PJ Medcast: Recent Episodes
PJ Med
A podcast to provide continuing education and on-demand reviews for the Pararescue community. All medical providers with an interest in remote and austere medicine, and rescue in both the tactical and non-tactical settings will find value in the material posted here.
PJs - you may log the hours you spend listening to the material in this podcast in your training folders.
Doc (Ret COL) Robert Mabry, prior 18D (SF & Task Force Ranger), Army EM Doc, Congressional Fellow, Military Medical Leader, and mentor of mine, discusses overarching issues facing operational medicine.
Jen and 5x5 based out of Anchorage have worked closely with the Paraerscue Foundation. Hear details about the services available to you and your Teammates if needed.
As always- please encourage family and friends to support the Pararescue Foundation, and do annual or semi- annual team events to raise money.
THAT OTHERS MAY LIVE
COL (Ret) Kevin Chung MD, US Army Critical Care Physician, finished his career as the Chairman of Medicine at the Walter Reed National Military Medical Center. He has been supporting SOF Medicine for many years.
Please support the Special Operations Medical Association. Come to the MAY 2024 meeting in NC. Go to specialoperationsmedicine.org
Attend- learn, network, become a better Medic.
Present- move the needle forward, share your experience and knowledge.
THAT OTHERS MAY LIVE
Col (Ret) Dorlac shares info from his experiences teaching and supporting. Ret USAF Trauma Surgeon and now PHTLS editor, Doc Dorlac has a lot of experience and passion for military pre-hosptial medicine.
chest seals
use of stethescopes in the field
tools to improve success of completing a protocol
Empiric vs deliberate TQ
TQ conversion vs. replacement
Conversion of TQ to pressure dressing and pressure dressing to non-pressure dressing
TQ risks- amputation, compartment syndrome, neurologic or muscle injury, renal failure
and more
There are 2 main phases of mortality on the combat casualty survival curve. As PJs , Medics and Corpsmen, you do not see the second phase in the ICU days to weeks later. What you do in the field impacts the second phase of mortality as well as morbidity (quality of life & functioning) .
Charles discusses what happens in the ICU relative to what you do as well as implications for prolonged casualty care (PCC) in severely injured casualties.
Operational and Tactical Medicine. Every movement matters. It should be automatic and not require thinking. Each step in the casaulty assessment drives an action. There is a physiologic reason to do things in a certain order. The assessment should complimnet MARCH PAWS in looking for work.
Do i need a tourniquet? - sweep the extremities
Do i need to pack a wound? - sweep the neck, axillae and groin
etc.
THAT OTHERS MAY LIVE
Ret US Army COL / Dr Kevin Chung is a Critical Care Specialist who finished his military medical career as the Chairman of Medicine at Walter Reed Military National Medical Center.
This is the first of several discussions with him about shock.
His perspective as an intensivist brings a fresh look at shock- what it is- how to diagnose it and what to do about it.
Enjoy!
THAT OTHERS MAY LIVE
Adding another new sereis- MASTER THE BASICS- a chance to review the most basic concepts in Pararescue and Operational Mediicne. First time to hear for the new PJs , Medics and Corpsman. And reenforcement for seasoned Operators.
Joseph is a USAF Med Student with a mathematics background. He explains what PJs and SOF Medics should understand about AI and Chat GPT and current and potential use in MIL MED.
An AF Resce Doc and Faculty at NYU in Gastroenterology discusses the diagnosis and treatment of diarrhea, as well as issues re: dehydration.
the 90% solution for performamce issues once you have the skills-
Hungry
Angry
Lonely
TIred
Like the rule of 3's for performance
USA (Ret) Col Llewellyn is back. On of our most experienced DOD Docs re: infectious and tropical disease. Great series, necessary to set the stage of how PJs, Medics and Corpsmen should evalate fever and infections. More to come.
Contact pjmedcourse@gmail.com
for PJ paramedic recert 27 FEB- 9 MAR. Trauma surgeon lead labs, ACLS, BLS, PALS, TC3 with long guns in kit, prolonged casualty care full day lab, full day of trauma lanes for all MTPs, small unit care, NREMT requrired curriculum, and more.
Veteran TBI study in CO, contact Caralyn.Ware@CUANSCHUTZ.EDU 303-724-0846
Check out PJ Medcast on iTunes for a series on training medics with Max, prior Dustoff Medic/Instructor
Max goes over his top 5 bullets for training and edcuation. He has a great command of the literature on adult education and relates it to how to train medics.
Lots of insight and lots of experience from this prior Army Dustoff Medic.
Great discussion with FDNY Doc Zabar on recent PCC mission on CONUS after the hurricane, and breif discussion on structural collapse issues common to FDNY Rescue and Pararescue.
This is a wide ranging discussion on the role of protein, body composition and the importance of lean body mass, protein sources and quality, total daily expenditure, recovery nutrition and more.
Performance nutrition in the context of Operational training.
