environments. They explore the application of tourniquets, fluid resuscitation strategies, and the monitoring of potential complications such as reperfusion injury and electrolyte imbalances. The conversation emphasizes the need for a structured approach to treatment, including the use of sodium bicarbonate and calcium, as well as the critical role of wound management and antibiotics in ensuring positive patient outcomes.
Takeaways
Scene safety is crucial for rescuers.
Crush syndrome patients may have multiple traumatic injuries.
Tourniquets should be applied before freeing the casualty.
Fluid resuscitation is essential for managing crush syndrome.
Monitoring for complications is vital after initial treatment.
Reperfusion injury can occur hours after the event.
Electrolyte imbalances, especially potassium, must be managed.
Sodium bicarbonate can help stabilize patients in shock.
Calcium administration is important for cardiac stability.
Wound management and antibiotics are key in crush injuries.
Chapters
00:00 Introduction to Crush Syndrome
02:50 Scene Safety in Dynamic Environments
05:55 Initial Assessment and Triage
09:01 Tourniquet Application and Management
12:08 Fluid Resuscitation Strategies
15:00 Monitoring and Managing Complications
18:10 Reperfusion Injury and Its Implications
20:48 Electrolyte Management in Crush Syndrome
23:55 Sodium Bicarbonate and Calcium Administration
27:10 Wound Management and Antibiotic Use
30:04 Final Thoughts and Summary
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Here's another great podcast from early '24. This was a great conversation and finished the year at #4.
In this episode of the PFC Podcast, Dennis and John delve into the complexities of chest trauma management, discussing the appropriate use of chest seals, the importance of blood resuscitation, and the nuances of various medical interventions such as needle decompression and finger thoracotomy. They also explore the need for a revised approach to the March algorithm, emphasizing the importance of prioritizing hemorrhage control over other interventions. The conversation highlights the evolving nature of trauma care and the necessity for continuous improvement in medical protocols.
Takeaways
Chest seals can be overused and may cause harm.
Assessing the need for a chest seal is crucial.
Blood resuscitation may take precedence over chest interventions.
The March algorithm may need reevaluation based on current data.
Finger thoracotomy should be a more widely taught skill.
Needle decompression has varying success rates and may not be the best first option.
The timing of interventions can significantly impact patient outcomes.
Training should reflect real-world scenarios and not just theoretical protocols.
Understanding the nuances of chest trauma is essential for effective treatment.
Continuous updates to medical guidelines are necessary for optimal care.
Chapters
00:00 Introduction to Chest Trauma Management
01:47 Understanding Chest Seals and Their Use
06:34 The Debate on Chest Seal Application
10:50 Reassessing the March Algorithm
12:49 The Role of Blood Resuscitation in Trauma
21:36 Exploring Needle Decompression and Finger Thoracotomy
32:51 Managing Hemothorax and Pneumothorax
43:58 Revamping the Chest Management Algorithm
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Here's another great podcast from early '24. This was a great conversation and finished the year at #5.
In this episode of the PFC Podcast, Dennis interviews Steve Schauer, an active duty lieutenant colonel in the US Army, about his research on calcium levels in trauma patients. They discuss the significance of calcium in trauma care, the challenges of conducting research in military settings, and the methodology of their study. Steve shares insights on the correlation between calcium derangements and patient outcomes, the importance of data collection, and the implications for trauma care practices. The conversation also touches on the prioritization of interventions in trauma situations and the evolving nature of medical practices.TakeawaysCalcium levels are critical in trauma care.The study aims to assess calcium derangements in trauma patients.There are significant differences between military and civilian trauma.Injury severity scores may not accurately reflect military trauma.Pre-hospital care can impact calcium levels upon arrival.Data collection is complex but essential for accurate results.Calcium administration should be approached cautiously.TXA is prioritized after blood in trauma interventions.Future research will provide more insights into calcium's role.Medical practices are constantly evolving based on new research.Chapters00:00 Introduction to Calcium Study in Trauma02:49 Understanding Calcium's Role in Trauma05:54 Challenges in Trauma Research09:05 Data Collection and Methodology11:50 Calcium Levels and Patient Outcomes15:00 Retrospective Data Insights18:02 Calcium Administration in Trauma Care20:55 Prioritizing Interventions in Trauma24:13 Future Research Directions27:06 Conclusion and Future InsightsThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Here's another great podcast from early '24. This was a great conversation with a legend and finished the year at #6.In this episode of the PFC Podcast, Phil Gonzalez shares his extensive experiences in combat medicine, detailing his journey from the military to becoming a Special Forces medic. He reflects on his time in Vietnam, the challenges faced, and the lessons learned in the field. Phil discusses the importance of teamwork, adaptability, and the unique role of medics in combat situations. He also shares insights into his culinary experiences in the field and his transition to working with indigenous communities, emphasizing the desire to make a positive impact on people's lives through medicine. In this conversation, Dennis shares his transformative journey as a medic, detailing his experiences in tropical medicine, community healing, and the importance of empathy and communication in medical practice. He reflects on the cultural integration he experienced while working in isolated regions, the challenges he faced, and the profound impact of his work on the lives of those he served. Dennis emphasizes the significance of mentorship, adaptability, and the human connection in medicine, ultimately highlighting the legacy of healing and lifelong learning that defines a true medic.
Takeaways
Phil Gonzalez is a renowned figure in combat medicine.
His military journey began in the Army Security Agency.
Vietnam was a pivotal experience that shaped his career.
The role of medics in combat is crucial and multifaceted.
Teamwork and adaptability are essential in high-stress situations.
Culinary experiences in the field can be unique and challenging.
Phil's epiphany to become a medic came from observing his peers.
The mystique of medicine creates a special bond with patients.
His experiences in Columbia highlighted the importance of community.
Phil's journey reflects a lifelong commitment to helping others. The journey of a medic is filled with challenges and learning opportunities.
Cultural integration is essential for effective community healing.
Empathy and human connection are at the core of medical practice.
Communication is crucial in crisis situations and can save lives.
Mentorship plays a vital role in shaping future medics.
The word 'doctor' translates to 'teacher' in many cultures.
Passion and dedication are key attributes for success in medicine.
Every patient deserves to be treated with dignity and respect.
Building trust within the community enhances the healing process.
The legacy of a medic is defined by the lives they touch and improve.
Chapters
00:00 Introduction to Phil Gonzalez and Combat Medicine
02:11 Phil's Early Military Experiences
04:33 Arrival in Vietnam: First Impressions
07:59 The Role of the Army Security Agency
10:23 Memorable Operations and Lessons Learned
15:15 Survival and Reflection in Combat
20:28 The Importance of Teamwork and Adaptability
23:58 Culinary Experiences in the Field
27:21 The Epiphany: Becoming a Medic
30:20 The Mystique of Medicine in Combat
32:43 Experiences in Columbia and the Role of Medics
37:48 Transitioning to a Medic Role
40:47 Life After Vietnam: New Assignments
43:41 The Journey into Archaeology and Medicine
51:43 Working with Indigenous Communities
52:40 The Journey of a Medic
59:59 Cultural Integration and Community Healing
01:10:10 Communication and Adaptability in Crisis
01:20:08 Empathy and Human Connection in Medicine
01:30:13 Legacy of Healing and Lifelong Learning
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
If you like what you hear in this podcast, I can tell you that they are looking for a few good medics.
Here's the link: https://capps.taleo.net/careersection/ex/jobdetail.ftl?job=00046711&tz=GMT-06%3A00&tzname=America%2FChicago
In this episode of the PFC Podcast, Dr. JR Pickett discusses his role as Chief Deputy Medical Director for the City of Austin, Texas, focusing on medical operations along the Southwest border. He shares insights into the unique challenges faced in remote areas, the common injuries encountered, and the importance of preparation and training for medical missions. The conversation also highlights innovative practices such as the walking blood donor program and the significance of teamwork in emergency medical services.
Takeaways
Dr. JR Pickett is the Chief Deputy Medical Director for Austin, Texas.
Medical operations in remote border areas present unique challenges.
Heat-related illnesses are prevalent in desert regions.
Common injuries include dehydration, blisters, and trauma from falls.
Rescue operations often rely on the compassion of migrants to report injuries.
Preparation for missions includes carrying essential medical and survival gear.
The walking blood donor program is crucial for remote medical care.
Operational planning is vital for effective rescue missions.
Training and skill maintenance are essential for medics in the field.
Teamwork is critical in emergency medical services, especially in remote areas.
Chapters
00:00 Introduction to Border Operations
03:03 Challenges of Medical Care in Remote Areas
05:47 Common Injuries and Illnesses Encountered
09:08 Rescue Operations and Finding Migrants
11:58 Preparation and Gear for Medical Missions
14:51 Innovations in Blood Resuscitation
18:09 Operational Planning and Coordination
20:48 Training and Skill Maintenance for Medics
24:04 Getting Involved in Border Medical Operations
26:58 Conclusion and Final Thoughts
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Here's another great podcast from early '24. This was a great conversation and finished the year at #7.
In this episode of the PFC podcast, Dennis, Jonathan, and Frank delve into the fascinating world of maggot therapy, exploring its historical roots, benefits, and applications in modern medicine, particularly in austere environments. They discuss how maggot therapy can effectively treat chronic wounds, its cost-effectiveness compared to traditional methods, and the importance of integrating it with other treatments. The conversation highlights the potential of maggot therapy as a viable option in military medicine, especially given the challenges of antibiotic supply chains and the need for innovative wound care solutions.
Takeaways
Maggot therapy has historical roots dating back thousands of years.
It effectively removes necrotic tissue and promotes wound healing.
Maggots have antimicrobial properties that aid in infection control.
Maggot therapy is cost-effective, especially in low-resource settings.
Chronic wounds often develop biofilms that resist antibiotics; maggot therapy can help.
Early application of maggot therapy can prevent complications.
Maggots can be used in both acute and chronic wound care.
Maggot therapy can be implemented in austere environments with proper training.
Sourcing and cleaning maggots is feasible even in challenging conditions.
Maggot therapy should be integrated with other wound care techniques for optimal results.
Chapters
00:00 Introduction to Maggot Therapy
01:40 Historical Context of Maggot Therapy
04:57 Benefits of Maggot Therapy
08:36 Maggot Therapy in Acute and Chronic Wounds
11:24 Maggot Therapy in Austere Environments
16:10 Sourcing and Cleaning Maggots
19:36 Application Techniques for Maggot Therapy
24:26 Treatment Protocols and Frequency
36:07 Integrating Maggot Therapy with Other Treatments
45:51 Future of Maggot Therapy in Military Medicine
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Here's another great podcast from early '24. This was a great conversation and finished the year at #8.
In this episode of the PFC Podcast, Dennis and Dr. Brendan Graham discuss the controversial topic of using blood from dying patients for transfusions. They explore the physiological changes that occur in dying patients, the potential risks and ethical implications of such practices, and the future of blood transfusion technology. The conversation emphasizes the importance of understanding the complexities of blood physiology and the moral dilemmas faced in trauma care.
Takeaways
The concept of 'zombie blood' raises significant ethical concerns.
Physiological changes in dying patients can render their blood inferior for transfusion.
Using blood from dying patients may not provide the intended benefits and could cause harm.
Future innovations in blood transfusion may include stem cell-derived blood products.
The medical community is exploring alternatives to traditional blood transfusions.
Ethical considerations are paramount when discussing blood donation from dying patients.
The risks of infection and coagulation issues are heightened in dying patients.
Action bias in medical practice can lead to ethically questionable decisions.
Understanding the physiological processes in death is crucial for medical professionals.
There is a need for more research and evidence before implementing new transfusion practices.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Here's another great podcast from early '24. This was a great conversation and finished the year at #9.
In this podcast episode, Winston and I delve into the intricate world of pain and its pathways. They explore the nervous system's role in pain transmission, the different types of pain including nociceptive, neuropathic, and nociplastic pain, and the significance of sensitization in chronic pain conditions. The discussion also highlights practical approaches to pain management, including the use of multimodal therapies and the impact of neuroplasticity on pain perception, particularly in cases like phantom limb pain. In this conversation, Dennis discusses the complexities of pain management, emphasizing the importance of understanding the patient's history and the trajectory of their pain. He highlights the shift from opioid reliance to a multimodal approach that includes various analgesics such as acetaminophen, NSAIDs, lidocaine, capsaicin, cannabinoids, and ketamine. Dennis also covers the role of anticonvulsants and antidepressants in managing chronic pain, providing practical recommendations for healthcare practitioners.
Takeaways
Understanding pain pathways can enhance treatment effectiveness.
Pain transmission involves complex processes in the nervous system.
There are three main types of pain: nociceptive, neuropathic, and nociplastic.
Peripheral and central sensitization play crucial roles in chronic pain.
Ketamine is effective in reducing central sensitization.
The placebo effect can significantly influence pain management.
Recognizing nociplastic pain is essential for proper treatment.
Mirror therapy can help alleviate phantom limb pain.
Neuroplasticity affects how pain is perceived and treated.
A multimodal approach is necessary for effective pain management. History taking is crucial in understanding pain types.
The goal of pain management is to improve function and quality of life.
Acetaminophen can be as effective as opioids in certain cases.
Lidocaine should be used with caution due to potential side effects.
Capsaicin is a natural option for neuropathic pain relief.
Opioids have significant side effects and should be used carefully.
Cannabinoids are gaining popularity but require more research.
Ketamine offers a new avenue for pain management.
Anticonvulsants can help with neuropathic pain but take time to work.
Amitriptyline is a cost-effective option for chronic pain management.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
It's that time of year again. Let's finish the year off strong with your favorite podcasts. Don't worry...I already have new episodes in the pipe starting in January.
In this episode of the PFC Podcast, Dennis and Jeff delve into the complexities of anoxic brain injury, discussing its causes, recovery processes, and prevention strategies in tactical environments. They emphasize the importance of monitoring, airway management, and resuscitation goals, while also addressing the management of hypotension and shock. The conversation highlights the significance of preventing secondary brain injuries and the role of basic medical practices in saving lives.TakeawaysAnoxic brain injury is caused by a lack of oxygen to the brain.Recovery from brain injuries can take time and various therapies.Preventing blood loss is crucial in tactical environments.Monitoring oxygen saturation is essential for early detection.Airway management decisions should be based on the patient's condition.Resuscitation goals should focus on maintaining adequate blood pressure and oxygen levels.Hypotension can arise from various causes and needs to be managed effectively.Resuscitation targets should aim for optimal blood pressure and oxygen saturation.Preventing secondary brain injuries is critical for patient outcomes.Basic medical practices can significantly impact survival rates. Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
We know what it does, but does it really have a real place in DCR?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-care-Podcast-210-Logistics-of-Labs-e2rv043
Use your lab values to check the accuracy of your other diagnostics.
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-care-Podcast-210-Logistics-of-Labs-e2rv043
Talk about ICU in a rucksack! Dealing with a crush patient in an austere environment.
Link to the full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-care-Podcast-210-Logistics-of-Labs-e2rv043
In this episode of the PFC podcast, Dennis and Doug delve into the practical aspects of lab values in trauma care. They discuss when to draw labs, the significance of pH, the role of bicarbonate and calcium in resuscitation, and the interpretation of blood gas values. The conversation also covers the limitations of hemoglobin measurements, the management of potassium levels in crush injuries, and the use of hypertonic saline in head injury cases. The episode emphasizes the importance of understanding lab values in the context of patient care and the need for timely interventions.
Takeaways
The pH level is crucial for assessing trauma patients.
Resuscitation strategies should be based on lab values.
Calcium and bicarbonate play significant roles in trauma care.
Blood gas values are essential for ventilator management.
Hemoglobin levels may not accurately reflect bleeding severity.
Lactate levels can be misleading in trauma situations.
Frequent lab draws are not always necessary in stable patients.
Hypertonic saline can be beneficial in head injuries.
Potassium management is critical in crush injuries.
Understanding lab values helps in making informed clinical decisions.
Chapters
00:00 Introduction to Trauma Labs
03:02 Understanding pH and Its Importance
06:06 Resuscitation Strategies in Trauma
08:58 The Role of Calcium and Bicarbonate
11:53 Interpreting Blood Gas Values
15:04 The Limitations of Hemoglobin Measurements
18:00 Ventilator Management and Blood Gases
20:47 Frequency of Lab Draws in Trauma
23:55 Managing Potassium Levels in Crush Injuries
26:48 Head Injury Management and Hypertonic Saline
30:08 Lactate Levels and Their Significance
33:13 Conclusion and Key Takeaways
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
What's actually happening? Why do I have to convert this TQ?
Link to full podcast:
https://spotifycreators-web.app.link/e/GKNRqK0tYOb
In this episode of the PFC Podcast, Dennis and Jamie discuss the critical topic of tourniquet conversion versus replacement in trauma care. They explore the guidelines for when and how to convert a tourniquet, the implications of prolonged tourniquet use, and the importance of assessing limb salvageability. The conversation also covers the management of reperfusion injury and the use of calcium and bicarbonate in resuscitation. Jamie emphasizes the need for medics to be prepared and confident in their decision-making to ensure the best outcomes for their patients.
Takeaways
Tourniquet conversion is crucial for effective hemorrhage control.
Understanding the difference between conversion and replacement is essential.
Guidelines for conversion depend on the tactical situation.
The two-hour mark for tourniquet application is significant for patient outcomes.
Resuscitation goals should guide the timing of tourniquet conversion.
Be prepared for potential reperfusion injuries after conversion.
Assess the viability of the limb before making decisions.
Calcium administration can help stabilize the heart during resuscitation.
Medics should be confident in their ability to convert tourniquets.
Always prioritize patient resuscitation over limb preservation.
Chapters
00:00 Understanding Tourniquet Conversion vs. Replacement
03:14 Guidelines for Tourniquet Conversion
08:59 The Two-Hour Rule and Its Implications
12:55 Techniques for Tourniquet Conversion
18:11 Challenges of Prolonged Tourniquet Use
23:48 Assessing Limb Salvageability
29:36 Managing Reperfusion Injury
35:30 Calcium and Bicarbonate in Resuscitation
46:40 Final Advice for Medics on Tourniquet Conversion
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
You need to be honest with yourself about the accuracy of the information you're using to diagnose or disposition your patient.
Link to the full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-209-Crashing-Transfer-Patient-e2rlspj
Does this patient need surgery or not? Use imagery to help determine if that patient really needs that evacuation. What if you don't have imagery?
Link to full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-209-Crashing-Transfer-Patient-e2rlspj
This week Alex and I dive into the data through a recent research paper on crashing trauma patients.
Link to the full episode:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-209-Crashing-Transfer-Patient-e2rlspj
In this episode of the PFC Podcast, Dennis and Alex delve into a recent study on hemodynamic deterioration in trauma patients during inter-hospital transfers. They discuss the implications of the study's findings, the challenges posed by the tyranny of distance in trauma care, and the importance of effective communication in medical transfers. The conversation also covers the study's methodology, the significance of injury severity scores, and the need for stringent monitoring parameters in trauma patient management. In this conversation, Dennis and Alex delve into the complexities of trauma data, particularly focusing on civilian versus military contexts. They discuss the prevalence of ground-level falls in geriatric patients, the challenges of translating civilian trauma data to military settings, and the importance of diagnostic imaging and clinical experience in making informed decisions about patient transfers. The conversation emphasizes the need for better methodologies in trauma research to identify reversible outcomes and improve patient care.TakeawaysThe tyranny of distance significantly impacts trauma care delivery.Retrospective studies have limitations that can affect their reliability.Effective communication is crucial in medical transfers between facilities.Monitoring parameters like heart rate and blood pressure may not always indicate true patient stability.Understanding injury severity scores is essential for assessing trauma patients.The shock index can be a valuable tool in trauma assessment.There is a need for more stringent criteria in determining patient deterioration.The study's findings highlight the importance of optimizing pre-hospital care.Collaboration between military and civilian medical communities is vital for improving outcomes.Evidence-based practice should guide trauma care protocols. The most common injury mechanism in civilian trauma is ground-level falls.Geriatric patients are particularly vulnerable to lethal injuries from falls.Civilian trauma data may not apply to military settings due to different injury patterns.Diagnostic imaging plays a crucial role in assessing trauma patients.Clinical experience is essential for making transfer decisions.Understanding the limitations of diagnostic tools is vital for accurate assessments.Identifying reversible outcomes can improve trauma care.There is a need for better trauma research methodologies.Noise in data can obscure meaningful insights in trauma studies.Engaging with recent articles can enhance the quality of trauma discussions.Chapters00:00 Introduction and Overview of the Podcast02:57 Exploring the Hemodynamic Deterioration Study05:55 Understanding the Tyranny of Distance in Trauma Care09:10 Analyzing the Study's Methodology and Outcomes11:51 Evaluating the Evidence Level and Its Implications14:45 Discussion on Monitoring Parameters in Trauma Patients18:01 The Importance of Communication in Medical Transfers20:46 Diving Deeper into the Study's Findings23:55 The Role of Injury Severity Scores in Trauma Care27:11 Concluding Thoughts on Trauma Patient Management38:01 Understanding Civilian Trauma Data41:18 Injury Patterns in Geriatric Patients43:21 Comparing Civilian and Military Trauma46:37 The Role of Diagnostic Imaging in Trauma49:17 Decision-Making in Patient Transfers52:11 The Importance of Clinical Experience56:30 Limitations of Diagnostic Tools01:01:30 Identifying Reversible Outcomes in Trauma01:05:12 Improving Trauma Research MethodologiesThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The conversation delves into the critical aspects of blood storage and resupply in military settings. It highlights the importance of maintaining temperature logs for blood storage, the challenges of resupplying blood to forward troops, and innovative solutions such as using drones for blood delivery. The discussion emphasizes the need for proper management and logistics to ensure that blood products are available and safe for use in chaotic environments.
Takeaways
Temperature logs are essential for blood storage compliance.
Blood must be resupplied regularly due to expiration.
Innovative blood refrigerators can support forward troops.
Drones could be a solution for blood resupply.
Proper storage is crucial for drone delivery of blood.
Managing blood types reduces mismatch risks in emergencies.
Walking blood banks are vital for immediate needs.
SOPs should include blood type verification.
Logistics play a key role in military medical operations.
Planning for blood resupply is a complex challenge.
Link to full podcast:
https://spotifycreators-web.app.link/e/O2eOrCcvNOb
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
We are definitely using these terms wrong and it's holding us back.Link to the full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-Blood-Storage-e2reott
In this episode of the PFC Podcast, Dennis interviews Monte Leja from Delta Development, discussing the critical need for blood refrigeration in prolonged field care. Monte shares his extensive military background and the challenges faced in transporting and storing blood products in combat situations. The conversation delves into the innovative technology developed for blood refrigeration, the importance of maintaining proper temperature guidelines, and the operational use of blood products in the field. Monte also discusses the potential for running mini blood banks in austere environments and the future of blood resupply in combat scenarios. The episode concludes with insights on data management and temperature tracking for blood products.TakeawaysProlonged field care requires immediate access to blood products.Innovative blood refrigeration technology can save lives in combat.Maintaining proper blood storage temperatures is critical.The military faces challenges in blood transport logistics.Blood products can expire, necessitating resupply.Mini blood banks can be established in austere environments.Temperature tracking is essential for blood safety.Operational guidelines for blood use must be adhered to.Future innovations may include drone resupply of blood.Data management enhances decision-making in blood storage. Chapters00:00 Introduction to Prolonged Field Care and Delta Development03:08 The Need for Blood Refrigeration in Combat06:06 Challenges of Blood Storage and Transport08:55 Innovations in Blood Refrigeration Technology11:49 Understanding Blood Temperature Guidelines15:07 Operational Use of Blood Products in the Field18:02 Running a Mini Blood Bank20:59 Future of Blood Resupply in Combat23:53 Data Management and Temperature Tracking27:10 Conclusion and Future DirectionsThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Set yourself up for success during patient transport. Listen to the advice of people who do this for a living.
Link to the full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-208-Evacuation-e2r2ove
Instead of just rattling off random gear, focus on what you actually need.
Link to the full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-208-Evacuation-e2r2ove
Just like we use MARCH for initial care...The Handover deserves it's own acronym.
Link for the full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-208-Evacuation-e2r2ove
Don't call for EVAC just because, do it because the patient NEEDs it.
Link for the full podcast:
https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-208-Evacuation-e2r2ove
In this episode of the PFC Podcast, Dennis and Rich discuss the intricacies of preparing for evacuation in various environments, focusing on rotary wing and ground operations. Rich, a soft medic with extensive experience in flight medicine, shares insights on the challenges faced during patient transport, common mistakes made during handovers, and the importance of accurate MIST reports. The conversation emphasizes the need for thorough preparation, effective communication, and the critical nature of documentation in ensuring optimal patient care during transport.
Takeaways
The environment significantly impacts patient care in rotary wing medicine.
Common mistakes during handover can jeopardize patient safety.
Accurate MIST reports are crucial for effective triage and resource management.
Documentation should be legible and concise to facilitate smooth handovers.
Patient care should not cease during evacuation preparations.
Understanding the capabilities of the receiving team is essential for effective handover.
Optimizing patient condition before transport is vital for successful outcomes.
Communication between ground and air medics is key to effective patient management.
Planning ahead for equipment needs can prevent last-minute complications.
Maintaining a focus on life-saving interventions is critical during transport.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Can we really depend on our Eldon Cards. Watch the entire podcast with the link below.
https://spotifycreators-web.app.link/e/iHOF668syOb
Knowing your capabilities, is a crutial part of planning. You'll have to take an honest look at yourself.
Link to the full episode:
https://spotifycreators-web.app.link/e/iHOF668syOb
With the recent passing of Dr. Warner "Rocky" Farr. I thought the best tribute to a man that spent so much of his life dedicated to teaching medical providers, was to replay a lecture he gave at SOMSA.
This is a clip from Friday's Podcast on Setting up an Austere Walking Blood Bank.
https://spotifycreators-web.app.link/e/iHOF668syOb
In this episode of the PFC Podcast, Dennis and Andrew Fisher discuss the critical aspects of setting up a walking blood bank in military settings. They explore the importance of pre-identifying donors, logistical planning for blood collection, and the necessity of effective communication and coordination among units. The conversation emphasizes the execution and timing of blood collection during emergencies, highlighting that understanding the principles of medical procedures is more important than specific techniques. The episode serves as a comprehensive guide for military personnel involved in medical emergencies and blood transfusion protocols.
Takeaways
Setting up a walking blood bank is crucial for military operations.
Pre-identifying donors can significantly reduce stress during emergencies.
Logistical planning is essential to ensure adequate blood supply.
Effective communication among units enhances coordination in blood donation.
Timing is critical; aim to have blood ready within 30 minutes of need.
Training all personnel in blood collection techniques is vital.
Understanding principles allows for better improvisation in emergencies.
Blood type identification should be done well in advance.
Practice and familiarity with procedures improve response times.
A well-prepared team can save lives during critical situations.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Dr. Brendan Graham discuss the controversial topic of using blood from dying patients for transfusions. They explore the physiological changes that occur in dying patients, the potential risks and ethical implications of such practices, and the future of blood transfusion technology. The conversation emphasizes the importance of understanding the complexities of blood physiology and the moral dilemmas faced in trauma care.
Takeaways
The concept of 'zombie blood' raises significant ethical concerns.
Physiological changes in dying patients can render their blood inferior for transfusion.
Using blood from dying patients may not provide the intended benefits and could cause harm.
Future innovations in blood transfusion may include stem cell-derived blood products.
The medical community is exploring alternatives to traditional blood transfusions.
Ethical considerations are paramount when discussing blood donation from dying patients.
The risks of infection and coagulation issues are heightened in dying patients.
Action bias in medical practice can lead to ethically questionable decisions.
Understanding the physiological processes in death is crucial for medical professionals.
There is a need for more research and evidence before implementing new transfusion practices.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Doug delve into the complexities of pneumothorax and hemothorax, discussing when treatment is necessary, the implications of tension physiology, and the management of trauma patients. They explore the differences between spontaneous and traumatic pneumothorax, the importance of patient assessment, and the medical management strategies for these conditions. The conversation emphasizes the need for vigilance in monitoring patients and making timely decisions regarding interventions such as chest tube insertion.TakeawaysTension physiology occurs when blood return to the heart is impaired.Pneumothorax can be observed if it is less than 30% of lung volume in stable patients.Healthy lungs tolerate losing lung volume better than sick lungs.Trauma is a common cause of pneumothorax, but COVID-19 also contributed significantly.Ultrasound is the gold standard for diagnosing pneumothorax and hemothorax.Medical management of pneumothorax involves minimizing positive pressure ventilation.Chest tubes are indicated when pneumothorax significantly affects oxygenation.Tension hemothorax requires urgent intervention to prevent hypovolemic shock.Young practitioners should be aware of complications associated with chest trauma.Vigilance is key in monitoring patients with chest trauma for deterioration. Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Josh discuss the critical role of laboratory tests in trauma care, particularly in austere environments. They cover the timing and importance of drawing labs, the significance of arterial blood gases, lactate levels, and the interpretation of hemoglobin and electrolytes. Josh emphasizes the need for medics to understand normal lab values and how to integrate lab data into patient care effectively.
Takeaways
Labs are essential for timely trauma care.
Draw labs after initial assessments in trauma situations.
Arterial blood gases provide crucial information for ventilation management.
Lactate levels indicate tissue oxygen delivery and resuscitation status.
Hemoglobin trends are more important than single values in trauma.
Electrolyte levels, especially potassium and calcium, are critical in trauma management.
Medics should focus on learning normal lab values for effective care.
Integrating lab data with patient context is vital for treatment decisions.
