From tourniquets to chest seals, our community has been at the forefront of innovating, problem solving and improvising when not able to get a commercially tested and manufactured medical device. A purpose-made, evidence-based solution should always be primaryRead More
The RAVINES Mnemonic was created to help the medical provider on the ground in an austere environment with a very sick patient. Most medics will do a decent TCCC SMARCH survey and when they get to the end of that, get vital signs to begin trending and repeat the MARCH sequence while adding E-PAWS-B…
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
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.
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.
-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?
-Imagine if 10,000 requests were simultaneously submitted for similar equipment…
-Attach the article to the request.
-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?
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
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
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.
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