


A Practical Approach to Care after SMARCH-E-PAWS-B: RAVINES
The RAVINES Mnemonic was created to help the medical provider on the ground in an austere environment with a very […]

Autotransfusion in the Austere Prehospital Setting
This is not a novel procedure. The first successful autotransfusion on record was conducted in 1818 by James Blundell on a patient suffering from postpartum hemorrhage. Through the end of the 1800s and into the early 1900s, surgeons utilized this technique with surprising success

Podcast Episode 69: Hot Weather Injury
Hot weather injuries are an issue medics have to account for even when not deployed. Proper planning, recognition and treatment […]

Podcast Episode 63: Oxygenation, Ventilation and COVID19
Doug and Dennis talk austere management of COVID19 patients with an emphasis on strategies for oxygenation and ventilatory support. The remainder of the post is an massive amalgamation of resources I have been collecting for over a year for my own respiratory refresher.

Podcast Episode 61: TBI Update with Dr. VanWyck
Traumatic Brain Injuries coupled with other injuries can be one of the most difficult wound patterns to manage in the field. Learn to manage TBI on its own and when other complications arrive you will be in better condition to handle an even more difficult situation.

Podcast Eposode 60: Ian Wedmore on Frostbite and Cold Weather Injuries
Dennis and Paul talk with Dr. Ian Wedmore and discuss some interesting updates to the management of frostbite injury in the field and what to do when you get back to a hard stand shelter.

Podcast Episode 57: Snake Envenomation in Austere Environments
Dangerous snakes can be found both while training at home and far away while deployed. It may be a rare […]

INCIDENT REPORT and Example of Remedial Plan of Action
https://www.nytimes.com/2019/10/11/world/africa/soldier-death-somalia.html Why does it take the NY Times to identify and disseminate our medical lessons learned?! How was this not […]

Podcast Episode 55: JJ and Dennis on HROs. Part 1
The principles of High Reliability Organizations are necessary in those professions where mistakes can cost lives. The airline industry is […]

Podcast Episode 54: SOP for the Ideal SF Clinic?
While no single clinic setup will work for every situation, a common baseline and checklist can make it far easier […]

Podcast Episode 53: Ventilating in the Prone?!
What happens when your patient has been given a cric or intubated but continues to decline… SpO2 continues to slowly […]

Version 22.2 (1Dec2020) of The Prolonged Field Care Card
We have been training teams in various settings over many years and have noticed that there are two categories of […]

Podcast Episode 52: Walking the Fence of Evidence, Environment and Experience with a word on Proning
After a few discussions with JJ who has also appeared in several Element Rescue podcasts, Doug and Dennis talk about […]

Podcast Episode 51: Tropical Medicine Considerations with CAPT Ryan Maves
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.

Protected: All things Airway, Ventilation, Oxygenation and COVID19
There is no excerpt because this is a protected post.

Podcast Episode 50: Simple Sepsis Recognition and Intervention for Prolonged Field Care
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.

Podcast Episode 49: Set Up a Walking Blood Bank with Andy Fisher
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.

Podcast Episode 48: Maximizing Hospital Rotations and Medical Proficiency Training
Hospital rotations for medical proficiency training give medics who operate in the field the opportunity to see what "right" looks like. Knowing this and understanding treatment principles can allow a flexible medic to adapt to unique situations in the absence of protocols, guidelines and evidence. If properly coordinated and supported, MPTs can be an invaluable and eye opening experience. When thrown together with a naive or indifferent staff or un motivated medic, it can be a huge waste of time and money for everyone involved. In this episode Dennis and Dr. Mark Shapiro talk about several MPT programs, and strategies to maximize the effectiveness of an MPT.

Podcast Episode 47: Andy Fisher and his Damage Control Resuscitation for Prolonged Field Care CPG
So what is different than what we already have in the THOR recommendations, the JTS DCR clinical Practice Guideline and […]

Podcast Episode 46: Bleeding in the Box: Non-Compressible Torso Hemorrhage with Dr. Mark Shapiro
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, it is important to do the simple interventions which we know make a difference for combat casualties such as tourniquets, wound packing, needle decompression and airway adjuncts. 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 the most promise to this point has been the early transfusion of whole blood and blood products. 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. 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.

