This Clinical Practice Guideline was written by a fellow 18D with input from around the surgical community. It reconciles the differences between wound care done in a role 2 or 3 facility, such as serial debridements, with what is taught in the 18D Special Forces Medical Sergeant Course with regards to delayed primary closure. One way is not “right” while the other wrong, it has more to do with Continue reading Podcast Episode 26: ICRC Style Wound Care and the NEW Acute Wound Care Management Clinical Practice Guideline
All posts by Paul
Podcast Episode 25: Lethal Triad Trauma Class Video
Podcast 24: Sepsis Roundtable Discussion
You have probably treated someone with an infection and likely even with someone with SIRS criteria at some point in your career. At what point does a simple infection become concerning to the point that you should call for a teleconsult?
When does it become emergent or life threatening, demanding intervention and treatment?
Podcast 23: Clinical Practice Guidelines for the SOF Medic
While at the 2017 Remote Damage Control Resuscitation(RDCR) conference put on by the Tactical Hemostasis, Oxygenation and Resuscitation(THOR) network in Norway, Sean took the time to corner Dr. Shackleford to get her thoughts on the Joint Trauma System Clinical Practice Guidelines. Continue reading Podcast 23: Clinical Practice Guidelines for the SOF Medic
Podcast 22: On Blood, Geir Strandenes at SOMSA 2017
Are you familiar with the concept of oxygen debt or oxygen deficit? What constitutes a “dose” of shock? What systolic BP constitutes hypotension on the battlefield? Where did the concept of permissive hypotension come from? Is it still valid? How long can fresh whole blood last?
Blood Transfusions were a huge topic at this year’s meeting in Charlotte with no less than 3 major speakers giving multiple talks on the subject. This talk was recorded during the Prolonged Field Care Pre-Conference Lab during the Special Operations Medicine and Scientific Assembly (SOMSA). Dr. Geir Strandenes
Continue reading Podcast 22: On Blood, Geir Strandenes at SOMSA 2017
SOMSA ’17 Poster Presentations
There were some truly interesting ideas, research and products showcased on the exhibition floor. If you missed the 2017 Special Operations Medicine Scientific Assembly this year in Charlotte or never made it all the way back to the poster boards, here are the posters from the 2017 assembly.
Continue reading SOMSA ’17 Poster Presentations
Analgesia and Sedation JTS/PFC Clinical Practice Guideline
TheJoint Trauma System joined up with us and several of our working group members to bring you this, our third CPG, for PFC.As with every PFC CPG, this is the time that goes beyond TCCC. With this specific CPG you are expected to provide appropriate analgesia and/or sedation
Continue reading Analgesia and Sedation JTS/PFC Clinical Practice Guideline
Podcast Episode 21: Optimizing Ventilation
The Special Operations Medical Association Podcast on Prolonged Field Care is back with a new episode on a long awaited topic, traumatic ventilation. We were finally able to corner a real, live anesthesiologist who was actually more than happy to sit down and talk about ventilation after his years of experience working at the heads of thousands of patients. This episode starts right off with a difficult scenario discussion that includes a hypovolemic patient with a GSW to the pelvis, RR 35
Podcast Episode 19: Sepsis
If you sit on a patient long enough, infection has a greater chance of taking hold and progressing to sepsis, or you may receive a patient who has already been sick for days. Doc Jabon Ellis walks us through the full spectrum from infection and SIRS to sepsis, shock and death.
Podcast Episode 16: Sedation
Being able to calm and sedate patient in operational or prolonged field care situations may be a valuable skill. Here are our thoughts on sedating your patients when patient comfort and safety are an issue? Continue reading Podcast Episode 16: Sedation
Special Warfare Magazine Articles: “Loss of the Golden Hour” & “18D: The Lifeline.”
Members of Prolonged Field Care Working Group wrote this article in an attempt to educate our operational leadership on the challenges faced when dealing with medicine in austere environments. This is important because medicine normally takes a backseat to the operational mission. While this is true for good reason, commanders need to understand that the old axiom that, “an 18D can take care of a casualty for 72 hours,” is outright false in many situations. Continue reading Special Warfare Magazine Articles: “Loss of the Golden Hour” & “18D: The Lifeline.”