Regularly check kidney function indicators in trauma patients.
Communication with experienced colleagues can enhance lab interpretation skills.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Doug delve into the complexities of traumatic cardiac arrest, distinguishing it from medical cardiac arrest. They explore the various causes of traumatic cardiac arrest, emphasizing the importance of rapid assessment and intervention. The conversation highlights the need for effective resource allocation during resuscitation efforts and the significance of understanding the underlying causes of cardiac arrest to guide treatment. Doug shares insights on immediate actions to take in traumatic cardiac arrest scenarios, including the prioritization of interventions and the importance of teamwork in emergency situations.
Takeaways
Traumatic cardiac arrest can be caused by external injuries or direct heart trauma.
Understanding the mechanism of injury is crucial in managing cardiac arrest.
Immediate actions should focus on identifying and treating the cause of cardiac arrest.
Massive hemorrhage is a common cause of traumatic cardiac arrest.
Effective CPR can help restore circulation in certain scenarios.
Teamwork and clear roles are essential during resuscitation efforts.
Pre-delegated roles can streamline emergency responses and save lives.
Assessing the situation while performing CPR is vital for effective management.
Recognizing reversible causes of cardiac arrest can guide treatment decisions.
Communication and coordination among team members are key in emergency medicine.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Brad discuss the transition from fentanyl lollipops to SuFentanyl in military medicine. They explore the characteristics of SuFentanyl, its advantages and disadvantages compared to traditional fentanyl, and the practical implications of administering these drugs in the field. The conversation highlights the importance of understanding dosage, effectiveness, and the challenges faced by medical personnel in high-stress environments. In this conversation, Dennis discusses the critical aspects of medical training, particularly in the context of administering narcotics and managing pain in field care. He emphasizes the importance of After Action Reviews (AARs) for collecting data and improving practices, the need for hands-on experience with narcotics, and the risks associated with long-term use. The discussion also covers the transition between different narcotics and the importance of titrating to effect based on patient response, particularly respiratory rate. Dennis advocates for thorough training and preparation to ensure medics can make informed decisions in high-pressure situations.TakeawaysFentanyl lollipops are being replaced by SuFentanyl tablets.SuFentanyl is significantly stronger than fentanyl.The characteristics of SuFentanyl make it effective for pain management.Lollipops were easier to administer in field settings.Sublingual tablets have absorption challenges compared to lollipops.Swallowing the tablet reduces its effectiveness drastically.Field conditions can affect drug absorption and efficacy.Medical personnel need to adapt to new drug administration methods.Dosage adjustments may be necessary for effective pain relief.Feedback from field use is crucial for optimizing drug protocols. AARs are crucial for improving medical practices.Hands-on experience with narcotics is essential for comfort.Understanding the risks of addiction is vital in narcotic use.Transitioning between narcotics requires careful consideration.Titrating to effect is key in pain management.Respiratory rate is a critical indicator in narcotic administration.Training should focus on real-world scenarios and decision-making.Medicine requires flexibility beyond strict algorithms.Discussing potential injury patterns can improve team response.Preparation and training can prevent mistakes in the field.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC podcast, Dennis and Winston discuss Methoxyfluorine, a volatile anesthetic agent known as the 'green whistle'. They explore its mechanism of action, indications for use, and practical applications in emergency care, particularly for managing severe pain in pre-hospital settings. The conversation emphasizes the importance of patient control in analgesia, safety considerations, and best practices for using Methoxyfluorine effectively.
Takeaways
Methoxyfluorine is used for procedural sedation and analgesia.
It acts as an analgesic in low doses and anesthetic in higher doses.
The green whistle allows for patient-controlled analgesia.
It is effective for severe pain, particularly in burns treatment.
Safety concerns include potential renal toxicity at high doses.
Patient education and preparation are crucial for effective use.
The onset of analgesia occurs within 6 to 10 breaths.
Contraindications include altered consciousness and significant organ impairment.
The device is designed to minimize environmental contamination.
Effective communication with patients enhances their experience and satisfaction.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and JP Kolcun, a neurosurgery resident, delve into the complexities of spinal trauma. They discuss the differences between spinal shock and neurogenic shock, the assessment and management of penetrating and blunt spinal injuries, and the critical importance of addressing secondary injuries. The conversation emphasizes the need for timely intervention and the nuances of trauma care in both field and hospital settings. This conversation delves into the complexities of spinal cord injury treatment, emphasizing the importance of timely surgical decompression, understanding spinal cord perfusion, and the role of intrathecal pressure. The discussion highlights the need for optimizing spinal cord perfusion pressure and the implications of using vasopressors. Innovations in treatment, including the potential for intrathecal medication delivery and advancements in brain-computer interfaces, are explored as future avenues for improving patient outcomes.
Takeaways
- Spinal shock is a neurologic phenomenon, while neurogenic shock is hemodynamic.
- Penetrating spinal cord injuries are often more severe than blunt injuries.
- Immediate stabilization and ABCs are crucial in trauma care.
- Understanding the difference between spinal shock and spinal cord injury is vital.
- Secondary injury can worsen outcomes if not addressed promptly.
- Timely decompression of the spinal cord can improve recovery chances.
- Assessment of spinal stability is essential in blunt trauma cases.
- The presence of a bulbocavernous reflex can indicate spinal cord injury.
- Norepinephrine is preferred for treating neurogenic shock.
- Avoid hypotension to prevent further complications in spinal injuries. The timing of surgical decompression can significantly impact recovery.
- Surgical decisions must consider the overall health of the patient, not just the injury.
- Spinal cord perfusion is critical for recovery post-injury.
- Intrathecal pressure varies and can affect spinal cord perfusion.
- Targeting spinal cord perfusion pressure may improve outcomes over traditional MAP goals.
- Vasopressors can constrict blood vessels, potentially reducing perfusion to the spinal cord.
- Innovative treatments, such as lumbar drains, can enhance spinal cord perfusion.
- Research is ongoing into the use of intrathecal medications for spinal cord injury.
- The ultimate goal is to improve quality of life for spinal cord injury patients.
- Advancements in technology may lead to breakthroughs in treating chronic spinal cord injuries.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis, Jacob, and Alex discuss the unique challenges of providing medical care in Arctic conditions. They share their experiences and insights on managing cold weather injuries, innovative techniques for treating frostbite, and the complexities of airway management in extreme cold. The conversation also covers the importance of preparation, equipment, and training for military personnel operating in such environments, emphasizing the need for adaptability and understanding of the unique challenges posed by the Arctic.
Takeaways
Cold weather injuries are a significant concern in Arctic operations.
Training for Arctic conditions was previously lacking and is now essential.
Innovative solutions like sous vide for frostbite treatment have proven effective.
Airway management poses unique challenges in extreme cold temperatures.
Maintaining patient warmth is critical during evacuation and treatment.
Shelter and heating solutions are vital for casualty care in cold environments.
Medications can freeze and lose efficacy; proper storage is crucial.
Preparation and knowledge of equipment are key to success in Arctic missions.
Basic soldier tasks must be mastered to operate effectively in cold weather.
The basics of medical care are what ultimately save lives in extreme conditions.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and ICU doctor Doug discuss the intricacies of resuscitation techniques, focusing on the use of freeze-dried plasma (FTP) and its benefits in trauma care. They explore the physiological aspects of trauma, the role of endotheliopathy, and practical applications of FTP in emergency situations. The conversation also touches on the comparison between FTP, whole blood, and albumin, highlighting the challenges and considerations in using these fluids for resuscitation. The episode concludes with a discussion on the future of blood products in trauma care and the importance of making FTP more accessible.
Takeaways
FTP is a viable alternative to whole blood in trauma resuscitation.
Endotheliopathy of trauma can lead to widespread coagulation issues.
FTP helps stabilize the vascular endothelium during resuscitation.
Whole blood is preferred when available, especially in early resuscitation.
Albumin has limited benefits and can dilute clotting factors.
FTP has a longer shelf life and is easier to store than whole blood.
The physiological effects of trauma require careful consideration in resuscitation.
Resuscitation goals should focus on patient stability rather than strict numerical targets.
Acidosis can complicate trauma resuscitation and should be monitored closely.
Increased access to FTP could improve outcomes in trauma care.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis speaks with Dr. Lee Cancio, a surgeon and director of the U.S. Army Institute of Surgical Research Burn Center. They discuss the complexities of managing white phosphorus burns, a serious concern in modern warfare. Dr. Cancio shares insights on the properties of white phosphorus, the mechanisms of injury, and the critical steps in initial care and management of such injuries. The conversation also covers the importance of fluid resuscitation, monitoring for complications like hypocalcemia, and the role of surgical interventions in treating burn patients. Dr. Cancio emphasizes the need for urgent care and the challenges faced in prolonged field care scenarios.TakeawaysDr. Cancio has extensive experience in treating burn injuries from combat.White phosphorus burns can cause both thermal and chemical injuries.Immediate immersion in water is crucial for managing phosphorus burns.Hypocalcemia is a significant risk in patients with phosphorus injuries.Surgical debridement is often necessary for effective treatment.Fluid resuscitation is essential, especially for deeper burns.Monitoring heart rate and EKG is critical for detecting complications.Whole blood can be used in burn shock if no other options are available.Ongoing assessment of wounds is necessary to prevent re-ignition.The relationship between burn size and mortality can be atypical in phosphorus injuries.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis Price discusses the efforts of Heroes for Humanity in response to Hurricane Helene's devastation in Western North Carolina. He shares insights on the immediate activation of volunteers, the assessment of needs, and the challenges faced during search and rescue operations. The conversation highlights the importance of community knowledge, the integration of various organizations, and the human behavior observed during crises. As winter approaches, the focus shifts to recovery efforts and the ongoing need for support and resources.
Takeaways
Heroes for Humanity activated volunteers immediately after Hurricane Helene.
Community knowledge is crucial in identifying vulnerable individuals.
The initial response focused on delivering medical supplies and aid.
Search and rescue operations were prioritized in the aftermath of the hurricane.
Integration with government and other organizations improved coordination.
Survival mode affects human behavior during crises, leading to security issues.
The transition to recovery involves addressing winter preparedness.
Hope and faith play a significant role in recovery efforts.
Safety concerns, such as carbon monoxide poisoning, are critical during winter.
Support can be provided through donations and volunteering efforts.
Donations Needed: https://www.zeffy.com/en-US/fundraising/a5925aa7-6994-4247-9271-527face51842
Find Heroes for Humanity @ https://theheroesforhumanity.org/
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis and Chris discuss the essentials of starting a podcast, including overcoming initial fears, the importance of authentic conversations, essential gear, post-production techniques, and the significance of media hosting. They also address common pitfalls like podfading, the need for quality content, and the importance of energy and authenticity in podcasting. The conversation provides valuable insights for aspiring podcasters looking to create engaging and successful shows.
Takeaways
Podcasting can be for fun or a serious endeavor.
Authentic conversations resonate more with listeners.
Audio quality is more important than video quality.
Starting with a clear purpose helps guide your podcast.
Longer conversations can feel more natural than short, scripted ones.
Invest in good audio equipment for better sound quality.
Post-production is crucial for a polished final product.
Media hosting is essential for distributing your podcast.
Maintaining passion is key to avoiding podfading.
Quality content will keep listeners engaged, regardless of length.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode, Dennis discusses the role of sodium bicarbonate in medical protocols, particularly in the context of rhabdomyolysis and hyperkalemia. He emphasizes the importance of fluid management and the potential over-hyping of bicarbonate as a treatment. The conversation explores the risks associated with rhabdomyolysis, the mechanisms of potassium management, and the clinical considerations for bicarbonate use in critical care settings.
Takeaways
Sodium bicarbonate is often over-hyped in medical treatments.
Rhabdomyolysis can lead to serious kidney damage.
Immediate fluid administration is crucial in suspected rhabdo cases.
Bicarbonate has not shown clinical benefits in trials.
Managing potassium levels is essential in rhabdomyolysis treatment.
Insulin can help drive potassium back into cells.
Urine output is a key indicator in treatment effectiveness.
Alkalizing urine may not significantly prevent kidney injury.
Correcting pH can be important in severe shock situations.
Bicarbonate should be used judiciously in critical care.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC podcast, Dennis and Kevin delve into the critical aspects of patient care, particularly focusing on hypothermia management. They explore the mechanisms of heat loss in patients, strategies to prevent it, and the challenges faced in austere environments. The conversation emphasizes the importance of maintaining patient warmth during trauma care and the implications of blood resuscitation on body temperature. They also discuss practical approaches for managing hypothermia in deployed settings and the significance of team coordination in patient care. The episode concludes with insights on temperature monitoring techniques and the necessity of understanding heat loss to improve patient outcomes.
Takeaways
Hypothermia management is crucial in patient care.
Heat loss occurs through radiation, convection, conduction, and evaporation.
Keeping the ambient temperature warm is essential for patient care.
Covering the head can significantly reduce heat loss.
Fluid warming is a key strategy in managing hypothermia.
Team coordination is vital to prevent unnecessary patient exposure.
Active cooling can complicate patient management in trauma cases.
Blood resuscitation can lead to further cooling of the patient.
Innovative solutions like inflatable tents can help maintain warmth.
Understanding heat loss mechanisms is critical for effective patient care.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis and Aubrick discuss the critical importance of improvised medicine in austere environments, particularly focusing on the MARCH algorithm for trauma care. They delve into various techniques for managing massive hemorrhage, including improvised tourniquets and pelvic binders, as well as airway management strategies. The discussion emphasizes the need for practical skills and improvisation in emergency situations, highlighting the significance of training and practice in using improvised medical devices effectively.
Takeaways
Improvised medicine is essential in emergency situations.
The MARCH algorithm is a vital framework for trauma care.
Improvised tourniquets can significantly reduce mortality in massive hemorrhage cases.
Pelvic binders must be applied correctly to be effective.
Airway management requires controlling the tongue and using appropriate devices.
Improvised suction devices can be created from available materials.
Practicing with improvised devices is crucial for effective emergency response.
Finger thoracotomies may be more effective than needle decompressions.
Using gravity can aid in suctioning during emergencies.
Improvised traction splints can help stabilize femur fractures.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis interviews Mark Little, a recently retired Navy medic with extensive maritime experience. They discuss the unique challenges faced in maritime operations, including planning for casualties, the importance of waterproof gear, and the need for thorough preparation. Mark emphasizes the significance of mastering basic skills and being an asset to the team, while also navigating the complexities of medical facilities at sea. The conversation provides valuable insights for medics operating in maritime environments.
Takeaways
Planning is crucial in maritime operations due to unique environmental challenges.
Waterproofing gear is essential for effective medical care at sea.
Basic medical skills should never be neglected, even in advanced training.
Understanding the maritime environment can significantly impact casualty management.
Coordination with air and sea assets is vital for patient evacuation.
Medics should be proactive in seeking knowledge and mentorship.
Communication is key in ensuring effective patient care and logistics.
Pre-planning for contingencies can save lives in critical situations.
Being an asset to the team requires both technical and tactical proficiency.
The environment dictates the approach to medical care, whether on land or at sea.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Burjor Langdana delve into the intricacies of maxillofacial surgery, particularly in austere environments. They discuss critical aspects of managing facial trauma, including hemorrhage control, airway management, and techniques for treating various injuries. The conversation highlights the importance of understanding the anatomy and physiology of facial structures to effectively address complications arising from trauma. Additionally, they touch on the humanitarian efforts of Team Five Medical Foundation, which provides medical care and training in remote areas.
Takeaways
Hemorrhage control is crucial in facial injuries.
Facial injuries can complicate airway management.
Understanding the vascular nature of facial structures is essential.
Techniques for managing scalp lacerations include direct and indirect pressure.
Bone bleeds can often be managed by approximating fractured segments.
Mid-face injuries require careful assessment to prevent airway compromise.
Visual acuity tests are vital in assessing eye injuries.
Nasal packing is important for managing septal hematomas.
Team Five Medical Foundation focuses on providing care in remote areas.
Experience and comfort level influence treatment approaches in trauma care.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode, Dennis interviews Justin, a second-year medical student and co-founder of Special Operations Forces to School of Medicine (SOFTSOM), a nonprofit organization that helps Special Operations Forces service members and veterans in their journey to become physicians. Justin explains that SOFTSOM provides mentorship, guidance, and support to individuals from the SOF community who are interested in pursuing a career in medicine. The organization helps with the application process, offers scholarships for MCAT prep, conducts research on veterans in medicine, and partners with universities to increase soft representation in medical school classes. Justin also emphasizes the importance of tailoring application essays and preparing for interviews to highlight the unique experiences and skills of SOF applicants.
Takeaways
SOFTSOM is a nonprofit organization that helps Special Operations Forces service members and veterans in their journey to become physicians.
The organization provides mentorship, guidance, and support throughout the application process for medical school.
SOFTSOM offers scholarships for MCAT prep and conducts research on veterans in medicine.
The organization partners with universities to increase soft representation in medical school classes.
Applicants from the SOF community should tailor their application essays and prepare for interviews to highlight their unique experiences and skills.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Dr. Burjor Langdana discusses dental care in austere environments and provides tips for handling dental emergencies. He emphasizes the importance of preventive care, such as dental check-ups and good oral hygiene, before embarking on a trip. He advises carrying a dental kit with essential materials like temporary filling material and an intra-oral bandage. Dr. Langdana also shares strategies for managing dental emergencies, including broken fillings, infections, and impacted wisdom teeth. He highlights the need for a team approach and training local providers in dental care. The conversation concludes with advice for preparing for a deployment and information about Dr. Langdana's website, which offers free resources on wilderness expedition dentistry.
Takeaways
Preventive care, such as dental check-ups and good oral hygiene, is crucial before embarking on a trip to an austere environment.
Carry a dental kit with essential materials like temporary filling material and an intra-oral bandage.
Manage dental emergencies like broken fillings, infections, and impacted wisdom teeth with appropriate techniques and materials.
Adopt a team approach and train local providers in dental care to improve access and outcomes.
Prepare for a deployment by motivating participants to prioritize dental care and ensuring the availability of necessary materials.
Dr. Burjor Langdana's website, Wilderness Expedition Dentistry, offers free resources on handling dental emergencies and basic facial injuries in austere environments.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis and Mark discuss the importance of understanding wound ballistics in trauma surgery. Mark shares his experience working with special operations teams and developing medical proficiency training. They delve into the impact of high-energy rifle wounds and the fragmentation of bullets inside the body. They also discuss the role of entrance and exit wounds, the risks of packing hollow viscous injuries, and the importance of clinical judgment in treating gunshot wounds. In this conversation, Dr. Mark Shapiro discusses various aspects of wound ballistics, including gunshot wounds, shotgun wounds, and blast injuries. He shares his experiences treating patients with these types of injuries and provides insights into the different behaviors and treatment approaches for each. Dr. Shapiro emphasizes the importance of relying on common sense and making quick decisions in resource-depleted environments. He also highlights the unpredictable nature of blast injuries and the challenges they present. Overall, this conversation provides valuable information for medical professionals dealing with traumatic injuries.
Takeaways
Understanding wound ballistics is crucial in trauma surgery to effectively treat gunshot wounds.
High-energy rifle wounds can cause significant damage due to the speed and fragmentation of the bullet.
Entrance and exit wounds may not always be reliable indicators of the bullet's path inside the body.
Packing hollow viscous injuries, such as the abdomen or torso, is generally not recommended.
Clinical judgment and assessment of vital signs are essential in determining the appropriate course of action for treating gunshot wounds. Gunshot wounds in the cardiac box can sometimes have unexpected outcomes, and observation can be a valid approach.
Shotgun wounds are complex and require careful management due to the extensive tissue destruction and risk of infection.
Assessing neurovascular function in conscious patients involves physical exams and evaluating pulse, color, and temperature.
In blast injuries, the primary blast wave, secondary injuries from being thrown against objects, and tertiary injuries from fragments all contribute to the overall damage.
Treating blast injuries requires addressing the various types of injuries, such as bowel injuries, lung injuries, and infections.
Experience and common sense play a crucial role in making decisions and providing the best care in challenging situations.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The conversation explores the topic of unconventional medical networks and how to establish them. The guest, Regan Lyon, discusses his thesis on this subject and the challenges involved. They discuss the historical context of guerrilla hospitals and the need for medical care in unconventional warfare scenarios. They also touch on the limitations and constraints of current medical doctrine and the importance of training, blood supply, hospital capacity, and evacuation routes. The conversation highlights the need to adapt to changing environments and the role of technology in both aiding and complicating medical care. In this conversation, Dennis and Regan discuss the challenges of providing medical care in conflict zones and austere environments. They highlight the importance of being prepared for situations where the medical supply chain is disrupted and improvisation is necessary. They emphasize the need for medical professionals to think outside the box and consider alternative solutions when faced with limited resources. They also discuss the importance of coordination and interoperability between different military and civilian organizations, as well as the need to empower and support local communities in providing medical care. Overall, they stress the need for a proactive and adaptable approach to casualty care in unconventional warfare.
Takeaways
Establishing unconventional medical networks is a complex and challenging task.
Historical examples of guerrilla hospitals provide insights into the unique challenges and strategies involved.
Current medical doctrine has limitations and constraints that need to be addressed in unconventional warfare scenarios.
Training, blood supply, hospital capacity, and evacuation routes are crucial factors in establishing effective medical networks.
Technology can both aid and complicate medical care in unconventional warfare situations. Medical professionals need to be prepared for situations where the medical supply chain is disrupted and improvisation is necessary.
Thinking outside the box and considering alternative solutions is crucial in austere environments.
Coordination and interoperability between different military and civilian organizations are essential for effective casualty care.
Empowering and supporting local communities in providing medical care can enhance resilience and response capabilities.
A proactive and adaptable approach is necessary for casualty care in unconventional warfare.
In this conversation, Kevin and Dennis discuss nursing care in a prolonged field care (PFC) setting. Kevin, an experienced nurse anesthetist, provides insights into when PFC nursing care begins and the importance of gathering data and assessing patients. He emphasizes the role of nurses in providing interventions such as pulmonary toileting, turning patients, skincare, dressing changes, medication infusions, and more. Kevin also discusses the challenges of training for PFC and the need to have a standard of care before entering the field. He shares practical tips for cleaning patients and changing interventions in a resource-limited environment. In this part of the conversation, Kevin and Dennis discuss the importance of getting to know the patient and recognizing when interventions are not working. They also talk about the need for clear guidelines and parameters for nursing care, as well as the challenges of providing nursing care in a prolonged field care setting. Kevin emphasizes the importance of turning patients, preventing skin breakdown, and doing proper pulmonary toileting. He also suggests learning from historical examples, such as the Navy's approach in the South Pacific during World War II, to solve the challenges of prolonged field care.
Takeaways
Prolonged field care nursing begins when life-saving interventions are complete and the patient is stable.
Nursing care in PFC involves gathering data, assessing patients, and providing interventions such as pulmonary toileting, skincare, dressing changes, and medication infusions.
Training for PFC should include working in an ICU to learn the standard of care and understand what gets degraded in the field.
In a resource-limited environment, improvisation and prioritization are key in providing nursing care.
Monitoring vital signs and recognizing changes is crucial in determining when to involve a provider in the patient's care. Getting to know the patient and recognizing when interventions are not working is crucial in providing effective care.
Clear guidelines and parameters for nursing care are important to ensure proper treatment.
Turning patients, preventing skin breakdown, and doing proper pulmonary toileting are essential nursing interventions.
Learning from historical examples, such as the Navy's approach in the South Pacific during World War II, can provide valuable insights for solving the challenges of prolonged field care.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis and Andy Fisher discuss the co-administration of ketamine and Versed. They explore the reasons behind the common practice of adding Versed to ketamine, the concept of emergence reactions, and the appropriate use of Versed. They also touch on the potential risks and side effects of both drugs and the importance of individualized dosing. The conversation emphasizes the need for critical thinking and careful consideration when administering these medications.
Takeaways
The practice of adding Versed to ketamine is based on historical protocols and the belief that it provides amnestic properties and prevents emergence reactions.
There is no clear definition of emergence reactions, but they can include unpleasant sensations, disconnection, hallucinations, and agitation.
Ketamine itself has amnestic properties and should provide adequate amnesia without the need for Versed.
The use of Versed should be based on individual patient needs, such as safety and mission comfort, and not protocolized.
Careful consideration of dosage, administration speed, and patient physiology is crucial to avoid adverse events and ensure optimal outcomes.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis and Dave discuss procedures like cricothyroidotomy (cric) and chest tube placement in the context of extended care. They explore the challenges of managing patients with airway interventions and the importance of considering the context and resources available. They also discuss the criteria for removing a cric or chest tube and the potential complications that may arise. The conversation highlights the need for careful assessment and monitoring of patients to ensure optimal outcomes.
Takeaways
Context is crucial when considering procedures like cricothyroidotomy and chest tube placement in extended care settings.
The decision to remove a cric or chest tube should be based on careful assessment of the patient's condition and the availability of resources.
Monitoring the patient's airway and respiratory status is essential after removing a cric or chest tube.
Consider the potential complications and risks associated with procedures and weigh them against the benefits.
In resource-limited environments, training auxiliary personnel to perform non-clinical tasks can help alleviate the workload of medics.
Ultrasound can be a valuable tool for assessing the placement and function of chest tubes and airway interventions.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis and Pac discuss the use of ketamine in medical settings, particularly in austere environments. They cover topics such as the differences between S-ketamine and R-ketamine, the dosing and administration of ketamine for sedation and analgesia, and its use in hemodynamically unstable patients and refractory seizures. They also touch on the importance of proper training and monitoring when using ketamine, as well as the potential benefits of combining regional anesthesia with IV sedation. Overall, ketamine is seen as a versatile and effective drug for pain management and sedation in various medical scenarios.TakeawaysKetamine, particularly S-ketamine, is a versatile and effective drug for sedation and analgesia in medical settings.The dosing and administration of ketamine depend on the patient's condition and the desired effect, and it can be given via various routes, including IV, IM, subcutaneous, oral, and rectal.Ketamine is especially useful in hemodynamically unstable patients and refractory seizures.Proper training and monitoring are essential when using ketamine, and it is important to have a plan and be prepared for potential adverse effects.Combining regional anesthesia with IV sedation can be beneficial in certain situations.Ketamine is commonly used in developing countries and can provide valuable hands-on experience for medical professionals.Collaborating with local doctors and clinics can offer valuable insights and knowledge about the use of ketamine in specific regions.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis and Monti discuss the process of product development. They cover topics such as generating ideas, validating ideas with potential customers, protecting intellectual property, and deciding whether to build a business or collaborate with another company. Monti shares his experience with developing the APRU and Delta Ice products, highlighting the importance of customer feedback and iteration. They also touch on the challenges and time commitment involved in bringing a product to market. The conversation explores the challenges and lessons learned in developing and bringing a medical device to market. The guest, Monti, shares his experience in creating a portable blood storage device for military use. He discusses the regulatory hurdles, the importance of listening to end-users, and the need for patience and perseverance in the business world. Monti emphasizes the significance of timing and market demand, as well as the need to continually innovate and expand product offerings. He also highlights the role of technology in improving medical care on the battlefield.
Takeaways
Generating ideas for product development often involves talking to potential customers and understanding their needs.
Validating ideas with potential customers is crucial to determine if there is a market demand for the product.
Protecting intellectual property through patents and non-disclosure agreements can help prevent others from stealing or copying your idea.
Deciding whether to build a business or collaborate with another company depends on factors such as the scope of the product, market potential, and personal goals.
Customer feedback and iteration are essential in the product development process to refine and improve the product.
Bringing a product to market can be a time-consuming and challenging process that requires patience and financial resources. Developing and bringing a medical device to market requires navigating regulatory hurdles and addressing the needs of end-users.
Timing and market demand are crucial factors in the success of a product.
Patience and perseverance are essential in the business world, as it often takes longer than expected to achieve success.
Continual innovation and expansion of product offerings are necessary to stay competitive.
Technology plays a significant role in improving medical care on the battlefield.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Rick, a senior medic for the 10th Special Forces Group, shares lessons learned from a mass casualty event in Eastern Afghanistan. He discusses the different types of mass casualty situations and the challenges faced in both reactive and proactive scenarios. Rick emphasizes the importance of realistic training scenarios and the need to think critically and adapt in high-stress situations. He also highlights the significance of effective communication, pre-coordination with medevac assets, and documenting patient information. Rick concludes by stressing the need to focus on good medicine rather than striving for perfection. In this conversation, Dennis discusses the importance of managing chaos and effective communication during mass casualty situations. He emphasizes the need to step back, take a breath, and develop a plan to ensure the best possible outcomes. Dennis also highlights the significance of triaging patients and categorizing them based on urgency. He stresses the importance of cross-training medics and being familiar with each other's roles and responsibilities. Additionally, he emphasizes the need for clear and concise communication and the importance of talking about traumatic experiences to promote healing and understanding.
Takeaways
Differentiate between reactive and proactive mass casualty situations and adapt accordingly
Create realistic training scenarios to prepare for high-stress situations
Think critically and prioritize patient care in chaotic environments
Communicate effectively and pre-coordinate with medevac assets
Document patient information and maintain accountability
Focus on good medicine rather than striving for perfection Manage chaos by stepping back, taking a breath, and developing a plan
Effective communication is crucial during mass casualty situations
Triage patients and categorize them based on urgency
Cross-train medics to ensure they can treat each other and their patients
Talk about traumatic experiences to promote healing and understanding
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis, Rick, and Paul discuss the challenges of training in the field of prolonged field care (PFC) and advanced medical training. They address the common problems of miscommunication and unrealistic expectations when it comes to training requests. The conversation covers topics such as setting realistic goals, creating effective scenarios, and the importance of having flexible and experienced instructors. They also discuss the value of worst-case scenario training and the need for integration of medical training into combat training. Overall, the episode emphasizes the importance of effective communication, realistic planning, and collaboration in training scenarios. The conversation focuses on the challenges of training and leading medical teams in high-stress situations. The speakers discuss the importance of team leadership and decision-making, as well as the need for continuous training and learning. They emphasize the value of starting with the basics and building a strong foundation before tackling more advanced skills. The conversation also touches on the importance of understanding the purpose behind medical procedures and equipment, as well as the need for real-world experience and clinical decision-making. Overall, the speakers highlight the need for realistic and practical training that prepares medics for the unpredictable nature of their work.
