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Special Operations Medical Association
Prolonged Field Care Working Group
This podcast covers medical care targeted to the Special Operations medical community with a focus on providing prolonged care in austere environments.
Jul 6, 2021
92: Ventilation Basics
Sometimes it's good to go over the basics again. Doug gives us the run down on who needs vent management and how to get started.
Jun 17, 2021
91: Paralytics and Vent Management
Everyone knows how hard it is to do good ventilation management using our gear. If the patient is spontaneously breathing in any way it can be next to impossible. Are paralytics the answer? Dennis speaks Evan (ER Doc) and Josh (ICU Doc) about the use of paralytics in vent management.
Jun 3, 2021
90: Abdominal Trauma with Stacy Shackelford
With bleeding from the "Box" causing such a large portion of the potentially survivable deaths, can we go in there? A better question probably "should we?". Stacy goes over how large the actual problem is and better yet, "What can be done", and "what does it take to do it?"
May 20, 2021
89: Getting and Giving Blood with Brad
We're beyond explaining that blood is better than water, when it comes to resus and trauma. Now let's start talking about HOW to do it better. How to collect it faster and give it faster in the austere environment. How can we use the gear we have and optimize this life saving process.
May 8, 2021
Usually, we are sending our patients to a higher level of care. What do you do with the patients you can't? Dennis and Ian go over a timely topic.
Apr 15, 2021
87: Analgesia and Sedation part deux
Jon does this for a living. Dennis discusses some more practical aspects of analgesia and sedation, such as how to assess for pain when your patient is unconscious. Jon also discusses the practicality using IV lidocaine in an austere environment. This is another podcast from the study discussed on IV lidocaine. http://www.oxfordjournals.org/podcasts/bjaed_intravenous_lidocaine_vol_16_issue_9.mp3
Apr 1, 2021
86: Optimize your patient for surgery
Sometimes our patients are too sick to recieve the care they need. Dennis and Mark discuss the decision points of who goes to surgery and when.
Mar 18, 2021
85: Optimizing your patient for Evac
Dennis and the guys from the "Dustoff Medic podcast", discuss optimizing your patient for evacuation. We go over the common mistakes and some of the decision making processes of Load and go or Stay and Play whan it comes to the more invasive procedures.
1 hr 7 min
Mar 4, 2021
84: What if you can't descend? Altitude Illness in PFC
Sometimes it's not an easy decision to turn around and go home. I talk with Dr. Moon, about taking care of a patient with AMS, HAPE, and or HACE in a PFC environment and when is it worth the consequences to evac the patient.
Feb 18, 2021
83: Should we be using a pediatric BVM?
I discuss overventilation with Jeff. Should we be using a pediatric bvm?
Feb 4, 2021
82: Acute Kidney Injury
Dennis and Doug break down the pretty complex issue of dealing with an AKI in the austere environment.
Jan 30, 2021
81: Sepsis in the PFC environment
Dennis along with Doug and Justin discuss the latest PFC CPG on Sepsis Management in the austere environment.
1 hr 5 min
Dec 24, 2020
80: Acute Abdomen
Dennis discusses the acute abdomen with Ian and Tim, but ER docs working in some very remote locations.
Dec 10, 2020
79: Expeditionary Medicine
Dennis discusses a recent trip to Antarctica with Ian and Tim.
Nov 25, 2020
78: Physical Therapy assessments
Dennis and Scott discuss what to do after the life threats have been addressed and the healing begins.
Nov 5, 2020
77: Nutrition in Critical Patients
Dennis talks with Mark on the importantce of nutrition in critically injuried patients.
1 hr 11 min
Oct 15, 2020
76: Herniation Syndromes
Dennis and Dave deep dive into TBI and the various types of herniation. Hint...the most common is not the one we have been trained on.
Oct 1, 2020
Dennis talks with Josh and Jeremy about the Special Operations Medic Coalition, what they are doing for the community, and what's in store for the future.
1 hr 4 min
Sep 17, 2020
74: MSK Trauma considerations
Dennis and Mark discuss considerations in MSK trauma in a PFC environment.
Sep 3, 2020
73: Military medics and their transition to civilian practice
This was a big one. Dennis, Evan, Ricky, and Brock all chimed in on the topic of SOF medics and the transition to civilian practice.
