Prolonged Field Care Podcast

Mikola, a combat medic from the Ukrainian Special Operations Task Forces, shares his experience and challenges in providing medical care in the war-torn region of Ukraine during SOMSA 24. He discusses the difficulties of operating in a large and constantly changing frontline, with different terrain and medical systems in each administrative region. Mikola explains the concept of medical evacuation and the various facilities and modes of transportation used. He also highlights the dangers faced by medics, including attacks from Russian forces and the use of drones with payloads. Mikola emphasizes the importance of training, supply management, and improvisation in overcoming these challenges. If you would like to see the slides, sign up for our Patreon (link below) and get early access to presentations and more. Takeaways Operating as a combat medic in the war-torn region of Ukraine presents numerous challenges, including a large and constantly changing frontline. Medical evacuation involves coordinating with different facilities and modes of transportation, taking into account the specific terrain and enemy patterns in each administrative region. Medics face significant dangers, including attacks from Russian forces and the use of drones with payloads. Training, supply management, and improvisation are crucial in overcoming the challenges faced by combat medics in Ukraine. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this podcast episode, Dr. DeMello discusses the management of burns in a pre-hospital setting. He emphasizes the importance of following the MARCH approach and not letting the burn distract from other life-threatening injuries. He also highlights the challenges of accurately calculating the total body surface area (TBSA) affected by the burn and recommends using the serial halving method. Dr. DeMello advises against over-resuscitating with fluids and suggests using a simple fluid resuscitation protocol. He also discusses the use of oral fluids and the benefits of allowing patients to have clear fluids. Other topics covered include pain control, escharotomies, cooling the burn, and monitoring urine output. Takeaways Follow the MARCH approach and prioritize life-threatening injuries over the burn. Use the serial halving method to estimate the TBSA affected by the burn. Avoid over-resuscitating with fluids and use a simple fluid resuscitation protocol. Allow patients to have clear fluids if there is no upper airway burn or evidence of inhalational burn. Consider using ketamine for analgesia in burn patients. Cool the burn as quickly as possible, but not the patient. Monitor urine output and look for trends in color to assess for rhabdomyolysis. Provide compassionate care to reduce anxiety and pain requirements. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this episode, Dennis and Alex discuss the importance of reading research papers and critically analyzing their applicability to the operational environment. They review a paper on the role of red blood cells in thrombosis and post-transfusion hypercoagulability. The study found that red blood cell aggregation increased in the presence of tissue factor and calcium. While the study had limitations in terms of sample size and external validity, it raised questions about the use of calcium and tranexamic acid (TXA) in trauma patients. Dennis emphasizes the need to critically assess the need for these interventions based on individual patient factors. The conversation explores the complexity of blood clotting and the challenges of managing critically ill trauma patients. The hosts discuss the activation of blood components, the role of red blood cells in clot formation, and the use of thrombin matrix. They also touch on the age of blood and its impact on clotting, as well as the importance of trauma surgeons in managing these patients. The conversation emphasizes the need for continuous learning and clinical decision-making based on individual patient scenarios. Takeaways Reading research papers and critically analyzing their applicability is important in the operational environment. The study discussed the role of red blood cells in thrombosis and post-transfusion hypercoagulability. Red blood cell aggregation increased in the presence of tissue factor and calcium. The study raised questions about the use of calcium and tranexamic acid (TXA) in trauma patients. It is important to critically assess the need for interventions based on individual patient factors. Blood clotting is a complex process involving the activation of various blood components. Red blood cells play a role in clot formation and can drift to the site of injury. The age of blood does not significantly affect clotting ability. Trauma surgeons are crucial in managing critically ill trauma patients. Clinical decision-making should consider individual patient scenarios and the nuances of clotting. Continuous learning is essential in the field of trauma medicine. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this episode of the PFC Podcast, Colonel Stacey Shackelford discusses abdominal trauma and exsanguinating hemorrhage. He highlights the findings from studies on casualties who died before reaching a surgical hospital, with close to 90% of those deaths caused by bleeding. The majority of potentially survivable injuries resulting in death were from torso hemorrhage, particularly abdominal injuries. The current toolkit for managing abdominal trauma includes pressure dressings, blood transfusions, TXA, and calcium. However, there is a need for further research and development of advanced pre-hospital care options. Takeaways Studies have shown that a significant number of casualties die before reaching a surgical hospital due to bleeding from abdominal trauma. The majority of potentially survivable injuries resulting in death are from torso hemorrhage, particularly abdominal injuries. The current toolkit for managing abdominal trauma includes pressure dressings, blood transfusions, TXA, and calcium. Further research and development is needed for advanced pre-hospital care options to improve survival rates for abdominal trauma. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