Takeaways
Effective communication and realistic planning are crucial for successful training.
Setting realistic goals and objectives is essential for effective training.
Worst-case scenario training can be valuable in preparing for challenging situations.
Integration of medical training into combat training is important for comprehensive preparedness.
Flexible and experienced instructors are key to successful training. Team leadership is crucial in high-stress medical situations, and team members need to understand their roles and responsibilities.
Training should start with the basics and build a strong foundation before moving on to more advanced skills.
Understanding the purpose behind medical procedures and equipment is essential for effective decision-making.
Real-world experience and exposure to different clinical settings can enhance a medic's skills and decision-making abilities.
Training should be realistic and practical, preparing medics for the unpredictable nature of their work.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis and Ian discuss the process of disposition in emergency medical care. They explore how to transfer patients who cannot be evacuated to a higher level of care and instead need to be sent back to their families or local medical systems. The key steps in the disposition process include evaluating life threats, stabilizing the patient, determining if continuous medical care is necessary, assessing if the patient can be cared for at home, and ensuring they have access to follow-up care. The hosts also discuss the importance of patient education and communication in the disposition process.
Takeaways
The disposition process involves evaluating life threats, stabilizing the patient, and determining the appropriate level of care needed.
Patient education is crucial in the disposition process, ensuring that patients and their families have the knowledge and resources to care for themselves at home.
Communication and collaboration with local medical systems are important when transferring patients to ensure they receive the necessary care.
The decision to transfer a patient to a higher level of care or to a local medical system depends on the patient's condition and the available resources.
In some cases, transferring a patient to a lower level of care, such as an EMS system, may be appropriate if the necessary skills and equipment are available.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Mikola, a combat medic from the Ukrainian Special Operations Task Forces, shares his experience and challenges in providing medical care in the war-torn region of Ukraine during SOMSA 24. He discusses the difficulties of operating in a large and constantly changing frontline, with different terrain and medical systems in each administrative region. Mikola explains the concept of medical evacuation and the various facilities and modes of transportation used. He also highlights the dangers faced by medics, including attacks from Russian forces and the use of drones with payloads. Mikola emphasizes the importance of training, supply management, and improvisation in overcoming these challenges. If you would like to see the slides, sign up for our Patreon (link below) and get early access to presentations and more.TakeawaysOperating as a combat medic in the war-torn region of Ukraine presents numerous challenges, including a large and constantly changing frontline.Medical evacuation involves coordinating with different facilities and modes of transportation, taking into account the specific terrain and enemy patterns in each administrative region.Medics face significant dangers, including attacks from Russian forces and the use of drones with payloads.Training, supply management, and improvisation are crucial in overcoming the challenges faced by combat medics in Ukraine.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dr. DeMello discusses the management of burns in a pre-hospital setting. He emphasizes the importance of following the MARCH approach and not letting the burn distract from other life-threatening injuries. He also highlights the challenges of accurately calculating the total body surface area (TBSA) affected by the burn and recommends using the serial halving method. Dr. DeMello advises against over-resuscitating with fluids and suggests using a simple fluid resuscitation protocol. He also discusses the use of oral fluids and the benefits of allowing patients to have clear fluids. Other topics covered include pain control, escharotomies, cooling the burn, and monitoring urine output.
Takeaways
Follow the MARCH approach and prioritize life-threatening injuries over the burn.
Use the serial halving method to estimate the TBSA affected by the burn.
Avoid over-resuscitating with fluids and use a simple fluid resuscitation protocol.
Allow patients to have clear fluids if there is no upper airway burn or evidence of inhalational burn.
Consider using ketamine for analgesia in burn patients.
Cool the burn as quickly as possible, but not the patient.
Monitor urine output and look for trends in color to assess for rhabdomyolysis.
Provide compassionate care to reduce anxiety and pain requirements.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode, Dennis and Alex discuss the importance of reading research papers and critically analyzing their applicability to the operational environment. They review a paper on the role of red blood cells in thrombosis and post-transfusion hypercoagulability. The study found that red blood cell aggregation increased in the presence of tissue factor and calcium. While the study had limitations in terms of sample size and external validity, it raised questions about the use of calcium and tranexamic acid (TXA) in trauma patients. Dennis emphasizes the need to critically assess the need for these interventions based on individual patient factors. The conversation explores the complexity of blood clotting and the challenges of managing critically ill trauma patients. The hosts discuss the activation of blood components, the role of red blood cells in clot formation, and the use of thrombin matrix. They also touch on the age of blood and its impact on clotting, as well as the importance of trauma surgeons in managing these patients. The conversation emphasizes the need for continuous learning and clinical decision-making based on individual patient scenarios.
Takeaways
Reading research papers and critically analyzing their applicability is important in the operational environment.
The study discussed the role of red blood cells in thrombosis and post-transfusion hypercoagulability.
Red blood cell aggregation increased in the presence of tissue factor and calcium.
The study raised questions about the use of calcium and tranexamic acid (TXA) in trauma patients.
It is important to critically assess the need for interventions based on individual patient factors. Blood clotting is a complex process involving the activation of various blood components.
Red blood cells play a role in clot formation and can drift to the site of injury.
The age of blood does not significantly affect clotting ability.
Trauma surgeons are crucial in managing critically ill trauma patients.
Clinical decision-making should consider individual patient scenarios and the nuances of clotting.
Continuous learning is essential in the field of trauma medicine.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Colonel Stacey Shackelford discusses abdominal trauma and exsanguinating hemorrhage. He highlights the findings from studies on casualties who died before reaching a surgical hospital, with close to 90% of those deaths caused by bleeding. The majority of potentially survivable injuries resulting in death were from torso hemorrhage, particularly abdominal injuries. The current toolkit for managing abdominal trauma includes pressure dressings, blood transfusions, TXA, and calcium. However, there is a need for further research and development of advanced pre-hospital care options.
Takeaways
Studies have shown that a significant number of casualties die before reaching a surgical hospital due to bleeding from abdominal trauma.
The majority of potentially survivable injuries resulting in death are from torso hemorrhage, particularly abdominal injuries.
The current toolkit for managing abdominal trauma includes pressure dressings, blood transfusions, TXA, and calcium.
Further research and development is needed for advanced pre-hospital care options to improve survival rates for abdominal trauma.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The conversation revolves around the topic of ether and its use in surgery. Mike and Brad, both medical professionals, discuss the benefits and drawbacks of using ether as an anesthetic. They highlight its historical significance, safety profile, availability in developing countries, and field expediency. They also mention the flammability and pungent smell of ether, as well as its slower uptake and potential for post-op nausea and vomiting. The conversation emphasizes the importance of understanding ether anesthesia and maintaining high clinical standards in austere settings. In this conversation, Brad, Mike, and Dennis discuss the use of ether as an anesthetic in prolonged field care scenarios. They emphasize the importance of understanding the different stages of anesthesia and how ether can be used for conscious sedation. They also highlight the significance of logistics and problem-solving in austere environments, where medical supplies may be limited. The conversation encourages listeners to do their own research and learn from historical medicine. Overall, the discussion provides valuable insights into the use of ether in resource-limited settings.TakeawaysEther is the foundation for all gas anesthesia inhalation and has been used in surgery since 1846.Ether is simple, safe, and easy to manufacture, making it a viable option in austere settings and developing countries.Ether has a unique safety profile, making it suitable for high-risk patients and trauma cases.Ether is field expedient and can be administered using simple techniques and equipment.Ether is highly flammable and has a pungent smell, but its availability and low cost make it a valuable option in certain situations.Understanding the stages of anesthesia and maintaining high clinical standards are crucial when using ether in surgery. Understanding the stages of anesthesia is crucial for using ether effectively in prolonged field care scenarios.Ether can be used for conscious sedation and is a versatile option for various medical procedures.Logistics and problem-solving skills are essential in austere environments where medical supplies may be limited.Learning from historical medicine and conducting research can enhance medical knowledge and preparedness in resource-limited settings.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and Jamie discuss the importance of tourniquet conversion in the context of combat medicine. They explain the difference between tourniquet conversion and tourniquet replacement, emphasizing the need to control bleeding and save tissue. They discuss the timing of tourniquet conversion, highlighting the importance of resuscitation and patient stability. The conversation also covers the physiological effects of tourniquet conversion, including reperfusion injury and metabolic waste products. The hosts provide insights into the challenges and decision-making process involved in tourniquet conversion, as well as the use of calcium and bicarbonate to manage potential complications. They emphasize the need for medics to be prepared, assess the patient's condition, and make informed decisions based on the available resources and clinical guidelines.
Takeaways
Tourniquet conversion involves making positive efforts to control bleeding or determining that the tourniquet is no longer necessary.
Tourniquet replacement is done when there is a need for a better or more proximal tourniquet to control bleeding.
Tourniquet conversion should be considered after resuscitating the patient and ensuring they are warm and non-coagulopathic.
The timing of tourniquet conversion depends on the tactical situation and the patient's resuscitation status.
Calcium and bicarbonate can be used to manage potential complications during tourniquet conversion.
Medics should be prepared, assess the patient's condition, and make informed decisions based on available resources and clinical guidelines.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis interviews Tom Avery, a surgeon who worked in Myanmar with the Free Burma Rangers. Tom shares his experience providing critical care in a war-torn area and the challenges he faced. He discusses the importance of stabilizing patients and bridging the gap between the frontline and higher echelons of care. Tom emphasizes the need for flexibility and creativity in an austere environment and the importance of communication and cooperation with local forces. He also highlights the lessons learned, including the need for in-field sterilization, the value of a mobile ultrasound device, and the importance of a standardized trauma kit.TakeawaysStabilizing patients and bridging the gap between the frontline and higher echelons of care is crucial in a war-torn area.Flexibility and creativity are essential in an austere environment.Communication and cooperation with local forces are key to success.In-field sterilization and cleaning of medical instruments are important considerations.Having a mobile ultrasound device and a standardized trauma kit can greatly enhance patient care.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis and Brad discuss the use of fentanyl as an opioid analgesic. They explore the history and development of fentanyl, its pharmacological properties, and its advantages over other opioids. They also discuss the administration of fentanyl, including IV and lollipop forms, and the importance of titrating the dose to the patient's respiratory rate. The potential side effects and contraindications of fentanyl are also addressed.TakeawaysFentanyl is a synthetic opioid that was developed in the 1950s as a reliable and titratable pain medication.It has a rapid onset and peak effect, making it useful for pain control in trauma and sedation during procedures.Fentanyl is 100 times more potent than morphine and is typically administered in microgram doses.Respiratory depression is a potential side effect of fentanyl, but it can be managed by monitoring the patient's respiratory rate.Fentanyl lollipops are an alternative route of administration, but they require proper technique and can cause nausea and vomiting.Fentanyl patches are not recommended for prehospital use due to their slow onset and potential for unpredictable drug release.Proper education and understanding of fentanyl's pharmacology and administration are essential for safe and effective use.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this part of the conversation, Dennis and Andy discuss common health issues and injuries that can occur in the jungle. They specifically focus on heat illnesses, musculoskeletal conditions, dermatological conditions, and tropical diseases. They provide tips on how to manage exertional heat illness, such as stopping activity, finding shade, and using water to cool down. They also discuss the importance of proper hydration, nutrition, and hygiene in the jungle. Additionally, they talk about the wet and dry routine for clothing, managing blisters and cuts, and dealing with insect bites and envenomation. In this conversation, Andy discusses various hazards and challenges faced in the jungle, including snake bites, tarantulas and spiders, toxic plants, and scorpion stings. He emphasizes the importance of pre-planning and education to mitigate risks. Andy also highlights the need for specialized equipment and techniques for evacuations in the jungle, such as technical rope rescues and securing stretchers in different modes of transportation. He recommends the Oxford Handbook of Expedition and Wilderness Medicine as a valuable resource for healthcare providers in jungle environments.
Takeaways
Common health issues in the jungle include heat illnesses, musculoskeletal conditions, dermatological conditions, and tropical diseases.
Proper management of exertional heat illness involves stopping activity, finding shade, and using water to cool down.
Hydration, nutrition, and hygiene are crucial in the jungle to prevent health issues.
The wet and dry routine for clothing helps maintain personal hygiene and prevent skin problems.
Proper management of blisters, cuts, and insect bites is important to prevent infections and complications. Educate yourself on the risks and hazards specific to the jungle environment you will be operating in.
Pre-plan and practice different evacuation scenarios, considering the challenges of the jungle terrain.
Have specialized equipment and techniques for technical rope rescues and securing stretchers in different modes of transportation.
Laminate important documents and resources to protect them from the jungle environment.
The Oxford Handbook of Expedition and Wilderness Medicine is a valuable resource for healthcare providers in jungle environments.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This podcast episode discusses the topics of PTSD, TBI, sleep, and suicide, particularly in relation to military personnel. The speaker, Joe Cooper, provides insights into the overlapping nature of these conditions and the need for a comprehensive approach to treatment. He emphasizes the importance of therapy as the primary treatment for PTSD and highlights alternative therapies such as stellate ganglion block, ketamine, acupuncture, cannabis, mindfulness, and testosterone replacement therapy. The episode also addresses the challenges of soldier buy-in and compliance with treatment. The conversation explores the importance of addressing victim status versus hero worship in the context of PTSD. It emphasizes the need for balance and understanding in conveying the impact of PTSD to individuals. The difficulty in connecting with providers and the role of medics in selling the treatment and providing support is highlighted. The conversation also delves into the challenges of soldier identity as a defense mechanism and the misconceptions about PTSD therapy. The importance of sleep in healing and the need for early intervention and post-traumatic growth are discussed. The success of therapy and the efforts of the military in addressing these issues are acknowledged.TakeawaysPTSD, TBI, sleep, and suicide are significant issues among military personnel.These conditions often overlap and have high levels of comorbidity.Therapy is the primary treatment for PTSD and has a high success rate.Alternative therapies such as stellate ganglion block, ketamine, acupuncture, cannabis, mindfulness, and testosterone replacement therapy can provide short-term symptom relief.Soldier buy-in and compliance with treatment are crucial for successful outcomes. Addressing victim status versus hero worship is crucial in conveying the impact of PTSD.Medics play a vital role in selling the treatment and providing support to individuals with PTSD.Soldier identity can be a defense mechanism, but PTSD therapy focuses on functionality and does not take away from one's identity as a soldier.Sleep is essential for healing, and sleep therapy can have positive outcomes for PTSD and other mental health issues.Early intervention and a focus on post-traumatic growth can lead to better outcomes for individuals with PTSD.The military is making efforts to address these issues, and the success of programs depends on soldier buy-in.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis interviews Andy, a former UK Special Forces paramedic, about working in the jungle. They discuss the challenges and skills required to operate in the jungle, such as personal administration, environmental health, and communication. Andy emphasizes the importance of being physically fit and mentally prepared for the jungle environment. He also provides tips for preparing and packing essential medical equipment. The conversation highlights common mistakes made by rookies and offers advice for those interested in venturing into the jungle.
Takeaways
Working in the jungle requires specific skills and preparation, including personal administration, environmental health, and communication.
Being physically fit and mentally prepared is crucial for surviving and thriving in the jungle.
Proper packing and preparation of medical equipment is essential for providing medical care in the jungle.
Rookies often make mistakes in setting up their hammocks, personal administration, and being prepared for the jungle environment.
Taking a course or participating in an expedition with experienced guides can provide valuable knowledge and experience for working in the jungle.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, the hosts discuss regional anesthesia and its role in the priorities of analgesia. They explain that regional anesthesia is a tool that allows for pain control without taking away consciousness or respiratory drive. They discuss the decision-making process for when to use regional anesthesia versus other forms of pain management. The hosts also cover topics such as indicators for when a patient is light enough for a regional block, the risks and complications associated with regional anesthesia, and the importance of training and references for this skill set.
Takeaways
Regional anesthesia is a tool that allows for pain control without taking away consciousness or respiratory drive.
The decision to use regional anesthesia depends on factors such as the complexity of the wound, the time available, and the patient's future needs.
Indicators that a patient is light enough for a regional block include increased respiration and heart rate.
Risks and complications of regional anesthesia include local anesthesia systemic toxicity, cardiac toxicity, and damage to the nerve sheath.
Training and references are important for developing the skill set required for regional anesthesia.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Phil Gonzalez, a combat medic, shares his experiences in Vietnam and his journey to becoming a medic. He discusses the intense situations he faced in Vietnam, including being in dangerous situations and witnessing the horrors of war. He also talks about the importance of medics in Special Forces and the impact they have on the people they treat. After Vietnam, Phil pursued a career in medicine and worked in various locations, including Panama and Salvador, providing medical care to those in need. Dennis shares his experiences working as a medic in remote areas, including his time in Panama and Colombia. He recounts the challenges he faced and the impact he made on the communities he served. Dennis emphasizes the importance of empathy, communication, and adaptability in providing effective medical care. He also highlights the power of mentorship and the need to pass on knowledge and skills to future generations. Dennis concludes by encouraging aspiring medics to never stop learning and to always seek out those in need.TakeawaysThe role of medics in Special Forces is crucial, as they provide medical care to those in need in intense and dangerous situations.Phil Gonzalez's experiences in Vietnam shaped his desire to become a medic and make a difference in people's lives.Phil's journey took him to various locations, including Panama and Salvador, where he provided medical care to those in need.The importance of compassion and bedside manner in being a medic and building trust with patients. Empathy and caring for fellow human beings are essential qualities for a medic working in remote areas.Effective communication and adaptability are crucial in providing medical care in challenging environments.Mentorship and passing on knowledge and skills are important for the future of healthcare in underserved communities.Continuous learning and seeking out those in need are key to making a lasting impact as a medic.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The conversation discusses patient positioning during procedural sedation and the use of Versed (Midazolam) as a sedative. The speakers explore the importance of patient positioning and the need to have a plan for airway management in different positions. They also provide insights into the mechanism of action and dosing of Versed, highlighting the importance of individual patient factors and context in determining the appropriate dose. The conversation emphasizes the need for a staged approach when using sedatives and the importance of communication with the patient to assess their response. In this conversation, Dennis discusses the use of different medications for sedation and anesthesia, focusing on the challenges and considerations involved. He explains that there is no specific dose for achieving amnesia with medications like Midazolam, Propofol, and Ketamine. The dose depends on various factors, including the patient's physiological state and the presence of alcohol in their system. Dennis emphasizes the importance of closely monitoring vital signs and respiratory rate during sedation to ensure the patient remains comfortable and ventilating properly. He also discusses the use of analgesics and local anesthesia to manage pain during procedures. The conversation concludes with a discussion on the reversal agent for sedatives and the importance of considering the set and setting when administering medications like Ketamine.
Takeaways
Consider patient positioning during procedural sedation and have a plan for airway management in different positions.
Understand the mechanism of action and dosing of Versed (Midazolam) as a sedative.
Take into account individual patient factors and context when determining the appropriate dose of Versed.
Use a staged approach when administering sedatives and communicate with the patient to assess their response. There is no specific dose for achieving amnesia with sedative medications like Midazolam, Propofol, and Ketamine.
The dose of sedative medications depends on various factors, including the patient's physiological state and the presence of alcohol in their system.
Monitoring vital signs and respiratory rate is crucial during sedation to ensure the patient remains comfortable and ventilating properly.
Analgesics and local anesthesia can be used to manage pain during procedures.
The reversal agent for sedatives, such as Versed, is Ramazicon, but it should be used cautiously and only after ruling out other causes for the patient not waking up.
Consider the set and setting when administering sedative medications, especially in high-stress environments like combat situations.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Dennis Price discusses his experiences in organizing rescues in Afghanistan and Ukraine. He attributes his success to the blessings of God and his strong faith. In Afghanistan, he formed a company called Polaris to legally protect himself and his team. They were able to save 55 Americans and SIV interpreters in two weeks. Later, he joined a committee called Save Our Allies and worked with the government to rescue and vet interpreters. In Ukraine, he formed a nonprofit called Heroes for Humanity and led a team to provide medical aid and assistance to special needs orphans. He describes the devastation of the war in Ukraine and the innovation of the local people in defending their towns. Dennis Price shares his experiences in Ukraine and his work in rescuing sexually trafficked children. He emphasizes the importance of doing the right thing for the right reasons and helping those in need. He also discusses the challenges of rescuing victims of human trafficking, including the influence of Stockholm syndrome and the need for a compassionate and nurturing approach. Dennis encourages listeners to get involved in organizations that are well-vetted and work closely with law enforcement. He also highlights the need to focus on the rescue mission and not engage in illegal activities. Dennis concludes by urging people to follow Heroes for Humanity on Instagram and support their efforts to make a difference.Click the link to support Heroes for Humanity https://www.zeffy.com/en-US/fundraising/a5925aa7-6994-4247-9271-527face51842Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis, Evan, and Doug discuss the debate between intubation and cricothyrotomy (cric) in the field. Dennis confesses his belief that intubation is the better option, while Evan and Doug argue for the use of cric in certain situations. They discuss the resource limitations in the field, the need for resuscitation prior to intubation, the challenges of obtaining and administering sedation medications, and the potential complications of intubation. They also touch on the importance of training and maintaining skills in a resource-constrained environment. The conversation explores the challenges of airway management in austere environments and the training and resources needed to optimize patient care. The speakers discuss the importance of experience and judgment in performing airway procedures and the need for ongoing training and skill sustainment. They highlight the differences between intubation and cricothyrotomy and the factors to consider when choosing the appropriate procedure. The conversation also touches on the training of role-one providers and the need for educational materials on difficult airway management.
Takeaways
The decision between intubation and cricothyrotomy depends on the resources available in the field.
Intubation requires the ability to resuscitate the patient prior to the procedure and access to suction.
Obtaining and administering sedation medications can be challenging in resource-constrained environments.
Intubation can lead to hemodynamic instability and worsen shock in already unstable patients.
Training and maintaining skills in a resource-constrained environment is crucial for successful airway management. Airway management in austere environments presents unique challenges and requires experience and judgment.
Training and skill sustainment are crucial for optimizing patient care in these environments.
The choice between intubation and cricothyrotomy depends on various factors, including patient stability and available resources.
Role one providers need training and educational materials on difficult airway management.
Standard of care should be maintained even in field environments, with deviations made consciously and deliberately.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis interviews Dr. Jim DuCanto, an anesthesiologist with a special interest in airway management. They discuss the decision-making process in emergency airway management, particularly in challenging situations such as facial trauma. Dr. DuCanto emphasizes the importance of assessing the patient's neurologic status and respiratory efforts, as well as considering the safety of the scene. He also highlights the need for clear communication with the patient and the use of appropriate techniques and tools for airway management. In this conversation, Dr. Jim DuCanto and Dennis discuss various aspects of airway management. They cover topics such as the importance of recognizing the signs of airway compromise, the stages of anesthesia, the role of the spinal cord and reflexes in anesthesia, and the use of different techniques and tools in emergency airway management. They also touch on the potential risks and complications of airway management procedures and the importance of thorough physical examinations. Overall, the conversation emphasizes the need for preparedness, clinical judgment, and the ability to adapt to different situations in airway management.
Takeaways
Assess the patient's neurologic status and respiratory efforts in emergency airway management
Consider the safety of the scene and the need for patient mobility
Communicate clearly with the patient and explain the procedure
Use appropriate techniques and tools for airway management The patient's ability to hear may persist even when they are unconscious under anesthesia.
Emergency airway management requires an understanding of the patient's reflexes and potential resistance.
Clinical judgment and the ability to adapt to different situations are crucial in airway management.
Thorough physical examinations can provide valuable information in assessing the patient's condition.
Preparedness and having the necessary tools and equipment readily available are essential in airway management.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode, Dennis, Doug, and Paul discuss how to treat expectant patients in a medical setting. They explore the concept of palliative care and its role in providing comfort to patients at all stages of care. They also discuss the challenges medics face when dealing with expectant patients and the importance of reaching out for support and guidance. The conversation emphasizes the need to prioritize efforts and provide pain control and symptom management to make the patient as comfortable as possible. The key takeaway is that even in difficult situations, medics should strive to do everything they can for their patients.
Takeaways
Palliative care is an important aspect of patient care at all stages, not just at the end of life.
Medics should prioritize efforts and provide pain control and symptom management to expectant patients.
It is crucial for medics to reach out for support and guidance when making difficult decisions.
Even if the outcome is not favorable, providing closure and knowing that everything possible was done can bring comfort to everyone involved.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
The podcast episode discusses the controversial topics of expectant care and end-of-life care in a role one setting. The panel of experienced medics and docs share their personal experiences and concerns regarding training and implementation of these types of care. They highlight the need for clear guidance and training for medics and corpsmen to make difficult decisions in the field. The panel also discusses the potential obstacles and unintended consequences of implementing clinical practice guidelines for expectant and end-of-life care. The conversation focuses on the need for guidance and training in making difficult medical decisions on the battlefield, particularly in the context of end-of-life care. The speakers discuss the importance of identifying patients who would most benefit from direct care and the potential moral injury that can occur when undertrained individuals are put in positions of medical directorship. They also explore the challenges of decision-making in mass casualty situations and the need for clear guidelines and policies. The conversation emphasizes the importance of having conversations about death and dying early in training and the need for realistic expectations and shared decision-making.
Takeaways
Expectant care and end-of-life care are important topics that need to be discussed and addressed in the role one setting.
Training for medics and corpsmen in expectant and end-of-life care is currently inadequate and needs improvement.
Clear guidance and clinical practice guidelines are necessary to help medics and corpsmen make difficult decisions in the field.
Implementing expectant and end-of-life care guidelines may have unintended consequences and require careful consideration.
Empowering medical directors to make decisions based on their unit's needs and training is important for effective implementation. The need for guidance and training in making difficult medical decisions on the battlefield, particularly in the context of end-of-life care
The potential moral injury that can occur when undertrained individuals are put in positions of medical directorship
The challenges of decision-making in mass casualty situations and the need for clear guidelines and policies
The importance of having conversations about death and dying early in training and the need for realistic expectations and shared decision-making
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Bryce, an 18 Delta out of the Special Forces group, discusses the challenges and strategies for training non-medics in medical skills. He emphasizes the importance of building a culture of medical training within the team and the benefits of cross-training. Bryce also highlights the impact of medical training on operational readiness and risk mitigation. He shares insights on mentorship, humility, and the progression of medical training for non-medics.
Takeaways
Building a culture of medical training within the team is essential for operational readiness and risk mitigation.
Mentorship and humility play a crucial role in the progression of medical training for non-medics.
Cross-training non-medics in medical skills enhances the team's capability and confidence in providing patient care.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, the speakers discuss the state of medics in Special Operations Medicine and offer recommendations for improvement. They highlight the importance of regular and realistic medical training at the unit level, as well as the need for feedback and accountability. The speakers also address specific issues such as lack of familiarity with protocols, equipment shortfalls, and training scars. They emphasize the need for critical thinking and individualized patient care rather than relying on algorithms. Overall, the podcast aims to improve the quality of medical training and performance among medics in Special Operations.
Takeaways
Regular and realistic medical training at the unit level is crucial for improving the skills and performance of medics in Special Operations.
Feedback and accountability are essential for medics to identify and address their shortcomings.
Familiarity with protocols, equipment, and drug administration is crucial for effective medical care.
Training should focus on critical thinking and individualized patient care rather than relying on algorithms.
Unit leaders and commanders should prioritize and support medical training to ensure the readiness of their medics.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis, Doug, and Justin discuss the development of a Sepsis Clinical Practice Guideline (CPG) for prolonged field care. They highlight the importance of early recognition and antibiotic administration in sepsis management. They also discuss the use of scoring systems like QSOFA and NEWS2 to aid in the identification of septic patients. The conversation covers the role of lactate monitoring and the potential confounding factors. They emphasize the need for a comprehensive assessment of the patient and the importance of not relying solely on one marker or number. The conversation also touches on the importance of proper catheter insertion and the consideration of prophylactic catheter replacement in austere environments. They discuss the use of fluids as the first-line treatment in septic patients and caution against over-resuscitation. The conversation concludes with a reminder to pay attention to the patient's response and not blindly adhere to formulas or protocols. In this conversation, the speakers discuss various aspects of sepsis management, including fluid resuscitation, the use of colloids, the importance of monitoring urine output, and the decision to initiate vasopressors. They also touch on the use of antibiotics and wound management in sepsis cases. The conversation provides valuable insights and practical tips for healthcare providers in austere environments.
Takeaways
Early recognition and timely administration of antibiotics are crucial in sepsis management.
Scoring systems like QSOFA and NEWS2 can aid in the identification of septic patients.
Lactate monitoring can be confounded by various factors, and a comprehensive assessment of the patient is necessary.
Proper catheter insertion and prophylactic catheter replacement should be considered in austere environments.
Fluids are the first-line treatment in septic patients, but over-resuscitation should be avoided.
Pay attention to the patient's response and use clinical judgment rather than blindly following formulas or protocols. In sepsis cases, fluid resuscitation is crucial, and the choice of fluid depends on availability. Balanced electrolyte solutions like Ringer's lactate or plasma light are preferred, but normal saline can be used if that's all that's available.