Aug 27, 2020
72: Corticosteroids and SIRS
Dennis and David discuss when is the right time to use corticosteroids.
Aug 13, 2020
71 Fundamental Critical Care Support - Resource Limited
Dennis, Doug, and Jeremy discuss a new course by the Society of Critical Care that has a focus on the resource limited environment,
Jul 30, 2020
70: Paroxysmal Sympathetic Hyperactivity and TBI
Jul 20, 2020
69: Hot Weather Injury
Dennis and Ian discuss Hot Weather injury.
Jul 2, 2020
68: Pediatric Basics
Dennis and Matt Borgman discuss Pediatric trauma.
Jun 18, 2020
67: PFC Airway CPG
Dennis and Collin discuss the long overdue PFC Airway CPG.
Jun 2, 2020
66: Calcium and RDCR
Dennis nerds out with Justin and Ricky on calcium, clotting cascade, and RDCR.
May 15, 2020
65: Airway Mastery
Evan uses his experiences to up our airway game.
May 11, 2020
64.5: Austere COVID 19 CPG
In this podcast Sean goes over the new Austere COVID 19 Clinical Practice Guideline.
May 1, 2020
64: Resiliency and Teamwork
On this podcast Dennis and Mark talk about Resiliency and teamwork during Mark's time working in the ICU during the COVID 19 pandemic in New Jersey.
Apr 17, 2020
63: Oxygenating COVID 19 Patients
Mar 31, 2020
62: Confined Space Rescue
Sean and Dennis discuss considerations for confined space rescue.
1 hr 6 min
Mar 6, 2020
61: TBI Update with Dr. VanWyck
Feb 21, 2020
60: Ian Wedmore on Updates to Cold Weather Injury Treatments
Feb 8, 2020
59: Med Facility Assessment Part 1: What is the Difference Between Levels of Trauma Centers?
Dec 14, 2019
58: Justin on Planning
Oct 30, 2019
57: Snake Envenomation in Austere Environments
1 hr 21 min
Oct 16, 2019
56: Spinal Trauma with Ian Wedmore
Sep 27, 2019
55: JJ and Dennis on HROs
Jul 16, 2019
54: SOP for the Ideal SF Clinic?
Jul 1, 2019
53: Ventilating in the Prone?!
Doug reviews a NEJM article on prolonged proning.
Jun 10, 2019
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 when no prospective randomized controlled trials exist for a specific problem you face. With such a wide scope of practice while deployed and a lack of protocols SF medics are often faced with unique situations in which they must actually weigh the evidence, best practice, guidelines and expert consensus against the given situation. This is a great responsibility not entrusted to many other combat arms troops. In order to weigh the evidence you must first be aware it exists and how to interpret what you are reading. This will help get you on the right path in making informed decisions.
May 30, 2019
51: Tropical Medicine Considerations for Prolonged Field Care 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 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!
May 17, 2019
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.
Apr 19, 2019
49: Set up a Walking Blood Bank
Apr 19, 2019
48: Maximizing Medical Proficiency Hospital Rotations With Mark
Apr 3, 2019
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 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...
Mar 20, 2019
46: Bleeding in the Box: Non-Compressible Torso Hemorrhage with Dr. Mark Shapiro
Feb 25, 2019
45: Regional Anesthesia as an Analgesic Adjunct in PFC
When properly and safely administered regional anesthesia can augment your limited supply of narcotics and ketamine. 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. If you have a portable ultrasound machine and a little practice you can also use the techniques found in the videos made available in by the New York School of Regional Anesthesia.
Feb 6, 2019
44: Prep for Flight and En Route Care
Dec 16, 2018
43: 5 Years of Prolonged Field Care
Nov 26, 2018
42: Wound Care Basics and Beyond
Aug 13, 2018
41: The Death of the Golden Hour
Jul 27, 2018
Episode 40: Medic Team Dynamics with Dennis and Doug
Jul 5, 2018
Doug and Dennis talk about the application and limitations of monitoring ETCO2 in prolonged field care situations.