In memory of MSgt Hughes.
and out comes Mike and Andy- Emergency Medicine Doc and Surgeon. Two prior Operators who are committed to optimizing training and education for the next generation. Here we discuss their new article in the Journal of Special Operations Medicine with an important observation on operational medical training, lead by prior SOCM Jon McCarthy. The article is entitled "A Lost Opportunity".
THAT OTHERS MAY LIVE
RANGERS LEAD THE WAY
Highlights of CoTCCC meeting, update on rescue and recovery ops for human space flight, interim summaries for Operators to optimize their care , lessons learned from a FMP, quick note on the DM cruise ship mission.
Recovery
Sleep
Journaling
Physical Stillness
Whole food nutrition
PT- smart and consistent
Optimizing social interactions
Managing allostatic load
Mindufulness- prioritze work when you are working, prioritize family when you are with family, etc.
Read
IN this episode we have a roundtable with 3 Docs and reference the North American Resuce Posts regarding the recent South Korea event on Halloween. We review some basic MASCAL principles, differnet types of MASCAL events including crowd surge and stampede/trampling as mechanisms of injury, injury patterns, and the poetnetial role of CPR in MASCAL events.
Great discussion with my guests who are great Docs and very experienced. More to come on this.
THAT OTHERS MAY LIVE and RLTW
Doc Hill is the COO of Columbia University Hosptial, part of the NY Presbyterian system. She was previously the Chair of Anesthesiology at Emory University. Her leadership experience is vast and varied. She was also the Executive managing the response to COVID at Columia University here in NY, of which SOF Medics were part, under her direction.
In this episode we cover the qualities of a high performing team and some nuances of the leadership role.
More to follow on this topic.
Thanks very much to Doc Hill for her time and expertise, and previous support in the education of PJs and SOF Medics.
THAT OTHERS MAY LIVE
This episode is an intro to basic concepts regarding radiation and nuclear weapons based on radiation science. It will give PJs and SOF Medics the basic vocabulary, concepts and principles from which to approach this daunting subject.
This podcast will serve as an intro to issues related to casualty response and responder safety in resposne to such an event and give you the basic knowledge to understand later discussions on the topic.
Learn about radiation, ionizing vs non ionizing, fusion vs fission, the difference between an atom or nuclear bomb vs. a thermonuclear bomb, and more.
Doc Mitchell was and GA, ST and SOST EM Doc who performed the first pre hosptial combat reboa. In this episode he discusses a key article reviewing the pathophysiology of the Lethal Triad and now the diamond of death. Hypocalcemia is implicated in reduced myocardial contractility, loss of vascular tone, and several impacts on the clotting cascade and clot strength. In Part 1 of 2, Doc M puts this together for the medics and covers down on calcium cholride vs calcium gluconate.
TOML
Doc Mitchell was and GA, ST and SOST EM Doc who performed the first pre hosptial combat reboa. In this episode he discusses a key article reviewing the pathophysiology of the Lethal Triad and now the diamond of death. Hypocalcemia is implicated in reduced myocardial contractility, loss of vascular tone, and several impacts on the clotting cascade and clot strength. In Part 1 of 2, Doc M puts this together for the medics and covers down on calcium cholride vs calcium gluconate.
TOML
Steve's storry on the pile on 9-11.
In memory of the New Yorkers we lost 21 years ago
THAT OTHERS MAY LIVE
Steve's storry on the pile on 9-11.
In memory of the New Yorkers we lost 21 years ago
THAT OTHERS MAY LIVE
MASCAL discussion, civilian experience with triage and MCI systems
Dr Kamler, EM, Cornell Medical College, NY Presbyterian Hospital
MASCAL discussion, civilian experience with triage and MCI systems
Dr Kamler, EM, Cornell Medical College, NY Presbyterian Hospital
Dr Jon Kamler, EM Doc at Cornell who is first author on a paper to be published in JSOM, discusses our literature review and relevant findings to pushing for change in MASCAL response.
Triage accuracy, plethora of systems, actual use of MASCAL systems in training and real world events and more.
Dr Jon Kamler, EM Doc at Cornell who is first author on a paper to be published in JSOM, discusses our literature review and relevant findings to pushing for change in MASCAL response.
Triage accuracy, plethora of systems, actual use of MASCAL systems in training and real world events and more.
COL Miles discusses the background of one of the leading edge SOF resuscitation meetings, new thoughts on needle decompression and tension pneumothorax, and TXA.
TOML meets RLTW
Our great friend COL Miles, USA, prior Ranger Regimental Surgeon, tells us what the THOR meeting is, the contributions of our buddy Geir from Norway vis-a-vis pushing whole blood for SOF, and a thoughtful discussion of highlights from the meeting inlcuding provocative discussion about the place of needle decompression.
TOML meets RLTW
Retired Chief discusses setting yourelf up for success during your career to land on your feet when you separate or retire. Wisdom from an experienced Chief.
THAT OTHERS MAY LIVE
This is the final installment of AC CC Dave Ruvola discussing open ocean, nightitme survival in 70 foot seas during the Perfect Storm. All while rallying the aircrew scattered in the Atlantic, and being rescued by our Brothers and Sisters in the USCG.
