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.
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???
We have been training teams in various settings over many years and have noticed that there are two categories of care that emerge during prolonged care: Those that react to stimuli and chase their tails and those that have a plan and follow it. Of course this happens on a spectrum Continue reading Version 22 of The Prolonged Field Care Card
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