Deployment Downloads
Pre-deployment checklists, cheat sheets and other resources now updated! Everything I am posting below could help anyone who finds themselves in over their heads Continue reading Deployment Downloads
Prolonged Field Care for the New Year
PFC community,
I wanted to take a moment to wish everyone a Happy, fruitful (safe) Year in 2017! This past year has proved to be a tremendous transition for the PFC SOF medicine community. It was the year where we took
Podcast #15 Analgesia Case Discussion Follow Up and a Word on Emerging PTSD Research
Just snow your patient with ketamine and versed to prevent PTSD right? Maybe not. While talking through some more analgesia and sedation strategies, Doc Powell shares his thoughts on what he has read recently and it might blow your mind. It did mine and
SFMS / SOCM Prolonged Field Care Card
This is the newest version (v22.2) of the single page Prolonged Field Care Card. It is in use in both the Special Forces Medical Sergeant (SFMS) Course as well as the Special Operations Combat Medic Course (SOCM) at the Joint Special Operations Medical Training Center (JSOMTC) at Fort Bragg. Print it out, laminate it and stick it in the back of your aid bag. It takes up almost no space and weight and it’ll be there for you when you run out of space on your TCCC card.
JTS/PFC Clinical Practice Guideline on Crush Injury for Medics and Role 1 Providers
The Prolonged Field Care(PFC) Working Group has been working hand in hand with the Joint Trauma System (JTS) for almost a year in writing and editing new guidelines for medics and providers who may have to take care of casualties for longer than normal planning guidelines in resource constrained environments. This could be Continue reading JTS/PFC Clinical Practice Guideline on Crush Injury for Medics and Role 1 Providers
GSW to Lower Extremity: PFC Case Discussion 7
Our case discussions are provided to get you, the medic or provider, to think about treatment and logistical issues. The following case is a ‘simple’ scenario constructed to get you thinking about long term pain control
Continue reading GSW to Lower Extremity: PFC Case Discussion 7
Prolonged Field Care Planning
I like Eisenhower’s quote: “Plans are useless, Planning is everything.”
Everyone knows that during a crisis your plan may fall apart. This is why the process of planning and researching is so important. It gives you options that wouldn’t otherwise exist
Podcast Episode 13: Ketamine and Pharmacology SOMSA 2016 Pre Conference Lab Talk
Effectively taking away pain can be one of the most important things you can do as a medic. It will enable you to
Continue reading Podcast Episode 13: Ketamine and Pharmacology SOMSA 2016 Pre Conference Lab Talk
Podcast Episode 14: Crush Injury Round Table PFC Case Discussion
This podcast is a follow up from our last post on managing crush injuries in austere environments. We included a scenario discussion with
Continue reading Podcast Episode 14: Crush Injury Round Table PFC Case Discussion
MEDAUSA Symposium
If you can’t bring the patient back to the capability you must bring the capability to the patient.