Colloids may be used in sepsis patients with high output losses or compartment syndrome. Options include FFP, albumin, or freeze-dried plasma.
Monitoring urine output is important in assessing the response to fluid resuscitation. If urine output increases, it indicates a positive response. However, if urine output remains high despite fluid administration, it may indicate over-resuscitation.
When considering the use of vasopressors, the decision should be based on the patient's blood pressure and mental status. If the patient remains hypotensive and shows no improvement after a substantial amount of fluid, vasopressors may be initiated.
Antibiotics should be given empirically in sepsis cases, and the choice of antibiotic depends on the suspected source of infection. Wound management, including effective debridement and irrigation, is crucial in preventing infection.
Regular assessment of wounds is important to identify any signs of infection or non-viable tissue.
In austere environments, it may be necessary to make treatment decisions based on the patient's clinical presentation and endemic risk, even without confirmatory tests.
The conversation highlights the importance of collaboration and mentorship in developing clinical practice guidelines and acknowledges the contributions of healthcare professionals in the field.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode, Doug and Dennis discuss the appropriate use of vasopressors, specifically epinephrine and norepinephrine, in the management of shock. They highlight the importance of fluids in sepsis resuscitation and the potential dangers of using high concentrations of epinephrine. They also discuss the different effects of epinephrine and norepinephrine on heart rate and blood pressure, and the potential side effects of epinephrine, such as arrhythmias and lactic acidosis. The conversation concludes with a discussion on the use of epinephrine in anaphylaxis and the importance of individualizing treatment based on the patient's response.
Takeaways
Epinephrine is commonly used as a vasopressor in the management of shock, but it should be used with caution due to its potential side effects.
Norepinephrine is often preferred over epinephrine in sepsis resuscitation due to its more selective vasoconstrictive effects and lower risk of arrhythmias.
Fluid resuscitation is an important component of sepsis management and should be prioritized before initiating vasopressor therapy.
Monitoring the patient's response to vasopressor therapy, including blood pressure, heart rate, and organ perfusion, is crucial in determining the effectiveness and safety of the treatment.
Individualizing treatment based on the patient's specific needs and response is essential in optimizing outcomes in shock management.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis and Andrew Fisher discuss the process of setting up a walking blood bank in a military setting. They emphasize the importance of practicing and adapting the process to specific needs. They recommend conducting ABO testing for all potential donors and identifying low-titer O donors as a preferred option. They also discuss the logistics of preparing supplies and coordinating with multiple units. The podcast concludes with a reminder of the importance of communication and planning in order to execute the process effectively.TakeawaysPracticing and adapting the process of setting up a walking blood bank is crucialConduct ABO testing for all potential donors and identify low-titer O donorsPrepare supplies and coordinate with multiple unitsEffective communication and planning are key to executing the process successfully
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis interviews Victor about his experiences in Burma and his work with Free Burma Rangers. Victor discusses the changing dynamics of the conflict in Burma and the progress made by ethnic forces. He also talks about his role as a medic and the challenges of teaching combat medicine to indigenous groups. Victor emphasizes the importance of focusing on the basics and tailoring training to the specific needs of the students. He shares his experiences with teaching pressure points, tourniquets, casualty drags, and blood collection. Victor also reflects on the challenges of triage and decision-making in a mass casualty situation. During the conversation, Victor shares several lessons learned from his trip to Burma. He discusses the importance of going back to the basics and relying on ground reconnaissance when operating without ISR capabilities. He also highlights the need for movement and noise discipline to avoid detection by the enemy's reconnaissance planes and jets. Victor emphasizes the significance of good topside cover and concealment to protect against airstrikes and mortar attacks. He also talks about the challenges of providing prolonged field care and the importance of being mentally sharp and prepared for the continuous cycle of problems that arise during operations. Victor mentions the disbursement of medical equipment and the need for contingency plans in case of CCP destruction. Overall, the conversation provides valuable insights into the realities and complexities of operating in a hostile environment with limited resources.
Takeaways
The ethnic forces in Burma have been gaining ground and achieving significant victories in the conflict.
Teaching combat medicine to indigenous groups requires focusing on the basics and tailoring training to their specific needs.
Training on pressure points, tourniquets, casualty drags, and blood collection were essential for the indigenous groups in Burma.
Triage and decision-making in a mass casualty situation can be challenging, but it is important to prioritize casualties based on their chances of survival. Rely on ground reconnaissance and basic skills when operating without ISR capabilities
Maintain movement and noise discipline to avoid detection by enemy aircraft
Seek good topside cover and concealment to protect against airstrikes and mortar attacks
Be mentally sharp and prepared for the continuous cycle of problems during operations
Disburse medical equipment strategically and have contingency plans in case of CCP destruction
Here are some clips from Victor's experiences:
https://youtu.be/dBkTziMluyk?si=DIwvc-SAHCJ81hSMhttps://youtu.be/wNKHL_OJ4TMsi=vC1WoJWH_hhKme1hThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This podcast episode focuses on the importance of measuring urine output as a cheap and effective method for monitoring hemodynamics in prolonged field care. The hosts discuss the benefits of using a Foley catheter for urine measurement and emphasize the need for proper sterility during the procedure. They also touch on the topic of hypotensive resuscitation and the challenges of managing patients with low blood pressure in a prolonged field care setting.
Takeaways
Measuring urine output is a simple and cost-effective way to monitor a patient's hemodynamic status in a prolonged field care setting.
A Foley catheter is a reliable tool for measuring urine output and can provide valuable information about a patient's overall health.
Proper sterility is important when inserting a Foley catheter to prevent infections.
Hypotensive resuscitation is a complex topic that requires further discussion and consideration in the context of prolonged field care.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis and Doug discuss crush syndrome and the challenges it presents in dynamic environments such as natural disasters or man-made incidents. They emphasize the importance of scene safety and the need to assess and stabilize any other traumatic injuries before addressing crush syndrome. They also discuss the use of tourniquets and the potential risks and benefits associated with their application. The conversation covers the management of crush syndrome, including fluid resuscitation, monitoring for cardiac complications, and the use of calcium and sodium bicarbonate. They highlight the need for a comprehensive approach to diagnosis and treatment, considering factors such as time of response and the presence of other injuries. In this conversation, Dennis and Doug discuss the management of crush syndrome in a resource-limited setting. They cover topics such as tourniquet use, fluid resuscitation, potassium management, and the use of sodium bicarbonate. They also touch on wound management and the importance of antibiotics. The conversation concludes with a discussion on the use of insulin and dextrose, as well as albuterol, in managing cardiac instability. Overall, the conversation provides a comprehensive overview of the management of crush syndrome in a challenging environment.
Takeaways
Scene safety is paramount in crush syndrome situations, and rescuers should be aware of potential hazards such as secondary devices, unstable structures, and chemical releases.
Assessing and stabilizing any other traumatic injuries is crucial before addressing crush syndrome.
The use of tourniquets in crush syndrome is a topic of debate, and a protocol should be in place to reassess their necessity and remove them as soon as possible.
Fluid resuscitation is important in managing crush syndrome, and the amount and rate of fluid administration should be based on the patient's condition and available resources.
Monitoring for cardiac complications, such as arrhythmias and acidosis, is essential, and interventions such as calcium and sodium bicarbonate may be necessary.
A comprehensive approach to diagnosis and treatment is necessary, considering factors such as time of response and the presence of other injuries. Tourniquets can be used to manage crush syndrome in the lower extremities, but there is a risk of unnecessary amputations.
Fluid resuscitation is important in stabilizing the patient and increasing urine output.
Sodium bicarbonate can be used to manage metabolic acidosis and improve the effectiveness of vasopressors.
Calcium can be given to stabilize cardiac rhythm, and insulin and dextrose can be used to manage high potassium levels.
Albuterol can be used to treat respiratory acidosis, but it may be challenging to administer in a resource-limited setting.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the Prolonged Fuel Care Podcast, Dr. Ben Abo and Jordan Benjamin discuss snake envenomation. They debunk common myths about snakebite treatment, such as using tourniquets, extractors, ice, or cutting into the wound. They emphasize the importance of preparing for deployment in snake-infested areas by researching the local hazards and having the appropriate equipment. They provide a standardized snake bite assessment method, which involves a bottom-up top-down approach to identify the type of venom and the severity of the envenomation. They also discuss the decision-making process for airway management and the use of antivenom. The solution to snakebite envenomation is early and appropriate treatment with antivenom. It is important to irrigate the bite site and dilute the venom as quickly as possible. The use of tourniquets is not recommended, and if one is already applied, it should be slowly released. Pain management is crucial, and opioids and ketamine are effective options. Monitoring the progression of symptoms is more important than assigning a grade to the envenomation. Early intervention and proper training in snakebite management can lead to better outcomes.
Takeaways
Do not use tourniquets, extractors, ice, or cutting into the wound for snakebite treatment.
Research the local hazards and have the appropriate equipment when deploying to snake-infested areas.
Use a standardized snake bite assessment method to identify the type of venom and the severity of the envenomation.
Make decisions about airway management based on the patient's symptoms and use tools like capnography and pulse oximetry.
Antivenom is the key treatment for snake envenomation, and there are no absolute contraindications to its administration. The solution to snakebite envenomation is early and appropriate treatment with antivenom
Irrigate the bite site and dilute the venom as quickly as possible
Avoid using tourniquets, but if one is already applied, slowly release it
Pain management is crucial, and opioids and ketamine are effective options
Monitor the progression of symptoms rather than assigning a grade to the envenomation
Early intervention and proper training in snakebite management can lead to better outcomes
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis interviews Pete, a former Navy Special Warfare medic with experience in maritime operations. They discuss the unique challenges of providing medical care in a maritime environment, including the need for self-extraction and the difficulties of working on an unstable platform. Pete emphasizes the importance of realistic training and self-reliance in maritime medicine. They also touch on the training of Ukrainian forces and the misconceptions surrounding tourniquet use. Overall, the conversation highlights the need for constant adaptation and a focus on patient survivability in maritime medical operations.
Takeaways
Providing medical care in a maritime environment presents unique challenges, including the need for self-extraction and working on an unstable platform.
Realistic training and self-reliance are crucial in maritime medicine, as medical professionals must be prepared to adapt to the dynamic nature of the environment.
Training Ukrainian forces in medical skills requires expectation management and prioritizing the most essential knowledge and skills within a limited timeframe.
Misconceptions surrounding tourniquet use in Ukraine highlight the importance of proper training and understanding of when and how to apply tourniquets.
In maritime medical operations, constant adaptation and a focus on patient survivability are key to providing effective care.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Ricky and Justin discuss their research on the administration of calcium in hemorrhagic shock. They explain how they became interested in the topic and the gaps they identified in current medical knowledge. They discuss the importance of calcium in the clotting cascade and the potential role of citrate in contributing to hypocalcemia. They also explain the protocol for administering calcium in the field and the different forms of calcium that can be used. They discuss the risks of overcorrection of hypocalcemia and the need for further research on the topic. Overall, their research aims to improve patient outcomes and reduce mortality in hemorrhagic shock.
Takeaways
Calcium plays a crucial role in the clotting cascade and may be important in the treatment of hemorrhagic shock.
Hypocalcemia is common in trauma patients and may contribute to increased mortality.
The administration of calcium, along with blood products, can help prevent hypocalcemia and improve patient outcomes.
The protocol for administering calcium in the field includes giving one gram upfront and one gram every four units of threshold blood.
There is a risk of overcorrection of hypocalcemia, which can lead to hypercalcemia and increased mortality.
Further research is needed to determine the optimal timing and dosage of calcium administration in hemorrhagic shock.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis interviews Steve Schauer about his calcium study in trauma patients. Steve provides an introduction to himself and his background in emergency medicine and research. He explains that the study aims to determine the prevalence of calcium derangement in trauma patients upon arrival at the trauma center. The study is being conducted at three different trauma centers and has completed enrollment. Steve also discusses the challenges of extrapolating research findings from military trauma to civilian trauma. They also touch on the limitations of the Injury Severity Score (ISS) in assessing military trauma. The conversation then delves into the logistics of the study, including the collection of calcium levels and the potential impact of pre-hospital blood transfusions on calcium levels. They discuss the importance of timing and accuracy in collecting calcium levels and the need for better documentation in trauma care. They also explore the administration of calcium and the differences between calcium gluconate and calcium chloride. Steve emphasizes the importance of administering calcium slowly to avoid adverse effects. They also discuss the timing of calcium administration in relation to blood transfusions and the challenges of determining the optimal calcium levels in trauma patients. The episode concludes with a discussion on the need for iStat machines in trauma centers to monitor calcium levels in real-time. In this conversation, Dennis and Steven Schauer discuss the administration of calcium in trauma patients. They explore the role of calcium in the coagulation cascade and its potential benefits in improving hemodynamics. They also discuss the challenges of administering calcium in the field and the need for further research to determine its efficacy. The conversation highlights the importance of prioritizing blood and tranexamic acid (TXA) administration before considering calcium. Overall, the conversation provides valuable insights into the use of calcium in trauma care.
Takeaways
The study aims to determine the prevalence of calcium derangement in trauma patients upon arrival at the trauma center.
Extrapolating research findings from military trauma to civilian trauma poses challenges due to differences in injury mechanisms.
The Injury Severity Score (ISS) has limitations in assessing military trauma.
Timing and accuracy are crucial in collecting calcium levels in trauma patients.
Calcium administration should be done slowly to avoid adverse effects.
Determining the optimal calcium levels in trauma patients is challenging.
iStat machines can be valuable in monitoring calcium levels in real-time. Calcium is a cofactor in the coagulation cascade and may play a role in improving hemodynamics in trauma patients.
The administration of calcium should be prioritized after blood and tranexamic acid (TXA) in trauma care.
The optimal method of calcium administration, such as infusion plus drip, is still under investigation.
Further research is needed to determine the efficacy of calcium in trauma care.
The availability of resources and logistics may influence the choice of calcium formulation for administration.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode, Jim discusses the importance of adapting to the changing world and the need to prioritize the well-being of soldiers. He emphasizes the need for commanders and medical providers to understand the risks and challenges faced by the national treasure, the sons and daughters of the nation. Jim highlights the changing nature of warfare and the need to adapt to austere and rapidly evolving environments. He also discusses the importance of whole-of-government approaches and the need for joint, inter-organizational, and multinational collaboration. Jim encourages listeners to develop adaptive thinking and to be prepared to win in a complex world.
Takeaways
The well-being of soldiers should be the top priority for commanders and medical providers
Adapting to the changing world and the challenges of warfare is crucial
Whole-of-government approaches and collaboration are essential for success
Developing adaptive thinking and being prepared to win in a complex world is necessary
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis interviews Alex McDonald, a medical student and member of Tactical Medicine New Zealand, about the republishing of the book 'Guerilla Surgeon.' The book tells the story of Dr. Lindsay Rogers, a New Zealand-born surgeon who served with the Special Operations Executive in Yugoslavia during World War II. The conversation covers topics such as the challenges of providing medical care in resource-limited environments, building trust with local forces, and the importance of cultural competency. Alex also discusses the mission of Tactical Medicine New Zealand and their partnership with the Special Operations Medical Association (SOMA) to republish the book.
Takeaways
The book 'Guerilla Surgeon' tells the story of Dr. Lindsay Rogers, a New Zealand-born surgeon who served with the Special Operations Executive in Yugoslavia during World War II.
Providing medical care in resource-limited environments requires improvisation and making the most of available resources.
Building trust with local forces is crucial for successful medical operations in foreign nations.
Cultural competency is important for effective communication and collaboration with partner forces.
Tactical Medicine New Zealand aims to promote and advance tactical medicine in New Zealand and has partnered with SOMA to republish 'Guerilla Surgeon.'
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Dr. Van Wyk discusses updates in traumatic brain injury (TBI) management, focusing on the CRASH 3 trial and the use of tranexamic acid (TXA). He explains that TXA is safe and reduces head injury-related death, particularly in patients with moderate and mild TBI. He also discusses the use of hypertonic saline and recommends considering higher concentrations, such as 23.4%, which have been shown to be safe and effective. Dr. Van Wyk mentions the use of sodium bicarbonate as an alternative and emphasizes the importance of clinical judgment in determining the appropriate treatment. He also discusses monitoring options for cerebral edema and increased intracranial pressure, such as optic nerve sheath diameter measurements. Finally, he touches on the topic of decompressive hemicraniectomy and the considerations for performing this procedure in austere environments.
Takeaways
Tranexamic acid (TXA) is safe and reduces head injury-related death in patients with moderate and mild traumatic brain injury (TBI).
Higher concentrations of hypertonic saline, such as 23.4%, may be considered as they have been shown to be safe and effective.
Sodium bicarbonate can be used as an alternative to hypertonic saline, particularly in austere environments.
Optic nerve sheath diameter measurements can be used to monitor cerebral edema and increased intracranial pressure.
Decompressive hemicraniectomy may be considered in severe TBI cases, and general surgeons may be trained to perform the procedure in the absence of a neurosurgeon.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Summary:
In this conversation, Dennis and Ian discuss the new high altitude Clinical Practice Guideline (CPG) in the Joint Trauma System. They cover topics such as acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). They discuss the pathophysiology, symptoms, diagnosis, and treatment options for these conditions. They also touch on pre-treatment strategies and the use of portable hyperbaric chambers. Overall, the conversation provides a comprehensive overview of altitude-related illnesses and their management. In this conversation, Dennis and Ian discuss the treatment options for altitude illness, specifically AMS, HAPE, and HACE. They cover the use of pharmacologic therapy, oxygen, and portable hyperbaric chambers to stabilize and bring down patients with altitude illness. They also discuss the use of dexamethasone as the primary treatment for HACE and the potential use of hypertonic saline for extreme cases. They touch on the side effects of dexamethasone and the importance of protecting the airway. They also mention the use of acetazolamide for prophylaxis and the benefits of intermittent hypoxic exposure. Finally, they discuss the importance of good nutrition and hydration and the new medic encounter form for recording data on altitude illness.
Takeaways:
Acute mountain sickness (AMS) occurs when the body does not have enough time to acclimatize to the physiological stress of altitude.
High altitude cerebral edema (HACE) is characterized by ataxia and can occur even without AMS symptoms.
High altitude pulmonary edema (HAPE) is characterized by decreased exercise tolerance and tachypnea.
Assessment of vital signs, such as heart rate and respiratory rate, can help differentiate between altitude illnesses.
Portable hyperbaric chambers can be used to stabilize patients with altitude illnesses until they can be brought down to lower altitudes.
Pharmacologic treatments, such as acetazolamide and dexamethasone, can be used for prophylaxis and treatment of altitude illnesses.
Improvement in symptoms of HAPE can be rapid with oxygen therapy.
Pre-treatment strategies, such as using acetazolamide, can help acclimatize the body to altitude before ascent. Pharmacologic therapy, oxygen, and portable hyperbaric chambers can be used to stabilize and bring down patients with altitude illness.
Dexamethasone is the primary treatment for HACE, and hypertonic saline may be considered for extreme cases.
Side effects of dexamethasone include increased sugar, gastric erosions, gastric bleeding, and adrenal suppression.
Acetazolamide can be used for prophylaxis, and intermittent hypoxic exposure may help with acclimatization.
Good nutrition, hydration, and iron status are important for preventing altitude illness.
The new medic encounter form is a valuable tool for recording data on altitude illness.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Jay Baker discusses the topic of SOF surgical support in Special Operations Forces (SOF). He compares the different types of missions that soft surgical teams might be called upon to support and describes the gap that exists in institutional experience for surgical support in the setting of unconventional warfare. Baker highlights the lessons learned from surgical support in World War II and emphasizes the need to prepare for providing surgical support in more challenging environments. He also discusses the efforts being made to improve soft surgical support, including the development of RSOF surgical teams and the Prolonged Field Care initiative.
Takeaways
Sof surgical support in Special Operations Forces (SOF) is an evolving problem set that requires preparation for providing surgical support in more challenging environments.
Lessons can be learned from surgical support in World War II, where surgeons provided care in dangerous and challenging environments.
Efforts are being made to improve soft surgical support, including the development of RSOF surgical teams and the Prolonged Field Care initiative.
Training and experience in caring for critical patients over longer periods of time, performing tactical evacuations, and developing innovative solutions to resupply challenges are important for soft surgical teams.
Maggot therapy, also known as maggot debridement therapy (MDT), is a treatment that uses live maggots to clean and heal wounds. The therapy has a long history, dating back thousands of years, and has been used in various settings, including war zones and modern hospitals. Maggots are effective in wound healing because they eat necrotic tissue, have antimicrobial properties, and promote the growth of new tissue. The therapy is cost-effective and can be used in low-resource settings. It can be applied directly to the wound or placed in a mesh bag. Maggot therapy is often used as an adjunct to antibiotics and other wound treatments.TakeawaysMaggot therapy is a cost-effective and efficient treatment for wound healing.Maggots eat necrotic tissue, have antimicrobial properties, and promote the growth of new tissue.The therapy can be used in various settings, including war zones and low-resource environments.Maggot therapy can be used as an adjunct to antibiotics and other wound treatments.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Doug discusses the use of End-tidal CO2 monitoring in medical practice. End-tidal CO2 is used to monitor the percent of carbon dioxide in blood that has been returned to the lungs. It is commonly used to confirm the placement of an endotracheal tube and to monitor ventilation during surgery. In the field, End-tidal CO2 monitoring is particularly useful for trauma patients and those with severe traumatic brain injuries. However, it is important to note that End-tidal CO2 should be used as part of a comprehensive approach to patient care, and clinical judgment is still crucial in making treatment decisions.TakeawaysEnd-tidal CO2 monitoring is used to confirm the placement of an endotracheal tube and to monitor ventilation during surgery.In the field, End-tidal CO2 monitoring is particularly useful for trauma patients and those with severe traumatic brain injuries.End-tidal CO2 should be used as part of a comprehensive approach to patient care, and clinical judgment is still crucial in making treatment decisions.Other markers of resuscitation, such as lactate levels, may provide more valuable information in certain situations.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode, Dennis interviews John and Paul about the Abdominal Aortic and Junctional Tourniquet (AAJT). They discuss the background and reasons for inventing the AAJT, including the need to control bleeding in the pelvis. They also talk about the first application of the AAJT and the positive results seen in combat situations. The conversation then moves on to study data and research on the device, including some negative studies that have been conducted. They also discuss the pressure levels used with the AAJT and the potential for extending the application time. Finally, they address the negative consequences of high pressure and the comfort level of wearing the device. The conversation explores the application and function of the Abdominal Aortic Junctional Tourniquet (AAJT) and its potential use in pre-hospital care. It discusses the challenges of prolonged application and the risks associated with it. The conversation also delves into alternative techniques and future developments in the field. The importance of reperfusion and monitoring is highlighted, along with the impact of the AAJT on breathing and inspiratory pressure. The discussion touches on the considerations for reducing pressure during reperfusion and the duration of application. The risk-benefit analysis of heroic interventions is examined, emphasizing the need for rapid hemorrhage control. The limitations and risks of Roboa are discussed, and a cadaveric study on the AHAT is presented. The conversation concludes with the role of the AHAT in preparing for future wars and its potential use in traumatic cardiac arrest.TakeawaysThe AAJT was invented to control bleeding in the pelvis and junctional areas.The device has been successfully used in combat situations and has saved lives.There have been several studies conducted on the AAJT, with mixed results.The device applies pressure to occlude blood flow, but the pressure levels are safe and well-tolerated. The Abdominal Aortic Junctional Tourniquet (AAJT) is a fielded device that can be used for rapid hemorrhage control in non-compressible torso hemorrhage.Prolonged application of the AAJT should be avoided, and it is important to consider the risks and benefits of its use.Alternative techniques and future developments, such as foams, are being explored for the treatment of non-compressible torso hemorrhage.Reperfusion and monitoring are crucial considerations when using the AAJT, and the pressure can be reduced during transfusion to mitigate ischemic change.The AAJT has shown promising results in traumatic cardiac arrest and can be a valuable tool in pre-hospital care.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis and Ian discuss heat injuries and illnesses. They cover the background science of body heat and heat transfer, as well as the different types of heat injuries, including heat cramps, heat syncope, heat exhaustion, and heat stroke. They emphasize the importance of hydration and urine color as indicators of hydration status. The treatment for heat stroke involves cooling the body as quickly as possible, with immersion in ice water or the use of ice sheets being the most effective methods. They also discuss the importance of acclimatization to heat and the need for prompt evacuation in cases of heat stroke.TakeawaysHeat injuries and illnesses can range from minor heat cramps to life-threatening heat stroke.The body dissipates heat through radiation, conduction, convection, and evaporation.Hydration is crucial in preventing heat injuries, and urine color can be used as an indicator of hydration status.Heat stroke is a medical emergency that requires immediate cooling of the body.Acclimatization to heat and proper planning can help prevent heat injuries.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode, Dennis and Alex discuss the truth about pelvic binders and their relevance in trauma care. They explore the background and experience of Alex, who has extensive knowledge in trauma surgery. They delve into the anatomy and injury patterns of pelvic fractures, as well as the different phases of damage control surgery. They also discuss the importance of understanding research and the levels of evidence. The conversation highlights the contradictory evidence surrounding the use of pelvic binders and emphasizes the need to critically evaluate citations and research findings. This conversation covers blast injuries, types of pelvic fractures, mortality rates, considerations for prolonged field care (PFC), the flow of care in PFC, normalization and observation, initial stabilization, massive transfusion protocol, futile transfusions, clinical decision making, pelvic binder design, imaging challenges, ultrasound for pelvic fracture assessment, duration of pelvic binder use, preventing pressure sores, consulting with medical professionals, proper application of pelvic binder, retroperitoneal hemorrhage, the role of telemedicine, critical care and decision making, and resources for further learning.TakeawaysUnderstanding the anatomy and injury patterns of pelvic fractures is crucial in trauma care.The levels of evidence in research range from high-quality studies to expert opinions.The use of pelvic binders in trauma care is a topic of debate, with conflicting evidence and opinions.It is important to critically evaluate citations and research findings to make informed decisions in patient care. Understanding blast injuries and the different types of pelvic fractures is crucial in providing effective care in PFC.Mortality rates for pelvic fractures vary depending on the severity of the injury and associated injuries.Clinical decision making in PFC requires a thorough understanding of the patient's condition and available resources.Proper application and duration of pelvic binder use are important considerations in PFC.Consulting with medical professionals and seeking skeptics' opinions can help in making informed decisions in PFC.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis and Ricky discuss how to pick and evaluate research papers to inform medical practice. They differentiate between causative research papers and retrospective observational studies, emphasizing the importance of reading the methods section to determine the validity of the research. They also highlight the common mistakes people make when reading research papers, such as relying solely on the title and abstract. The conversation delves into the challenges of conducting pre-hospital research and the difficulties in applying research findings to practice. Ricky also shares his experiences in mentoring aspiring medical school applicants and launching a new podcast.Takeaways Differentiate between causative research papers and retrospective observational studies when reading research papers. Read the methods section to determine the validity of the research and understand the inclusion and exclusion criteria, statistical analysis, and potential biases. Avoid common mistakes when reading research papers, such as relying solely on the title and abstract. Consider the challenges of conducting pre-hospital research, including data collection and controlling for environmental factors. Extrapolate research findings to pre-hospital practice by discussing and collaborating with other providers.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This conversation explores the topic of gas anesthesia, its historical background, and its use in various environments. The conversation covers the shift to the TIVA technique, the importance of the anesthesia machine and equipment, and the training required to administer gas anesthesia. It also discusses the combined techniques used in the operating room and the stages of anesthesia. The conversation highlights the advantages and disadvantages of ether and chloroform as anesthetics. It emphasizes the need for vigilant monitoring and the use of IV induction agents for safety. The conversation concludes by discussing the duration of gas anesthesia and the importance of witnessing wakeups.TakeawaysGas anesthesia has a long history and is still used today in various environments.The TIVA technique is a popular approach to gas anesthesia, especially in field environments.The anesthesia machine and equipment play a crucial role in administering gas anesthesia.Vigilant monitoring is essential during gas anesthesia to ensure patient safety.Witnessing the stages of anesthesia, including wakeups, is important for understanding the process.Ether and chloroform were popular anesthetics in the past but have been replaced by safer alternatives.IV induction agents are used to quickly transition patients through the stages of anesthesia.The duration of gas anesthesia depends on the amount and length of use.Observing gas anesthesia in the operating room provides valuable insights into its application.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
This episode of the PFC podcast focuses on in-route casualty care. The guest, Nikki, shares her background and experience in the Navy and explains why she started an in-route care training course. The conversation covers common mistakes in preparing patients for flight, securing lines and equipment, and the importance of constant assessment and monitoring. Nikki also discusses the training scenarios she uses to prepare nurses and corpsmen for in-route care. The episode concludes with a discussion on effective handovers, monitoring endotracheal tube placement, and the importance of collaboration in in-route care.TakeawaysProper planning and assessment are crucial in in-route casualty care.Securing lines and equipment and packaging the patient appropriately are important considerations for flight.Constant assessment and monitoring are essential during in-route care.Effective handovers and communication are critical for patient care during transport.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis and John discuss chest trauma management, specifically the use of chest seals and the sequence of interventions. They explore the overuse of chest seals and the potential complications they can cause. They also discuss the importance of assessing the patient and determining if a chest seal is necessary. John shares his insights on the use of finger thoracostomy and the technique for performing it. They also touch on the revision of the TCCC algorithm and the need to prioritize hemorrhage control. The conversation explores the challenges and approaches in operational medicine, emphasizing the need to align policy and guidelines with the experiences of field practitioners. It highlights the importance of preserving the rich experience and lessons learned by experienced personnel. The discussion also delves into the management of chest trauma, specifically focusing on emergent situations and the challenges in current practices. The conversation concludes with the anticipation of future discussions and the potential for further exploration of the topics.TakeawaysChest seals should be used specifically for sucking chest wounds or open pneumothorax.Chest seals can cause tension pneumothorax if used inappropriately.The decision to use a chest seal should be based on the patient's breathing status and the nature of the injury.Negative suction can be beneficial in re-inflating the lung and improving oxygenation in patients with chest trauma.The TCCC algorithm may need revision to prioritize hemorrhage control. Operational medicine requires a balance between algorithmic approaches and the practical experiences of field practitioners.Preserving the experience and lessons learned by experienced personnel is crucial for the development of effective policies and guidelines.Chest trauma management involves various emergent situations, including tension pneumothorax, hemothorax, and pneumothorax.Challenges in chest trauma management include the use of occlusive dressings and the need for surgical interventions.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this conversation, Dennis and John discuss chest trauma management, specifically the use of chest seals and the sequence of interventions. They explore the overuse of chest seals and the potential complications they can cause. They also discuss the importance of assessing the patient and determining if a chest seal is necessary. John shares his insights on the use of finger thoracostomy and the technique for performing it. They also touch on the revision of the TCCC algorithm and the need to prioritize hemorrhage control. The conversation explores the challenges and approaches in operational medicine, emphasizing the need to align policy and guidelines with the experiences of field practitioners. It highlights the importance of preserving the rich experience and lessons learned by experienced personnel. The discussion also delves into the management of chest trauma, specifically focusing on emergent situations and the challenges in current practices. The conversation concludes with the anticipation of future discussions and the potential for further exploration of the topics.TakeawaysChest seals should be used specifically for sucking chest wounds or open pneumothorax.Chest seals can cause tension pneumothorax if used inappropriately.The decision to use a chest seal should be based on the patient's breathing status and the nature of the injury.Negative suction can be beneficial in re-inflating the lung and improving oxygenation in patients with chest trauma.The TCCC algorithm may need revision to prioritize hemorrhage control. Operational medicine requires a balance between algorithmic approaches and the practical experiences of field practitioners.Preserving the experience and lessons learned by experienced personnel is crucial for the development of effective policies and guidelines.Chest trauma management involves various emergent situations, including tension pneumothorax, hemothorax, and pneumothorax.Challenges in chest trauma management include the use of occlusive dressings and the need for surgical interventions.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this podcast episode, Dennis interviews Monte from Delta Development about the need for a small blood refrigerator for prolonged field care. Monte shares his military background and experiences in Afghanistan and Iraq, where he realized the importance of carrying blood products in the field. They discuss the challenges of storing and transporting blood, including temperature control and cumulative time. Monte explains how Delta Development's blood refrigerator solves these issues and can even be used to run a mini blood bank. They also touch on the future possibilities of resupplying blood in the field. Overall, the podcast highlights the critical role of blood in prolonged field care and the importance of proper storage and transport methods.