Apr 12, 2018
38: Far Forward Surgical Support
Mar 29, 2018
37: PFC from the NGO Perspective With Alex Potter of GRM
Mar 10, 2018
36: ROLO to SOLO: The Logistics of Fresh Whole Blood Transfusion
The Tactical Hemostasis, Oxygenation and Resuscitation(THOR) Group 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. In 2015 the Ranger Medical Leadership along with founders of the ROLO program published the paper, "Tactical Damage Control Resuscitation" outlining in detail why they chose to bring back fresh whole blood at the point of injury. Since that time further studies have strongly suggested that the earlier fresh whole blood was transfused, the greater the benefit to the patient. Shackleford et al demonstrated that the greatest benefit to a patient receiving fresh whole blood occurred within 36 minutes of injury. After 36 minutes no decrease in 24-hour mortality was found. Blood must be replaced as soon as possible. The Committee on Tactical Combat Casualty Care also recommends FWB as the first line intervention for patients in hemorrhagi…
Feb 22, 2018
35: Burn Care Priorities With Dr. Cairns of UNC Chapel Hill
Jan 12, 2018
34: Telemedicine to Reduce Risk in Austere Environments
Telemedicine is a crucial capability that must be planned and practiced. The base of knowledge that a SOF medic's knowledge encompasses includes many areas of medicine but generally lacks the depth and experience of specialists available to consult. This depth of knowledge is almost universally available when making a simple telephone call to any number of docs willing to take a call at all times of the day and night. Don't let pride or hubris prevent you from seeking advice from someone more experienced than you in taking care of critically injured, complex patients. Telemedical consult is one of the most important core capabilities in a prolonged field care situation. BOTH the medic making the call as well as the Provider receiving the call must practice and rehearse a telemedical consult placed from a field environment. The medic will gain confidence and be able to relay vital information efficiently in a timely manner. The provider on the other end will have to anticipate problem…
Dec 21, 2017
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.
Dec 9, 2017
32: Doug Explains the Burn Care Clinical Practice Guideline
Burns present another wound pattern that can be extremely difficult and time consuming for any level of provider to manage. So much so that there are dedicated burn teams that will often fly to where burn patients are being held in order to get them back to the burn center in San Antonio with the best chance of survival. We have taken the expert guidance of these critical care providers and packaged everything they have learned into a single clinical practice guideline targeted at the medic and other Role 1 Providers who might find themselves sitting on a patient at a Battalion Aid Station or team house before evacuation is available. Initial priorities such as estimating percentage of body surface area burned, starting fluid resuscitation with the rule of 10s, foley placement along with many others may determine the mortality and morbidity of your patient.
Nov 24, 2017
31: CBRN for Dummies COL Melissa Givens
We recorded this live from the Joint Special Operations Medical Training Center where Guest Lecturer COL Givens, shares the CBRNe knowledge she has learned working (among many other positions) as a Clinical Toxicologist around the world including as the SOCAFRICA Command Surgeon where she personally helped prepare members of 10th SFG(A) to deal with some of the most venomous snakes in the world. COL Melissa (Missy) Givens MD, MPH is a graduate of the United States Military Academy and USUHS alumni. She is board certified in Emergency Medicine with subspecialty training in Clinical Toxicology and Sports Medicine and certification as a Strength and Conditioning Specialist. She is the former program director for the Carl R. Darnall Emergency Medicine Residency and EM-PA Fellowship. She has held various academic and operational assignments and completed several combat tours and deployments with both conventional and Special Operations Forces. COL Givens is currently faculty in the Departm…
Nov 1, 2017
30: REBOA for Prolonged Field Care with Joe DuBose
Dr. Joe DuBose is an Air Force Trauma Surgeon who recognized early in his career that hemorrhage was the number one killer of potentially survivable patients. This led him to a fellowship in vascular surgery and, as Dennis put it made him a guru in the emerging technology that allows a catheter to be placed in the femoral artery and snaked up past a bleed in the pelvis, abdomen and even chest where a balloon is then inflated cutting off all blood flow below that point. Dr. DuBose was the first to do This in the ED using a newer version that had a small enough diameter that a vascular repair would not be required after use. It is simply placed through a central line and removed as such later on. This is called REBOA or Resuscitative Endovascular Balloon Occlusion of the Aorta. As you can imagine this is not without limits and complications if done improperly.
Sep 28, 2017
29: Dr. Cap on Fresh Whole Blood for Resuscitation in PFC
Sep 17, 2017
28: Critical Skills for PFC 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. We will get more into this cycle in the future however, this should be a good place to start. Many thanks go out to Andrew who labored over many versions of the list over the past few months.