Video Recap of a Civil War Field Hospital Reenactment and PFC Display at Bentonville Battlefield in NC
ATTENTION FORT BRAGG! TOMORROW! Modern SF PFC Medical Exhibition to Contrast a Civil War Field Hospital Reenactment THIS WEEKEND at Bentonville Battlefield in NC The Battle of Bentonville was fought 154 years ago just a short distance from Fort Bragg, NC. Each year the North Carolina Historic Site Staff and reenactors commemorate the battle with different types of reenactments. This year the focus is on Civil War Medicine and the originally preserved Union XIV Corps Field Hospital at the Harper house. This Event is called, "A Fighting Chance For Life." It is important for us to look deep into the past and hold close the lessons learned which now benefit all mankind. I thought that this would be the perfect opportunity in which to display the advents of modern combat medicine in order to compare and contrast the care received by those who sacrificed so much on our own home soil under such terrible circumstances. While Chloroform and ether anesthesia were gaining acceptance and being used in the United , antiseptic technique and germ theory were just emerging from Joseph Lister and Louis Pasteur across the Atlantic. This important discovery could have saved tens of thousands but would not be widely adopted in the US for decades. Amputations were common place without the more conservative debridement strategy instituted by Dr. Theodore-Marin Tuffier in 1915. Penicillin wasn't discovered the first time until over 30 years after the war in 1897 by 23 year old Ernest Duchesne and not used to treat a human until 1942 after rediscovery by Alexander Fleming in 1928. The Ambulance Corps was arguably one if the greatest contributions to modern combat medicine to come out of the war from the Surgeon to the Army of the Potomac, MAJ Jonathan Letterman. He is widely recognized as, "The Father of Modern Battlefield Medicine." His evacuation chain included tiered levels of care starting with stretcher bearers and far forward dressing stations which led back to field hospitals and larger hospitals beyond that. These levels of care which paved the way for the current roles of care allowed the Union Army to truly preserve the fighting strength by keeping fighting men in the fight and returning as many as possible to the front lines. Prior to that men would either lay dying on the field of battle for days or their squad mates would stop fighting and carry them far to the rear. You can now walk through an original Union Field Hospital, The Harper House, at the Bentonville Battlefield in Four Oaks, NC complete with original blood stains on the hardwood floor where over 600 soldiers were treated. We will have a tent set up with a modern demo of prolonged field care to include some of the latest high tech gadgets such as the SAVE2, TempusPro and many others on the grounds a few feet from the Civil War Field Hospital and reenactors. Once the sun goes down and we are packed up there will be additional professional role players reenacting multiple surgical procedures including some of the following from historic records. The night time tours are $15.00 if tickets are still available but the exhibition during the day is free until 1600. You can hear more about Dr. Letterman and see more of the exhibits available in the visitors center on Saturday at 1500 and Sunday at 1400 by Civil War Historian Chris Grimes. If you can't make it check back and I'll update this post with more of my own pics from the weekend. For more information or tickets to the night tour, check out the links on the post at www.prolongedfieldcare.com See you there!

Podcast Episode 45: Regional Anesthesia as an adjunct to Analgesia
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.

Podcast Episode 44: Prep For Flight and En Route Care: The 10th Core PFC Capability
Prep for flight is the 10th Core PFC Capability. Our working group had always deferred to subject matter experts

Standard Prolonged Field Care Training Curriculum Crowdsource Project
It has been our experience that high quality prolonged field care training takes time, resources and expertise by dedicated trainers […]

Crowdsourcing a Standard PFC Deployment Med Box
All of us are smarter than one of us. This project is an opportunity to collaborate and will attempt to […]

Podcast Episode 43: 5 years of Prolonged Field Care
A Re-Introduction to Prolonged Field Care After 5 Years of Work PFC is doing the best you can to treat […]

Podcast Episode 42: Wound Care Basics and Beyond
In this episode Dennis talks to PFC Wound Care CPG author Justin along with Surgery Instructors Jon and Rick about […]

Prolonged Field Care at MHSRS 2018
The essence of prolonged field care is now infused into many aspects of the austere and military medical lexicon. The […]

Episode 41: The Death of the Golden Hour: SOMSA 2018 Talk, by COL (Ret.) Rocky Farr, MD
Colonel Warner “Rocky” Farr has made an important contribution to the body of SOF knowledge with this well-researched monograph. He […]

Podcast Episode 40: Medic Team Dynamics with Dennis and Doug
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 […]

Episode 39: End Tidal CO2 Application and Limitations in Prolonged Field Care
Upgrading your airway kit with a portable end tidal CO2 monitor can help in a couple situations. While it has […]

The White Powder You Should Bring on Every Deployment
Powdered High Strength Calcium Hypochlorite (Ca(ClO)₂) is essential for a medic to keep in the team house or aid station in an austere environment. It can easily be bought, transported and reconstituted for many purposes...


Episode 37: PFC from the NGO Perspective With Alex Potter of GRM
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 the ISIS was in its infancy.

Podcast Episode 36: ROLO to SOLO: The Logistics of Fresh Whole Blood Transfusion
A Special Operations Battalion Surgeon explains how to easily navigate the logistics of setting up a battalion wide blood transfusion program.

Podcast Episode 35: Priorities of Burn Care With Dr. Cairns of The UNC Chapel Hill Jaycee Burn Center and the AMIT Program
Which burn fluid resuscitation formula is best? Does it really matter? What can happen if you over resuscitate? Under? What […]

Podcast (video) Episode 34: Telemedicine to Reduce Medical Risk in Austere environments
Telemedical consult is one of the most important core capabilities in a prolonged field care situation.

