Tag Archives: Discussion

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 medical 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? What is your alternate, contingency or emergency? Do you and the people that may potentially be treating you, fully grasp the principles behind all the fancy, expensive equipment that you use for the environment in which you are operating? The easiest example is the tourniquet. A tourniquet provides the user a secure mechanical advantage to apply pressure to the vessels of a limb or junction over what they would normally be able to reliably apply without something such as a windlass or ratchet system. It also incorporates materials that will not break a wide enough strap to disperse the pressure over a wider area to reduce the chance of iatrogenic injury from a narrow strap or cord. Same with a pad under the mechanism to reduce the incidence of pinching. Once the principles of these devices are fully understood, trial and error testing can begin. You must test what ever it is that you are planning to use in place of a vetted product.

Does it work?

Is it reproducible?

By your less trained partner force?

In the conditions that you will be contending with?

Once you have a plan and begin testing. Make sure you record your results, including tips and pearls so that the next person can duplicate what you did. Here is our post on bleach powder for disinfection and Dakins solution as an example. If you have something that has worked for you, please detail it in the comments below and perhaps we can add it here as an addendum or as a separate post in the future.

Improvised Medical Supplies

What if you have to improvise more than a tourniquet or IFAK contents though? Here is a list put together in the case that you find yourself in a situation where traditional MEDLOG channels cannot keep up with, you have limited budget with which to purchase purpose made supplies, or have extremely limited space with which to travel and transport equipment. This list is not comprehensive and should not limit your imagination. It should, however, help organize your thoughts and jog your memory while on your shopping trip to Walmart or Maxima. Other outlets that have some of these supplies are agricultural stores and, of course, drug stores or apothecaries.

Once you do this locally, even just by taking pictures and comparing items with others. Try doing it while traveling or on deployment to a developing country where there is no Walmart.

Some of the testing and evaluation mentioned above, may have already been done with evidence published in peer reviewed resources. Check back issues of the Journal of Special Operations Medicine. Once you sign up for a membership, either directly with a digital subscription or though a membership with SOMA, you can download all past issues via PDF and search through them. Another resource that every austere clinician should check out is the book, “Improvised Medicine 2nd Edition,” by Kenneth Iserson. I cannot recommend this book enough. As a testament to its popularity, each time I have purchased a copy for a course, it gets reappropriated. The kindle edition is a little cheaper and can’t just walk away. We probably need an Amazon Smile account with all the book recommendations I’ve made but we don’t receive money from any purchases… yet.

What would you add?

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

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 said we also believe that there are fundamental principles which can help

Continue reading Standard Prolonged Field Care Training Curriculum Crowdsource Project

Episode 37: PFC from the NGO Perspective With Alex Potter of GRM

Non-Governmental Organizations, Non-Profits and Volunteers have been providing critical services on the battlefield for millennia. Historically the traditional view of medical care in conflict zones was that the military focused on victory Continue reading Episode 37: PFC from the NGO Perspective With Alex Potter of GRM

Podcast Episode 36: ROLO to SOLO: The Logistics of Fresh Whole Blood Transfusion

The Trauma Hemostasis and Oxygenation Research (THOR) Network including the 75th Ranger Regiment, NORNAVSOF, and others have led the way in re-implementing type-O, low titer fresh whole blood far forward with the Ranger type-O Low titer(ROLO) program. Continue reading Podcast Episode 36: ROLO to SOLO: The Logistics of Fresh Whole Blood Transfusion

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 SOF Medicine.  He made it a point to spend a fair amount of time with surgical teams when possible and has gained quite a bit of real world knowledge that we hope to pass on to a wider audience here. Continue reading Podcast Episode 33: TIVA: Another Look at Pre-Hospital Analgesia and Sedation

Free JSOU Book: “The Death of the Golden hour and the Return of the Guerilla Hospital” COL (RET) Warner D. “Rocky” Farr M.D.

From the Back Cover:

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 to guerrilla warfare medicine—care provided by predominantly indigenous medical personnel under austere conditions with limited evacuation capability— by providing a survey of the historical record in UW literature. Colonel Farr relates many historical experiences in the field, assesses their effectiveness, and lays a foundation for further in-depth study of the subject. The Joint Special Operations University is pleased to offer this monograph as a means of providing those scholars and operators, as well as policymakers and military leaders, a greater understanding of the complex and complicated field of guerrilla warfare medicine.

Download the PDF: The Death of the Golden Hour and the Return of the Guerilla Hospital -COL (RET) Warner D. Rocky Farr MD


http://jsou.libguides.com/jsoupublications/2017


COL (RET) Warner D. “Rocky” Farr Bio

PFC Grand Rounds Talk at UC Davis Health

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

Here is the study he referenced in the video which he also happened to head up for our working group and the Joint Trauma System.

54 pfc cases 20171121DeSoucy

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?

Continue reading Podcast 24: Sepsis Roundtable Discussion

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 much needed answers to some frequently asked questions. Continue reading Podcast Episode 20: TBI Round Table and Case Discussion

How to make labels to practice Medication administration:

Tactical Trauma Casualty Care(TCCC) and Prolonged Field Care can be heavy on the medication administration, but during training we can’t really give our real role player patients or even our mannequins a bunch of narcotics and other controlled substances, so it’s often verbalized in training. Not training on the medication they carry downrange, far from providers, can lead to improper Continue reading How to make labels to practice Medication administration:

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