Sep 2, 2017
27: Winning in a Complex World
Jim originally gave this talk at SOMSA2017. Due to popular demand, we were able to convince him to rerecord after the conference concluded. Enjoy...
Aug 11, 2017
26: ICRC Style Wound Care
Version:1.0 StartHTML:000000313 EndHTML:000022696 StartFragment:000021664 EndFragment:000022613 StartSelection:000021664 EndSelection:000022613 SourceURL:https://prolongedfieldcare.org/2017/08/11/podcast-episode-25-advanced-icrc-wound-care-and-the-acute-wound-care-management-clinical-practice-guideline/ Podcast Episode 25: ICRC Style Wound Care and the NEW Acute Wound Care Management Clinical Practice Guideline â€“ ProlongedFieldCare.org This Clinical Practice Guideline was written by a fellow 18D with input from around the surgical community. Â It reconciles the differences between wound care done in a role 2 or 3 facility, such as serial debridements, with what is taught in the 18D Special Forces Medical Sergeant Course with regards to delayed primary closure. Â One way is not â€œrightâ€ while the other wrong, it has more to do with the amount of time and resources available to the medic or other provider. Â The remainder of the blog post and podcast is meant to be a…
Jul 21, 2017
24: Infection to Sepsis Round Table Expert Discusion Panel
In this episode Dennis moderates a discussion on recognition and management of sepsis in Prolonged Field Care. We have Doug and Jaybon from the ICU, Jay from the ER perspective along with Paul providing some questions and insight on prehospital and evacuation considerations.
Jul 8, 2017
23: JTS 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.
Jun 20, 2017
22: On Blood, Geir Strandenes at SOMSA2017
This talk was recorded live during the Prolonged Field Care Pre-Conference Lab during the Special Operations Medicine and Scientific Assembly(SOMSA). Dr. Geir Strandenes is a founding member of the THOR(tactical Hemostasis, Oxygenation and Resuscitation) Group, the Senior Medical Officer of the Norwegian Naval Special Operations and a Researcher in the Department of Immunology and Transfusion Medicine at Haukeland University Hospital in Bergen, Norway. He has worked hand in hand wit the US Army Institute of Surgical Research and the US Armed Forces Blood Program.
Jun 3, 2017
21: Optimizing Traumatic Ventilation
Dennis was finally able to corner an anesthesiologist who was actually more than happy to sit down and talk about his years if experience working from the head of thousands of patients. While we are working on an Airway Clinical Practice Guideline with the Army Institute of Surgical Research, this will go along with our earlier posted airway recommendations until we can get a consensus and get it published.
May 11, 2017
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. What are your priorities? How do you assess in the field without labs and imagery? Do you include severe TBI injuries in your trauma training? What if he also has a pelvis injury or internal bleeding? When do you take the airway, if at all? When do you provide positive pressure ventilation in these patients? When is that dangerous?
Apr 30, 2017
19: Infection, SIRS and Sepsis
If you sit on a patient long enough, infection has a greater chance of taking hold and progressing to sepsis, or may receive a patient who has already been sick for days. Doc Jaybon walks us through the full spectrum from infection and SIRS to sepsis, shock and death. Despite firm CoTCCC recommendations for early antibiotics, in the past we may have foregone that luxury because of lighting fast evacuation times, maybe even thinking, 'they'll take care of it at the next echelon.' A great medic should not only treat their patient but set them up for success at the next echelon, as Sepsis is a testament to how poor care during the TCCC phases of care can cost our patients days and weeks in a hospital later. But what if you are your own next echelon? Point of injury to Role 1+ could be your own team house or single litter aid station. Go down the checklist on the right side of the PFC trending chart and make sure you are taking care of anything that could result in an infection. Have you…
Apr 24, 2017
18: TBI Management in PFC
Be sure to visit www.prolongedfieldcare.org for the associated quiz and show notes! Dr. David Van Wyck an Intensivist and Neurointensivist Fellow at Duke Medical Center in North Carolina explains the evolving management of TBI in the field for medics in austere environments. Go to www.prolongedfieldcare.org for the accompanying blog post, shownotes and quiz.