-Sean
Our working group has identified 10 of these capabilities that we feel to be critical in making a difference in the morbidity or even mortality of a patient. Continue reading MEDAUSA Symposium
Podcast Episode 12: Crush Syndrome From a Prolonged Field Care Perspective
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, Continue reading Podcast Episode 12: Crush Syndrome From a Prolonged Field Care Perspective
PFC Sponsored by SOMA
The Special Operations Medical Association (SOMA) was founded in 1992. 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. Continue reading PFC Sponsored by SOMA
The Journal of Trauma and Acute Care Surgery on the Future of PFC
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
Podcast Episode 11: Beyond the Golden Hour: Austere Critical Care in Future Operating Environments
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 Podcast Episode 11: Beyond the Golden Hour: Austere Critical Care in Future Operating Environments
Prolonged Field Care Classes for 68Ws
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 Prolonged Field Care Classes for 68Ws
THOR Fresh Whole Blood Triage and Screening Tool
Not all blood programs are created equal. For Fresh Whole Blood (FWB) transfusions in an operational environment, Continue reading THOR Fresh Whole Blood Triage and Screening Tool
SOMSA 2016 Academic Posters
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
Podcast Episodes 9 &10: Scott Weingart SOMSA Podcasts on Ketamine for PFC
Scott Weingart, of EMCrit fame, was gracious enough to do a two-part, flipped classroom presentation on the use of ketamine since he pushes the drug on a daily basis for a wide variety of applications. Continue reading Podcast Episodes 9 &10: Scott Weingart SOMSA Podcasts on Ketamine for PFC
Burn with Airway Involvement: PFC Case Discussion 5
A U.S. service member sustains deep partial thickness burns to both arms and the chest while burning the trash…
Continue reading Burn with Airway Involvement: PFC Case Discussion 5
$47 Million For Prolonged Field Care
This is an amazing opportunity for clinicians and researchers to make needed advances in the operational medicine provided far forward by our medics. Continue reading $47 Million For Prolonged Field Care
MVC with Pelvic Trauma: PFC Case Discussion 4
A U.S. service member sustains pelvic trauma secondary to a vehicle rollover in the middle of nowhere. The patient complains of severe pain and you initially opt to control his pain with
Continue reading MVC with Pelvic Trauma: PFC Case Discussion 4
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 I watch a medic go through a PFC
Continue reading Principles for Practicing Effective Prolonged Field Care
JTS Combat Medic Teleconference
The 500th weekly Joint Theater Trauma System Trauma Teleconference out of San Antonio featured our own SOLCUS Point of Injury Ultrasound curriculum. It was specifically geared to the level of enlisted SOF medics and up. This is a great way to earn CEUs CNEs or CMEs while hearing about recent cases and the latest and greatest in combat medicine.
Video AAR of the Jan 2016 Marjah Firefight and PFC MEDEVAC
A small team surrounded in a compound, active firefight, helicopter attempting MEDEVAC inside the walls but blades strike the building, TCCC, Prolonged Field Care, blood transfusions, 6 attempts at converting a tourniquet over 17 hours…
Continue reading Video AAR of the Jan 2016 Marjah Firefight and PFC MEDEVAC
2015 Year in Review
The following is a letter from Sean sent out on our big email list. If you’re not on the list don’t worry because it is posted here in it’s entirety. The letter highlights what we have done over the last year and, more importantly, what we have planned for the year to come, specifically a whole day of Prolonged Field Care specific training
Foley in the Aidbag??? Open Mic Post
Here is an issue that has come up more than once over the past year. It sparked good discussion with some great points that we will attempt to repopulate in the comment section: Continue reading Foley in the Aidbag??? Open Mic Post
Podcast Episode 8: Phone a Friend – Telemedical Consult
Here’s a podcast we recorded last year. There are some key points in this that we cover in overview lectures, and continue to teach medics individually, about what we refer to as “phoning a friend.” Continue reading Podcast Episode 8: Phone a Friend – Telemedical Consult
CALL FOR CASES!
The U.S. Institute Of Surgical Research Joint Trauma Service and PFC Working Group need your help:
The JTS is working to conduct a retrospective case review relating to PFC in order to conduct an aggregate analysis.
We are currently collecting as many cases as we can obtain relating to prolonged role 1 care (anything greater than 4 hours) both trauma and non-trauma. We are accepting unclassified AAR’s, medical records, powerpoint summaries from meeting presentations, or even just personal memory/war stories. If the medic is available, we would like to interview them if possible. As there is really no database of such cases, many of the cases will be identified by word of mouth, although we are also searching the trauma registry, SOMA and SOCMSSC databases.
The results of our analysis will include the epidemiology of PFC cases and aggregate lessons learned. The report will be returned to the PFC working group and operational communities and published (likely in JSOM).
