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
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!
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.
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.
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 unmotivated 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.
Here are several elements necessary for a positive MPT experience:
- An approved MOU
- A motivated lead clinician
- An administrative coordinator
- A limited amount of competition with residents and fellows
- Multiple capabilities and scope of practice briefs and videos to catch staff in all departments and shifts in which a medic will be working (Share this episode)
- A synopsis of your scope of practice and goals emailed to the specific departments in the days prior
- A list of procedures or experiences the medic is trying to complete may help the staff understand goals
- If an MPT is meant to prep for prolonged field care the medic should strive to respond to the trauma bay and accompany the patient through the continuum of care including prep, surgery, post op and ICU
One last thing before the podcast;
Please dont show up to your first day to work at a world class level 1 trauma center and medical school wearing pink ranger panties when everyone else is in suit and tie. I wouldn’t say it if it hadn’t happened…
Here are some links from current and past Academis partners who have participated in Military/civilian MPT partnerships:
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…
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, Continue reading Podcast Episode 46: Bleeding in the Box: Non-Compressible Torso Hemorrhage with Dr. Mark Shapiro
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 was 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. This was a perfect opportunity in which to see the advents of modern combat medicine
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.
Prep for flight is the 10th Core PFC Capability. Our working group had always deferred to subject matter experts