An exercise in consumate leadership and professionalism.
THAT OTHERS MAY LIVE
Continuing with a description of the misssion and attempts at aerial refueling.
THAT OTHERS MAY LIVE
Oct 30, 1991, this is the story of the real Mission of the NY AIr Guard Rescue Team that went out into the storm, later immortalized in the book and movie, The Perfect Storm. Dave Ruvola, prior PJ and aircraft commander on the mission recounts the story of the rescue attempt, ditching the helo, the ocean survival scenario, and the tragic loss of PJ Rick Smith who we remember and honor. This is a dramatic and riveting real world story of professionalism, excellence and leadership.
THAT OTHERS MAY LIVE
In memory of Rick Smith.
New paper will be coming out discussing new thoughts on MASCAL incorpoarting new ideas on Time and Triage to be published in the Journal of Trauma and Acute Care Surgery.
Also look for our upcoming discussion on the PFC podcast with Dennis.
THAT OTHERS MAY LIVE
Our deep dive into MASCAL begins with the horrific Boston Marathon Bombing, Hear my discussion with COL Ricky Kue MD, US Army Reserve, Emergency Medicine Doc. He was the on scene medical commander.
THAT OTHERS MAY LIVE
Matt Stevens, prior NSW, and the Honor Foundation have created a well oiled machine to help you navigate transtioning.
Very impressive program for post career growth and navigation.
More insightful stories about casualty care and analgesia in Vietnam.
THAT OTHERS MAY LIVE
Yale educated Doc Llewellyn tells his exceptional story of Military Service from Vietnam through distinguisehed service in retirement.
Stories of his support of SOF, relationship with COL Charlie Beckwith, research, global and tropical medicine, CONTOMS and much more. Dr LLewellyn is a prior Professor and Chairman of the Department of Military Medicine at the Uniformed Srevices University of hte Health Sciences, Consultant to the Army SG for Medical Support of Special Operations, leader inCombat Casualty Care and Medical Chemical Defense, etc.
This was an honor and one of the most enjoyable and enlightenting conversations I have had.
Please share this widely and enjoy.
Part 1 of 3.
THAT OTHERS MAY LIVE
Joint Trauma System Shock
Airway
Chest trauma
Hemorrhage Control
Care under fire mission
We begin to explore the role of human factors in mishaps. Training mishaps unfortunately occur, the development of self awareness is critical in personal and professional development, and can reduce injury and worse from training mishaps. Mission safety, team and personal safety are enhanced by self awareness, risk management and taking ego out of the decision making process. This podcast with a USAF SME sets the stage for some studies we are doing after observiing the human factor role in mishaps.
Response to a question from downrange. If whole blood is frozen, DO NOT USE IT.
Move all Teams to getting titered if Group O within 8-12 weeks of deployment so you can identify live universal donors.
We are in the process of finalizing the sTBI protocol for TCCC. This podcast reviews some of the controversies in the use of 23.4% NaCl in the field, and how the discussions evolve. In the meantime it is a great review of sTBI and increased ICP(intracranial pressure). Remember to distinguish between sTBI, increased ICP and herniation. In truama they are on a contiuum of catastrophic injury.
THAT OTHERS MAY LIVE
Pyschologist and US Army Reserve LTC /Doc Ben Keizer discusses management of mental health issues in combat veterans at the Center for the Intrepid in San Antonio, including their published experience using Ketamine therapeutically.
Prior NSW Operator Quinn, discusses his story and successful use of therapeutic ketamine. This is part of a series with Quinn and then follow up with a Psychologist from the Center for the Intrepid, and an excellent discussion from a Clinical Health Psychologist with a significant experience in caring for our Warfighters.
Final episode in this series with Maj Kashlan, spine surgeon at the Univ or Michigan and Air Guard Flight Doc.
That Others May Live
Doc Kashlan is a Neurosurgeon at the University of Michigan specializing in the Spine and Spinal Cord. He is also a Flight Surgeon in the Air National Guard.
We will do two series of podcasts with him. The first is to discuss spine injuries in Operators, mostly from wear and tear. Later we will do a deep dive into combat injuries of the spine and spinal cord.
In this episode we introduce Doc Kashlan and review the anatomy and function of the spine, and review critical elements in the history and physical examination.
I have heard some honest discussions from Operators who prioritized Career over Fatherhood. You can do both, it just has to be a conscious effort.
Marcus is doing research and creating a practice to coach men how to be better Dads. This is a phenomenal idea, parenting does not always come naturally, and having a coach may be just the answer. In this 2 part discussion Marcus addresses:
-
Creating a Dad-Identity- seeing yourself as a Dad; understanding the importance of the role.
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Consistency- discipline, routines, keeping promises.
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Importance of play.
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Not perfect, PRESENT-putting Dad time on the schedule; focusing attention on them; listening.
Holiday season is an important time to reflect on family, and what we can re commit ourselves to.