Takeaways
- Carrying blood products in the field is crucial for prolonged field care.
- Temperature control and cumulative time are key factors in blood storage and transport.
- Delta Development's blood refrigerator provides a solution for maintaining proper blood temperature in austere environments.
- The device can be used to run a mini blood bank and facilitate blood resupply in the field.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this conversation, Dennis and Mike discuss the process of providing medical care and education in austere environments. They emphasize the importance of understanding the requirements and asking the right questions to ensure success. They also discuss the significance of analyzing the environment, finding reliable sources of information, and building relationships with partners and friends. Planning and preparation are highlighted as crucial steps, along with effective teaching methods and the use of the Learning to Listen, Listening to Teach technique. The conversation concludes with a discussion on measuring performance and effectiveness, and the importance of flexibility and focusing on the student.TakeawaysUnderstand the requirements and ask the right questions to ensure success in providing medical care and education in austere environments.Analyze the environment and find reliable sources of information to make informed decisions.Build relationships with partners and friends to enhance understanding and collaboration.Plan and prepare thoroughly, focusing on the basics and acquiring the necessary knowledge.Use effective teaching methods and the Learning to Listen, Listening to Teach technique to engage and educate students.Measure performance and effectiveness to assess the impact of the medical care and education provided.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this conversation, Dennis and Justin discuss lessons learned in analgesia and sedation. They emphasize the importance of understanding medications and dosages, as well as having a plan for drug administration. They share case studies and examples of the wrong drug being used in the wrong situation. They also highlight the need for a strong foundation in medication knowledge and the importance of setting measurable goals for pain control. They caution against following trends and emphasize the importance of individual patient responses and safety measures.Takeaways Understand the medications and dosages you are using Have a plan for drug administration and set measurable goals for pain control Avoid using the wrong drug for the situation Build a strong foundation in medication knowledge Avoid following trends and focus on individual patient responses and safety measuresThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this conversation, Aaron Epstein from GSMSG discusses the background and formation of GSMSG, their focus on training partners rather than providing services, and their work with military and security forces around the world. He shares lessons learned in surgical resuscitation, dealing with mass casualties, and planning for different phases of war. Aaron emphasizes the importance of tourniquet use and the need for more surgeons in combat situations. He also discusses the challenges in the training pipeline and the need for more medical training. The conversation concludes with a discussion on transportation challenges and lessons learned, as well as how to get in contact with GSMSG.Takeaways GSMSG focuses on training partners rather than providing services. Tourniquet use is vital in combat situations and should not be removed from the treatment algorithm. Planning for different phases of war, including defensive, static, and offensive actions, is crucial for effective medical support. There is a need for more surgeons and better medical training in combat situations. Transportation challenges in combat zones require innovative solutions. GSMSG can be contacted through their website, www.gsmsg.org.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this podcast episode, Dennis talks with Doug (an ICU doctor) about acute kidney injury. They discuss the causes and types of acute kidney injury, how to recognize it, and the treatment options available. They also cover the recovery and prognosis of acute kidney injury, as well as the crush injury protocol and managing potassium levels. The episode provides valuable insights for healthcare practitioners dealing with acute kidney injury in prolonged field care situations.
Takeaways
- Acute kidney injury can be caused by a drop in perfusion to the kidneys, blockage of urine flow, or toxic injury to the kidneys.
- Recognizing acute kidney injury is important, and urine output and laboratory tests can help in the diagnosis.
- Treatment of acute kidney injury involves preventing further injury, ensuring adequate volume replacement, and adjusting medication dosages.
- Most young healthy kidneys will recover from a hypoxic type of injury, but toxic injuries may cause irreversible damage.
- The crush injury protocol includes bicarbonate, albuterol, insulin, and glucose to manage potassium levels.
- Monitoring and adjusting treatment is crucial, and Lasix may be used in certain cases of acute kidney injury.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this podcast episode, Dennis interviews David Hardin, a general surgeon with experience in austere environments. They discuss the differences between surgeons in first-world and austere environments, the importance of improvisation, training and manpower considerations, supplies and procedures in austere surgery, moving patients in austere environments, preparing for austere surgery, making decisions in austere environments, logistics and equipment, dealing with loss, preparing for unknowns, coping with emotional stress, and finding joy in austere surgery.TakeawaysAustere surgery requires improvisation and resourcefulness due to limited supplies and equipment.Training and teamwork are crucial in austere surgery, and having a resilient and adaptable team is important.In austere environments, decisions must be made based on available resources and the best interest of the patient.Preparing for austere surgery involves pre-planning, understanding the environment, and being mentally and physically prepared.Coping with loss and emotional stress is a challenge in austere surgery, and supporting and insulating team members is important.Finding joy in the work and being grateful for the opportunity to help others can sustain surgeons in austere environments.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this podcast episode, Dennis talks with Mark, a trauma surgeon, about lower extremity trauma and limb salvage. They discuss the decision-making process for determining if a limb is salvageable or not, the risk vs reward of tourniquet approximation, assessing motor function and arterial supply, the importance of preserving limb length, and the use of traction in pelvic fractures. They also touch on the struggles medics face in making these decisions and the importance of training and experience.Takeaways
- Assessing motor function and arterial supply are key factors in determining if a limb is salvageable or not.
- Preserving as much length and soft tissue as possible is important for future prosthetic use.
- The risk vs reward of tourniquet approximation should be carefully considered, weighing the potential for continued bleeding against the need to preserve tissue.
- In cases of pelvic fractures with concomitant femur fractures, traction may be necessary but should be monitored to prevent skin necrosis.
- Training and experience are crucial in making informed decisions about limb salvage in traumatic injuries.
In this podcast episode, Dennis and Antonio discuss the challenges and friction points that arise when working with providers from different countries. They explore how to iron out these issues efficiently to provide good care. The conversation covers topics such as common friction points on the ground, resolving conflicts and revamping protocols, establishing leadership, and learning from local providers. They also discuss the importance of adapting to different practices and resolving conflicts during handovers. Antonio shares insights from his own experiences and highlights the need for effective communication and collaboration in international healthcare settings.TakeawaysWorking with providers from different countries can lead to friction due to different protocols and approaches.Resolving conflicts and ironing out issues early on is crucial for providing good care.Effective communication and collaboration are key to navigating challenges in international healthcare settings.Learning from local providers and adapting to different practices can enhance patient care and outcomes.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this podcast episode, Dennis and Doug discuss the importance of team dynamics in critical care, specifically when dealing with critically injured patients. They highlight the challenges that arise when team members work individually and fail to communicate effectively. The conversation explores the team dynamics at Baltimore Shock Trauma, where roles and positions are protocolized to ensure efficient patient care. The role of the team leader is emphasized as crucial in overseeing the entire resuscitation process and preventing crucial details from being missed. The episode concludes with a discussion on training for team dynamics in both solo medic scenarios and mass casualty situations.Takeaways Effective team dynamics are crucial in critical care settings to ensure efficient and comprehensive patient care. Protocolizing roles and positions within a team can help streamline the resuscitation process and prevent crucial details from being missed. The team leader plays a vital role in overseeing the entire resuscitation process and maintaining a global perspective. Training for team dynamics should be conducted in both solo medic scenarios and mass casualty situations, with an emphasis on empowering all team members to contribute and communicate effectively.
In this podcast episode, Dennis interviews JR Pickett, an ER physician and EMS medical director, about excited delirium. They discuss the definition and history of excited delirium, the challenges faced by law enforcement and medical providers in managing these cases, and the importance of timely intervention. They also explore the differences between excited delirium and other conditions, such as combative patients in combat situations. The conversation highlights the need for proper assessment and observation of patients exhibiting excited delirium and the selection of appropriate medications for sedation. The podcast concludes with a discussion on the criminalization of medical care and the impact it may have on patient outcomes.TakeawaysExcited delirium is a complex condition characterized by a disturbed state of mind, violent behavior, and physiological elevation. It has a long history and has been associated with various names over the years. Law enforcement and medical providers face challenges in managing patients with excited delirium, as they must balance the need to protect the individual and others with the potential risks of sedation. Differentiating excited delirium from other conditions, such as combative patients in combat situations, can be challenging but is crucial for appropriate management. Proper assessment and observation of patients exhibiting excited delirium are essential for determining the most appropriate interventions and medications for sedation. The criminalization of medical care is a concerning trend that may discourage medical providers from engaging in high-risk situations and could have negative consequences for patient outcomes.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dr. Mark Shapiro discusses resilience and teamwork in the medical field during the COVID-19 pandemic. He highlights the differences between the civilian medical system and the military's approach to stress and resilience training. Dr. Shapiro emphasizes the importance of identifying and teaching resilience in medical professionals, as well as integrating stress inoculation into medical education. He also discusses the challenges of working in a crisis and the need for effective team composition and communication. Dr. Shapiro concludes by sharing his hopes for the future of the medical system and the lessons learned from the current pandemic.
Takeaways
- Resilience and stress inoculation are crucial in the medical field, but are often lacking in the civilian medical system.
- Teaching resilience and stress management should be integrated into medical education to prepare medical professionals for high-stress situations.
- Effective team composition and communication are essential in crises to ensure the best patient care.
- Experience and exposure to stress and difficult situations can help medical professionals develop resilience and adaptability.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Today I chat with the Godfathers of PFC and discuss the concept of Prolonged Field Care (PFC) and its importance in military and civilian medical settings. It highlights the need for PFC in situations where evacuation is delayed or not possible, and the challenges faced by medics in providing care in such scenarios. The conversation also explores the civilian analog of PFC and the importance of risk management and training. It emphasizes the principles and evidence-based medicine behind PFC and the need for creativity and improvisation. The conversation concludes with gratitude towards the community involved in advancing PFC.Takeaways
- Prolonged Field Care (PFC) is essential in situations where evacuation is delayed or not possible, and medics need to provide extended care to patients.
- The concept of PFC is not limited to the military and has applications in civilian medical settings as well.
- Risk management and training are crucial in preparing medics for PFC scenarios.
- Principles and evidence-based medicine form the foundation of PFC, and creativity and improvisation are key in finding solutions in resource-limited environments.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org
Dr. Ryan Maves discusses clinical medicine topics, specifically malaria and other tropical diseases. He emphasizes the importance of preventing infections when traveling in tropical and remote areas through vaccination, hand hygiene, malaria prophylaxis, insect repellents, and safer sex habits. He also provides resources for pre-deployment information. Dr. Maves shares a cautionary tale of a Marine Corps Lance Corporal with severe malaria and highlights the need for vigilance in diagnosing and treating tropical diseases. He discusses major tropical diseases, the workup of febrile travelers, and treatment options for malaria on deployment. He concludes by emphasizing the importance of improving care for infections in prolonged field care.Takeaways
- Preventing infections is crucial when traveling in tropical and remote areas, and measures such as vaccination, hand hygiene, malaria prophylaxis, insect repellents, and safer sex habits should be followed.
- Vigilance is necessary in diagnosing and treating tropical diseases, especially malaria, which can have severe consequences if not promptly addressed.
- Major tropical diseases to be aware of include malaria, dengue, zika, chikungunya, yellow fever, meningococcus, and cholera.
- The workup of febrile travelers should include a detailed chronology of illness, assessment of exposures and syndromes, and appropriate diagnostic tests.
- Treatment options for malaria on deployment include Malarone and Coartem, with Coartem being the preferred oral antimalarial therapy.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org
In this podcast episode, Dennis and Jeff discuss anoxic brain injury, its causes, progression, and treatment. They emphasize the importance of preventing anoxic brain injury by following the March algorithm and maintaining blood flow, airway patency, and oxygenation. They also discuss the role of monitoring and airway management in identifying and treating anoxic brain injury. The podcast covers the decision-making process for airway management and the importance of maintaining adequate oxygenation and blood pressure. The hosts also highlight the need to prevent secondary problems, such as pain, agitation, and seizures, and discuss resuscitation goals for anoxic brain injury.TakeawaysPreventing anoxic brain injury is crucial and can be achieved by following the March algorithm and maintaining blood flow, airway patency, and oxygenation.Monitoring and airway management are essential in identifying and treating anoxic brain injury.The decision-making process for airway management should consider the patient's condition, available resources, and the provider's proficiency.Maintaining adequate oxygenation and blood pressure is crucial in preventing and treating anoxic brain injury.Preventing secondary problems, such as pain, agitation, and seizures, is important in the management of anoxic brain injury.Resuscitation goals for anoxic brain injury include maintaining a systolic blood pressure of 120-140 and a pulse oximetry saturation of at least 90%.Collaboration with neurocritical care specialists can help optimize fluid management and prevent further brain injury.Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org
In this podcast episode, Dennis discusses the history and evolution of medical support in guerrilla warfare. He explores the role of unconventional warfare in the Army and provides examples of guerrilla warfare campaigns. Dennis also delves into the importance of surgical teams and the challenges of providing medical care in prolonged field care scenarios. He highlights the shift from the golden hour concept to the need for prolonged care in remote areas. Dennis concludes by discussing the future of medical support in guerrilla warfare and the importance of reevaluating medical norms.
Takeaways
- Unconventional warfare (UW) has always been a challenge for the Army, but it plays a crucial role in achieving strategic objectives.
- Surgical teams are essential in guerrilla warfare scenarios, providing medical care to both indigenous forces and American personnel.
- The concept of the golden hour, where medical care is provided within 60 minutes, has been a significant development in recent conflicts.
- In the future, medical support in guerrilla warfare may require a focus on prolonged field care, local care, and the use of organic surgery capability.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org
In this podcast episode, Dennis interviews Eric and Ted from Prytime Medical about the P-REBOA catheter. They discuss the training process in Ukraine, the differences between the P-REBOA and the original REBOA catheter, the benefits of the P-REBOA in terms of balloon times and blood product use, and the complications and monitoring for reperfusion injury. They also address the placement of the catheter and the challenges of using it in the field. The episode concludes with information about future plans and research, as well as contact information for Prytime Medical.TakeawaysThe P-REBOA catheter is used to stabilize patients with severe hemorrhage in the field, particularly in situations where immediate surgical intervention is not possible.Training for the P-REBOA catheter involves a combination of didactic instruction and hands-on practice with simulation devices.The P-REBOA catheter has a semi-compliant balloon that allows for partial occlusion, maintaining some blood flow below the balloon and reducing the risk of reperfusion injury.The P-REBOA catheter can be used to extend the time window for surgical intervention, allowing for stabilization and transport of critically injured patients.Securing the P-REBOA catheter during transport involves suturing or using a catheter clamp to prevent dislodgement.Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org
In this podcast episode, Dennis interviews Ian, an ER physician with experience in wilderness medicine, about spinal trauma. They discuss the initial approach to spinal trauma, the process of clinically clearing the spine, the neuro exam for spinal trauma, and the treatment of neurogenic shock. They also cover the goals of fluid resuscitation, the use of vasopressors, and the prevention of complications such as pressure injuries and hypothermia. The episode concludes with a discussion on the use of steroids in spinal cord injuries.TakeawaysThe initial approach to spinal trauma involves utilizing the MARCH algorithm and maintaining C-spine precautions until the patient can be clinically cleared.The neuro exam is crucial in determining the grade of spinal trauma and whether neurogenic shock is present.Treatment of neurogenic shock involves fluid resuscitation and the use of vasopressors to maintain blood pressure.Nursing care for spinal trauma includes preventing pressure injuries, monitoring for respiratory complications, and preventing hypothermia.Steroid use is not recommended in spinal cord injuries due to the associated risks.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective
In this episode, Sean McKay discusses the challenges and considerations of subterranean mobility and rescue. He emphasizes the importance of understanding the geology and environmental pathology of underground environments, as well as the need for continuous training and innovation in equipment usage. McKay also highlights the significance of risk assessment and uncertainty management in rescue operations. Additionally, he explores the complexities of communication and coordination in subterranean environments. In this conversation, Sean discusses the complexity of rescue operations and emphasizes that there is no one-size-fits-all approach. He highlights the importance of considering various factors, such as team capabilities, training, and environmental conditions. Sean also emphasizes the need for continuous training and seeking weaknesses in order to improve. He encourages rescuers to innovate and find solutions that fit their specific mission and team. Additionally, he emphasizes the importance of knowing and understanding the equipment and being comfortable with improvisation when necessary.TakeawaysUnderstanding the geology and environmental pathology of underground environments is crucial for effective subterranean mobility and rescue operations.Continuous training and innovation in equipment usage are essential for adapting to the challenges of subterranean environments.Risk assessment and uncertainty management play a vital role in planning and executing rescue operations.Communication and coordination are key factors in successful subterranean mobility and rescue operations. Rescue operations are complex and there is no one-size-fits-all approach.Consider factors such as team capabilities, training, and environmental conditions when planning a rescue.Continuous training and seeking weaknesses are crucial for improvement.Innovate and find solutions that fit your specific mission and team.Know and understand your equipment, and be comfortable with improvisation when necessary.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this podcast episode, Nate, a Special Forces Detachment Commander, discusses the importance of incorporating medical training into team operations. He shares his journey of realizing the limitations of his own medical knowledge and the need to improve his personal medical capabilities. Nate emphasizes the importance of creating formalized Standard Operating Procedures (SOPs) for team clinics and the need to test and refine these plans. He also highlights the need for training medical reps in realistic scenarios and standardizing medic training. Nate encourages commanders and medics to be honest about their medical capabilities and to communicate effectively with higher command. He concludes by seeking feedback on clinic setup from the wider PFC community.TakeawaysIncorporating medical training into team operations is crucial for commanders to understand the limitations and capabilities of their medical resources.Creating formalized Standard Operating Procedures (SOPs) for team clinics is essential to reduce friction and improve efficiency in medical operations.Testing and refining medical plans is necessary to ensure they are effective and realistic in austere environments.Training medical reps in realistic scenarios and standardizing medic training can improve the overall medical capabilities of the team.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective
In this episode, Dennis and Brad discuss the use of fentanyl in medical settings. They provide an overview of the background and development of fentanyl, highlighting its reliability and predictability as an opioid. They explain the characteristics and benefits of fentanyl, including its rapid onset, peak effect, and short duration. The conversation also covers the side effects and considerations of fentanyl, such as respiratory depression and histamine release. The appropriate administration and dosage of fentanyl are discussed, along with its use for sedation and procedures. The use of fentanyl lollipops and patches is explored, as well as the importance of proper administration and monitoring. The episode concludes with final thoughts on the use of fentanyl and the need for further education and understanding of its use. In this conversation, Brad discusses the use of ampules for protection in combat medicine. He explains various methods of using ampules and emphasizes the importance of protecting them. The conversation concludes with Dennis providing closing remarks and directing listeners to the Prolonged Field Care website and social media channels.
Takeaways
- Fentanyl is a reliable and predictable opioid with a rapid onset, peak effect, and short duration.
- It is important to understand the side effects and considerations of fentanyl, such as respiratory depression and histamine release.
- Fentanyl is commonly used for pain control and sedation, and it is particularly effective in trauma scenarios.
- Proper administration and dosage of fentanyl are crucial, and it is important to monitor patients closely for respiratory depression.
- Fentanyl lollipops and patches have specific uses and considerations, and their administration should be carefully managed. Ampules can be used in various ways for protection in combat medicine.
- It is important to protect ampules to ensure their effectiveness.
- Listeners are directed to the Prolonged Field Care website and social media channels for more information.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis is interviewing Dr. John Quinn who's on the ground working Role 1 medical operations for an NGO somewhere in Ukraine.The lessons being learned by John and others during the early days of this conflict and the past 8 years can be used to help those on the ground now and into the future. This is an amazing opportunity to stay informed of current events and prepare ourselves by narrowing expectations and tweaking training.During the interview John stated that anything that can be done to further enable FWB availability and knowledge would be greatly appreciated. In particular, when asked what we could translate, he asked for: Damage Control Resuscitation guidelines to be translated, Prehospital Blood guidelines, anything on Damage Control Surgery for non-surgeons (they have a lot of OB/GYNs and others like OMFS functioning as DCS surgeons at Role 2s). He also stated that they're seeing a TON of TBI "walking wounded" and anything on mild to moderate TBI management would be great.When asked about a trauma registry, John stated that the Ministry of Health is attempting to catalogue all civilian casualty numbers. The Ministry of Defense is VERY close-hold with any info and it would be very hard to elicit the ground-truth there for the time being.John stated that many organizations are using the TCCC cards and all documentation is trying to be written in BOTH Ukranian and English, due to the large number of non-native providers helping in country. They LOVE the DeployedMedicine app, the translation of TCCC and Emergency War Surgery and absolutely look to US and NATO standards of care.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Today, I'm joined by Rick, a senior medic with 18 years of experience in AFSOC and the Green Berets. We dive into lessons learned from mass casualty events, focusing on reactive and proactive scenarios. Rick recounts a harrowing mission in Eastern Afghanistan, where planning mishaps led to a challenging situation. They had to adapt on the fly, dealing with casualties and limited resources. Rick emphasizes the importance of improvisation, quick thinking, and knowing your available assets. He also discusses the need for effective communication and maintaining composure in high-stress situations. A must-listen for anyone in the field.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Merry Christmas...Today, we're diving into the nitty-gritty of ketamine – that mind-bending stuff, you know? So, ketamine's like this receptor blocker, messing with your brain's signals. It's a mixed bag, really. In low doses, it kills pain like a champ. But crank it up, and bam! You're in a world of dissociation. Picture it: brain's top half talking gibberish with the bottom half, and you're floating in a weird dream world.
