CALL FOR CASES!

JTS_Operational_Cycle

The U.S. Institute Of Surgical Research Joint Trauma Service and PFC Working Group need your help:

The JTS is working to conduct a retrospective case review relating to PFC in order to conduct an aggregate analysis.

We are currently collecting as many cases as we can obtain relating to prolonged role 1 care (anything greater than 4 hours) both trauma and non-trauma. We are accepting unclassified AAR’s, medical records, powerpoint summaries from meeting presentations, or even just personal memory/war stories. If the medic is available, we would like to interview them if possible. As there is really no database of such cases, many of the cases will be identified by word of mouth, although we are also searching the trauma registry, SOMA and SOCMSSC databases.

The results of our analysis will include the epidemiology of PFC cases and aggregate lessons learned. The report will be returned to the PFC working group and  operational communities and published (likely in JSOM).

Thank you for any assistance you can provide to help identify these cases and the medics who provided such care. Cases may be submitted to usarmy.jbsa.medcom-aisr.list.jts-prehospital@mail.mil

Click here to download the AAR Form


Once you open the PDF, click
Once you open the PDF, click “Fill and Sign” then “Add Text” to fill out as much as you can.

Podcast Episode 7: Part 4 of the Pharm Series… Ketamine and PFC

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.

Ketamine in Prehospital Care – highlights

Ketamine_for_procedural_sedation_and_analgesia_by_nonanesthesiologists_in_the_field

Svenson Ketamine For Prehospital Use AmJEmergMed 2007

Ketamine Clinical Guideline Annals of EM May, 2011

PFC WG analgesia and sedation comments (Feb, 14)

If you haven’t subscribed to the podcast on iTunes listen now:

Click here to listen on iTunes

10 Ultrasound-Guided PFC Essentials

Ultrasound: The most powerful diagnostic tool available to SOF Medics […]. It should be a top procedural skill goal for all SOF providers to become subject matter experts in point-of-care ultrasonography.

I’ve been thinking about this post for a while…  searching for the right format. And then it finally hit me! Why on earth would I re-invent the wheel, if I can channel this message through the paths you are quite familiar with!? Especially after Doug Powell gifted me such a brilliant introduction in a previous post!

Continue reading 10 Ultrasound-Guided PFC Essentials

Lessons Learned from a 2015 PFC Medical Exercise

ICU Doc, Doug Powell, was on staff for the recent Prolonged Field Care train-the-trainer exercise in June, and he observed Medics running through multiple scenarios, each 24 hours in length.

Continue reading Lessons Learned from a 2015 PFC Medical Exercise

Tactical Damage Control Resuscitation

A medic from the 75th Ranger Regiment conducts combat trauma management training April 15 at Fort Benning. Picture via: http://www.army.mil/article/149250/
75th Ranger Regiment medic – combat trauma management training

This article is a nice review of where we are (U.S. – and Norwegian – SOF) now in implementing a FWB program. It also gives good background and a simple algorithm of when to pull the trigger to initiate FWB transfusions.
In PFC, we may not have the luxury of confirmed typing and anti-A, anti-B titering, but rapid screening and typing at the point of care, as per the TMEPs protocol, should be adequate for “contingency” use of FWB.

                                                          Sean

Continue reading Tactical Damage Control Resuscitation

Podcast Episode 5: Part 2 of the Pharm Series… The MSMAID Acronym From Anesthesia Adapted to Prolonged Field Care

Pharm Part 2

Justin and Brad continue the discussion of pharmacology started last episode by talking about the MSMAID Acronym/Mnemonic and how it applies to the way SOF Medics should be  Continue reading Podcast Episode 5: Part 2 of the Pharm Series… The MSMAID Acronym From Anesthesia Adapted to Prolonged Field Care

PFC Meeting Handouts

If you were one of the lucky guys packed into a small classroom yesterday, then I don’t have to tell you how great that talk was.  Mike and his guys have been tackling the issues associated with prolonged field care for a few years now and had quite a bit to tell us including his butcher block presentation on

Continue reading PFC Meeting Handouts

Podcast Episode 4: Part 1 of the Pharm Series… 12 Principals of Pharmacology

Pharm Part 1

In this great podcast Justin introduces the principals of pharmacology that have served him well over the years and have done far more for him than simply keeping him out of trouble.  He also introduces Brad Morgans CRNA who is a wealth of knowledge and experience in Continue reading Podcast Episode 4: Part 1 of the Pharm Series… 12 Principals of Pharmacology