I hope this is meaningful during this time. Merry Christmas and Happy New Year.
This is a real and meaningful discussion by a Doc with significant Role 1 and Role 2 experience, as well as many years training PJs in ST and RQ.
The value of this podcasts for PJs, Medics and Corpsmen is exceptional.
THAT OTHERS MAY LIVE
Doc Givens is an Army Emergency Medicine Doc with fellowships in Toxicology and Sports Medicine. Also deployed as an EM Doc and has served as a Med Director for operational units. She recently become the Executive Director of CHAMP- the Center for Health and Military Performance at the Uniformed Services University in Bethesda. This is the human performance arm of our nation's military med school, and center of policy for many mil performance programs. in this episode we discuss what is known and unknown in recovery from training.
THAT OTHERS MAY LIVE
Winn is one of the DODs most experienced operational medical educators. Hear lessons learned, thoughts on optimizing training and learning and more in this wide ranging and insightful discussion from one of our SF Brothers.
THAT OTHERS MAY LIVE
CSAR response to poly trauma patient four injured extremities in shock.
Key point-
Iliac crest IO is an option for whole blood transfusion in a poly trauma patient without peripheral access. This is the first documented case in the mil prehospital setting.
THAT OTHERS MAY LIVE
Comm with pjmedcourse@gmail.com to sign up and get more info for operationally focused paramedic recerts, with an emphasis on experiential training including labs taught by trauma surgeons, PFC training, TCCC scenarios, and real world lessons learned.
Dr Lim from SKRATCH LABS talks about overtraining. This is an insidious syndrome from doing too much and not recovering enough. It is complex, can take 2-4 weeks to recover from, and is all too common.
Avoiding overtraining along with reducing injuries from training is one of the reasons we need coaches, very few people can coach themselves when training hard and operating harder!
THAT OTHERS MAY LIVE
This is one of the most insightful and thoughtful discussions I have had the privilege to be part of. It includes perspectives from the ST side of the house that give perspective and consideration for future directions.
THAT OTHERS MAY LIVE
This is an exceptional discussion from the FDNY EMS Med Director on scene, roving CCPs, loss of C2, the human toll in the middle of it all, losing his senior enlisted, and getting knocked out by the blast wave from the second collapse, regrouping and finding work. One of the many heroes, thousands of them from 11 SEP 2001.
THAT OTHERS MAY LIVE
Steve retired as an FDNY Captain and was a responder for 3 months on the pile. Steve talks about first hearing about the attack and scrambling to get to his firehose ,and then get to the site. Everything from the emotions, discussion of response the massive structural collapse, and looking for work.
I am proud to introduce you to my friend and retired FDNY Captain.
THAT OTHERS MAY LIVE
The 106th Rescue Wing is on Long Island. Many of our Guardsmen are NYC Firefighters and Police Officers. In this series we will hear from New Yorkers who responded to the attacks here in New York. All of this on the backdrop of the news of the last few weeks. From our FDNY, NYPD, EMS first responders, and our citizens who perished in the attack, to our Marines we recently lost, I hope we will honor and remember all Americans and partner forces who have made sacrifices during GWOT.
THAT OTHERS MAY LIVE
USAF MAJ /Doc Hintz is an Internal Medicine Doc with a Primary Care Sports Medicine Fellowship. She takes care of Air Force Special Warfare candidates in the pipeline.
In this podcast we discuss common injuries. Besides being of interest, these are pertinent to small unit care. Other than the pool events, these are all relevant for patrol and sick call issues.
THAT OTHERS MAY LIVE
Ongoing, always, in the summer with MIL Teams.
Always worth the review.
FOOT STOMP_ heat stroke- focus on the word stroke. CNS/Brain affects!!!
Immediate cooling
THAT OTHERS MAY LIVE
The case for 23.4% hypertonic saline in the field. This will begin several discussions of TBI leading to the new CoTCCC sTBI protocol.
We will continue to footstep the must know issues for PJs, SOCMs, Medics and Corpsman.
This discussion is from our Summer 2021 JSOM article.
THAT OTHERS MAY LIVE
This is an interview I did with the Journal of Special Operations Medicine for their 20th anniversary.
BLUF
Unit Cohesion and Maintaining a sense of purpose and meaning are protective against mental health problems from combat and recovery ops. Based on research from the USAF Psych Service.