Thank you for any assistance you can provide to help identify these cases and the medics who provided such care. Cases may be submitted to usarmy.jbsa.medcom-aisr.list.jts-prehospital@mail.mil
Click here to download the AAR Form
Articles Now Published in the Journal of Special Operations Medicine
Podcast Episode 7: Part 4 of the Pharm Series… Ketamine and PFC
This podcast is a direct result from questions, comments and emails we have received along the way. It helps to clear up some confusion and explain some of the recommendations the working group first made in February of 2014. Justin begins the episode by talking about 3 different uses of Ketamine in a prehospital or field setting; The first as an adjunct to opiate analgesia. The second in procedural sedation for shorter yet painful procedures. The third for long term sedation in a Prolonged Field Care situation. He then introduces LTC(Ret.) Jim Reed CRNA who explains field Ketamine use in each of these scenarios.
Throughout the episode several articles and the Working Group’s recommendations on Analgesia and Sedation are discussed or referenced and are included in the show notes below.
Ketamine in Prehospital Care – highlights
Ketamine_for_procedural_sedation_and_analgesia_by_nonanesthesiologists_in_the_field
Svenson Ketamine For Prehospital Use AmJEmergMed 2007
Ketamine Clinical Guideline Annals of EM May, 2011
PFC WG analgesia and sedation comments (Feb, 14)
If you haven’t subscribed to the podcast on iTunes listen now:
Podcast Episode 6: Part 3 of the Pharm Series… Opiate Analgesic Pain Control
Another great episode with Justin Interviewing Brad Morgans with some great questions every medic should have the answers for concerning opioid pain control.
and
Click here to Download the Opiate Analgesic Comparison Chart
The PFC Truths
The Original SOF Truths were created to inform those both in, as well as out of, Special Operations not entirely familiar with the operating conditions faced in uncertain environments. This has helped commanders and guys on the ground
Lessons Learned from a 2015 PFC Medical Exercise
ICU Doc, Doug Powell, was on staff for the recent Prolonged Field Care train-the-trainer exercise in June, and he observed Medics running through multiple scenarios, each 24 hours in length.
Continue reading Lessons Learned from a 2015 PFC Medical Exercise
Tactical Damage Control Resuscitation
This article is a nice review of where we are (U.S. – and Norwegian – SOF) now in implementing a FWB program. It also gives good background and a simple algorithm of when to pull the trigger to initiate FWB transfusions.
In PFC, we may not have the luxury of confirmed typing and anti-A, anti-B titering, but rapid screening and typing at the point of care, as per the TMEPs protocol, should be adequate for “contingency” use of FWB.
Sean
Podcast Episode 5: Part 2 of the Pharm Series… The MSMAID Acronym From Anesthesia Adapted to Prolonged Field Care
Justin and Brad continue the discussion of pharmacology started last episode by talking about the MSMAID Acronym/Mnemonic and how it applies to the way SOF Medics should be Continue reading Podcast Episode 5: Part 2 of the Pharm Series… The MSMAID Acronym From Anesthesia Adapted to Prolonged Field Care
PFC Meeting Handouts
If you were one of the lucky guys packed into a small classroom yesterday, then I don’t have to tell you how great that talk was. Mike and his guys have been tackling the issues associated with prolonged field care for a few years now and had quite a bit to tell us including his butcher block presentation on
Podcast Episode 4: Part 1 of the Pharm Series… 12 Principals of Pharmacology
In this great podcast Justin introduces the principals of pharmacology that have served him well over the years and have done far more for him than simply keeping him out of trouble. He also introduces Brad Morgans CRNA who is a wealth of knowledge and experience in Continue reading Podcast Episode 4: Part 1 of the Pharm Series… 12 Principals of Pharmacology
Medics, Where’s the Data? Improve Your Knowledge with Journals, Articles and Studies
Protocols and algorithms likely drive the majority of decisions a medic will ever make. Past that you may have unit or service SOPs. If you find yourself in a situation, such as a prolonged field care situation, that outlasts all of those you should know Continue reading Medics, Where’s the Data? Improve Your Knowledge with Journals, Articles and Studies
Podcast Episode 3: Nutrition in Prolonged Field Care
Need for “Nutrition” has been hotly debated and somewhat blindly held up as a critical need according to the mnemonic “HITMAN.” This should not be the case! Though important in some less injured patients, feeding a patient, especially one who requires feeding by NG tube, can be fraught Continue reading Podcast Episode 3: Nutrition in Prolonged Field Care