After extensive cooperation and collaboration with operational medics and Docs at home and abroad, we continue to see that there is a clear desire to improve patient care by incorporating or improving Prolonged Field Care. The following should be viewed like a checklist to help jump start any tactical medical program to accommodate
Crush injuries are difficult to manage in the best of circumstances. In an austere environment by a practitioner with little to no experience they can be overwhelming. In deciding which problem to address in depth first, crush syndrome seemed to be a great choice. The Clinical Practice Guideline is well on it’s way to being released very soon. As discussed in the podcast, our recommendations are an amalgamation of best practices adapted for our difficult environment. It is an injury that can happen anywhere to anyone and the correct initial management can make all the difference in patient outcome. Enough out of me, I’ll let Doc Riesberg explain it via his talk he gave earlier this year to the Joint Trauma System Teleconference.
Take a couple minutes and test your knowledge:
Next episode we have a great discussion with Doc Riesberg, Doc Powell, Erik and myself in which we will discuss your answers as well as the following case presentation on the topic of crush injury:
During our last deployment to BFE, we were tasked with training local police in vehicle mobility. The original “house” we were using must have been around forever. We didn’t have our Engineer Sergeant out with us at the time that building was put up and didn’t know if the house was rated to hold the weight of the large water tank on the roof.
One night we all woke up to a loud crash and screaming. As we scrambled to make sense of what had just happened, we found Josh under a pile of debris as he continued to call for help and grunt in pain.
I was on the other end of the building and grabbed my aid bag. As I made my way through the rubble, I clicked on my headlight and crawled over to where his screams were coming from. His abdomen, torso and arms appeared uninjured, but his legs were not visible. Josh was in the worst pain I had ever seen anyone in. I gave him 100mg of Ketamine IM, which wasn’t as effective as I had hoped it would be, and started a Ketamine drip before the initial dose wore off He didn’t have any respiratory distress, beside the dust, so I gave him 2mg of midazolam as well. His right tib/fib was clearly broken and I had someone splint it. It was at this point that someone started to manage the scene and worry about secondary collapse. Some shop lights were brought in and set up so that we could properly assess the situation. Our team leader started making calls: the TSOC, the B Team etc. The 250cc bag of NS I had running wide open quickly ran out and I switched it for a 500cc bag of LR. I knew the longer he was trapped, the worse it would be when we finally got him out.
We didn’t have a crane or a winch. After about an hour of running around someone finally thought of drilling a hole in the bottom of the tank to let the majority of the remaining water out. The iron supports and muddy bricks were still pinning him down.
I knew he was probably going to need a Foley but didn’t want to do it in that ridiculously dirty environment. At this point I had given him nearly 2 liters of LR and knew he was probably going to pee soon. I emptied a Nalgene and put it where I thought it would catch his urine if he did go. I had also started up some Invanz IV. I also hooked up the new tempus monitor with the 12 lead. We hadn’t figured out how to network the vitals back to a receiving station yet, but could email pictures of rhythms.
By the time we thought we were ready to jack the mangled iron off of his leg. He had been trapped with his leg crushed for over 3 hours and I had used roughly 4 liters of fluids and 600mg of Ketamine. I organized my notes and called the Virtual Critical Care Consult:
- Using the PFC casualty card and the Telecom cheat sheet, what do you want to tell them?
- What do you want them to help you with?
- What follow on problems are you worried about?
- What will you do to address them?
Questions and comments are always welcome below or on our Facebook Page.
The Special Operations Medical Association (SOMA) was founded in 1987. It now consists of hundreds of members in pre-hospital, tactical, wilderness, austere, disaster and deployed medicine. The primary goal of the association is to advance the art and science of special operations medical care through the education and professional development of special operations medical providers. This is where the Prolonged Field Care Working Group and our website come into play.
All of the work you see on our site and in our recommendations has come from our own money and volunteer hours in our spare time. Current and past working group websites have been paid for by my own money in an effort to get the the right information out to the guys who need it. SOMA has closely collaborated with the working group ever since COL Mabry challenged COL Keenan to do something about the problems and questions we we raised about far-forward, austere medical care facing our medics. We took that challenge not knowing how time consuming and resource intensive this undertaking would be. It is worth every minute and every penny when we hear the impact we have on the way medics train, prepare and deploy to the far reaches of the globe. While SOMA has always maintained the www.libsyn.com site that hosts the PFC podcast they are now proud to directly sponsor http://www.ProlongedFieldCare.org in an effort to provide vitally needed educational content to medics around the world.
If you are a SOMA member we thank you for your support. If you are not, I urge you to go to www.specialoperationsmedicine.org and sign up. As part of your membership you will receive a subscription to the Journal of Special Operations Medicine (JSOM) which is an official publication of SOMA. Our working group has a dedicated section in the JSOM reserved for articles recommendations and case studies pertaining to prolonged field care. As you can see we’ve long been intertwined, we’re just now making it official.
Each year our presence at the Special Operations Medical and Scientific Assembly has grown and this year was our biggest yet. We put on an entire day of labs, discussions, lectures and panels in a closed pre-conference session. It was closed in order to limit the audience to active duty medics and their Battalion Surgeons and PAs. In actuality it was completely packed and standing room only. For those of you who couldn’t make it to Charlotte SOMA sponsored our session by providing a camera crew who recorded almost all of the presentations that day. I now have the hard drive in my possession and am going through the footage in order to release everything I can right here on our site for medics around the world.
The next SOMSA meeting will be on 22 May 2017. If you want to attend and you are a medic, do what you can to take an interest now and get involved in advancing your practice. SOMA is always looking for presenters and the medic vignettes are almost always the most anticipated and well received.
Let us know if this partnership is serving you well.
The following article was published in the Journal of Trauma and Acute Care Surgery. If you haven’t read it, it’s a great look into the amount of time and effort being put into the research and solving of problems having to do with Prolonged Field Care based on our 10 Capabilities model. This includes everything from improvement of enroute care to organ replacement and futuristic methods of targeted resupply. Check out table 2 in the article linked below to get a better idea of what I’m talking about.
Authors: Todd E. Rasmussen, MD, David G. Baer, PhD, Andrew P. Cap, MD, PhD, and Brian C. Lein, MD, Fort Detrick, Maryland
The following video podcast was recorded live at the JSOMTC during the July 21 2016 weekly Joint Trauma System Teleconference. Dr. Doug Powell talks about providing critical care in austere environments. Continue reading
This post is for the both the PA charged with training medics in the Battalion Aid Station as well as the medic with the initiative to take their medical education Continue reading
Not all blood programs are created equal. For Fresh Whole Blood (FWB) transfusions in an operational environment, Continue reading
This was my third time attending SOMSA and each time I seem to be more and more busy with my involvement in the working group, networking and just catching up with buddies I haven’t seen in a while. In the past I would try and naively