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective
This Podcast was from June of this year.This is Dennis, and today I'm joined by Anri, a Ukrainian medic who will share some lessons learned from the battlefield. Anri talks about how wound patterns change in urban versus rural areas, with urban areas having more trauma from shrapnel and secondary trauma from debris. He mentions the challenges medics face in treating these complex wounds, including fractures and extensive tissue damage caused by multiple waves of explosions. Anri also discusses the impact of seasonal variations and the difficulties in evacuation due to artillery shelling, long distances, and the use of unconventional methods by the enemy. He emphasizes the importance of adapting medical techniques, such as splinting and triage, to the unique conditions on the front lines. Anri also mentions the use of blood products, saline, and telemedicine for prolonged field care.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In the latest episode of the PFC podcast, I spoke with Evan and Doug about airway management. As experienced airway takers in both pre-hospital and hospital settings, they had some valuable insights. We discussed the controversy over intubation versus cricothyrotomy. Evan and Doug raised some valid points, such as the need for suctioning and the difficulty of obtaining post-intubation sedation medication in resource-limited environments. We also talked about the importance of ongoing training to maintain skills and the need for better difficult airway education in training programs. Overall, it was a great discussion.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In today's podcast, I chat with Aebhric OKelly the founder and Dean Emeritus of the College of Remote and Offshore Medicine (COROM) about Improvised medicine. I will be the first to say, as cool as it is to learn Improvised techniques, this is an emergency plan, not a way to lighten your ruck. We run through items for MARCH and principles to apply to this problem. This is only part one, so plenty more in the next episode, when we go through PFC and improvised gear.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis and Kevin Worth talk about combat anesthesia. The podcast discusses the four pillars of anesthesia, which are amnesia, analgesia, akinesia, and autonomic stability. The focus is on the importance of autonomic stability in combat situations. The best medication for amnesia in a downrange environment is Midazolam or Versed, and ketamine is a potent analgesic. The podcast also covers the MAP (mean arterial pressure) and how to maintain it in trauma patients. Finally, the podcast discusses various scenarios that require different types of sedation or analgesia, including the administration of fentanyl or calcium.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Now, let's dive into treating tension pneumothorax. Joined by Andy Fisher, our favorite surgery resident and social media provocateur. We're talking IFAC essentials and the needle decompression debate. Andy's been stirring the pot, suggesting ditching Needle D's from the IFAC due to lack of official backing. The IFAC's about saving lives for non-medics, but is it hemorrhage, not tension, we should focus on? Special ops pushed decompression needles, but is it justified? Andy questions the success rate of needle decompressions and suggests focusing on actual tension physiology. Training rush may play a role. Is sticking needles in pre-emptively smart? Well, let's focus on true tension signs instead. I mention tension either shows up or it doesn't, and hemodynamic changes trigger action. Thoracic trauma, mostly hemothorax, outweighs tension pneumothorax deaths. Andy, if king for a day, would adjust chest injury treatment. Surgical insights, plain talk, only on the PFC podcast.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
For the rest of the month, every Mon, Wed, and Fri, I will be posting the top 10 podcasts of '23. I will resume with the regular schedule on New Year's Day. Happy Holidays.This podcast discusses the importance of patient positioning in prolonged field care. The guest, Ethan Miles, a board-certified family medicine physician with extensive military experience, emphasizes that patient positioning is a forgotten aspect of medical training and that simple, low-cost interventions are often overlooked. Miles states that patient positioning is especially crucial in prolonged field care and can help in treating patients with traumatic brain injury, manage airways, and improve oxygenation. However, patient positioning can also have downsides, such as orthostatic hypotension, and should be reassessed regularly. Miles suggests that improvised things can also work well when pre-made things are unavailable.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis discusses MDMA therapy for PTSD with guest Emily, a pharmacist. They explore how MDMA is being researched as a treatment for combat-related PTSD, especially when conventional medications like SSRIs and SNRIs fall short. MDMA offers a unique approach by providing stimulating effects while fostering empathy and helping patients reprocess traumatic memories. Emily emphasizes the importance of integration in therapy. Clinical trials have shown promising results, with 67% of participants achieving remission from PTSD. The episode also touches on the challenges and progress in getting MDMA therapy approved and accessible to patients.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dr. Givens talks about dealing with CBRNE patients in the field. They discuss the need for standardized approaches and clinical guidelines. I'm all about simplifying things and making them user-friendly. The hot zone requires quick thinking and auto injectors for CBRNE agents. They emphasize the importance of TCCC and teamwork. Dr. Givens covers various agents like nerve agents, cyanide, chlorine, and more, offering practical insights for handling them.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
"Correction: The correct initial dose of lipid emulsion is 1.5mL/kg, not 1 mL/kg"Dennis interviews Sandeep, an anesthesiologist with military experience, about the use of IV lidocaine for acute pain management. Sandeep explains that IV lidocaine can be a useful opioid-sparing option, especially in austere environments with limited resources. While it has a narrow therapeutic window, proper dosing can provide analgesia and reduce opioid consumption. Sandeep emphasizes the importance of safety considerations, including patient selection and monitoring for side effects. He also discusses the potential benefits in the context of trauma and surgery. Overall, IV lidocaine could be a valuable tool when managed carefully in the field.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis hosts two special guests, Stacy Shackelford and Doc Rush, to discuss rethinking triage. They emphasize the need for a shift in the way medics are trained and how triage is approached. They challenge traditional triage algorithms and encourage a more flexible, data-driven approach that prioritizes time-sensitive interventions such as hemorrhage control and airway management. The conversation also touches on the importance of training medics in trauma care, the role of team leaders in risk management, and the need for preparation and rehearsal in managing large-scale casualties. Ultimately, they stress the importance of sticking to basic principles while being prepared to adapt in dynamic situations.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis and guest Jeff Siegler, an assistant professor of emergency medicine, discuss the use of ketamine in managing status epilepticus. Status epilepticus is a prolonged seizure lasting more than five minutes, which can be life-threatening. They explore the challenges of treating seizures in the field and the role of benzodiazepines in initial treatment. Ketamine, while generally considered an excitatory drug, is being studied as a potential option when seizures become refractory to standard treatments. The podcast highlights the need for further research and individualized care plans while considering the limitations of pre-hospital settings and state regulations.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis and guest Shawn McKay discuss the basics of confined space rescue. They touch upon the importance of understanding the environment and potential risks, the need for monitoring equipment, and the selection of the right personnel for specific tasks during rescue operations. They also mention the relevance of NFPA standards and the importance of choosing appropriate equipment. The conversation emphasizes the significance of training and preparedness in handling complex rescue situations.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis and Brad discuss the use of Nubain, also known as Bufene. Nubain is a non-controlled narcotic that was FDA-approved in 1979 and gained popularity in the 1980s and 1990s. It is similar in strength to morphine but lacks some of its side effects like respiratory depression. Nubain's unique properties include its ability to reverse itching caused by other narcotics and its use as an adjunct to ketamine or other pain management drugs. Dennis emphasizes the importance of monitoring respiratory rates and adjusting doses accordingly. Overall, Nubain is a valuable tool for managing pain in a field environment.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Jay Baker, a brigade surgeon with limited special operations experience, discusses the evolving landscape of surgical support in Special Operations Forces (SOF). He highlights the differences between traditional trauma care provided during the Global War on Terror and the potential challenges of unconventional warfare. Drawing from historical examples of surgeons supporting resistance movements in World War II, he emphasizes the need for adaptable and resourceful surgical teams capable of extended missions in hostile environments. Baker also discusses the concept of prolonged field care (PFC) and the development of SOF surgical teams to meet future mission requirements.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis and Josh discuss ventilator training on the PFC Podcast. Josh, a former ranger medic now working in a level one ICU, shares insights. They emphasize the importance of proper ventilation in the field and address common mistakes, like setting inappropriate rates that lead to patient agitation. Josh advises cautious opioid use, balancing sedation with patient needs. They delve into adjusting PEEP, flow, and waveform, emphasizing patient synchronization. Josh highlights the significance of addressing pain, resuscitation, and lung disease simultaneously. He clarifies end-tidal CO2 readings and the role of kidneys in metabolic acidosis. Josh also stresses IV maintenance and patient assessment.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis and Doug discuss the fundamentals of ventilatory management in trauma cases. They emphasize the distinction between the need for an airway and the need for a ventilator. Patients requiring an airway may have issues like swelling or trauma obstructing their airway, while those needing a ventilator typically have respiratory failure. They explain the importance of monitoring compliance, tidal volume, minute ventilation, and peak and plateau pressures. Additionally, they touch on the importance of supporting blood pressure during intubation and the need for continuous resuscitation in trauma cases.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis interviews Thomas Trust Have, a former Danish Special Forces operative turned doctor, discussing the challenges of providing medical care in Arctic environments. Thomas emphasizes the extreme conditions, highlighting a hypothetical scenario involving a special operations team enduring frigid temperatures and harsh winds. He underscores the importance of preparation, teamwork, and proper gear in these situations. Thomas also addresses medical considerations such as tourniquet use, fluid warming, and the complexity of providing care in cold conditions. The episode sheds light on the unique challenges faced by healthcare providers in remote, freezing environments.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis and Doug discuss the critical importance of effective team dynamics when dealing with critically injured patients. They highlight the challenges faced by medical teams who often work in silos, failing to communicate and coordinate efficiently. Doug, drawing from his experience at Baltimore Shock Trauma, emphasizes the value of well-organized roles and protocols in high-volume trauma facilities. He underscores the need for designated positions and a clear team leader to oversee the patient's care. The conversation also touches on adapting such practices to operational environments, stressing the importance of training, teamwork, and constant vigilance in providing life-saving care.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In today's episode, we're diving into the topic of tourniquet conversion. With conflicts happening globally, it's crucial to understand the difference between tourniquet conversion and replacement. Conversion means finding an alternative to control bleeding when the tourniquet is no longer needed. Replacement involves swapping a tourniquet for a more effective one. Conversion timing depends on the tactical situation and patient's resuscitation status. You should consider resuscitating the patient before converting, ensuring they're warm, non-coagulopathic, and ideally have a systolic blood pressure above 90. Science-wise, the two-hour rule may have originated from studies in cooler environments. Converting tourniquets in austere settings requires confidence and proper patient assessment. Crush syndrome, re-bleeding, and metabolic changes can be concerns when converting tourniquets. Use bicarb cautiously to mitigate potential acidosis. Calcium can also help, but pay attention to the specific calcium source and dosing. The goal is to save lives while minimizing limb loss.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Today, we're diving into the crucial topic of medical contingency planning. Evan and I discuss the importance of planning for medical emergencies in various scenarios, emphasizing that timely evacuation is often more effective than improvised solutions.
We stress the significance of conducting thorough risk assessments, considering factors like location, climate, endemic diseases, and enemy threats. It's essential to evaluate local healthcare resources and potential evacuation options, even in remote areas.
We debunk the idea of one-size-fits-all pace plans, emphasizing that planning should be proportionate to the situation's criticality. We also highlight the need for rehearsals and practical evaluations to uncover plan weaknesses.
Lastly, we advise against overloading aid bags with unnecessary supplies, and we stress the importance of adapting to the circumstances, keeping in mind that helicopters may not always be available.
Remember, preparation is key, and flexibility is vital in ensuring the success of your medical contingency plans.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis hosts a discussion with various military medics. They explain the role of Special Operations Forces (SOF) medics, emphasizing their training and responsibilities. Each guest represents different SOF units, such as Rangers, Navy SEALs, and Special Forces. They discuss the extensive training, medical capabilities, and the need for trust and support from other team members and medical professionals. The conversation highlights the unique challenges SOF medics face, as they often operate in austere environments with limited resources. Overall, the podcast sheds light on the crucial role these medics play in the continuum of patient care during missions. Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this podcast, Dennis discusses cold weather injuries, particularly frostbite and non-freezing cold injuries like trench foot. He highlights their historical significance, citing examples from military campaigns. Prevention is emphasized, including proper clothing, buddy checks, and staying hydrated. Dennis explains the stages of frostbite, the importance of rapid rewarming, and the risks of refreezing or overheating. He also mentions the Kachi classification system to assess severity. Antibiotics aren't used prophylactically, and debridement is avoided. Dennis concludes by stressing the need for prompt treatment and staying vigilant for symptoms, especially in cold, wet conditions.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis welcomes his friend Pac to discuss S-Ketamine. Pac, an anesthetist with extensive experience, shares insights on using S-Ketamine in various medical settings. He highlights its potential advantages, such as improved analgesia and reduced hallucinogenic effects in mid-doses. They discuss its use in austere environments, especially during military operations, and Pac emphasizes the importance of adapting dosages based on transportation methods and patient conditions. They touch on the role of ketamine in managing seizures, refractory seizures, and its potential benefits for asthmatic patients. The podcast provides valuable insights into ketamine's applications in medical care.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Welcome back to the PFC Podcast. Mark and I chat about feeding the critically ill. Now, look, when you're done stitching folks up and pumping them with antibiotics, there's a point you'll need to feed them. Mark shed light on how crucial nutrition is, whether you're in a remote outpost or a high-end trauma center. Nutrition aids in healing, plain and simple. We dove into the nitty-gritty – feeding patients with head injuries, burns, and other nasty stuff. And hey, feeding ain't just about the belly. Got a tube? Use it wisely. Remember, everything we do has its ups and downs. But, here's the deal, the human body, is just trying to get back to square one. Lastly, be mindful of that re-feeding syndrome - it's nasty. Bottom line? Understand your patient, feed smartly, and keep learning.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Today, we've got Brett, a paramedic legend from El Paso County Search and Rescue. The mountains? Tricky business. One moment it's beach weather, the next it's a frigid winter wonderland – and that’s in the summer! Know what you're packing; it's not a weekend getaway! And those space blankets? Not the lifesavers you might think. Weight's your enemy up there, but be smart. And remember, it's not just about the med kit; weather's unpredictable, avalanches are sneaky, and a good medic knows that it’s not always about the medicine.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Today, on the PFC Podcast, we dived deep into altitude illness with the experienced Dr. Moon from Duke University and Patrick O'Boyle, a senior medical instructor. Dr. Moon's been to Everest Base Camp, studies altitude physiology, and works with the Navy. He shared that altitude illness, including symptoms like nausea, vomiting, and insomnia, is not fully understood. The dangerous forms like cerebral edema (brain swelling) and pulmonary edema (fluid in lungs) can be deadly. Rapid altitude changes and the body's reaction to lowered oxygen levels play a role. If you're feeling symptoms, descend ASAP and administer oxygen if possible. And folks, while some meds can help, the real gold standard is descending and getting to a safer altitude. That's altitude illness in a nutshell.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Here's the lowdown from the PFC Podcast episode 150 with Dennis and Alex, diving into ETCO2. Dennis chats with Alex, who's had a colorful career, from being a 68 Whiskey and a paramedic to now working with Massimo. They discuss the Emma capnograph, a handy gadget that monitors exhaled CO2. It's essential to keep everything sealed, or the readings might be off. The device runs on batteries with different lifespans, depending on the type. Calibration? It's a must, but hold the buttons longer than feels right, or you might mess it up. This tool can be a lifesaver, giving insights into cardiac output and more. Just remember, if you're seeing weird numbers, there might be leaks or other issues. It's a nifty piece of kit but, like all tools, make sure you familiarize yourself with it outside of emergencies.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Bryce joined the podcast to share insights on training non-medics. Why bother? Well, Bryce emphasized the value of cross-training within teams. While it's not always easy to motivate folks to grasp medical tasks, it's a lifesaver. Literally. The key? Make it competitive! And remember, it's not just about the skills, but the trust built within the team. If teammates can handle tasks without needing constant supervision, it makes everyone more effective. But, it's not just about having a skill; understanding the 'why' is crucial. Bryce's advice to new medics? Be good at your job, and immerse yourself in continuous learning. Get out of the office and train. It's all about being proactive and ensuring everyone's prepared for any situation.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
This is part 2 of our 2.5 hour conversation with Aebhric OKelly the founder and Dean Emeritus of the College of Remote and Offshore Medicine (COROM) about Improvised medicine. I will be the first to say, as cool as it is to learn Improvised techniques, this is an emergency plan, not a way to lighten your ruck. We run through items for PFC when the gear starts running out.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.comFor more content go to www.prolongedfieldcare.org
Today, we're diving deep into pneumothorax and hemothorax. Pneumothorax can quickly become an emergency, especially when it's not about the pressure but the declining SPO2. But where's the line between tension and hemothoraces? Our ICU doc expert clarifies that it's all about the impaired blood return to the heart. When your preload drops, it affects the cardiac output. If vitals are stable, though, it's not tension physiology. Also, did you know there are folks walking around with untreated pneumothoraces? The literature suggests only treating those affecting over 30% of the thoracic cavity. And, oh boy, many pneumothoraces come from trauma, but spontaneous cases exist. Especially with COVID, the lung scarring has made things fragile. Add trauma and narcotics, and things can get dicey. But remember, before deciding to treat a pneumothorax, be sure it's the right move. Better safe than sorry!Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Today's podcast is part one of a 2.5 hr chat with Aebhric OKelly the founder and Dean Emeritus of the College of Remote and Offshore Medicine (COROM) about Improvised medicine. I will be the first to say, as cool as it is to learn Improvised techniques, this is an emergency plan, not a way to lighten your ruck. We run through items for MARCH and principles to apply to this problem. This is only part one, so plenty more in the next episode, when we go through PFC and improvised gear.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Now, let's dive into treating tension pneumothorax. Joined by Andy Fisher, our favorite surgery resident and social media provocateur. We're talking IFAC essentials and the needle decompression debate. Andy's been stirring the pot, suggesting ditching Needle D's from the IFAC due to lack of official backing. The IFAC's about saving lives for non-medics, but is it hemorrhage, not tension, we should focus on? Special ops pushed decompression needles, but is it justified? Andy questions the success rate of needle decompressions and suggests focusing on actual tension physiology. Training rush may play a role. Is sticking needles in pre-emptively smart? Well, let's focus on true tension signs instead. I mention tension either shows up or it doesn't, and hemodynamic changes trigger action. Thoracic trauma, mostly hemothorax, outweighs tension pneumothorax deaths. Andy, if king for a day, would adjust chest injury treatment. Surgical insights, plain talk, only on the PFC podcast.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Welcome back, folks! Had a chat with Ephraim Matto, who's seen the thick of things in Burma. He spent the last six months there, amidst security crises and medical emergencies. Burma's ethnic minorities are resisting subjugation, and the mountainous borders provide relative safe areas. Still, things are pretty dire. On top of internal conflicts, there's interference from the Russians and Chinese. On the medical front, there's a dire need. His crew operates ambulances and boats to get folks the care they need, and of course, the logistics! The rainy season and challenging terrain make things tough. Tragically, the Burma army isn't holding back. Just recently, 17 villagers, including children, were brutally murdered. It's heavy stuff, and the situation demands attention.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Today's episode, is all about "Versed." We've got Kevin and Paul here, chatting about patient positioning and the intricacies of using Versed, a benzodiazepine, for sedation. They touch on how different patients react to the drug, emphasizing the art of medicine over strict calculations, especially in challenging scenarios. The podcast delves into dosing strategies, dealing with hemodynamically unstable patients, and the complexities of maintaining sedation during procedures. Remember, every patient is unique, so adapt the approach accordingly.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Today, I'm chatting with Colin about the new Prolonged Fieldcare Airway CPG. Basically, it's a guideline for managing airways in tough situations. Colin's a special ops medic and he helped put this thing together. CPGs are like gold for medics, so Google "PFC CPG" for info. Airway's vital, but sometimes overlooked. We're diving into the details, from procedures to training. It's not just about sticking a tube in; it's a whole process. Training's key – keep practicing. Units need to back it up too.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Welcome back to the PFC podcast! Today, it's Dennis here with Casper and Paul. We're discussing a leadership tool called the Tactical Timeout, which helps teams ensure everyone is on the same page. Casper, a NATO Special Operations combat medic, gives a shout-out to the timeout used in the medical community, ensuring correct procedures. Using the Tactical Timeout, they discuss the tactical situation, security, and evacuation plans, ensuring efficient shift changes and patient updates. It fosters cohesion, especially with non-medical personnel. Dennis emphasizes the importance of contingency planning and clear communication, while Paul urges junior medical team members to ask questions to avoid confusion. Stay tuned for more on the PFC podcast!
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Hey there, it's Dennis from the Prolonged Field Care Podcast, episode 144. Today, Winston and I dive into pain pathways. You know, those definitions of pain like visceral or psychogenic, they've never helped me treat pain practically. So, understanding the nervous system might just boost my pain management skills. The pain pathway consists of transduction, where energy turns into nerve impulses, ascending pathways, spinal cord travel, brain processing, and descending pathways. Remember, understanding the whole system aids better pain management.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Today, I'm joined by Brad, a former special operations medic and instructor, to talk about a harrowing experience during a night raid in Afghanistan. They faced a barricade shooter situation and multiple casualties. Despite the danger, their medical training and preparedness shone through. Brad emphasizes the importance of casualty training and incorporating it into every mission. They stress the need for repetition and selecting the right equipment for efficient treatment. The podcast covers various medical aspects, and Brad commends the use of 16-gauge catheters and pressure infuser pumps for better blood flow and control. Remember, be prepared, train well, and stay on the bleeding edge of combat medicine!
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Welcome back to the PFC Podcast. Today, we've got Regan on the show discussing her thesis on unconventional medical networks. She's an emergency medicine physician with extensive experience in special operations and unconventional warfare scenarios. Her thesis delves into the difficulties in the establishment and operation of medical networks in challenging environments. They explore historical examples like the Yugoslavian resistance, highlighting the importance of proximity to the frontline and adaptability. Regan emphasizes the need for cognitive agility and understanding local resources when providing medical aid. Cooperation with allies and partners is vital for interoperability and empowering them to effectively respond to conflicts.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Hey there, folks! Welcome to the Prolonged Field Care Podcast. Today's episode is all about Crush Syndrome and how to handle tourniquet conversion. Our speaker, Doc Jamie Riesberg, is a pro in this field, so listen up! Crush Syndrome happens when muscle tissue leaks into the bloodstream, causing trouble. We're entering a new era of war with limited evacuation and medical supplies, so we gotta be prepared. Field care providers need to know the best practices to manage this challenging condition. We'll cover some controversies too. Stay tuned for more discussions on this crucial topic.
Hey, welcome back to the PFC podcast! This is Dennis, and I'm here with Aaron, an emergency medicine physician and medical toxicologist. We discuss carfentanil, a synthetic opioid used in the 2002 Moscow hostage rescue. Carfentanil can cause CNS depression, pinpoint pupils, respiratory depression, and decreased gut motility. Reversing its effects may require higher doses of naloxone. However, its potency and unknown modifications make it challenging to combat. We're still waiting for better treatments and auto-injectors. In the field, it's crucial to differentiate opioid overdoses from other injuries, considering opioids' widespread use and potential for weaponization.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Hey there, folks! Welcome back to the PFC podcast! Today, we're diving into some operational medicine stuff, and let me tell you, it's a gem. We'll be talking about the often overlooked, underestimated, and dirt-cheap way of monitoring patients in prolonged field care - measuring urine output. Now, this might not sound exciting, but trust me, it's essential! You can get crucial hemodynamic info using just a BP cuff, stethoscope, pulse ox, and a Foley catheter kit. It's all about keeping things simple and effective. Remember, sterility is vital, and we need to consider hypotensive resuscitation too. So, keep those fluids flowing and keep listening!
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Welcome back to the PFC Podcast. This is Dennis, and today I'm joined by my friend Burjor. We discuss facial trauma and the importance of hemorrhage control in austere environments. Burjor shares his expertise in maxillofacial surgery and emphasizes the need to address bleeding and fluid loss in patients with scalp lacerations. He also provides insights on managing injuries in different areas of the face, such as the cheek, lip, and jaw, including techniques like counter pressure and balloon tamponade. We touch on the significance of proper airway management and the challenges of diagnosing and treating mid-face fractures. Overall, it's an informative conversation aimed at helping medical practitioners deal with facial trauma in challenging settings.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Hey there, folks! Welcome back to the PFC Podcast. Today's episode is a special one, recorded live at the JSOMTC during the joint trauma system teleconference. Dr. Doug Powell, a battalion surgeon in a special forces group, joins us to talk about providing critical care in austere environments. With the increasing trend of sending smaller teams to more places, it's crucial for SOF medics to be prepared for initial critical care and stabilization. Dr. Powell emphasizes the importance of conferences like this in training our special operations medics. The podcast covers topics such as prolonged field care stages, vital signs trending, checklists, teleconsultation, improvisation techniques, and nursing care. Remember to visit ProlongedFieldCare.org for free downloads.
Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective
Welcome back to the PFC Podcast with Dennis and guest JR, discussing their work on the border. Dr. JR Pickett, the Chief Deputy Medical Director for Austin, Texas, describes the rugged, rural regions they cover, far from major cities. The area experiences scorching temperatures, and many migrants pass through, making it crucial to provide medical assistance. They encounter accidents, venomous snakes, and challenging terrain. The team uses various vehicles and equipment, including ATVs and a walking blood donor program, to navigate and provide care. Training and collaboration are essential since most agents aren't dedicated medics. BLS skills and effective planning play a vital role in delivering care.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
This Clinical Practice Guideline was written by a fellow 18D with input from around the surgical community. It reconciles the differences between wound care done in a role 2 or 3 facility, such as serial debridements, with what is taught in the 18D Special Forces Medical Sergeant Course with regards to delayed primary closure. One way is not "right" while the other wrong, it has more to do with the amount of time and resources available to the medic or other provider. The remainder of the blog post and podcast is meant to be a refresher for those who have already been taught these procedures. It is also meant to be informational for those medical directors who may not be exactly certain of what has been taught as far as wound care and surgery. If you haven't been trained to do these procedures before going ahead with them, it is very likely that you may do more harm to the patient than good.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Hey there, welcome back to the PFC podcast! I'm Dennis, and today I'm joined by David and Tim. We'll be discussing the topic of Return to Duty and the important work these guys are doing for our service members. They hope to spread the word and get more people involved in helping out. David shares his background, mentioning his experience as a combat medic and his transition into the field of endoscopic spine treatment. He talks about his own spine injury and how it led him to realize the need for better options for military members. They formed a network of trusted surgeons and started informally helping others. We discuss the challenges service members face in accessing timely and appropriate treatment, and how they aim to bridge that gap. They highlight their unique skill set in advocating for spine care and their collaboration with experienced surgeons who understand the needs of tactical athletes. They also mention the importance of early intervention, proper diagnosis, and tailored treatment plans. They're dedicated to providing top-notch care to all service members, regardless of their location. Overall, their goal is to make a lasting impact and ensure that service members receive the care they deserve.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Hey, welcome back to ProlongedFieldCare.org. I'm Paul, and today I want to talk about the importance of documentation in prolonged field care situations. Before you head out, make sure you have a checklist and all the necessary equipment, including medications, fresh whole blood kits, blood typing cards, fluids, specialty equipment, power supply, cables, and filled oxygen bottles. Ensure your team is trained in tactical medicine and prolonged field care, and have a telemed plan in place. Plan for multiple evacuation platforms. Use the 10 essential Prolonged Field Care capabilities worksheet to determine what you need to bring. When you arrive, secure your medications and distribute supplies among the available platforms. Set up your aid station and familiarize your team with the equipment and layout. Have a communication plan in place and double-check all contact information. For documentation, use brain sheets similar to those used by ICU nurses. Consider using PFC casualty cards to track vital signs, injuries, treatments, and plans for each patient. Trend vitals regularly and communicate changes to the team. Prioritize treatments and share care plans with the entire team. Use specialty flow sheets and checklists for specific conditions like burns, fluid administration, and ketamine drips. Finally, consider using the multi-patient evacuation chart for organizing and tracking multiple patients. By implementing these documentation practices, you can improve patient care and enhance efficiency in prolonged field care situations.
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective
Welcome back to the PFC Podcast with Dennis and Winston discussing the "Green Whistle". Methoxofluorine, a volatile hydrocarbon similar to modern anesthetics, was used in general anesthesia until 2005 due to renal toxicity risks. However, it continued to be used in Australia, New Zealand, and recently in the UK for pre-hospital care and burns units. In low doses, it acts as an analgesic, while higher doses have an anesthetic effect. The Green Whistle, containing methoxofluorine, is a mouthpiece with an activated carbon chamber to reduce contamination. It provides pain relief for severe pain lasting 30 to 60 minutes. Patient control and comfort are important during its use. Could this be an alternative to the fentanyl lollipop?
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Welcome back to the PFC podcast! Today we have a diverse group of individuals discussing their experiences in Ukraine. Kasha, an emergency pre-hospital critical care expert, spent several months there, while Denys, a physician and medical course director, has extensive experience in training medics for the Ukrainian armed forces. Kevin, a former special agent and tactical paramedic, is currently embedded in a Ukrainian army unit conducting MEDEVAC operations. They emphasize the importance of prolonged field care (PFC) in modern warfare, cautioning against applying strategies from previous conflicts to new battlefields. They share anecdotes about challenging situations and highlight the need for medical leadership, telemedicine, proper training, and logistics in PFC. The discussion emphasizes that PFC is not limited to the military and is relevant to all medical professionals in challenging environments.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Welcome back to the PFC Podcast. This is Dennis, and today I'm joined by Anri, a Ukrainian medic who will share some lessons learned from the battlefield. Anri talks about how wound patterns change in urban versus rural areas, with urban areas having more trauma from shrapnel and secondary trauma from debris. He mentions the challenges medics face in treating these complex wounds, including fractures and extensive tissue damage caused by multiple waves of explosions. Anri also discusses the impact of seasonal variations and the difficulties in evacuation due to artillery shelling, long distances, and the use of unconventional methods by the enemy. He emphasizes the importance of adapting medical techniques, such as splinting and triage, to the unique conditions on the front lines. Anri also mentions the use of blood products, saline, and telemedicine for prolonged field care.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
In the latest episode of the PFC podcast, I spoke with Evan and Doug about airway management. As experienced airway takers in both pre-hospital and hospital settings, they had some valuable insights. We discussed the controversy over intubation versus cricothyrotomy. Evan and Doug raised some valid points, such as the need for suctioning, paralytics, and the difficulty of obtaining post-intubation sedation medication in resource-limited environments. We also talked about the importance of ongoing training to maintain skills and the need for better difficult airway education in training programs. Overall, it was a great discussion.
Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com
For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis is hosting the PFC podcast with Monty as his guest. Monty is a former army medic who has multiple rotations in Afghanistan and Iraq. He is now part of Delta development, which created a battery-powered blood refrigerator that can store blood between 1 and 6 degrees Celsius, which is vital for prolonged field care. The device can keep blood for up to 10 days on battery power and has a temperature log for easy record-keeping. The goal is to push blood forward to the front lines and eventually back to role three to ensure that blood is available when needed.
Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective
Welcome back to the PFC Podcast! Today, we're discussing some important topics that have come up recently. One of them has been going on for 10 years, while the other has been around even longer, related to irregular warfare. We're exploring how these two subjects can inform each other. Now, before we begin, I want to clarify that the views and opinions expressed here are solely mine. I also want to mention some disclosures about my upcoming internship and the Prolonged Field Care Collective. If you want more content like this, visit Prolongedfieldcare.org.
There are operational environments where the training we provide in the Prolonged Field Care Collective can benefit medics and other providers. We have trained numerous individuals from various special operations and international communities, as well as conventional forces. The challenge lies in the training and the operational context. We adhere to doctrinal timelines for casualties, which vary based on the severity of injuries. It's important to understand the complexity of the operating environment and tailor care accordingly. In the past, there have been issues with overclassifying all patients as urgent, leading to adverse outcomes. While there are ongoing discussions and efforts to standardize terminology and lexicons, we will continue our work and problem-solving under the Prolonged Field Care name.PFC encompasses robust planning, hands-on training, and a strategy for palliative care. Education and training are different, and it's crucial to get hands dirty to truly understand the challenges. We have encountered complex problems in our field and collaborated with various stakeholders, including the Morpheus Group, to crowdsource solutions. Irregular warfare medical support shares similarities with prolonged field care, and there are similar activities worldwide. The aim is to strengthen countries' capabilities to stand on their own during conflicts or degraded civilian infrastructure situations.Training opportunities abound, even in busy schedules, and it's important to optimize and utilize available resources. Feedback and lessons learned from different entities are invaluable. Additionally, initiatives like National Stop the Bleed Month contribute to increased resiliency and readiness, both domestically and internationally. However, it's crucial to understand the legal and operational aspects of medical support in different regions.Humility is key when approaching international missions, as we can learn from past mistakes. By simplifying the complex landscape and using self-guided assessments, we can identify areas for improvement. Global health engagement plays a significant role, as Special Forces have been involved in improving medical care in underserved populations. Civil Affairs and SF have historically been engaged in global health initiatives, and it remains an important aspect of our work.So, despite ongoing discussions and potential changes in terminology, the focus remains on providing effective care in prolonged field care scenarios.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis and Kevin Worth talk about combat anesthesia. The podcast discusses the four pillars of anesthesia, which are amnesia, analgesia, akinesia, and autonomic stability. The focus is on the importance of autonomic stability in combat situations. The best medication for amnesia in a downrange environment is Midazolam or Versed, and ketamine is a potent analgesic. The podcast also covers the MAP (mean arterial pressure) and how to maintain it in trauma patients. Finally, the podcast discusses various scenarios that require different types of sedation or analgesia, including the administration of fentanyl or calcium.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.com For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
This podcast discusses the importance of patient positioning in prolonged field care. The guest, Ethan Miles, a board-certified family medicine physician with extensive military experience, emphasizes that patient positioning is a forgotten aspect of medical training and that simple, low-cost interventions are often overlooked. Miles states that patient positioning is especially crucial in prolonged field care and can help in treating patients with traumatic brain injury, manage airways, and improve oxygenation. However, patient positioning can also have downsides, such as orthostatic hypotension, and should be reassessed regularly. Miles suggests that improvised things can also work well when pre-made things are unavailable.Thank you to Delta Development Team for in part, sponsoring this podcast.
deltadevteam.com
For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
Dennis introduces the Prolonged Field Care (PFC) Podcast 130, welcoming Alex as his guest speaker. Alex, Dan, and Rick are working on a project for the upcoming SOMSA, where they will present the idea of defining the different phases of care in PFC, just like TCCC. They believes that the medics should think about March for taking care of their patients, where they would continue to think about March irrespective of the setting, but maybe through a different lens when they're in PFC. Alex talks about the phases of care in prolonged field care, which are preparation, stabilization, normalization, observation, and transportation, (PSNOT) and compares them to the thought process of doctors in damage control surgery. Dennis and Alex discuss the importance of SOF medics finding time to be good at SOF medicine, and how they need to understand their true capabilities and reach out to others for help when needed.
