In the 100th Episode of the Prolonged Field Care Podcast Dennis sits down with Jamie, Sean and Paul to talk about the last 100 episodes and how prolonged field care evolved over the past 7 years from when the working group was established at SOMA 2013 in Tampa, FL. Sean has since moved on and retired from the military and founded a non profit, Specialized Medical Standards, dedicated to developing, and distributing high quality education and training resources to the international medical community, much of it based on the lessons learned from his unique experiences and expertise.
After some time to reorganize, restructure, and strategize, we will be continuing to update best practices, share ideas and raise the important questions faced by medics around the world. We have taken this step to lay the old prolonged field care working group construct to rest and form a new organization (with the same core people): the Prolonged Field Care Collective. Membership is based on participation and contribution. Dennis will continue to record podcasts, which will be posted on http://www.prolongedfieldcare.org, our new podcast feed (Search “Prolonged Fieldcare Podcast”) as well as the same old Special Operations Medical Association Libsyn feed. This will allow us to reach a wider audience, maintain complete control of our content, continue to “push the envelope,” nurture the unconventional Think Tank, and expand what we offer in the future.
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.
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.
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…
When properly and safely administered regional anesthesia can augment your limited supply of narcotics and ketamine in resource poor environments. It can also preserve your patient’s mental status while providing targeted pain relief. This can be accomplished using a nerve stimulator and the techniques found in the Military Advanced Regional Anesthesia and Analgesia Handbook as taught in the Special Forces Medical Sergeant course. If you have a portable ultrasound machine and a little practice you can also use the safe techniques found in the videos made available in by the New York School of Regional Anesthesia at NYSORA.com.
Which burn fluid resuscitation formula is best? Does it really matter?
What can happen if you over resuscitate? Under?
What can cause an increase or decrease in the demand of fluids?
What can you do if you are running out of Lactated Ringers?
As a Lt. Cmmdr. with the U.S. Navy, Dr. Cairns was on duty and a principle responder to the KAL flight that crashed in 1997 in Guam. Dr. Cairns was instrumental in developing the level of preparedness at the Naval Hospital there which received and managed dozens of critical patients in the morning following the crash of the 747.
In this live recording, guest lecturer COL Missy Givens shares the CBRNe knowledge she has learned while working as a clinical toxicologist, among many other positions, around the world including as the SOCAFRICA Command Surgeon where she personally helped prepare members of 10th SFG(A) to deal with some of the most venomous snakes in the world. Continue reading Podcast Episode 31: CBRN for Dummies By COL Missy Givens→
You are in your Team House or BAS. You have given FDP, Whole blood, TXA calcium and don’t have much left despite the few units from the walking blood bank. Your patient continues to bleed internally. Nothing in the chest or upper abdomen. Probably pelvic. Damn. MEDEVAC is en route. They will have some blood too. You just need your patient to hold on for another hour before he gets to surgery… Continue reading Podcast Episode 30: REBOA?! with Joe DuBose→
Training materials were the number 1 most requested item from our SOMSA AAR. We have put out other training recommendations in the past but wanted to also highlight some important skills that will help you identify gaps in your PFC training program, plan future training and measure progress. We will get more into this cycle in the future however, this should be a good place to start. Many thanks go out to Andrew who labored over many versions of the list over the past few months. One last thing, be sure that you are already at 100% T for Trained on your TCCC task list. There is no use in getting into PFC training prior to mastering TCCC. If you see something we may have overlooked and would like to see it on future versions, please comment below and let us know.
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?
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
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.
“We were assigned to train the Colombian military in Reconnaissance operations. It was the rainy season, so travel was limited to trucks, ATVs, and good ol’ fashioned walking. We were about two days into our training mission/jungle slog, when we happened upon a vehicle at the base of the mountain that had been pushed off the road by a
Despite our best efforts, endless training, and reading, some of our patients will die. This has been a taboo subject that is difficult to broach in the best of times. We aim to start a conversation here with the hope that
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→
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
As promised, here it is – the SOLCUS talk on ultrasound education in special operations medicine. It was given at the Joint Trauma System Combat Casualty Tele-Conference # 500,on Feb 18th, 2016.Once again – many thanks to the JTS Team for their kind invitation!
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.
In this episode Justin introduces the importance of properly using urine output to monitor hemodynamics of both trauma and medical patients by interviewing 2 of our contributing working group members; Dr. Phil Mason Air Force Emergency Medicine Physician and Critical Care Intensivist and Dr. Chris Burns who is a Retired Navy Trauma Surgeon. Both of these doctors have been instrumental in answering the complex questions we have put forth because of their familiarity of our training and equipment available while also putting themselves out there in austere environments from time to time. Thank you both for taking your time to do this podcast.
Our first episode is hosted by Justin, interviewing Colonel Sean Keenan MD who is the 10th Special Forces Group Surgeon. Doc Keenan has worked tirelessly alongside Justin and the rest of the Prolonged Field Working Group at both our group level and with SOCOM. The work they are doing is having a lasting impact on military medicine and the way it will be taught and trained in the future. Many people will say, including the entire working group, that this is nothing new, that SF medics have been trained for the situations we describe for decades. This may be true but as military medicine progressed the mindset of the medic reverted as unbelievably fast evacuation times took hold in recent conflicts causing a huge loss in the institutional knowledge base. As medicine, and military medicine especially, progressed at lightning speed, so too has medical technology, research and education. In order for medics and the providers charged with their training to keep pace a new forum was born with the idea of knowledge retention and sharing across the services, government and international medical community. Now a conversation a medic has with a surgeon or anesthesiologist while deployed can be recreated in order to enlighten all medics who will likely have similar questions or concerns. This is the first conversation that explains all of this and more. We hope that the following series will both educate medical personnel as well as begin the dialogue that will keep our craft moving forward as fast as the entire medical field. As always be sure to comment and most importantly, share this site with anyone in the health field whom you think it may benefit.
I hate not knowing an acronym. In my line of work acronyms are language and the ignorance of one normally results in the ignorance of entire programs or departments. FOAMed is Free Open Access Meducation a term growing in popularity mostly in part due to the SMACC committee and it’s world wide network of Critical Care, Emergency Medicine and Prehospital care Cadre. SMACC stands for Social Media And Critical Care. There are now a plethora of podcasters known as “providers” who attempt to tackle the pressing problems of the aforementioned specialties while striving to educate, for free, the hungry Paramedics, Interns, residents and colleagues at large. They are succeeding beyond what they thought possible and it is spreading to all facets of medical education. The first SMACC conference was held in 2013 with the worlds most famous podcasters lecturing and fielding questions from the audience and twitter simultaneously. It was hailed as the most inspiring and interactive medical conference and if you listen to the podcasts you will see why. The second was held on the Gold Coast of Australia with even better results.
After many, many hours of work collaborating, recording, editing and coding, Prolonged Field Care is live to be downloaded and especially subscribed-to from iTunes! This is another huge leap forward for us in reaching medics with the information they will need. With a long drive to work I normally listen to SMACC, EMCrit, or other critical care or emergency medicine podcasts. As a medic many of them are good to hear and have great info but often don’t apply to my scope of practice or environment I operate in. These podcasts are hosted by an 18D Medic, interviewing Doctors and nurses of all specialties with the unique challenges we face when taking care of our buddies and partner forces in the worst circumstances with little or no help.
This is exactly what I need as an independent medic in an austere environment.