The conversation revolves around the topic of ether and its use in surgery. Mike and Brad, both medical professionals, discuss the benefits and drawbacks of using ether as an anesthetic. They highlight its historical significance, safety profile, availability in developing countries, and field expediency. They also mention the flammability and pungent smell of ether, as well as its slower uptake and potential for post-op nausea and vomiting. The conversation emphasizes the importance of understanding ether anesthesia and maintaining high clinical standards in austere settings. In this conversation, Brad, Mike, and Dennis discuss the use of ether as an anesthetic in prolonged field care scenarios. They emphasize the importance of understanding the different stages of anesthesia and how ether can be used for conscious sedation. They also highlight the significance of logistics and problem-solving in austere environments, where medical supplies may be limited. The conversation encourages listeners to do their own research and learn from historical medicine. Overall, the discussion provides valuable insights into the use of ether in resource-limited settings. Takeaways Ether is the foundation for all gas anesthesia inhalation and has been used in surgery since 1846. Ether is simple, safe, and easy to manufacture, making it a viable option in austere settings and developing countries. Ether has a unique safety profile, making it suitable for high-risk patients and trauma cases. Ether is field expedient and can be administered using simple techniques and equipment. Ether is highly flammable and has a pungent smell, but its availability and low cost make it a valuable option in certain situations. Understanding the stages of anesthesia and maintaining high clinical standards are crucial when using ether in surgery. Understanding the stages of anesthesia is crucial for using ether effectively in prolonged field care scenarios. Ether can be used for conscious sedation and is a versatile option for various medical procedures. Logistics and problem-solving skills are essential in austere environments where medical supplies may be limited. Learning from historical medicine and conducting research can enhance medical knowledge and preparedness in resource-limited settings. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this episode of the PFC Podcast, Dennis and Jamie discuss the importance of tourniquet conversion in the context of combat medicine. They explain the difference between tourniquet conversion and tourniquet replacement, emphasizing the need to control bleeding and save tissue. They discuss the timing of tourniquet conversion, highlighting the importance of resuscitation and patient stability. The conversation also covers the physiological effects of tourniquet conversion, including reperfusion injury and metabolic waste products. The hosts provide insights into the challenges and decision-making process involved in tourniquet conversion, as well as the use of calcium and bicarbonate to manage potential complications. They emphasize the need for medics to be prepared, assess the patient's condition, and make informed decisions based on the available resources and clinical guidelines. Takeaways Tourniquet conversion involves making positive efforts to control bleeding or determining that the tourniquet is no longer necessary. Tourniquet replacement is done when there is a need for a better or more proximal tourniquet to control bleeding. Tourniquet conversion should be considered after resuscitating the patient and ensuring they are warm and non-coagulopathic. The timing of tourniquet conversion depends on the tactical situation and the patient's resuscitation status. Calcium and bicarbonate can be used to manage potential complications during tourniquet conversion. Medics should be prepared, assess the patient's condition, and make informed decisions based on available resources and clinical guidelines. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this podcast episode, Dennis interviews Tom Avery, a surgeon who worked in Myanmar with the Free Burma Rangers. Tom shares his experience providing critical care in a war-torn area and the challenges he faced. He discusses the importance of stabilizing patients and bridging the gap between the frontline and higher echelons of care. Tom emphasizes the need for flexibility and creativity in an austere environment and the importance of communication and cooperation with local forces. He also highlights the lessons learned, including the need for in-field sterilization, the value of a mobile ultrasound device, and the importance of a standardized trauma kit. Takeaways Stabilizing patients and bridging the gap between the frontline and higher echelons of care is crucial in a war-torn area. Flexibility and creativity are essential in an austere environment. Communication and cooperation with local forces are key to success. In-field sterilization and cleaning of medical instruments are important considerations. Having a mobile ultrasound device and a standardized trauma kit can greatly enhance patient care. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this podcast episode, Dennis and Brad discuss the use of fentanyl as an opioid analgesic. They explore the history and development of fentanyl, its pharmacological properties, and its advantages over other opioids. They also discuss the administration of fentanyl, including IV and lollipop forms, and the importance of titrating the dose to the patient's respiratory rate. The potential side effects and contraindications of fentanyl are also addressed. Takeaways Fentanyl is a synthetic opioid that was developed in the 1950s as a reliable and titratable pain medication. It has a rapid onset and peak effect, making it useful for pain control in trauma and sedation during procedures. Fentanyl is 100 times more potent than morphine and is typically administered in microgram doses. Respiratory depression is a potential side effect of fentanyl, but it can be managed by monitoring the patient's respiratory rate. Fentanyl lollipops are an alternative route of administration, but they require proper technique and can cause nausea and vomiting. Fentanyl patches are not recommended for prehospital use due to their slow onset and potential for unpredictable drug release. Proper education and understanding of fentanyl's pharmacology and administration are essential for safe and effective use. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this part of the conversation, Dennis and Andy discuss common health issues and injuries that can occur in the jungle. They specifically focus on heat illnesses, musculoskeletal conditions, dermatological conditions, and tropical diseases. They provide tips on how to manage exertional heat illness, such as stopping activity, finding shade, and using water to cool down. They also discuss the importance of proper hydration, nutrition, and hygiene in the jungle. Additionally, they talk about the wet and dry routine for clothing, managing blisters and cuts, and dealing with insect bites and envenomation. In this conversation, Andy discusses various hazards and challenges faced in the jungle, including snake bites, tarantulas and spiders, toxic plants, and scorpion stings. He emphasizes the importance of pre-planning and education to mitigate risks. Andy also highlights the need for specialized equipment and techniques for evacuations in the jungle, such as technical rope rescues and securing stretchers in different modes of transportation. He recommends the Oxford Handbook of Expedition and Wilderness Medicine as a valuable resource for healthcare providers in jungle environments. Takeaways Common health issues in the jungle include heat illnesses, musculoskeletal conditions, dermatological conditions, and tropical diseases. Proper management of exertional heat illness involves stopping activity, finding shade, and using water to cool down. Hydration, nutrition, and hygiene are crucial in the jungle to prevent health issues. The wet and dry routine for clothing helps maintain personal hygiene and prevent skin problems. Proper management of blisters, cuts, and insect bites is important to prevent infections and complications. Educate yourself on the risks and hazards specific to the jungle environment you will be operating in. Pre-plan and practice different evacuation scenarios, considering the challenges of the jungle terrain. Have specialized equipment and techniques for technical rope rescues and securing stretchers in different modes of transportation. Laminate important documents and resources to protect them from the jungle environment. The Oxford Handbook of Expedition and Wilderness Medicine is a valuable resource for healthcare providers in jungle environments. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

This podcast episode discusses the topics of PTSD, TBI, sleep, and suicide, particularly in relation to military personnel. The speaker, Joe Cooper, provides insights into the overlapping nature of these conditions and the need for a comprehensive approach to treatment. He emphasizes the importance of therapy as the primary treatment for PTSD and highlights alternative therapies such as stellate ganglion block, ketamine, acupuncture, cannabis, mindfulness, and testosterone replacement therapy. The episode also addresses the challenges of soldier buy-in and compliance with treatment. The conversation explores the importance of addressing victim status versus hero worship in the context of PTSD. It emphasizes the need for balance and understanding in conveying the impact of PTSD to individuals. The difficulty in connecting with providers and the role of medics in selling the treatment and providing support is highlighted. The conversation also delves into the challenges of soldier identity as a defense mechanism and the misconceptions about PTSD therapy. The importance of sleep in healing and the need for early intervention and post-traumatic growth are discussed. The success of therapy and the efforts of the military in addressing these issues are acknowledged. Takeaways PTSD, TBI, sleep, and suicide are significant issues among military personnel. These conditions often overlap and have high levels of comorbidity. Therapy is the primary treatment for PTSD and has a high success rate. Alternative therapies such as stellate ganglion block, ketamine, acupuncture, cannabis, mindfulness, and testosterone replacement therapy can provide short-term symptom relief. Soldier buy-in and compliance with treatment are crucial for successful outcomes. Addressing victim status versus hero worship is crucial in conveying the impact of PTSD. Medics play a vital role in selling the treatment and providing support to individuals with PTSD. Soldier identity can be a defense mechanism, but PTSD therapy focuses on functionality and does not take away from one's identity as a soldier. Sleep is essential for healing, and sleep therapy can have positive outcomes for PTSD and other mental health issues. Early intervention and a focus on post-traumatic growth can lead to better outcomes for individuals with PTSD. The military is making efforts to address these issues, and the success of programs depends on soldier buy-in. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