Medics, Where’s the Data? Improve Your Knowledge with Journals, Articles and Studies

      Protocols and algorithms likely drive the majority of decisions a medic will ever make.  Past that you may have unit or service SOPs.  If you find yourself in a situation, such as a prolonged field care situation, that outlasts all of those you should know Continue reading Medics, Where’s the Data? Improve Your Knowledge with Journals, Articles and Studies

Podcast Episode 3: Nutrition in Prolonged Field Care

World_War_II_Patriotic_Posters_USA_Conservation_Food_1LG

Need for “Nutrition” has been hotly debated and somewhat blindly held up as a critical need according to the mnemonic “HITMAN.”  This should not be the case!  Though important in some less injured patients, feeding a patient, especially one who requires feeding by NG tube, can be fraught Continue reading Podcast Episode 3: Nutrition in Prolonged Field Care

Create a Prioritized Care Plan

Screenshot 2015-03-16 18.14.46

Building prioritized care plans has completely changed and revolutionized the way I think about medicine and treating casualties. Before this my thoughts were rather chaotic, attempting to “put out fires,” handling emergencies as they occurred. This is an unorganized and stressful way to handle a crisis.

Continue reading Create a Prioritized Care Plan

PFC Video Series Ep 2: PFC Airway Management

Special Operations and Prolonged Field CareTactical Airway Algorithm

It’s been a while since we have posted anything but I feel the wait was worth it.  Many of us have been deployed, traveling and busy spreading the word.  Thanks to everyone who helped contribute and add advice to this lecture.  I wanted to create this lecture to simply share some information I recently became aware of Continue reading PFC Video Series Ep 2: PFC Airway Management

Podcast Episode 2: UOP-The Best Field Monitor for PFC… and a Word on Hypotensive resuscitation

pfc UOP pic

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.

Click here to listen to Episode 2: UOP-The Best Field Monitor for PFC…and a Word on Hypotensive Resuscitation

Check out the show notes and handout below:

Continue reading Podcast Episode 2: UOP-The Best Field Monitor for PFC… and a Word on Hypotensive resuscitation

Podcast Episode 1: What’s this PFC stuff anyway and why should I care?

pfc 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.

Click here to listen now to Episode 1: What is all this PFC stuff anyway and why should I care?

PFC Video Lecture Series Ep 1: Documentation in PFC

V15 Side 1v 15 Back

I hate hearing about other guys who have had to reinvent the wheel when there is so much to draw from already.  I was initially going to record this as a podcast but quickly realized that there was far too much lost without showing the specific charts and checklists to which I was referring.  If there is anything I left out as far as downloads, let me know and Continue reading PFC Video Lecture Series Ep 1: Documentation in PFC

Position Paper – 10 Essential Core Capabilities for Prolonged Field Care

This post has been a long time coming.  This is where it began and may be the most important tool we have to offer.  This is the 10 Capabilities Position Paper revisited with the grid made easily available.  If you have read the position paper you know that everything we recommend is in the “Minimum, Better and Best” format. Continue reading Position Paper – 10 Essential Core Capabilities for Prolonged Field Care

FOAMed, SMACC and PFC

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.

Continue reading FOAMed, SMACC and PFC

Joint Trauma Service Clinical Practice Guidelines: The Standard of Deployed Medicine

The Joint Trauma System (JTTS)Clinical Practice Guidelines(CPGs) are the standard of care for all US Military

Medcal Providers.  They are backed by evidence and represent the current expectations of care.  Continue reading Joint Trauma Service Clinical Practice Guidelines: The Standard of Deployed Medicine

WE ARE LIVE ON iTUNES!

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. 

Continue reading WE ARE LIVE ON iTUNES!

Telemedicine Issues

Who should medics call for help while managing a critical patient for prolonged periods of time?  Different aspects of this have been discussed via different forums such as the SOMSA lunchtime working sessions and email chain.  We are posting it here in order to reach a wider knowledge base including those who it affects directly such as the medics on the ground.

Continue reading Telemedicine Issues

Recommended Research?