references of original research on which this talk is based:
Military Mental Health. The Role of Daily Hassles While Deployed. Elizabeth A. Heron, PhD, MPH,* Craig J. Bryan, PsyD, ABPP,Þ Craig A. Dougherty, BA,þ and William G. Chapman, BASþ. The Journal of Nervous and Mental Disease & Volume 201, Number 12, December 2013
Military Psychology © 2014 American Psychological Association 2014, Vol. 25, No. 6, 568–576.. Posttraumatic Stress, Depression, and Insomnia Among U.S. Air Force Pararescuemen. Chad E. Morrow Hurlburt Field, Mary Esther, Florida. James A. StephensonMaxwell Air Force Base, Montgomery, Alabama. Jeremy Haskell.Nellis Air Force Base, Las Vegas, Nevada. Craig J. Bryan. National Center for Veterans Studies, Salt Lake City, Utah and University of Utah. AnnaBelle O. Bryan. National Center for Veterans Studies, Salt Lake City, Utah and University of Utah. Mark Staal. Pope Army Air Field, Fayetteville, North Carolina
Warzone Stressor Exposure, Unit Support,
and Emotional Distress Among U.S. Air Force Pararescuemen. Erica L. Armstrong; Craig J. Bryan, PsyD, ABPP; James A. Stephenson, PsyD, ABPP; AnnaBelle O. Bryan, BSPH; Chad E. Morrow, PsyD, ABPP. Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014
THAT OTHERS MAY LIVE
The PJ Foundation is running a wellness program/ free education series over the next month- on sleep, nutrition, finding happiness , stress management, etc for PJs/CROs/SERE and families.
Sign up with Dr Jenn Byrne at 5x5performancetherapy@gmail.com
New research discussing optimal cooling techniques in hot weather ops- from Dr Andrew Huberman's IG and podcast.
More data supporting whole blood from NAR DOCTOR.
Please support the Pararescue Foundation. Ask family and friends an do Team events please.
THAT OTHERS MAY LIVE
Dr Lim, from SKRATCH Labs, discusses the importance of specificity for excellence in performance of job related tasks, beyond general physical preparation.
THAT OTHERS MAY LIVE
You can find our article on performance improvement by searching for:
Psychological Skills to Improve Emergency Care Providers’ Performance Under Stress
Michael J. Lauria, BA, NRP, FP-C*; Isabelle A. Gallo; Lt Col Stephen Rush, MD; Jason Brooks, PhD, MSc; Rory Spiegel, MD; Scott D. Weingart, MD
Ann Emerg Med. 2017;70:884-890
Doc Lauria was an ST PJ. you can find a lot of his work on YouTube and various podcasts, as well as peer reviewed literature.
Mike is an Emergency Medicine Doc now, back in the USAF! In these two episodes he discusses the neuroscience of Mastery.
Search our prior podcasts with him too. He has also been on several EMCRIT podcasts.
THAT OTHERS MAY LIVE
Thanks to NAR and NAR Doctor I will record and release some of the great instagram content from NAR DOCTOR to increase circulation for operational medical education and SA.
Chief AK discusses coming to after the explosion, getting treated, and what it's like to Operate after having been hit. On top of this, AK shares several insights into being a PJ, and the importance of starting from optimal physical and mental strength, so you can press when you need to.
More treatment, exhaustion, transition to a new team from CONUS to assume recovery ops.
Chief, recently retired, was one of 6 PJs on site for the attack on the Khobar Towers 25 JUN 1996 in Saudi Arabia during Operation Southern Watch. There were 19 deaths and 498 injured making this one of the largest Military Mass Casualty Responses.
This is an exceptional discussion starting with his career over 31 years and a snapshot into PJ Ops over these 3 decades.
He then discusses living through the blast and beginning to search and triage, organize, treat, then support the AF Doc for hours of treating casualties.
This is riveting, informative, and a document of the largest military MCI that I am aware of.
Hear this awesome story of service by a Ranger Medic and how he benefitted from Call Sign Canine.
Please share widely and consider supporting Call Sign Canine.
callsigncanine.org
THAT OTHERS MAY LIVE
Hear this inspiring story of a private citizen stepping up to provide a great service to our community. How it began, and the devotion to SOF Veterans in need. She has provided ~30 dogs to many different SOF Veterans agnostic to branch of service.
Service dogs and Veterans are matched, and trained for specific support functions in addition to the natural bond that develops.
Please support, share with family and friends who love dogs.
callsigncanine.org
THAT OTHERS MAY LIVE
The first in a special series on the work JT Gabriel has done as a private patriot supporting SOF Veterans with specialized service dogs for a range of needs in all branches of SOF and related organizations.
please share widely with all Operators, encourage family and friends to support callsigncanine.org.
listen to this series of remarkable and inspiring podcasts. Share widely with the SOF community.
Encourage family and friends to support at
callsigncanine.org
THAT OTHERS MAY LIVE
Max and Morgan do a great job with the DUSTOFF MEDIC Podcast. We recorded this with USN CAPT Walrath and USA COL Smith. I am proud to be amongst these great Physician Leaders and happy to share this episode of the DUSTOFF Medic Podcast.
Please subscribe and support these guys- they are true professionals and dedicated medical providers. We are lucky in the DOD to have them.
THAT OTHERS MAY LIVE
Scotty is a dynamic and brilliant instructor. He is passionate and entertaining. But most importantly, he has created teaching methods for invasive life saving procedures and anatomy training that captivate his students while learning a ton.
Scotty educates civilian and military medics.
But perhaps a unique attribute and accomplishment which has been a profound contribution to our community is that Scotty is a co-inventer of the EZ IO.
