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Category: Recommendations

Joint Trauma System Newsletter Update

The Joint Trauma System and Defense Committees on Trauma are made up of several committees including the Committee on Tactical Combat Casualty Care (CoTCCC), the Committee on EnRoute Combat Casualty Care (CoERCCC) and the Committee on Surgical Combat Casualty Care (CoSCCC). These committees, along with the other branches of the JTS, strive to share lessons learned, data, research and form recommendations to DoD medical communities.

Improvised Field Medicine Shopping List for the Austere Clinician

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 device. A purpose-made, evidence-based solution should always be primary in the PACE plan. After the primary manufactured and evaluated product is exhausted, what then?

Prolonged Casualty Care for all

The wait is over... The Role 1 Prolonged Casualty Care Guidelines for the entire DoD are now available here and on the Joint Trauma System website! This was a monumental undertaking from the beginning

Autotransfusion in the Austere Prehospital Setting

This is not a novel procedure. The first successful autotransfusion on record was conducted in 1818 by James Blundell on a patient suffering from postpartum hemorrhage. Through the end of the 1800s and into the early 1900s, surgeons utilized this technique with surprising success

Podcast Episode 69: Hot Weather Injury

Hot weather injuries are an issue medics have to account for even when not deployed. Proper planning, recognition and treatment can greatly reduce frequency and severity of these patients and […]

Podcast Episode 63: Oxygenation, Ventilation and COVID19

Doug and Dennis talk austere management of COVID19 patients with an emphasis on strategies for oxygenation and ventilatory support. The remainder of the post is an massive amalgamation of resources I have been collecting for over a year for my own respiratory refresher.

Podcast Episode 61: TBI Update with Dr. VanWyck

Traumatic Brain Injuries coupled with other injuries can be one of the most difficult wound patterns to manage in the field. Learn to manage TBI on its own and when other complications arrive you will be in better condition to handle an even more difficult situation.

INCIDENT REPORT and Example of Remedial Plan of Action

https://www.nytimes.com/2019/10/11/world/africa/soldier-death-somalia.html 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 […]

Podcast Episode 51: Tropical Medicine Considerations with CAPT Ryan Maves

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.

Podcast Episode 49: Set Up a Walking Blood Bank with Andy Fisher

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.

Podcast Episode 48: Maximizing Hospital Rotations and Medical Proficiency Training

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 un motivated 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.

Video Recap of a Civil War Field Hospital Reenactment and PFC Display at Bentonville Battlefield in NC

ATTENTION FORT BRAGG! TOMORROW! Modern SF PFC Medical Exhibition to Contrast a Civil War Field Hospital Reenactment THIS WEEKEND at Bentonville Battlefield in NC The Battle of Bentonville was fought 154 years ago just a short distance from Fort Bragg, NC. Each year the North Carolina Historic Site Staff and reenactors commemorate the battle with different types of reenactments. This year the focus is on Civil War Medicine and the originally preserved Union XIV Corps Field Hospital at the Harper house. This Event is called, "A Fighting Chance For Life." It is important for us to look deep into the past and hold close the lessons learned which now benefit all mankind. I thought that this would be the perfect opportunity in which to display the advents of modern combat medicine in order to compare and contrast the care received by those who sacrificed so much on our own home soil under such terrible circumstances. While Chloroform and ether anesthesia were gaining acceptance and being used in the United , antiseptic technique and germ theory were just emerging from Joseph Lister and Louis Pasteur across the Atlantic. This important discovery could have saved tens of thousands but would not be widely adopted in the US for decades. Amputations were common place without the more conservative debridement strategy instituted by Dr. Theodore-Marin Tuffier in 1915. Penicillin wasn't discovered the first time until over 30 years after the war in 1897 by 23 year old Ernest Duchesne and not used to treat a human until 1942 after rediscovery by Alexander Fleming in 1928. The Ambulance Corps was arguably one if the greatest contributions to modern combat medicine to come out of the war from the Surgeon to the Army of the Potomac, MAJ Jonathan Letterman. He is widely recognized as, "The Father of Modern Battlefield Medicine." His evacuation chain included tiered levels of care starting with stretcher bearers and far forward dressing stations which led back to field hospitals and larger hospitals beyond that. These levels of care which paved the way for the current roles of care allowed the Union Army to truly preserve the fighting strength by keeping fighting men in the fight and returning as many as possible to the front lines. Prior to that men would either lay dying on the field of battle for days or their squad mates would stop fighting and carry them far to the rear. You can now walk through an original Union Field Hospital, The Harper House, at the Bentonville Battlefield in Four Oaks, NC complete with original blood stains on the hardwood floor where over 600 soldiers were treated. We will have a tent set up with a modern demo of prolonged field care to include some of the latest high tech gadgets such as the SAVE2, TempusPro and many others on the grounds a few feet from the Civil War Field Hospital and reenactors. Once the sun goes down and we are packed up there will be additional professional role players reenacting multiple surgical procedures including some of the following from historic records. The night time tours are $15.00 if tickets are still available but the exhibition during the day is free until 1600. You can hear more about Dr. Letterman and see more of the exhibits available in the visitors center on Saturday at 1500 and Sunday at 1400 by Civil War Historian Chris Grimes. If you can't make it check back and I'll update this post with more of my own pics from the weekend. For more information or tickets to the night tour, check out the links on the post at www.prolongedfieldcare.com See you there!

Prolonged Field Care at MHSRS 2018

The essence of prolonged field care is now infused into many aspects of the austere and military medical lexicon. The response by the medical community to come together to help […]

Get Started Here  

After extensive cooperation and collaboration with operational medics and Docs at home and abroad, we continue to see that there is a clear desire to improve patient care by incorporating […]

The White Powder You Should Bring on Every Deployment

Powdered High Strength Calcium Hypochlorite (Ca(ClO)₂) is essential for a medic to keep in the team house or aid station in an austere environment. It can easily be bought, transported and reconstituted for many purposes...

New CPG! Traumatic Brain Injury Management in PFC

Traumatic Brain Injuries coupled with other injuries can be one of the most difficult wound patterns to manage in the field. Learn to manage TBI on its own and when other complications arrive you will be in better condition to handle an even more difficult situation.

Podcast Episode 28: Critical Skills for Prolonged Field Care Providers

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.

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. Be sure to check out the new JTS Facebook, LinkedIn Pages, Instagram and Twitter feeds and YouTube Channel for more updates.

The appearance of U.S. Department of Defense (DoD) visual information does not imply or constitute DoD endorsement.

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) by Dr. Geir Strandenes.

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