Apr 3, 2017
17: Expectant Patients and Palliative Care
Despite our best efforts, endless training, and reading, some of our patients will die. This has been a taboo subject that is difficult to broach in the best of times. We aim to start a conversation here with the hope thatit continues with your Medical Director, PA, Surgeon and fellow Medics before you are ever faced with this difficult situation out on your own. Often prolonged field care involves treating the most critically sick or injured patients longer than you expect to. Inevitably some of these "sickest-of-the-sick" will not make it in time to see definitive care and you will be left to ease the suffering during end of life care alone. While you may have to deliver end of life care by yourself, you may not have to make all the decisions alone. In this episode Dennis and Doc Powell discuss how to treat expectant patients. This could be as part of a multi-patient MASCAL or a happen to a single patient who is critically ill or injured. If it happens during a MASCAL, once you are…
Mar 17, 2017
16: Sedation in PFC
A follow up to our last analgesia podcast, Dennis hosts Doug and Paul to talk about pearls when dealing with sedation in the ICU and how they translate to care in the field by medics.
Jan 2, 2017
15: Analgesia Case Discussion Podcast with a word on Emerging PTSD Research
Just snow your patient with ketamine and versed to prevent PTSD right? Maybe not. While talking through some more analgesia and sedation strategies, Doc Powell shares his thoughts on what he has read recently and it might blow your mind. It did mine andI'll definitely have to dig in and do more research of my own. We also go through some of the answers to our survey we put out on our last post. For the most part we did pretty good as a whole. There were, however, some dangerous answers such as using propofol or benzodiazepines for pain control, and we will discuss why that's not necessarily such a great idea.
Nov 1, 2016
14: Round Table Crush Injury Discussion
In this episode we gathered around a microphone to discuss the management of crush injury in austere environments including a scenario and the answers to our poll. Go to www.prolongedfieldcare.org to take the follow-up, 3-question quiz to make sure you understand the principles of the latest evidence based recommendations.
Jun 2, 2016
10: Scott Weingart on Ketamine for Prolonged Field Care Part 2
In this episode Paul and Scott Weingart of EMCrit wrap up their discussion about issues with ketamine for military medics
May 29, 2016
9: Scott Weingart Interview on Ketamine for Prolonged Field Care Part 1
In this episode Paul interviews Scott Weingart of EMCrit about issues with ketamine for military medics
Oct 20, 2015
8: Telemedicine - The Basics
Justin and Sean review the basic concepts with telemedicine. Often confused with the technology used, telemedicine, at its most basic form, is calling for remote consultation to help manage a patient. It's a basic concept in civilian medicine, but will require a cultural shift and training to incorporate into SOF and austere medicine. Luckily, the PFC WG, in conjunction with partners at SOCOM and the medical facilities, are jumping into the problem set to bring you the concepts and solutions to some of your operational challenges.
Sep 14, 2015
7: Ketamine and PFC
May 12, 2015
6: Opiate Analgesic Pain Control
Apr 7, 2015
5: Pharm episode II - MSMAID
Mar 18, 2015
4: Pharm for SOF Medics
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 not only combat and austere theaters but also in working with and relating to, SOF medics and the challenges we face. This is the first with more episodes in the series to come. So listen, download, read and understand the principals that, if heeded, can make the lives of you and your patients’ safer and more comfortable. These principals should challenge you and spur you along to learn more about the drugs in the magic, locked narc box and the effects they will have on your patient. If you have questions or comments add them to the comments section of this post at www.prolongedfieldcare.org
Feb 11, 2015
3: Nutrition in Prolonged Field Care
Jan 22, 2015
2: UOP - The Best field monitor for PFC...and a word on hypotensive resuscitation
Now it’s time to bust out some clinical content and talk resuscitation. You can start today! You don’t need fancy equipment or tools. Just reach down and grab something, use a Foley and you’re there…and as a special bonus, you get a little intro on hypotensive resuscitation and why it may not be all that for the long haul…Drs. Phil Mason and Chris Burns are interviewed by Justin.
Jan 9, 2015
1: What's this PFC stuff anyway and why should I care?
This podcast was originally recorded in May, 2014. Some of the information and discussion about the direction of the Prolonged Field Care Working Group (PFC WG) is a little dated, but this will give the listener some idea of what this PFC thing is all about and how the US SOF PFC WG started out. Dr. Sean Keenan is interviewed about the initial development and concept. Enjoy!