Listen to this dynamic podcast in which Scotty poetically discusses methods to maximize your training.
THAT OTHERS MAY LIVE
Good money
Great for prolonged care training
Excellent clinical experience
EMAIL- recruiting@rvtsolutions.com
We will be discussing this, and another option shortly.
Great news! Increasing opportunities for Medics to contract and make a difference at home, or new transitioning opportunities.
This is the beginning of Domestic healthcare recognizing what our SOF and MIL Medics can bring to the fight at home.
THAT OTHERS MAY LIVE
See the open source coverage in the media on the Alaska heli ski crash 29 AMR 21
https://www.nytimes.com/2021/03/29/us/helicopter-crash-alaska.html
Excellent AAR and discussion of key points:
Search
Terrain
Crash site
Avalanche
ORM
Survivor care
THAT OTHERS MAY LIVE
Some personal experiences with our analgesia protocols.
Lessons learned and foot stomps from recent training.
Shock protocol- 2 lines, TXA, Blood, calcium. Hang 2 units of blood!
Support CallSignCanine.org service dogs for SOF, upcoming podcast with PJ Augie!
New Alaska mish about to hit
New podcast with Joey and Chaney. Contracting opportunities on CONUS-direct patient care- hit up recruitingrvtsolutions.com
THAT OTHERS MAY LIVE
Doc R was a Ranger turned Emergency Medicine Doc- went on to become a Ranger Bat and SOAR Bat Doc, then SOAR Med Director.
Great story, discussion of memorable missions and lessons learned. Then we focus on tips for medics, med directors and in flight medical operations.
Doc R shares his unique perspective as a Ranger turned SOF Doc with insightful advice and mentorship.
Doc R can now be found training various SOF Teams.
TOML
Background intel presented re: change proposals for advanced airway management and sTBI.
This is background only, no changes have been made for TCCC guidelines on this yet.
Continue to use current guidelines or your med director's guidance.
Keto, paleo, traditional, etc.
Sam reviews the different options that are popular now.
in the end, try to eat real food. Reduce or eliminate processed food and refined sugar.
More to follow later...
Our PJ schoolhouse Doc, Doc Gray, talks about the lethal diamond, Calcium, and a great discussion about an aspect of resuscitation.
THAT OTHERS MAY LIVE
Please sign up for this great organization which supports military families.
Lots of great benefits and opportunities for you and your family, as well as support in times of need. This organization exists to support you!
Please share this widely with mil members.
https://bluestarfam.org
Dr Emily Johnston is an Emergency Medicine Physician, High Altitude Mountain Guide, and civilian instructor for the Military Mountain Medicine Program with Col (RET) Wedmore.
She discusses the latest on altitude illness and treatment, with many practical tips.
THAT OTHERS MAY LIVE
https://www.benning.army.mil/infantry/amws/
This is great stuff. This Senior Medic talks about lessons learned from the Army Mountain Warfare Center in Jericho, VT.
These practical and wise LLs are relatable to all of combat medicine.
1- be present in the moment and thrive
2-cut weight where it makes sense, knowledge weighs nothing
3-while being present, look ahead. Understand the consequence of every choice you make
4-be able to improvise, but don't make it your plan
5-understand why you are there and crush that role
Look them up and go train with them! Check out the rough evacuation courses and critical care in the mountains.
THAT OTHERS MAY LIVE
Dr. David Hirschwerk is an Infectious Disease specialist at North Shore University Hospital on Long Island, which is an educational partner of the 103rd Rescue Squadron.
We are in our second wave, over 300,000 deaths and the vaccine came out this week.
Dr. Hirschwerk discusses how we got here and what we have learned.
THAT OTHERS MAY LIVE
Max is a New Yorker who is in the Army and served in Congress. Max shares thoughts as a Citizen Soldier and explains from a Service Member's perspective issues in Congress, and the role of Congress regarding War and Military Action.
He also discusses issues re: a volunteer force vs. a draft.
THAT OTHERS MAY LIVE
Doc Becker is the PJ Doc for the 131st and Emergency Medicine and Global Health Doc at Stanford. He has years of experience as a Doc in Africa.
We are lucky to have one of our Flight Docs who is a subject matter expert.
THAT OTHERS MAY LIVE
Mr Castleton from the Armed Forces Blood program discusses how to do it. This is mission critical for PJ Teams and you should insatiate this now.
The ability to have a walking blood bank with universal donors is game changing on the ground.
THAT OTHERS MAY LIVE
This is a unique program. Veteran led, no diagnosis required, formal program focused on post traumatic growth.
If you feel you are not right- you are a candidate!
Call them to discuss.
If you go to this program please give me feedback.
boulder crest.org
The PJ Med Director and the PJ Medical Programs Manager discuss Ten key changes to the new handbook.
The handbook is being formatted and then out for print with the Journal of Special Operations Medicine.
DO NOT INSTITUTE THESE UNTIL THE HANDBOOK IS RELEASED OR YOUR FLIGHT DOC DIRECTS YOU TO.