Thank you to Delta Development Team for sponsoring this podcast in part.
deltadevteam.comFor more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this episode, the we discuss the unique challenges and considerations involved in providing medical care in extreme cold weather conditions. They cover topics such as hypothermia, frostbite, cold injuries, and equipment and supplies needed for arctic operations. They also provide tips and resources for medical personnel preparing for arctic deployments. So, if you're interested in learning more about arctic combat medicine, give this podcast a listen!For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this podcast, the Dennis and Doug discuss the challenges of treating traumatic cardiac arrest in the field and the importance of early intervention to improve outcomes. They also cover various topics such as identifying reversible causes, utilizing resuscitative thoracotomy, and managing hypovolemia.For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
In this podcast, Dennis and Berger Langda discuss austere dentistry, specifically how to handle dental emergencies in an austere environment. They discuss the importance of preventive preparation, such as motivating participants to have a dental checkup and using high fluoride toothpaste, as well as preparing oneself with an adequate dental kit. They also discuss common dental procedures and complaints that may arise in an austere environment, such as broken fillings and impacted wisdom teeth, and how to approach treating patients with limited time and resources. Finally, they touch on the importance of a team approach and distributing medications and antibiotics efficiently.For more content go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective
This is Dennis from the Prolonged FieldCare podcast. In this episode, we have a group running an austere emergency care course in Norway. They discuss the challenges of providing medical care in remote or austere environments where evacuation to a medical facility may not be possible for several hours or even days. The course focuses on changing people's mindsets and creating a team approach to caring for patients. They discuss the importance of checklists and the challenges of communicating with non-medical responders in emergency situations. The podcast is available on various platforms, including YouTube, and you can find more information about the Prolonged FieldCare course on their website and social media channels. Thanks for listening!For more content go to www.prolongedfieldcare.org
Consider supporting us: patreon.com/ProlongedFieldCareCollective
In this episode, Dennis and Dr. Cancio discuss the dangers and treatment of white phosphorus burns, which can be extremely painful and even fatal. They also talk about the challenges of providing medical care in combat situations and the importance of being prepared for any situation. It's an informative and interesting listen, so if you're interested in military medicine or emergency care, check it out!
I talk with Dr. Moon about taking care of a patient with AMS, HAPE, and/or HACE in a PFC environment and when is it worth the consequences to evac the patient. Altitude illness is a condition that can occur when someone goes to high altitudes, such as in the mountains, and experiences symptoms like headaches, nausea, and fatigue. The podcast explains how altitude illness occurs and provides tips on how to prevent it, such as slowly acclimating to high altitudes and staying hydrated.
Dennis speaks with a logistics expert, who has experience working in Ukraine with an NGO during the conflict. The conversation centers around the logistical challenges faced by refugees and the aid organizations that work to support them. The number of refugees in Ukraine fluctuates, and the population is highly mobile, which presents challenges for aid workers trying to provide services such as shelter, bedding, and medical care. The supply chain for aid is not streamlined and is often self-defeating due to duplication of effort and shortages of necessary items. Logistics are further complicated by the lack of fresh water and infrastructure in certain areas of the country. The conversation highlights the importance of efficient distribution of aid and communication between aid organizations to ensure that the needs of refugees are met.
Please consider supporting us: patreon.com/ProlongedFieldCareCollective
This Clinical Practice Guideline was written by a fellow 18D with input from around the surgical community. It reconciles the differences between wound care done in a role 2 or 3 facility, such as serial debridements, with what is taught in the 18D Special Forces Medical Sergeant Course with regards to delayed primary closure. One way is not "right" while the other wrong, it has more to do with the amount of time and resources available to the medic or other provider. The remainder of the blog post and podcast is meant to be a refresher for those who have already been taught these procedures. It is also meant to be informational for those medical directors who may not be exactly certain of what has been taught as far as wound care and surgery. If you haven't been trained to do these procedures before going ahead with them, it is very likely that you may do more harm to the patient than good.
Please consider supporting us: patreon.com/ProlongedFieldCareCollective
As superpowers begin moving into the artic circle, as medics we need to be prepared to treat patients in a very different environment they we have in recent past. Jacob and Eric speak about their experiences in the arctic.
If you sit on a patient long enough, infection has a greater chance of taking hold and progressing to sepsis, or you may receive a patient who has already been sick for days. Doc Jabon Ellis walks us through the full spectrum from infection and SIRS to sepsis, shock and death. Despite firm CoTCCC and ICRC recommendations for early antibiotics, in the past we may have foregone that luxury because of lighting fast evacuation times, maybe even thinking, ‘they’ll take care of it at the next echelon.’ A great medic should not only treat their patient but set them up for success at the next echelon, as sepsis is a testament to how poor care during the TCCC phases of care can cost our patients days and weeks in a hospital later. But what if you are your own next echelon? Point of injury to Role 1+ could be your own team house or single litter aid station. Go down the checklist on the right side of the PFC trending chart and make sure you are taking care of anything that could result in an infection. Have you given those antibiotics? How is your airway and respiratory care? Did you replace any dirty IV or IO sites you placed in the field? Are you doing all your procedures an as aseptic manner as much as possible? When will you debride? Are you doing everything you can to prevent pressure ulcers? When will you call for a telemedical consult? When your patient develops a fever? Blood pressure falling? Altered mental status? Do you know how to dilute your 1:1000 epinephrine to use as a push dose pressor? (It’s in the Tactical Medical Emergency Protocols) Is an Epi drip appropriate, why or why not? How much fluid will you give to help prop up that BP? All questions that the medic prepared for PFC should be looking to answer.
For more content, visit www.prolongedfieldcare.org
Today, I talk with Eric Bauer from Flight Bridge ED on Anaphylaxis and cover how bad and how fast this can overcome your patient.
You can hear more about critical care flight on Eric's Podcast Flight Bridge ED.
https://podcasts.apple.com/us/podcast/the-flightbridgeed-podcast/id595147712
Non-Governmental Organizations, Non-Profits and Volunteers have been providing critical services on the battlefield for millennia. Historically the traditional view of medical care in conflict zones was that the military focused on victory and everything else was ancillary, even care of their own wounded. Only in the last few centuries has there been an evolution of care as another focus after completing the mission. Through all of this it was often family members, clergy and Volunteers providing aid to those left to rot on historic battlefields.
These NGOs and Volunteers have recognized this gap and organized themselves into powerful coalitions that are able to go where traditional militaries cannot or will not due to political pressures. Sometimes however, there exists an overlap of traditional military presence and NGO response as the situation matures or devolves.
Alex Potter and Global Response Management positioned themselves far forward on the front lines of the battles for Mosul when times were tough and the International military and humanitarian response to ISIS was in its infancy. Thank you GRM for your hard work and dedication. We are extremely proud of what your team accomplished and maybe even a little jealous in the bittersweet way that only those who have experienced the horrors of armed conflict can comprehend. www.prolongedfieldcare.org
As a follow-up to the podcast on tension pneumothorax, how about simple pneumothorax? Dennis speaks with Doug on when you need to treat pneumothorax/hemothorax.
Dennis and the guys from the "Dustoff Medic podcast", discuss optimizing your patient for evacuation. We go over the common mistakes and some of the decision making processes of Load and go or Stay and Play when it comes to the more invasive procedures.
In preparation for SOMSA, Dennis speaks with Ricky D. on how to give a great presentation.
Remember to check out www.specialoperationsmedicine.org for SOMSA 2023 info.
Prolonged Field Care is back with a new episode on a long awaited topic, traumatic ventilation. We were finally able to corner a real, live anesthesiologist who was actually more than happy to sit down and talk about ventilation after his years of experience working at the heads of thousands of patients. This episode starts right off with a difficult scenario discussion that includes a hypovolemic patient with a GSW to the pelvis, RR 35 As they work to get the patient stabilized, Dr. Kopp recommends an end tidal CO2 Capnograph as the single best patient monitor for this situation. A SAVE2 vent is discussed along with the ARDSnet recommendations for a lung protective vent strategy including the preferred tidal volume of 6-8ml/kg of ideal bodyweight based on patient height. This is to reduce barotrauma and over-ventilation that can lead to other problems. This begins with attempting to match the patients physiologic respiratory rate to prevent acidosis by giving too few breaths. The beginning Positive End Expiration Pressure (PEEP) recommendation should start somewhere around 5 to keep alveoli open and recruited, prior to increasing oxygen levels if available. PIP or Peak Inspiratory Pressure or the maximum pressure of each breath which has a default setting of 30 corresponding with the ARDSnet protocol. For an uninjured patient in the Operating Room, Dr. Kopp would start at 20-22 and then titrate from there. While we are working on an Airway Clinical Practice Guideline with the Joint Trauma System and Army Institute of Surgical Research, this will go along with our earlier posted PFC WG Airway recommendations (April, 14) until we can get a consensus on the CPG and get it published.
www.prolongedfieldcare.org
In this episode Dennis speaks with Andy about tension pneumothorax, interventions, and training scars.
When you can’t take cold stored whole blood with you and not all of your soldiers are titered, a walking blood bank can mean the difference between life and death for a patient in hemorrhagic shock. With the mounting evidence suggesting early blood is essential and not just a good idea, you need to have a plan in order to hit the 30 minute target. I have seen students struggle for hours trying to get access in both the patient and the donor. An emphasis on early recognition and early access will save lives. This episode expands upon our latest JTS Clinical Practice Guideline on Remote Damage Control Resuscitation with Dennis interviewing the primary author Andy Fisher.
For more content, visit www.prolongedfieldcare.org
While no single clinic setup will work for every situation, a common baseline and checklist can make it far easier in customizing a clinic in similar circumstances. This is not professed to be THE way but it is A way in which ONE experienced team has created, tested, revised and rehearsed a clinic with different casualties. Their pictures and diagrams are provided in the hopes that this audience will help refine and finalize a common baseline which any medic can use in he future. Please leave comments on your thoughts. This builds upon clinic setups in SOCM, SFMS and other courses such as SOFACC and combines all into a single, ergonomic clinic in which all members of a team can easily assist the primary medic or in the worst case, effectively treat the wounded medic.
For more content, visit www.prolongedfieldcare.org
Sean and Dennis talk about the Shock Index, how it relates to our treatment decisions, and how it can guide our training. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057268/
Upgrading your airway kit with a portable end tidal CO2 monitor can help in a couple situations. While it has its limitations, it is essential for quickly determining if your tube is in the trachea during an intubation. This can be accomplished most accurately via a device with a quantitative waveform such as the Emma Capnograph. If you can’t get your hands on an Emma, the qualitative colormetric device that changes color when exposed to acid in the exhalations. False positives can occur due to other acids in the airway such as vomitus or even if the patient has recently had a carbonated beverage. While those are rare, you should be aware of the possibility. Having a visual indication of tube placement can be extremely helpful during loud transports such as on aircraft.
Another time that ETCO2 monitoring is very useful is during CPR. There will likely be a very low reading despite high quality CPR. If the heart begins to beat spontaneously, you should see an immediate increase of the numbers on the display of your device. ETCO2 can also be used as a prognostic indicator. If the ETCO2 remains below 10mmHg for 20 mins of CPR this may indicate that the patient has a very poor prognosis. After you listen to our podcast, Check out Scott Weingart’s EMCrit podcast on the subjects to hear his thoughts on this.
ETCO2 is also useful the intubated TBI patient. Per our clinical practice guideline, ETCO2 in a patient with moderate to severe TBI should be kept between 35-40mmHg. In a patient with herniation, you can temporarily increase ventilators rate in order to vasoconstrict the blood vessels in the brain, thus reducing swelling. This can only be done for a short time because hyperventilation worsens cerebral ischemia. Also avoid hypoventilation (EtCO2 45mmHg or more) that will increase ICP.
For more content, visit www.prolongedfieldcare.org
Well, maybe emergency laparotomies are not for field medics, but there are a lot of other interventions that are 100% in our court. Dennis and Sean discuss what can be done.
Dr. Van Wyke and Dennis go over what can be done when managing a severe TBI in an austere environment.
Can controlling pain alone have an effect on PTSD? If so, how much? We deep dive into analgesia and sedation and it's effect on the body and the mind.
It's getting to be that time of year again, Ian schools us treating cold weather injury.
Being ready for an emergent airway is more complicated than you probably think. Dennis talks with Kevin about the ENTIRE process of getting it done.
Urine output is the gold standard for adjusting any resuscitation, Dennis and Doug talk about the beans and what to do when things go wrong.
I know our listeners want to stay on the bleeding edge of medicine, but with today's "publish or die" environment, flashy titles can lead you down a wrong path. Ricky and Dennis go through how to properly read a research paper and be able to sift through the BS and find the good stuff to base your practice on.
Dennis nerds out with Justin and Ricky on the importance of calcium during fresh whole blood transfusion.
Recommended medications are always being updated in the guidelines, but the formulary does not change nearly as fast. This is the right way to get things changed.
Kids scare the crap out of everyone. Lets go through some basics and get back up to speed.
Life is the cruelest teacher....it gives you the test and then teaches you the lesson. Rick walks through a very difficult situation and the many things that went well and what did not.
Dennis and Mark discuss tourniquet conversion and pelvic fracture with associated mid-shaft femur fracture. For more content visit, www.prolongedfieldcare.org
Death is an unfortunate part of medicine, but what do you do after the patient dies? Rick and Dennis discuss what to do if your patient can not be saved.
Transfusion reactions are generally rare, but some are not as rare as you think? Combine that with other risk factors and you have a problem that you had better be prepared for. Don't worry Evan and Dennis walk through the the whole thing.
It's that time of year. Dennis and Ian talk about every medic favorite training injuries.
When it comes to dealing with crush syndrome, guys are super motivated to push sodium bicarb, but is it actually doing anything?
Dennis and Doug speak about everyone's favorite...Evidence Based Medicine...., but what do I do if there is none on what I'm researching?
Today, I speak with Dr. Shackleford and Dr. Rush about the realities of triage currently and moving into the future.
In this episode, I speak with Stacy Shackleford and Andy Fisher the need for surgery on the battlefield and what to do about it.
In this episode, I speak with Bryce about the importance of medical team training. What to teach and how to get involvement.
Despite our best efforts, endless training, and reading, some of our patients will die. This has been a taboo subject that is difficult to broach in the best of times. We aim to start a conversation here with the hope that
it continues with your Medical Director, PA, Surgeon and fellow Medics before you are ever faced with this difficult situation out on your own. Often prolonged field care involves treating the most critically sick or injured patients longer than you expect to. Inevitably some of these “sickest-of-the-sick” will not make it to see definitive care and you will be left to ease the suffering during end of life care alone. While you may have to deliver end of life care by yourself, you may not have to make all the decisions alone.
In this episode Dennis and Doc Powell discuss how to treat expectant patients. This could be as part of a multi-patient MASCAL or a happen to a single patient who is critically ill or injured. If it happens during a MASCAL, once you are done treating your urgent patients, what do you do when you go back to your expectant patients? It’s common to skip over discussing and training on losing patients… Taboo even. The fact is that it will eventually happen to some of us; No matter how good of a medic we are, patients will die. Doc Powell has spent innumerable hours in Intensive Care Units with the best and brightest medical teams a patient could hope for. Even in this setting the top notch care, medicines and interventions are not enough and patients code and die. This is part of medicine whether we talk about it openly or not and while many of these situations will be complicated and stressful we hope to give you a few tools to help manage the situation in a more professional manner.
How do you decide if your critically ill patients are expectant, when alone in a tactical or resource strained environment?
After that decision is made, what can we still do?
How is telemedicine different for curative vs. palliative cases, if at all?
In this episode I speak with Dr. De Mello, a retired anesthesiologist from the UK, with a lot of experience with burn patients both in the civilian hospital and military. Dr. De Mello is also a professor for the College of Remote and Offshore Medicine (CoROM) Masters in Austere Critical Care program.
https://corom.edu.mt/
Lots of tidbits for you to refine your game.
Enjoy
Dennis had the honor of interviewing Dr. John Quinn who's on the ground working Role 1 medical operations for an NGO somewhere in Ukraine.
The lessons being learned by John and others during the early days of this conflict and the past 8 years can be used to help those on the ground now and into the future. This is an amazing opportunity to stay informed of current events and prepare ourselves by narrowing expectations and tweaking training.
During the interview John stated that anything that can be done to further enable FWB availability and knowledge would be greatly appreciated. In particular, when asked what we could translate, he asked for: Damage Control Resuscitation guidelines to be translated, Prehospital Blood guidelines, anything on Damage Control Surgery for non-surgeons (they have a lot of OB/GYNs and others like OMFS functioning as DCS surgeons at Role 2s). He also stated that they're seeing a TON of TBI "walking wounded" and anything on mild to moderate TBI management would be great.
When asked about a trauma registry, John stated that the Ministry of Health is attempting to catalogue all civilian casualty numbers. The Ministry of Defense is VERY close-hold with any info and it would be very hard to elicit the ground-truth there for the time being.
John stated that many organizations are using the TCCC cards and all documentation is trying to be written in BOTH Ukranian and English, due to the large number of non-native providers helping in country. They LOVE the DeployedMedicine app, the translation of TCCC and Emergency War Surgery and absolutely look to US and NATO standards of care.
This is our 100th episode! Today I speak with the Godfathers of the Prolonged Fieldcare Working Group and talk about how things got started and where things are going in the future.
Coadministration of Ketamine and Versed has been practice for quite awhile, but is it best practice?
I realized there are some really good podcasts that haven't seen the light of day in a long while. The is no exception, Jamie discusses crush syndrome and lays out very well how to get it done.
I will continue to label all of the reruns and continue to get new podcast out to you guys every two weeks.
Enjoy
Of course you could pack the kitchen sink, but....Why? How about we start learning what labs are important, so that we can plan and pack better.
This is one of those areas that we do not get the oppertunity to practice as much as we would like. Anytime we can learn from someone else, we should listen.
We all know the indications to secure the airway, but when the time comes....we hesitate. Should I take the airway or should I wait. Do I have what I need? Today, I spoke with another medic about a situation he found himself in.
The Prolonged Field Care Working Group is dead (actually, evolved…).
In its place, the new Prolonged Field Care Collective arises.
We are back.
After some time to reorganize, restructure, and strategize, we will be continuing to update best practices, share ideas and raise the important questions faced by medics around the world. We have taken this step to lay the old prolonged field care working group construct to rest and form a new organization (with the same core people): the Prolonged Field Care Collective. Membership is based on participation and contribution. Dennis will continue to record podcasts, which will be posted on www.prolongedfieldcare.org, our new podcast feed as well as the same old Special Operations Medical Association Libsyn feed. This will allow us to reach a wider audience, maintain complete control of our content, continue to “push the envelope,” nurture the unconventional Think Tank, and expand what we offer in the future.
Dr. Cooper discusses how all of these are linked and what can be done to help ourselves and eachother.
Sometimes it's good to go over the basics again. Doug gives us the run down on who needs vent management and how to get started.
For more content visit www.prolongedfieldcare.org
Everyone knows how hard it is to do good ventilation management using our gear. If the patient is spontaneously breathing in any way it can be next to impossible.
Are paralytics the answer?
Dennis speaks Evan (ER Doc) and Josh (ICU Doc) about the use of paralytics in vent management.
With bleeding from the "Box" causing such a large portion of the potentially survivable deaths, can we go in there? A better question probably "should we?". Stacy goes over how large the actual problem is and better yet, "What can be done", and "what does it take to do it?"
We're beyond explaining that blood is better than water, when it comes to resus and trauma. Now let's start talking about HOW to do it better. How to collect it faster and give it faster in the austere environment. How can we use the gear we have and optimize this life saving process.
Usually, we are sending our patients to a higher level of care. What do you do with the patients you can't? Dennis and Ian go over a timely topic.
Jon does this for a living. Dennis discusses some more practical aspects of analgesia and sedation, such as how to assess for pain when your patient is unconscious. Jon also discusses the practicality using IV lidocaine in an austere environment. This is another podcast from the study discussed on IV lidocaine.
http://www.oxfordjournals.org/podcasts/bjaed_intravenous_lidocaine_vol_16_issue_9.mp3
Sometimes our patients are too sick to receive the care they need. Dennis and Mark discuss the decision points on who goes to surgery and when.
Dennis and the guys from the "Dustoff Medic podcast", discuss optimizing your patient for evacuation. We go over the common mistakes and some of the decision making processes of Load and go or Stay and Play when it comes to the more invasive procedures.
Sometimes it's not an easy decision to turn around and go home. I talk with Dr. Moon about taking care of a patient with AMS, HAPE, and/or HACE in a PFC environment and when is it worth the consequences to evac the patient.
On this podcast, I talk with Jeff about the problem with overventilation. Should we switch to a pediatric bvm for adults?
Dennis and Doug break down the pretty complex issue of dealing with an AKI in the austere environment.
Dennis and Scott discuss what to do after the life threats have been addressed and the healing begins.
Dennis and Dave deep dive into TBI and the various types of herniation. Hint...the most common is not the one we have been trained on.
Dennis talks with Josh and Jeremy about the Special Operations Medic Coalition, how they're helping the community, and what they have planned for the future.
For more content, go to www.prolongedfieldcare.org
Dennis and Mark discuss tourniquet conversion and pelvic fracture with associated mid-shaft femur fracture.
For more content visit, www.prolongedfieldcare.org
Dennis, Doug, and Jeremy discuss the newest edition to the Society of Critical care courses.
Dennis nerds out with Justin and Ricky on the importance of calcium during fresh whole blood transfusion.
Dennis and Justin discuss medical planning.
For more content, visit www.prolongedfieldcare.org
Dangerous snakes can be found both while training at home and far away while deployed. It may be a rare occurrence, but a catastrophic event when it does happen. Some austere providers may be aware of outdated treatments, and don’t know where to start when it comes to identification and management of a snake bite. Feel free to ask yourselves these questions, or bring them up in a group discussion before listening to the podcast:
1.) Which type(s) of snakes would you put a tourniquet on?
2.) Under what conditions would you apply ice, cut into, or use an extractor on the wound?
3.) Before you deploy to “country x”, how can you find out dangerous fauna and flora? How can I prepare, equipment wise?
4.) How important is it to identify the snake? What if it cannot be found?
5.) How do I assess a snake bite patient and tell a difference between the various types of venom?
6.) How can you tell if it’s a “dry bite”?
7.) You receive a patient with a Tourniquet already applied by a non-medic or junior medic… what now?
8.) When do I give anti-venom, of what type and quantity? What are the side effects?
9.) When would you take the airway in a patient with snake envenomation? When would you have MSMAID ready?
10) How do you handle a patient with venom sprayed into their eyes?
11) What are concerns with compartment syndrome in these patients?
12) How do you administer a push dose pressor or dirty epi drip for anaphylactic reaction?
13) If you have a confirmed snake bite but NO antivenom… how can you manage a patient, if at all?
14) What are your pain management considerations for these patients? Do you know the onset and durations for the medications you push or TIVA? What happens if the patient has breakthrough pain before the expected time?
Dennis and Ian discuss spinal trauma in the austere environment.
For more content, visit www.prolongedfieldcare.org
Dennis and JJ discuss Highly Reliable Organizations.
For more content, visit www.prolongedfieldcare.org
While no single clinic setup will work for every situation, a common baseline and checklist can make it far easier in customizing a clinic in similar circumstances. This is not professed to be THE way but it is A way in which ONE experienced team has created, tested, revised and rehearsed a clinic with different casualties. Their pictures and diagrams are provided in the hopes that this audience will help refine and finalize a common baseline which any medic can use in he future. Please leave comments on your thoughts. This builds upon clinic setups in SOCM, SFMS and other courses such as SOFACC and combines all into a single, ergonomic clinic in which all members of a team can easily assist the primary medic or in the worst case, effectively treat the wounded medic.
For more content, visit www.prolongedfieldcare.org
What happens when your patient has been given a cric or intubated but continues to decline… SpO2 continues to slowly drop despite taking control of the airway. You have placed your patient on a ventilator and slowly adjusted the PEEP up to 20cmH20… which quickly leads to hypotension. Do you go lower? Higher? Change volume or rate? You are out of bottled O2 and your oxygen concentrator does not seem to have much effect. The SpO2 continues dropping. Telemedicine is not available. You try positioning the patient by sitting them up. You try a couple other recruitment maneuvers you heard about.
Nothing is working.
What would Doug do?
Prone the patient???
Your patient may be suffering from ARDS, Acute Respiratory Distress Syndrome caused by a number of etiologies such as pneumonia or other lung injury. Carefully turning your patinet on their stomach may improve oxygenation by recruiting alveoli formerly compressed and “drowned” as demonstrated in the picture below. Positioning your patient on their stomach in the prone position must be practiced with anyone who will be helping you. Put someone else in a similar position and have the team with which you plan to help move the real patient do a couple rehearsals. You don’t want to flip them over only to lose your IVs, IOs and yank the airway out. Check out this Brazilian article which includes a proning checklist and some informative pictures and tips. You also don’t get an automatic win by flipping them on their belly and calling it a day. You will have to be even more vigilant about any potential complications with a dedicated airway person as is is a little harder to recognize a patient in distress if you are not used to it. You will also have to do more nursing care on the delicate skin of the face and other surfaces not normally on the down side: Shoulders, hips, knees tops of the feet. Put yourself in this position for a few minutes on a litter and you can quickly tell where the major pressure points will be. All of these complications increased along with the benefits of the study. While no prolonged field care patient should be on a bare litter, there is even more reason to move them to a mattress or other more comfortable padded surface.
For more content, visit www.prolongedfieldcare.org
After a few discussions with JJ who has also appeared in several Element Rescue podcasts, Doug and Dennis talk about using evidence based medicine whenever possible and what to do when no prospective randomized controlled trials exist for a specific problem you face. What do you do when no evidence exists for a specific problem you face? With such a wide scope of practice while deployed and a lack of protocols SF medics are often faced with unique situations in which they must actually weigh the evidence, best practice, guidelines and expert consensus against the given situation. This is a great responsibility not entrusted to many other combat arms troops. In order to weigh the evidence you must first be aware it exists and how to interpret what you are reading. This will help get you on the right path in making informed decisions.
Check out the Discussion: https://oembed.libsyn.com/embed?item_id=10109669
Prolonged Prone Positioning Article NEJM 2013
Protocols and algorithms likely drive the majority of decisions a medic will ever make. If you find yourself in a situation, such as a prolonged field care situation, that outlasts all of those you should know some of the current best practices and data to back up your decisions you may be forced to make. Dogma is believing something to be true without knowing if it actually is, or why. Don’t rely on dogma, question things and have your own opinions. Know why you believe what you believe. When you make a telemedicine consult call you should have a fairly good idea of the decision you are leaning toward and why. You will sound much more like the medical professional you claim to be and less like the knuckle dragger they may be expecting. Medicine is a separate language and you are expected to be somewhat fluent. Data and research are intellectual and professional currency and which can add to your credibility. Read an article, understand who the authors are, their specialty, where they work and who funded or sponsored it as well as the references at the end. You will run across words you aren’t familiar with. Put them in the Google machine and expand your medical vocabulary. You may even want to read those references and the references to those in order to really dig deeper. (Three deep, right Scott?) Podcasts are a great way to hear opinions on some of these studies and how others have incorporated them into their practice. Podcasts and blogs (even this one) are not journal articles and studies. They are meant to raise discussions and spark debate and make you aware of new techniques or practices. If a study is mentioned find the article and read it yourself. Does it apply to your environment, experience and training? Don’t be the guy quoting a podcast or Facebook post in a scholarly discussion, at that point it will just be entertainment, for the other guy. Know where it originated.
Not all PFC is trauma. Malaria, Dengue, Chikungunya and others will take you out of the fight if given the chance. In this episode CAPT Ryan Maves talks about some of the more concerning and prevalent diseases encountered by deployed military personnel and partner forces and what you can do about it before an infection becomes debilitating or life threatening. A few things to remember from the episode: - History and assessment are key in identifying tropical diseases. Remember to consider both history of exposures as well as the accompanying syndromes in formulating a differential diagnoses. - Malaria treatment consists of Malerone, Coartem or both. - No one dies without Doxycycline!
For more content, visit www.prolongedfieldcare.org
Why do we care about sepsis in prolonged field care? What can we do about septic shock with what we are normally carrying on a deployment? How do you mix an epinephrine drip? Dr. Maves lays it all out in about 20 minutes.
Here are some of the resources and pearls he mentioned in the episode:
Infection plus organ dysfunction is sepsis
Infection plus hypotension is septic shock
Q-SOFA positive with 2 of the three and suggestive of sepsis:
Systolic BP less than 100
RR greater than 22 breaths per minute
Presence of delirium
Earlier intervention is better than later
Higher mortality rate than poly trauma or myocardial infarction
Something is better than nothing
Septic shock is not purely distributive. You will also see myocardial depression loss of contractility, capillary leakage, microvascular obstruction from small thrombi and concomitant hypovolemia. Some fluids are good but more fluids mat be dangerous. If 2 or 3 liters does not work it is unlikely that 5 or 6 fix hypovolemia. At some point it will start increasing mortality. The best vasopressor is the one you have. Delaying proper antibiotics increases risk of death by 8% every hour.
For more content, visit www.prolongedfieldcare.org
When you can’t take cold stored whole blood with you and not all of your soldiers are titered, a walking blood bank can mean the difference between life and death for a patient in hemorrhagic shock. With the mounting evidence suggesting early blood is essential and not just a good idea, you need to have a plan in order to hit the 30 minute target. I have seen students struggle for hours trying to get access in both the patient and the donor. An emphasis on early recognition and early access will save lives. This episode expands upon our latest JTS Clinical Practice Guideline on Remote Damage Control Resuscitation with Dennis interviewing the primary author Andy Fisher.