Podcast Episode 33: TIVA: Another Look at Pre-Hospital Analgesia and Sedation
Rick Hines has spent the last 20+ years in service to his country much of it deployed to combat zones […]

Podcast 32: Doug Explains the JTS Burn Care Clinical Practice Guideline For Medics
When do you give a burn patient antibiotics? Which ones? How do you calculate TBSA and the rule of 10s? […]

New CPG! Traumatic Brain Injury Management in PFC
Traumatic Brain Injuries coupled with other injuries can be one of the most difficult wound patterns to manage in the field. Learn to manage TBI on its own and when other complications arrive you will be in better condition to handle an even more difficult situation.

Podcast Episode 31: CBRN for Dummies By COL Missy Givens
In this live recording, guest lecturer COL Missy Givens shares the CBRNe knowledge she has learned while working as a clinical […]

Free JSOU Book: “The Death of the Golden hour and the Return of the Guerilla Hospital” COL (RET) Warner D. “Rocky” Farr M.D.
From the Back Cover: Colonel Warner “Rocky” Farr has made an important contribution to the body of SOF knowledge with […]

PFC Grand Rounds Talk at UC Davis Health
Here is a great video on PFC and the cases we helped collect from Airforce MAJ Eric DeSoucy, DO doing a Grand Rounds talk for the Department of Surgery at UC Davis.

Podcast Episode 30: REBOA?! with Joe DuBose
You are in your Team House or BAS. You have given FDP, Whole blood, TXA calcium and don’t have much […]

Podcast Episode 29: Dr. Cap on Fresh Whole Blood and Resuscitation for PFC
Dr. Cap has been leading the way here in the US with the Armed Services Blood Program on fresh whole […]

New JTS AAR Submission Forms for Data Collection Trauma Registry
These singular stories are called anecdotes and while powerful and personal do not represent similar patient outcomes even in similar situations. They are not science. They do not take into account the vast number of variables that were present in that particular situation. Often these stories can mislead and misinform medical practice by inexperienced medics and practitioners due to that powerful personal experience clouding that person's own judgment. Experienced providers will take the sum of their experiences and add the most current and applicable science to make the most informed decision possible.

Podcast Episode 28: Critical Skills for Prolonged Field Care Providers
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.

Podcast Episode 27: Winning in a Complex World
Army Operating Concept_Winning in a Complex World DR-15-1-The-Army-Operating-Concept-2020-2040-Winning-in-a-Complex-World


Deployment Downloads
Pre-deployment checklists, cheat sheets and other resources now updated! Everything I am posting below could help anyone who finds themselves in […]

Get Started Here
After extensive cooperation and collaboration with operational medics and Docs at home and abroad, we continue to see that there is a clear […]

Version 22.2 (1Dec2020) of The Prolonged Field Care Card
We have been training teams in various settings over many years and have noticed that there are two categories of […]

Position Paper – 10 Essential Core Capabilities for Prolonged Field Care
This post has been a long time coming. This is where it began and may be the most important tool […]

Principles for Practicing Effective Prolonged Field Care
After witnessing certain trends from participating in, and observing many training scenarios and AARs. These principals glare at me each time […]

How to make labels to practice Medication administration:
Prolonged Field Care
What is a Cuff Manometer and should we be using it? (Yes)
During a break from the lectures at the last SOMSA one of the first issues identified was the lack of […]
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A Practical Approach to Care after SMARCH-E-PAWS-B: RAVINES
The RAVINES Mnemonic was created to help the medical provider on the ground in an austere environment with a very […]
Video AAR of the Jan 2016 Marjah Firefight and PFC MEDEVAC
Army Interview with SSG Matthew Decker, an Army reservist flight medic (68W F3), from Kentucky (214 Aviation Regiment/11th AviationCommand), deployed to Kandahar/Helmand Province, Afghanistan late 2015-early 2016. SSG Decker tells how he managed casualty care in a combat zone for 17 hours after his MEDEVAC aircraft was disabled.
Measure of Resuscitation
What measurement or technology, knowing BP measures aren’t always best, and mental status and peripheral pulses aren’t reliable, would be […]
PFC Video Lecture Series Ep 1: Documentation in PFC
I hate hearing about other guys who have had to reinvent the wheel when there is so much to draw […]
Tactical Damage Control Resuscitation
This article is a nice review of where we are (U.S. – and Norwegian – SOF) now in implementing a […]
Podcast Episode 50: Simple Sepsis Recognition and Intervention for Prolonged Field Care
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.
Recommended Research?
What research would help Medics on the ground provide better care to sick patients in an austere, environment today? Has anyone ever […]
Principles for Practicing Effective Prolonged Field Care
After witnessing certain trends from participating in, and observing many training scenarios and AARs. These principals glare at me each time […]