- Updated MARCH assessment to align w/ JTS TCCC guidelines
- Moved pelvic binder to circulation, specified how/how not to assess pelvis
- Combat/Hemorrhagic Shock and blood protocol
- TXA – 2gm (1 minute slow IV push)-also used for suspected TBI
- cold stored type 'O' whole blood>fresh low titer-'O' whole blood >PRBCs and plasma>plasma alone>PRBCs alone>non-titered type ‘O’ fresh whole blood>non-titered type specific fresh whole blood
- added 10mL of 10% calcium gluconate
- “bougie assisted cric” method
- Added vent troubleshooting and adjustment guide
- General fluid guidance
- Omitted Hextend
- LR is primary crystalloid for non-hemorrhagic shock casualties (may still carry 100CC for med recon)
- Removing 3% Saline (see TBI protocol update)
- TBI
- Replaced 3% Saline with 30mL of 23.4% hypertonic saline (learn the technique first)
- Versed for active seizures, Keppra for prophylactic (depressed skull fx/penetrating head wounds)
- Procedural Sedation
- Replaced procedural analgesia w/ procedural sedation and provided protocol
- No longer promoting ketamine/fentanyl/versed rotation
- Dilauded f/ long term pain control in hemodynamically stable
- Ketamine for unstable
- Medications added to formulary to support ATP small unit care capability/modified TMEPS
- Famotidine (Pepcid) – Zantac replacement
- Amoxicillin
- Azithromycin
- 1% Hydrocortisone cream
- Metronidazole (Flagyl)
- Malarone/primaquine
- Ciprofloxacin
- 4% saline
- Medications removed
- Albumin
- Ranitidine (Zantac)
- CBRNE updates
- Added CRESS acronym (Consciousness, Respirations, Eyes, Secretions, Skin)-NATO method
- Added MARCH Squared
- Updated Cyanide Antidote
- Hydroxycobalimin, Sodium thiosulfate and activated charcoal
Doc Dorsch then gives us an ATP update amongst other intel.
THAT OTHERS MAY LIVE
Insightful discussion with Brian and Aaron from Ones Ready. Hear about the podcast and insights from their careers and time at A & S.
Support our Operators at: PararescueFoundation.org
Follow instagram pjrqmed, and on the internet at pjmed.com
THAT OTHERS MAY LIVE
CAPT (RET) Butler received this award from the American College of Surgeons.
Thanks for pushing this podcast over 1 million downloads!
Think of krazy / super glue for painful cracks in the heels and around nail beds.
THAT OTHERS MAY LIVE
PJ Jon discusses the mission, stroke and it relevance to sTBI management.
THAT OTHERS MAY LIVE
This discussion represents an excellent primer into how ketamine and fentanyl are interacting with the brain.
Thanks to Dr Perusine and for her work at neurovationlabs.com
Dr Jen Perusini explains her discovery with the labs she has worked at on some of the basic brain biochemistry of PTSD. She discusses basic science research establishing localization of increase in distinct pathways in the fear center of the brain, the amygdala.
I am posting this unusual basic science discussion because Dr Persuini explains it a meaningful way. She discusses where they are in the effort to begin human clinical trials. In discovering the the possible mechanistic target for PTSD, they are able to begin to craft a trageted therapeutic response. Hear about the promising work Dr Perusini is doing on behalf of our Warriors.
It covers information that is the prelude to next weeks podcast re: some of the actions related with ketamine and fentanyl.
Find out more:
neurovationlabs.com
THAT OTHERS MAY LIVE
Chris discusses providing extremely remote medical support in up to 80-100 degrees below zero. Med planning, Evac, etc.
The program is through the University of Texas Medical Branch and the Center for Polar Medical Operations. They support the National Science Foundation.
Note- Chris is not officially representing the Univ of Texas or in any other official capacity. He is sharing his experience and letting our community know about this unique contracting opportunity.
Find info at :
https://www.utmb.edu/polar
THAT OTHERS MAY LIVE
USAF Pararescuemen (PJs) perform daring and unique rescues. Among the most unique are long range (>300 miles) ocean rescue missions accomplished by parachute insertion or helicopter using aerial refueling.
Learn about the infil and med details of these missions. This podcast is based on the article we published in the Journal of Special Operations Medicine.
THAT OTHERS MAY LIVE
Last week the 212th responded to a hunter who fell 100 feet down a slope and experienced significant skeletal trauma.
Dan reviews the technical and sometimes heinous rescue in unforgiving terrain during a windy, freezing rainstorm.
Pearls-
- To help dial in a diagnosis of sTBI- can the patient follow commands?
2- Med care in the elements focuses on hypothermia management and pain control to get into a place you can treat vs. thickets where it is impossible.
