


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.

Podcast Eposode 60: Ian Wedmore on Frostbite and Cold Weather Injuries
Dennis and Paul talk with Dr. Ian Wedmore and discuss some interesting updates to the management of frostbite injury in the field and what to do when you get back to a hard stand shelter.

Podcast Episode 57: Snake Envenomation in Austere Environments
Dangerous snakes can be found both while training at home and far away while deployed. It may be a rare occurrence, but a catastrophic event when it does happen. Some […]

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 55: JJ and Dennis on HROs. Part 1
The principles of High Reliability Organizations are necessary in those professions where mistakes can cost lives. The airline industry is the classic example and referenced many times in the articles […]

Podcast Episode 54: SOP for the Ideal SF Clinic?
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 […]

Podcast Episode 53: Ventilating in the Prone?!
What happens when your patient has been given a cric or intubated but continues to decline… SpO2 continues to slowly drop despite taking control of the airway. You have placed […]

Version 22.2 (1Dec2020) of The Prolonged Field Care Card
We have been training teams in various settings over many years and have noticed that there are two categories of care that emerge during prolonged care: Those that react to […]

Podcast Episode 52: Walking the Fence of Evidence, Environment and Experience with a word on Proning
After a few discussions with JJ who has also appeared in several Element Rescue podcasts, Doug and Dennis talk about using evidence based medicine whenever possible and what to do […]

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.

Protected: All things Airway, Ventilation, Oxygenation and COVID19
There is no excerpt because this is a protected post.

Podcast Episode 50: Simple Sepsis Recognition and Intervention for Prolonged Field Care
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.

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.

Podcast Episode 47: Andy Fisher and his Damage Control Resuscitation for Prolonged Field Care CPG
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 […]

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!

Podcast Episode 44: Prep For Flight and En Route Care: The 10th Core PFC Capability
Prep for flight is the 10th Core PFC Capability. Our working group had always deferred to subject matter experts

Standard Prolonged Field Care Training Curriculum Crowdsource Project
It has been our experience that high quality prolonged field care training takes time, resources and expertise by dedicated trainers well versed and experienced in critical care concepts. That being […]

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 […]

Podcast Episode 43: 5 years of Prolonged Field Care
A Re-Introduction to Prolonged Field Care After 5 Years of Work PFC is doing the best you can to treat a sicker patient than you are prepared to handle for […]

Podcast Episode 42: Wound Care Basics and Beyond
In this episode Dennis talks to PFC Wound Care CPG author Justin along with Surgery Instructors Jon and Rick about their experiences with austere wound care.

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 […]

Episode 41: The Death of the Golden Hour: SOMSA 2018 Talk, by COL (Ret.) Rocky Farr, MD
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 […]

Podcast Episode 40: Medic Team Dynamics with Dennis and Doug
Whether working on a casualty with a small team of medics or as a single medic with the help of other non-medic team members as helpers, someone has to be in charge of the situation […]

Episode 39: End Tidal CO2 Application and Limitations in Prolonged Field Care
Upgrading your airway kit with a portable end tidal CO2 monitor can help in a couple situations. While it has its limitations, it is essential for

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 or improving

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...


Podcast Episode 36: ROLO to SOLO: The Logistics of Fresh Whole Blood Transfusion
A Special Operations Battalion Surgeon explains how to easily navigate the logistics of setting up a battalion wide blood transfusion program.

Podcast Episode 35: Priorities of Burn Care With Dr. Cairns of The UNC Chapel Hill Jaycee Burn Center and the AMIT Program
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 […]

Podcast (video) Episode 34: Telemedicine to Reduce Medical Risk in Austere environments
Telemedical consult is one of the most important core capabilities in a prolonged field care situation.

Podcast Episode 33: TIVA: Another Look at Pre-Hospital Analgesia and Sedation
Rick Hines has spent the last 20+ years in service to his country much of it deployed to combat zones and other unstable, austere environments and is dedicated to improving […]

Podcast 32: Doug Explains the JTS Burn Care Clinical Practice Guideline For Medics
When do you give a burn patient antibiotics? Which ones? How do you calculate TBSA and the rule of 10s? What do you use to guide fluid resuscitation? What fluid? […]

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 31: CBRN for Dummies By COL Missy Givens
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 […]

PFC Grand Rounds Talk at UC Davis Health
Here is a great video on PFC and the cases we helped collect from Airforce MAJ Eric DeSoucy, DO doing a Grand Rounds talk for the Department of Surgery at UC Davis.

Podcast Episode 29: Dr. Cap on Fresh Whole Blood and Resuscitation for PFC
Dr. Cap has been leading the way here in the US with the Armed Services Blood Program on fresh whole blood transfusion research in conjunction with the THOR Network and […]

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 Episode 26: ICRC Style Wound Care and the NEW Acute Wound Care Management Clinical Practice Guideline
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 […]

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.

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.

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 […]

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, […]

Podcast Episode 20: TBI Round Table and Case Discussion
This podcast is a follow up from our last post on managing traumatic brain injuries in austere environments. We included a scenario discussion with David, Jamie, Daryl, Jay, Doug and I with […]

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 […]