For more content, visit www.prolongedfieldcare.org
So what is different than what we already have in the THOR recommendations, the JTS DCR clinical Practice Guideline and the Ranger Regiment TDCR? No hextend?! Calcium with the 1st unit of blood?! TXA slow push?! What if the patient is not responding to resuscitation efforts? This is a guideline truly written for the Medic working despite lack of help or resources in an austere environment…
When reviewing and editing this evidence-based consensus guideline there were lengthy discussions about the realities of some of the issues mentioned above. One of the biggest questions came when discussing TCCC because there are slight differences with the CoTCCC guidelines which were written specifically for a medic treating a patient sequentially in the combat environment.
I will attempt to explain the thought process of the group of authors as I understood the conversations and email chains in order to help you make a better decision for your practice. That fact alone makes this guideline different. It is specifically written for an independent duty medic or corpsman who has the flexibility to make decisions about the care based on available evidence for the patient which may or may not yet exist in which case expert consensus was used.
Guidelines for medics must be written in a linear manner because they do not merely manage the care of a patient as part of a large team working together, they manage, prioritize, and physically complete each task one after another. Training other team members to complete certain tasks can greatly assist the medic. Gains in the quality of care and outcomes can come from optimizing a dedicated trauma system. When that system is a single person working problems in series, the variables must be looked at in a sequential manner because that is how they are performed. The administration of TXA comes to mind when talking about these minute changes.
TXA Slow Push: TXA is not the cornerstone of austere resuscitation, administration of blood is. Since the CRASH2 TXA trial results and per manufacturer recommendations, it has been recommended that TXA be given slowly over 10 minutes so as to not cause transient hypotension. The provider should absolutely be aware of this possibility no matter how small of a chance it may have of occurring. Once aware and taken into account, a decision can be made for the current situation. Do they have time to get out an IV bag, reconstitute the TXA, Inject it into the bag, start a new IV/IO site, hook up the line, count the drips, adjust the drip rate multiple times and then check on the drip rate multiple times so as to make sure that 10 minutes is vehemently adhered to? Does this bring the risk of transient hypotension to absolute zero or does it merely reduce an already small chance? This guideline gives the medic the same guidance and recommendations from conclusions of the original study with the caveat not to waste time they or the patient may not have due to the situation or environment. If that IV line is already the second line, it may be needed for other adjuncts including calcium, pain control, sedation, antibiotics, antiemetics, etc. 10 minutes is a long time when someone is writhing in pain, vomiting, mentally altered while bleeding out. If on the other hand, a patient arrives to your aid station with 2 IVs, blood hanging, with appropriate sedation and analgesia, there is likely time to adhere to the slow drip over 10 minute recommendation. Again, it is the prerogative of the independent duty medic or corpsman to weigh the risks versus gain.
Many efforts in the pre-hospital combat environment had been aimed at prolonging the viability of a patient until they are able to make it to a surgeon. The goal of military triage and evacuation is to have urgent surgical patients to a waiting surgical team within 2 hours. Despite our best efforts, this is not always possible. When it is not possible,it is important to do the simple interventions which we know make a difference for combat casualties such as tourniquets, wound packing, needle decompression, airway adjuncts and pelvic binding. Wounds causing non-compressible hemorrhage to the torso need additional strategies to bridge the time and space gap to definitive treatment. A non-surgical adjunct which has shown much promise has been the early transfusion of whole blood and blood products until surgical care can be provided. Our newest Clinical Practice Guideline on Remote Damage Control Resuscitation details what should be done and why. There is an entirely separate working group, The Tactical Hemostasis, Oxygenation and Resuscitation (THOR) group dedicated to exactly those principles which we partnered with early on to help identify solutions dealing with hemorrhagic shock. Despite all that effort and brain power however, blood remains a finite resource in the austere environment and Medics have faced terrible situations where even blood administration is not enough and surgery is too far away. It is in these times of worst-case desperation that we want to do more for our patients. Some of the adjuncts discussed in this episode are abdominal tourniquets, REBOA and open surgical procedures. We don’t take any of this lightly and realize that for the vast majority of our pre-hospital audience, many of the procedures discussed are far outside the current scope of practice.
What is possible?
What is responsible?
What is sustainable?
Enjoy the talk.
When properly and safely administered regional anesthesia can augment your limited supply of narcotics and ketamine in resource poor environments. It can also preserve your patient’s mental status while providing targeted pain relief. This can be accomplished using a nerve stimulator and the techniques found in the Military Advanced Regional Anesthesia and Analgesia Handbook as taught in the Special Forces Medical Sergeant course. If you have a portable ultrasound machine and a little practice you can also use the safe techniques found in the videos made available in by the New York School of Regional Anesthesia at NYSORA.com.
For more content, visit www.prolongedfieldcare.org
Colonel Warner “Rocky” Farr has made an important contribution to the body of SOF knowledge with this well-researched monograph. He advances the understanding of the many challenges and accomplishments related to guerrilla warfare medicine—care provided by predominantly indigenous medical personnel under austere conditions with limited evacuation capability— by providing a survey of the historical record in UW literature. Colonel Farr relates many historical experiences in the field, assesses their effectiveness, and lays a foundation for further in-depth study of the subject. The Joint Special Operations University is pleased to offer this monograph as a means of providing those scholars and operators, as well as policymakers and military leaders, a greater understanding of the complex and complicated field of guerrilla warfare medicine.
For more content, visit www.prolongedfieldcare.org
Whether working on a casualty with a small team of medics or as a single medic with the help of other non-medic team members as helpers, someone has to be in charge of the situation in order to maintain a global view of priorities. The minute you get sucked in to do a specific task you are losing situational awareness of the complete patient and environment. If you are working on your own as a lone medic with no helper you have to fill both the technician and team leader role. Treat life threats through your TCCC/MARCH sequence and then mentally step back and take in the whole picture. When the situation permits and as you begin a more detailed secondary exam, start writing down each problem as you encounter it and then prioritize what is going to kill or cause permanent damage first with. Making a plan and being proactive is what separates the great medics from less experienced medics who are constantly chasing their tails reactively. If you are not taking care of patients on a daily basis training with the small team can help delineate roles and responsibilities. This is why if you are doing medical training you should have your team or platoon leadership involved along with anyone else who will be helping.
For more content, visit www.prolongedfieldcare.org
Upgrading your airway kit with a portable end tidal CO2 monitor can help in a couple situations. While it has its limitations, it is essential for quickly determining if your tube is in the trachea during an intubation. This can be accomplished most accurately via a device with a quantitative waveform such as the Emma Capnograph. If you can’t get your hands on an Emma, the qualitative colormetric device that changes color when exposed to acid in the exhalations. False positives can occur due to other acids in the airway such as vomitus or even if the patient has recently had a carbonated beverage. While those are rare, you should be aware of the possibility. Having a visual indication of tube placement can be extremely helpful during loud transports such as on aircraft.
Another time that ETCO2 monitoring is very useful is during CPR. There will likely be a very low reading despite high quality CPR. If the heart begins to beat spontaneously, you should see an immediate increase of the numbers on the display of your device. ETCO2 can also be used as a prognostic indicator. If the ETCO2 remains below 10mmHg for 20 mins of CPR this may indicate that the patient has a very poor prognosis. After you listen to our podcast, Check out Scott Weingart’s EMCrit podcast on the subjects to hear his thoughts on this.
ETCO2 is also useful the intubated TBI patient. Per our clinical practice guideline, ETCO2 in a patient with moderate to severe TBI should be kept between 35-40mmHg. In a patient with herniation, you can temporarily increase ventilators rate in order to vasoconstrict the blood vessels in the brain, thus reducing swelling. This can only be done for a short time because hyperventilation worsens cerebral ischemia. Also avoid hypoventilation (EtCO2 45mmHg or more) that will increase ICP.
For more content, visit www.prolongedfieldcare.org
Non-Governmental Organizations, Non-Profits and Volunteers have been providing critical services on the battlefield for millennia. Historically the traditional view of medical care in conflict zones was that the military focused on victory and everything else was ancillary, even care of their own wounded. Only in the last few centuries has there been an evolution of care as another focus after completing the mission. Through all of this it was often family members, clergy and Volunteers providing aid to those left to rot on historic battlefields.
These NGOs and Volunteers have recognized this gap and organized themselves into powerful coalitions that are able to go where traditional militaries cannot or will not due to political pressures. Sometimes however, there exists an overlap of traditional military presence and NGO response as the situation matures or devolves.
Alex Potter and Global Response Management positioned themselves far forward on the front lines of the battles for Mosul when times were tough and the International military and humanitarian response to ISIS was in its infancy. Thank you GRM for your hard work and dedication. We are extremely proud of what your team accomplished and maybe even a little jealous in the bittersweet way that only those who have experienced the horrors of armed conflict can comprehend. www.prolongedfieldcare.org
The Trauma Hemostasis and Oxygenation Research (THOR) Network including the 75th Ranger Regiment, NORNAVSOF, and others have led the way in re-implementing type-O, low titer fresh whole blood far forward with the Ranger type-O Low titer(ROLO) program. In 2015 the Ranger medical leadership along with founders of the ROLO program published the paper, “Tactical Damage Control Resuscitation” outlining in detail why they chose to bring back fresh whole blood at the point of injury. Since that time further studies have strongly suggested that the earlier fresh whole blood was transfused, the greater the benefit to the patient. Shackleford et al. demonstrated that the greatest benefit to a patient receiving fresh whole blood occurred within 36 minutes of injury. After 36 minutes no decrease in 24-hour mortality was found.
Blood must be replaced as soon as possible. The Committee on Tactical Combat Casualty Care also recommends FWB as the first line intervention for patients in hemorrhagic shock with blood products in both second and third place. We cannot ignore whole blood any longer if we wish to deliver the best possible battlefield care possible. Excuses citing logistical difficulty, concerns about safety or lack of information are unfounded. There are multiple ways to ensure our casualties are receiving fresh whole blood. The first is through the Armed Services Blood Program (ASBP) delivering cold stored O-Low titer blood to a Role 2 facility where it is picked up and pushed forward from there. Refrigeration is necessary in order to keep it below 4°C. If going out on mission insulated containers such as the Golden Hour or Golden Minute containers can be used to keep the blood within temperature specs for 24 hours, 72 hours or longer. If dismounted, a transfusion can occur at or near the point of injury with pre-typed, screened and titered ROLO/SOLO donors. Other non-Ranger Special Operations units have since followed suit and have tweaked the name to suit them, hence the new SOLO (Special Operations Low-O) acronym.
www.prolongedfieldcare.org
Which burn fluid resuscitation formula is best? Does it really matter?
What can happen if you over resuscitate? Under?
What can cause an increase or decrease in the demand of fluids?
What can you do if you are running out of Lactated Ringers?
As a Lt. CMMDR. with the U.S. Navy, Dr. Cairns was on duty and a principle responder to the KAL flight that crashed in 1997 in Guam. Dr. Cairns was instrumental in developing the level of preparedness at the Naval Hospital there which received and managed dozens of critical patients in the morning following the crash of the 747. Dr. Cairns has served North Carolina as a Burn Trauma Surgeon at the state’s Burn Center at UNC. In 2006, Dr. Cairns was named as the Director of the North Carolina Jaycee Burn Center and is nationally known as a leader in Burn Trauma Care. He is a John Stackhouse Distinguished Professor of Surgery, an Associate Professor of Surgery, Microbiology and Immunology at the University of North Carolina at Chapel Hill School of Medicine. Be sure to read the Clinical Practice Guideline discussed in this and a prior episode with Dr. Doug Powell. In this episode we will take another look at the CPG from another perspective.
Telemedicine is a crucial capability that must be planned and practiced. The base of knowledge that a SOF medic’s knowledge encompasses includes many areas of medicine but generally lacks the depth of knowledge and experience of specialists available to consult. This depth of knowledge is almost universally available when making a simple telephone call to any number of docs willing to take a call at all times of the day and night. Don’t let pride or hubris prevent you from seeking advice from someone more experienced than you in taking care of critically injured, complex patients. Telemedical consult is one of the most important core capabilities in a prolonged field care situation. BOTH the medic making the call as well as the Provider receiving the call must practice and rehearse a telemedical consult placed from a field environment. The medic will gain confidence and be able to relay vital information efficiently in a timely manner. The provider on the other end will have to anticipate problems that the medic may not have thought of and help create a prioritized treatment care plan from incomplete information. Trust must be built prior to an actual call being made under stressful conditions; trust in the receiving physician and, more importantly, trust in the process. Medics may be apprehensive in calling a complete stranger if they haven’t made a test call or even better, a face to face meeting. If you build the rapport before the crisis, this won’t be an issue. You may even have the time to prep a draft email who you are and your equipment, training level and usually a region where you will be if you think it will be pertinent. For more content, visit www.prolongedfieldcare.org
Rick Hines has spent the last 20+ years in service to his country much of it deployed to combat zones and other unstable, austere environments and is dedicated to improving SOF Medicine. He made it a point to spend a fair amount of time with surgical teams when possible and has gained quite a bit of real world knowledge that we hope to pass on to a wider audience here. He was formerly an SF Medical Sergeant turned Team Sergeant before going on to work as the 3rd SFG(A) Senior Enlisted Medical Advisor, the Unites States Army Special Forces Command (USAFC) SEMA and within the USASOC Surgeon’s Office.
For more content, visit www.prolongedfieldcare.org
When do you give a burn patient antibiotics? Which ones?
How do you calculate TBSA and the rule of 10s?
What do you use to guide fluid resuscitation? What fluid?
When is an escharotomy in the field appropriate?
Burns present another wound pattern that can be extremely difficult and time consuming for any level of provider to manage. So much so that there are dedicated burn teams that will often fly to where burn patients are being held in order to get them back to the burn center in San Antonio with the best chance of survival. We have taken the expert guidance of these critical care providers and packaged everything they have learned into a single clinical practice guideline targeted at the medic and other Role 1 Providers who might find themselves sitting on a patient at a Battalion Aid Station or team house before evacuation is available. Initial priorities such as estimating percentage of body surface area burned, starting fluid resuscitation with the rule of 10s, Foley placement along with many others may determine the mortality and morbidity of your patient. For more content, visit www.prolongedfieldcare.org
In this live recording, guest lecturer COL Missy Givens shares the CBRNe knowledge she has learned while working as a clinical toxicologist, among many other positions, around the world including as the SOCAFRICA Command Surgeon.
For more content, visit www.prolongedfieldcare.org
You are in your Team House or BAS. You have given FDP, Whole blood, TXA calcium and don’t have much left despite the few units from the walking blood bank. Your patient continues to bleed internally. Nothing in the chest or upper abdomen. Probably pelvic. Damn. MEDEVAC is en route. They will have some blood too. You just need your patient to hold on for another hour before he gets to surgery… Dr. Joe DuBose is an Air Force Trauma Surgeon who recognized early in his career that hemorrhage was the number one killer of potentially survivable patients. This led him to a fellowship in vascular surgery and, as Dennis put it made him a guru in the emerging technology that allows a catheter to be placed in the femoral artery and snaked up past a bleed in the pelvis, abdomen and even chest where a balloon is then inflated cutting off all blood flow below that point. Dr. DuBose was the first to do This in the ED using a newer version that had a small enough diameter that a vascular repair would not be required after use. It is simply placed through a central line and removed as such later on. This is called REBOA or Resuscitative Endovascular Balloon Occlusion of the Aorta. As you can imagine this is not without limits and complications if done improperly. You are in your Team House or BAS. You have given FDP, Whole blood, TXA calcium and don’t have much left despite the few units from the walking blood bank. Your patient continues to bleed internally. Nothing in the chest or upper abdomen. Probably pelvic. Damn. MEDEVAC is en route. They will have some blood too. You just need your patient to hold on for another hour before he gets to surgery… Dr. Joe DuBose is an Air Force Trauma Surgeon who recognized early in his career that hemorrhage was the number one killer of potentially survivable patients. This led him to a fellowship in vascular surgery and, as Dennis put it made him a guru in the emerging technology that allows a catheter to be placed in the femoral artery and snaked up past a bleed in the pelvis, abdomen and even chest where a balloon is then inflated cutting off all blood flow below that point. Dr. DuBose was the first to do This in the ED using a newer version that had a small enough diameter that a vascular repair would not be required after use. It is simply placed through a central line and removed as such later on. This is called REBOA or Resuscitative Endovascular Balloon Occlusion of the Aorta. As you can imagine this is not without limits and complications if done improperly. REBOA In this episode we explore the usefulness and limitations of this strategy in deployed settings and discuss the use of REBOA by non-physician providers in austere situations. He has written several articles on use of the REBOA and it is now one of the most promising and controversial adjuncts available for hemorrhage control of bleeding inside the box of the thorax, abdomen and pelvis. In order to do this o e would likely have to be within an hour of a facility that can repair the retired vessel as the lactic acid and other toxins would quickly build up causing a massive repercussion injury. To this end he discusses his strategy for partial REBOA during resuscitation that would leave the balloon partially inflated allowing a clot to strengthen and circulation distal to the balloon. For more content, visit www.prolongedfieldcare.org
Dr. Cap has been leading the way here in the US with the Armed Services Blood Program on fresh whole blood transfusion research in conjunction with the THOR Network and answering tough questions that different Special Operations Units come up with when analyzing how best to implement a fresh whole blood resuscitation protocol. In this episode Dennis presses him on the important resuscitation questions medics everywhere seem to be asking :
I don’t have blood yet; Crystalloid isn’t really that bad, is it?
Can’t I just resuscitate to a normal BP with hetastarch or hextend?
Where does FDP fit in with resuscitation?
What do you mean by, “dose of shock?”
Do I really have to give TXA over 10 minutes?
What comes first TXA, Calcium or Blood?
Why should patients get calcium as soon as possible once you identify they need blood?
What’s this about pre-hospital albumin?
For more content, visit www.prolongedfieldcare.org
Training materials were the number 1 most requested item from our SOMSA AAR. We have put out other training recommendations in the past but wanted to also highlight some important skills that will help you identify gaps in your PFC training program, plan future training and measure progress. We will get more into this cycle in the future however, this should be a good place to start. Many thanks go out to Andrew who labored over many versions of the list over the past few months. One last thing, be sure that you are already at 100% T for Trained on your TCCC task list. There is no use in getting into PFC training prior to mastering TCCC. If you see something we may have overlooked and would like to see it on future versions, please comment below and let us know.
For more content, visit www.prolongedfieldcare.org
This Clinical Practice Guideline was written by a fellow 18D with input from around the surgical community. It reconciles the differences between wound care done in a role 2 or 3 facility, such as serial debridements, with what is taught in the 18D Special Forces Medical Sergeant Course with regards to delayed primary closure. One way is not “right” while the other wrong, it has more to do with the amount of time and resources available to the medic or other provider. The remainder of the blog post and podcast is meant to be a refresher for those who have already been taught these procedures. It is also meant to be informational for those medical directors who may not be exactly certain of what has been taught as far as wound care and surgery. If you haven’t been trained to do these procedures before going ahead with them, it is very likely that you may do more harm to the patient than good. That being said… The following are recommendations made by the International Committee of the Red Cross (ICRC) concerning the surgical management of war wounds in austere conditions and with limited resources. This is when the provider has some or all of the following considerations which would prohibit him from performing serial (follow-on) debridement with associated post-operative care.
Dirty environment
Limited supplies
Limited manpower
Limited time (mission dictated)
Wounds greater than 24 hours
The considerations above, accompanied with the position that the provider will be managing that patient for more than a couple days or become the definitive provider, should warrant ICRC recommendations for surgical management. For more content, visit www.prolongedfieldcare.org
You have probably treated someone with an infection and likely even with someone with SIRS criteria at some point in your career. At what point does a simple infection become concerning to the point that you should call for a teleconsult? When does it become emergent or life threatening, demanding intervention and treatment? How can you prevent an infection from getting to that point? Once it becomes systemic how can you best manage a patient that meets SIRS criteria? When can you send a guy back to his room and when should you keep a close eye on him so that he doesn’t suddenly crash and die after discharge? At what point does sepsis turn into septic shock and become a life threatening emergency? In this episode Dennis moderates an interesting discussion on recognition and management of sepsis in Prolonged Field Care. We have Doug and Jaybon from the ICU, Jay from the ER perspective along with Paul providing some questions and insight on prehospital and evacuation considerations. This is a followup to Doc Jabon Ellis’ previous sepsis video podcast so if you want to “pre-read” listen to that first. If you just want to listen to this one and still have some questions, go back and watch that one… a coupe times. I feel like these 2 episodes will help make you a better medic who will be able to accurately place a patient on the SIRS/SEPSIS spectrum and apply appropriate treatments before we get to life threatening septic shock or death. www.prolongedfieldcare.org
What is the process that the CPGs go through before publication?
Medics identify what guidelines are needed.
A team consisting of a medic, unit surgeon and specialist in the field begin a draft.
Additional authors, specialists and SMEs are added as identified
Progress is monitored by the Prolonged Field Care Working Group Steering Committee and advisors from the Joint Trauma System. Final draft sent out to interested parties, other specialists and PFC working group members for review
Published in the Journal of Special Operations Medicine(JSOM) with proprietary format
Formatted for public release via the JTS website
Presented as a Thursday morning JTS CME Conference Talk.
Posted on prolongedfieldcare.org
Interviews with authors are published as podcasts.
Primary and Co-Authors may write additional thoughts as a blog post.
Polldaddy quizzes may be included in the posts or separately.
Released and promoted through social media such as our Facebook Pages, Instagram and Twitter feeds.
Why not just update the Tactical Medical Emergency Protocols? We wanted peer reviewed guidelines that could be updated individually as needed. Independent medical providers can now see what studies were referenced per recommendation. We have partnered with USSOCOM and advised several changes and additions to the TMEPs. The CPGs will help guide the CEB as they update future additions of the TMEPS as a reference. What are the origins of the CPGs? Sharing lessons learned and best practices accross the theaters of war Why are there CPGs specific to Prolonged Field Care and Critical Care Evacuation Teams(CCAT) in addition to the main JTS CPGs? There are large enough differences in levels of training, equipment and medications available and general logistics involved that make providing an identical care in all environments impossible. The CPGs take into consideration the unique challenges of the operational environment so the the provider is presented with several best options for the unique issues presented with each etiology and environment. What CPGs are in the works and when can we expect to see them published?
Are you familiar with the concept of oxygen debt or oxygen deficit? What constitutes a “dose” of shock? What systolic BP constitutes hypotension on the battlefield? Where did the concept of permissive hypotension come from? Is it still valid? How long can fresh whole blood last?
Blood Transfusions were a huge topic at this year’s meeting in Charlotte with no less than 3 major speakers giving multiple talks on the subject. This talk was recorded during the Prolonged Field Care Pre-Conference Lab during the Special Operations Medicine and Scientific Assembly (SOMSA).
Dr. Geir Strandenes is a founding member of the THOR (Tactical Hemostasis, Oxygenation, and Resuscitation) Group, the Senior Medical Officer of the Norwegian Naval Special Operations, and a Researcher in the Department of Immunology and Transfusion Medicine at Haukeland University Hospital in Bergen, Norway. He has worked hand-in-hand with the U.S. Army Institute of Surgical Research and the US Armed Forces Blood Program. You can read more about his research and other articles at www.RDCR.org. Our PFC working group has always gone to the THOR network with any blood questions that we have, as they usually have an answer or best practice already established. I have included a link to the THOR/RDCR.org publication page below along with other notable publications which he helped to author such as the recently published JTS ISR Clinical Practice Guideline on Damage Control Resuscitation and the Frequently Asked Questions we sent to Geir and the THOR network over the last couple years. www.prolongedfieldcare.org
Prolonged Field Care is back with a new episode on a long awaited topic, traumatic ventilation. We were finally able to corner a real, live anesthesiologist who was actually more than happy to sit down and talk about ventilation after his years of experience working at the heads of thousands of patients. This episode starts right off with a difficult scenario discussion that includes a hypovolemic patient with a GSW to the pelvis, RR 35 As they work to get the patient stabilized, Dr. Kopp recommends an end tidal CO2 Capnograph as the single best patient monitor for this situation. A SAVE2 vent is discussed along with the ARDSnet recommendations for a lung protective vent strategy including the preferred tidal volume of 6-8ml/kg of ideal bodyweight based on patient height. This is to reduce barotrauma and over-ventilation that can lead to other problems. This begins with attempting to match the patients physiologic respiratory rate to prevent acidosis by giving too few breaths. The beginning Positive End Expiration Pressure (PEEP) recommendation should start somewhere around 5 to keep alveoli open and recruited, prior to increasing oxygen levels if available. PIP or Peak Inspiratory Pressure or the maximum pressure of each breath which has a default setting of 30 corresponding with the ARDSnet protocol. For an uninjured patient in the Operating Room, Dr. Kopp would start at 20-22 and then titrate from there. While we are working on an Airway Clinical Practice Guideline with the Joint Trauma System and Army Institute of Surgical Research, this will go along with our earlier posted PFC WG Airway recommendations (April, 14) until we can get a consensus on the CPG and get it published.
www.prolongedfieldcare.org
This podcast is a follow up from our last post on managing traumatic brain injuries in austere environments. We included a scenario discussion with David, Jamie, Daryl, Jay, Doug and I with much needed answers to some frequently asked questions. What are your priorities? How do you assess in the field without labs and imagery? Do you include severe TBI injuries in your trauma training? What if he also has a pelvis injury or internal bleeding? When do you take the airway, if at all? When do you provide positive pressure ventilation in these patients? Can it be dangerous?
www.prolongedfieldcare.org
If you sit on a patient long enough, infection has a greater chance of taking hold and progressing to sepsis, or you may receive a patient who has already been sick for days. Doc Jabon Ellis walks us through the full spectrum from infection and SIRS to sepsis, shock and death. Despite firm CoTCCC and ICRC recommendations for early antibiotics, in the past we may have foregone that luxury because of lighting fast evacuation times, maybe even thinking, ‘they’ll take care of it at the next echelon.’ A great medic should not only treat their patient but set them up for success at the next echelon, as sepsis is a testament to how poor care during the TCCC phases of care can cost our patients days and weeks in a hospital later. But what if you are your own next echelon? Point of injury to Role 1+ could be your own team house or single litter aid station. Go down the checklist on the right side of the PFC trending chart and make sure you are taking care of anything that could result in an infection. Have you given those antibiotics? How is your airway and respiratory care? Did you replace any dirty IV or IO sites you placed in the field? Are you doing all your procedures an as aseptic manner as much as possible? When will you debride? Are you doing everything you can to prevent pressure ulcers? When will you call for a telemedical consult? When your patient develops a fever? Blood pressure falling? Altered mental status? Do you know how to dilute your 1:1000 epinephrine to use as a push dose pressor? (It’s in the Tactical Medical Emergency Protocols) Is an Epi drip approriate, why or why not? How much fluid will you give to help prop up that BP? All questions that the medic prepared for PFC should be looking to answer. For more content, visit www.prolongedfieldcare.org
We want you to be able to have more knowledge on this topic and more confidently be able to answer these questions and plan for it, as well as implement this into your training for hands on and trauma patient assessment skills. Traumatic Brain Injury (TBI) is physical damage to the brain caused by a blow to the head, penetrating objects, motor vehicles crashes and explosions, or a combination of these, which are all familiar scenarios we encounter in our community. This is especially true for Motor Vehicle Crash, the number one cause of death of our Operators on peacetime deployments, and still 5% of deaths even in warzones. To make matters worse, the force that caused the TBI also created other injuries such as a hemothorax, making it even more of an animal to treat. It’s more difficult to understand what is going on because there isn’t an artery spurting blood we can address, so we have to put on our thinking caps and understand what is going on at the cellular level.
For more content, visit www.prolongedfieldcare.org
Despite our best efforts, endless training, and reading, some of our patients will die. This has been a taboo subject that is difficult to broach in the best of times. We aim to start a conversation here with the hope that it continues with your Medical Director, PA, Surgeon and fellow Medics before you are ever faced with this difficult situation out on your own. Often prolonged field care involves treating the most critically sick or injured patients longer than you expect to. Inevitably some of these “sickest-of-the-sick” will not make it to see definitive care and you will be left to ease the suffering during end of life care alone. While you may have to deliver end of life care by yourself, you may not have to make all the decisions alone. In this episode Dennis and Doc Powell discuss how to treat expectant patients. This could be as part of a multi-patient MASCAL or a happen to a single patient who is critically ill or injured. If it happens during a MASCAL, once you are done treating your urgent patients, what do you do when you go back to your expectant patients? It’s common to skip over discussing and training on losing patients… Taboo even. The fact is that it will eventually happen to some of us; No matter how good of a medic we are, patients will die. Doc Powell has spent innumerable hours in Intensive Care Units with the best and brightest medical teams a patient could hope for. Even in this setting the top notch care, medicines and interventions are not enough and patients code and die. This is part of medicine whether we talk about it openly or not and while many of these situations will be complicated and stressful we hope to give you a few tools to help manage the situation in a more professional manner. How do you decide if your critically ill patients are expectant, when alone in a tactical or resource strained environment? After that decision is made, what can we still do? How is telemedicine different for curative vs. palliative cases, if at all? For more content, visit www.prolongedfieldcare.org
Being able to calm and sedate patient in operational or prolonged field care situations may be a valuable skill. Here are our thoughts on sedating your patients when patient comfort and safety are an issue? For more content, visit www.prolongedfieldcare.org