212th RQS!!! THAT OTHERS MAY LIVE
Mt Sinai Icahn School of Medicine Flex Program
Hofstra Zucker School of Medicine Direct admissions for SOF, no MCAT if qualified
Intro to 23.4 hypertonic saline for brain herniation in the field
Teaser on MCI research
THAT OTHERS MAY LIVE
A sailor fell ~35 feet on a ship in the Pacific- way out. Jump mission, 48 hrs PFC for spine, pelvis and extremity trauma, helo hoist off with multiple ARs.
Stay tuned for the 212th high angle mish coming up...
THAT OTHERS MAY LIVE
Dr Christine Sanchez is a SOF Performance Psychologist with over a decade of experience. She is an asset available to Guard and Reserve Teams, as well as AD, as a consultant.
5 Habits of High Performers to maintain cognitive bandwidth (direct focus & self-regulate psychophysiology)
1) Optimize mindset and facilitate productive failures 2) Engage in deliberate recovery to manage chronic stress and quiet busy brain 3) Develop performance routines to direct focus, energy levels, and mindset 4) Expand expertise through deliberate practice 5) Utilize strategic brain breaks to maximize productivity and energy levels Best ways for listeners to contact Dr Sanchez (or learn more about her services/background) 1) Email: drchristinesanchez@gmail.com 2) LinkedIn: https://www.linkedin.com/in/drchristinesanchezphd/
Travis is a TCCC Committee member, and prior Pararescue Medical Programs Manager.
Travis is reviewing the TCCC Airway guidelines and found some surprising literature and details about the basics.
This is a great discussion reflecting a lot of detective work.
Thanks to Travis for dong this, emphasizing how important it is to question and validate what we do.
THAT OTHERS MAY LIVE
Sleep consistency
Cool Dark Quiet
Don't eat meals within 2-3 hours of sleeping
Find what time of day exercising is best for you- upon waking may be best
Go to sleep as soon after your shift that you can
Thanks to WHOOP for allowing us to use their email briefs
You can find data and more info at whoop.com and click on THE LOCKER
Check out Preston Cline and Coleman Ruiz on their podcast and website at Mission Critical Teams Institute.
Improving performance for special teams, from an academic and Tier 1 perspective.
Website: MissionCTI.com
Check out their podcast at MCTI TEAMCAST
PJ Ian discusses the diagnosis of mTBI in austere operational and training environments, operational relevance, importance to post service records, considerations regarding reaction time, and a new tool on the horizon to assist medics.
THAT OTHERS MAY LIVE
Ian discusses the limitations of diagnostic options in the field for mild TBI ( concussion) despite the frequency in training and on Ops.
Ian then lets us know about a new research tool leveraging reaction time as a potential solution for FOBs, in garrison training, clinics and other hardened facilities you may be responsible for Operators.
THAT OTHERS MAY LIVE
Doc Derwae was an OSS Rescue Doc at Nellis and then completed a residency in Dermatology at U PENN. She is now an USAF Dermatology Attending.
Here she discusses the science behind sun damage to the skin and risk of skin cancer. The cumulative injury to the skin over a career is real and preventible.
Skin protection from the sun is analogous to HPO programs and injury prevention and reduction to improve your lifetime health. It is also important to understand to protect your children.
If you have questions for Doc Derwae you can reach her through your Flight Doc.
THAT OTHERS MAY LIVE
In April 2020 NYC was overrun by COVID.
New York Presbyterian (NYP) Medical Center comprised of several hospitals including Columbia and Cornell, exceeded capacity with COVID patients and created an overflow location on their football field in a bubble. Through personal relationships it was proposed that a social media call be made to recruit SOF medics to staff the field hospital. NYP agreed and this successfully occurred and became the Ryan Larkin Field Hospital at NYP.
NOTE- the medics came outside their military status as volunteers, but were soon integrated into the NYP staff.
From that, NYP tasked some of the medics to run another COVID ward, but inside the Columbia University Milstein Hospital.
This is the remarkable story of SOF Medics working in conjunction with civilian providers to support this world class hospital during a surge.
This model is a feasible approach to address surge needs in the Nation to hire military medics to work to their capability and become force multipliers for our healthcare providers who become overwhelmed and understaffed. SOF and other mil medics are a trained and reliable force, who come to the fight with humility and willing to do what is needed to support patient care.
Black mambas and cobras at some camps
thanks Dr Abo
Get POLYSERP for Africa
Check out the Asclepius Snakebite Foundation:
www.snakebitefoundation.org
Great PDF presentation:
https://jts.amedd.army.mil/assets/docs/presentations/Austere_Snake_Envenomation_Management_Presentation_Asclepius_Snakebite_Foundation.pdf
Prior Ranger and Ranger PA, and extremely effective medical policy writer and educator, Andy Fisher, M.D. just reviewed the state of the art for pain control, i.e. analgesia, for the TCCC Committee.
Besides discussing basic ideas such as the difference between analgesia and sedation, Dr Fisher reviews pharmacology and his thoughts on best practices on the X and beyond.
I cannot emphasize enough how Andy's perspective from his experience on innumerable operations, combined with his keen intellect, are unique and very meaningful.
THAT OTHERS MAY LIVE