Autotransfusion in the Austere Prehospital Setting?

Let’s start out with a scenario…

During a training mission to an extremely austere environment, one if your highly trained partner force Commandos takes a penetrating wound to the chest due to a negligent discharge by one of the new guys they are integrating into the longstanding unit. After initial treatment

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INCIDENT REPORT and Example of Remedial Plan of Action

Why does it take the NY Times to identify and disseminate our medical lessons learned?!

How was this not immediately circulated to all medics internally the way parachute failure incidents and military vehicle accidents are?!

Why is there not an immediate safety stand down and retraining required?!

Don’t let Dunning-Kruger fool you. Any one of us could have been the initial medic, the receiving PJ or even the patient. Incidents like this can even occur here at hole in the first world. Have you ever watched the Elain Bromily case?

Imagine if there were a proper incident report posted in every Command hallway, every time there were a poor outcome experienced across the enterprise?

How much easier would it be to justify training and equipment needs with the penny pinchers, bean counters and check writers who were acutely aware of the actual risk to force?

If the article is accurate, this was a catastrophe for everyone involved. The lives of the patient, the family, the team and the medics are irreversibly altered.

Our last podcast was about High Reliability Organizations. A key hallmark of an High Reliability Organization involved in life and death operations is a preoccupation with failure. We cannot continue to bury our collective failures and must focus on identifying and fixing them all from an organizational level.

Here is a sample plan of action for organizational remedial training that I would do if I were a Senior Leader with medical personnel in my unit.

I personally challenge you to actually complete the following action items this week. If we do not learn from our collective failure we will repeat it until we do.

  • There should be immediate notification, reeducation and retraining for everyone followed by an improved initial and sustainment training plan. Battalion Surgeons, PAs Instructors and Senior Medics should ensure every single medic does the following:
  • Receive(or Demand) the incident report and AAR from the Chain of Command the way other Safety Stand Down incident reports are disseminated. -Post it for the entire unit to read next to the parachute failure incident.
  • As a small group, read and review the report and AAR.

Botched Medical Procedures May Have Led to Death of U.S. Soldier (Published 2019)

Staff Sgt. Alex Conrad, 26, died from wounds he received during a militant attack on a small outpost in Somalia. Send any friend a story As a subscriber, you have 10 gift articles to give each month. Anyone can read what you share.

  • Reread the guidelines and watch the videos freely available on the DeployedMedicine App

  • Ensure everyone immediately participates in hands-on table top training with whatever you currently have available or can easily construct.

-Be sure to discuss shortfalls and inaccuracies of your trainer.-Dont just focus on the single skill, discuss other options that could have led to a better outcome:

-‘Could different patient positioning have helped the situation?’
-‘How could the outcome have been different with various pharmacological adjuncts?’

-‘One of the things I have seen in small group training was to inject a hematoma just over the cricothyroid membrane. This makes it super messy and hard to identify landmarks which is usually a slam dunk training scar.’

-Ask Medics how well their non-Medics are trained to take care of them if it were them on that table?

  • Submit a WRITTEN request through multiple channels for proper equipment citing the article, incident report and TCCC guidelines as justification to your MEDLOG, S4, XO and anyone else who can affect the situation.

-Imagine if 10,000 requests were simultaneously submitted for similar equipment…

  • Identify training deficiencies in your immediate organization and actually make a WRITTEN request to your Command for additional remedial training to be included in future non-medical training.

-Attach the article to the request.

  • Identify equipment deficiencies and again, submit a WRITTEN request through multiple channels for proper equipment citing the article, incident report and TCCC guidelines as justification to your MEDLOG, S4, XO and anyone else who can affect the situation.

-Do you have Super Glottic Airways in every aidbag and IFAK? An Emma Capnograph would have helped identify the false passage instantly.

These are just a few things an HRO can EASILY and IMMEDIATELY accomplish. What else can you do to ensure this death of our brother is not in vain?

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 use the wider working group audience to identify a standard list of drugs every Independant Duty Medic or Corpsman should have with him on every austere deployment. If put into practice properly across the force and coordinated with MEDLOGs, this will be one less chore for a medic and another place where we can help reduce mistakes and oversight. The following

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Get Started Here  

The following should be viewed like a checklist to help jump start any tactical medical program to accommodate prolonged field care situations. Most of these concepts are discussed in separate posts and papers but are compiled here specifically to address questions on how to start from scratch. Special equipment acquisition should only be considered after identifying gaps in training, planning and practice. While there are still some gaps which we are working to fill, I hope some of this helps. Read More

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 this well-researched monograph. He advances the understanding of the many challenges and accomplishments related to guerrilla warfare medicine—care provided by predominantly indigenous medical personnel under austere conditions with limited evacuation capability— by providing a survey of the historical record in UW literature. Colonel Farr relates many historical experiences in the field, assesses their effectiveness, and lays a foundation for further in-depth study of the subject. The Joint Special Operations University is pleased to offer this monograph as a means of providing those scholars and operators, as well as policymakers and military leaders, a greater understanding of the complex and complicated field of guerrilla warfare medicine.

Download the PDF: The Death of the Golden Hour and the Return of the Guerilla Hospital -COL (RET) Warner D. Rocky Farr MD

COL (RET) Warner D. “Rocky” Farr Bio

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.  Read More

Deployment Downloads

Pre-deployment checklists, cheat sheets and other resources now updated!  Everything I am posting below could help anyone who finds themselves Read More

Prolonged Field Care Card

This is the newest version (v24.1) of the single page Prolonged Field Care Card.   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.

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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

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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, Read More

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