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 when no prospective randomized controlled trials exist
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.
A few things to remember from the episode:
- History and assessment are key in identifying tropical diseases. Remember to consider both history of exposures as well as the accompanying syndromes in formulating a differential diagnoses.
- Malaria treatment consists of Malerone, Coartem or both.
- No one dies without Doxycycline!
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.
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.
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 unmotivated 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.
Here are several elements necessary for a positive MPT experience:
- An approved MOU
- A motivated lead clinician
- An administrative coordinator
- A limited amount of competition with residents and fellows
- Multiple capabilities and scope of practice briefs and videos to catch staff in all departments and shifts in which a medic will be working (Share this episode)
- A synopsis of your scope of practice and goals emailed to the specific departments in the days prior
- A list of procedures or experiences the medic is trying to complete may help the staff understand goals
- If an MPT is meant to prep for prolonged field care the medic should strive to respond to the trauma bay and accompany the patient through the continuum of care including prep, surgery, post op and ICU
One last thing before the podcast;
Please dont show up to your first day to work at a world class level 1 trauma center and medical school wearing pink ranger panties when everyone else is in suit and tie. I wouldn’t say it if it hadn’t happened…
Here are some links from current and past Academis partners who have participated in Military/civilian MPT partnerships:
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…
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 was 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. This was a perfect opportunity in which to see the advents of modern combat medicine
Prep for flight is the 10th Core PFC Capability. Our working group had always deferred to subject matter experts
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 said we also believe that there are fundamental principles which can help
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 Continue reading Crowdsourcing a Standard PFC Deployment Med Box