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.
There is no excerpt because this is a protected post.
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 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.
So what is different than what we already have in the THOR recommendations, the JTS DCR clinical Practice Guideline and…
Many efforts in the pre-hospital combat environment had been aimed at prolonging the viability of a patient until they are able to make it to a surgeon. The goal of military triage and evacuation is to have urgent surgical patients to a waiting surgical team within 2 hours. Despite our best efforts, this is not always possible. When it is not, it is important to do the simple interventions which we know make a difference for combat casualties such as tourniquets, wound packing, needle decompression and airway adjuncts. Wounds causing non-compressible hemorrhage to the torso need additional strategies to bridge the time and space gap to definitive treatment. A non-surgical adjunct which has shown the most promise to this point has been the early transfusion of whole blood and blood products. Our newest Clinical Practice Guideline on Remote Damage Control Resuscitation details what should be done and why.
There is an entirely separate working group, The Tactical Hemostasis, Oxygenation and Resuscitation (THOR) group dedicated to exactly those principles. Despite all that effort and brain power however, blood remains a finite resource in the austere environment and Medics have faced terrible situations where even blood administration is not enough and surgery is too far away. It is in these times of worst-case desperation that we want to do more for our patients. Some of the adjuncts discussed in this episode are abdominal tourniquets, REBOA and open surgical procedures. We don’t take any of this lightly and realize that for the vast majority of our pre-hospital audience, many of the procedures discussed are far outside the current scope of practice.
What is possible?
What is responsible?
What is sustainable?
Enjoy the talk.
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 http://www.prolongedfieldcare.com
See you there!
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.
Prep for flight is the 10th Core PFC Capability. Our working group had always deferred to subject matter experts