What research would help Medics on the ground provide better care to sick patients in an austere, environment today?  Has anyone ever told you any dogma that you hear but question and can’t find studies for such as; less than 8 intubate, trendelenberg position for hypovolemic patients, etc.?  We have the opportunity to make some of this research happen and use real science to find the best practice for our patients.  We simply need ideas and suggestions for research to be conducted.

Sustainment Training and Continuing Education

Due Outs are issues that we have identified without complete or perfect answers. This is our attempt to crowd source ideas and solutions from as many different perspectives as possible.  If you are a medic, this is your opportunity to speak up and let your surgeons or director know what could work for you.  If you are a provider and have had success with something, please let us know.  Our medics are Continue reading Sustainment Training and Continuing Education

AAR Comments From SOMSA 2014 and other PFC Training events

The following was originally recorded on the white board at the warehouse during the SOMSA training scenario with input from the entire group.  If anything was left out be sure to add it in the comments.  As always, you can read it in full here or download it now and read/reference it later.

Continue reading AAR Comments From SOMSA 2014 and other PFC Training events

Eye Emergencies in Prolonged Field Care

Open Globe Injury

Download the 2016 JTS Ocular Injury Management in PFC Clinical Practice Guideline


Eye emergencies are one of the big 3 concerns; life, limb or eye sight. This will be the first of many installments on PFC specific eye recommendations, Open Globe Injuries. It is presented in a Power Point presentation for easy down load and printing for future reference. This was submitted out of the blue while we were at SOMSA 2014 by a PFCWG partner and a welcomed addition to our reference material.

Download Open Globe Injury Management Graphic

Continue reading Eye Emergencies in Prolonged Field Care

Topics for Prolonged Field Care Training wanted

Here is a message from one of our brothers serving in Germany. I copy and pasted verbatim so that you don’t miss any nuances. My thoughts will be pasted as a new comment after the post to get some discussion going.  Please speak up and let us know what we forgot!

Continue reading Topics for Prolonged Field Care Training wanted

What is a Cuff Manometer and should we be using it? (Yes)

During a break from the lectures at the last SOMSA one of the first issues identified was the lack of knowledge of PEEP and the absence of PEEP valves on BVMs.  Within a few weeks the paper Why we need PEEP valves on BVMs was written, edited and posted for distribution.  Our unit ordered the extremely inexpensive valves and they were distributed down to the medics.  It is now standard to be using PEEP valves and considered less-than-best practice without.

Continue reading What is a Cuff Manometer and should we be using it? (Yes)

PFC Scenario Script

This script is a customizable situation that any provider should be able to pick up and immediately understand.  I will post a link to download it in full as well as the text of it here.  This will allow you to download it to your eReader or tablet right now or read through it and make comments and suggestions at the end.  Please read it and please comment! What other scenarios do you want to see? Do you have any for us? Are yours different? How so? Are we missing something? Was this page easy enough to access?  If you are not able to answer questions with positive feedback we have failed in getting the proper information to the end user, the medic on the ground in the worst place in the world in the worst situation of his life.


Click to Download PFC Scenario NOW

Continue reading PFC Scenario Script

Case Discussion #3: Fall With Lung injury

Fall

Carl sustains a Blunt LUNG injury from a fall from height. He complains of rib pain, but no obvious fractures. Other than tachycardia, his initial vital signs are within normal parameters.  Four hours into the situation, he has an obvious decrease in his pulmonary status (i.e. increasing RR, decreasing SpO2, increase work of breathing, etc.).  Continue reading Case Discussion #3: Fall With Lung injury

Closed Head Injury From ATV Crash: Prolonged Field Care Case Discussion 2

I usually start any PFC lecture I give with a common case such as this in order to drive home the realities of the operational context; a small team operating in the middle of nowhere dealing with a critically ill patient with little to no support.

Remember the “Rules”

Continue reading Closed Head Injury From ATV Crash: Prolonged Field Care Case Discussion 2

Case Discussion #1: GSW w/TQ

Indiginous force

Just as a rehearsal of a tactical operation will prepare the operator to better deal with contingencies, discussing and talking through realistic, hypothetical, medical scenarios will give the medic a good idea to how he might respond should a similar situation arise in real life. We encourage participation in the discussion by all levels of medic, nurse and provider. Constructively thinking through worst-case illness and injuries, through multiple perspectives, will open the eyes of those on the other side of the wire, no matter which side that may be. If you Continue reading Case Discussion #1: GSW w/TQ

Improving Far Forward Care

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