Prolonged Field Care Podcast

In this episode, I speak with Bryce about the importance of medical team training. What to teach and how to get involvement.

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 that it 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 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 done treating your urgent patients, what do you do when you go back to your expectant patients?  It’s common to skip over discussing and training on losing patients…  Taboo even.  The fact is that it will eventually happen to some of us; No matter how good of a medic we are, patients will die.  Doc Powell has spent innumerable hours in Intensive Care Units with the best and brightest medical teams a patient could hope for.  Even in this setting the top notch care, medicines and interventions are not enough and patients code and die.  This is part of medicine whether we talk about it openly or not and while many of these situations will be complicated and stressful we hope to give you a few tools to help manage the situation in a more professional manner. How do you decide if your critically ill patients are expectant, when alone in a tactical or resource strained environment? After that decision is made, what can we still do? How is telemedicine different for curative vs. palliative cases, if at all?

In this episode I speak with Dr. De Mello, a retired anesthesiologist from the UK, with a lot of experience with burn patients both in the civilian hospital and military. Dr. De Mello is also a professor for the College of Remote and Offshore Medicine (CoROM) Masters in Austere Critical Care program. https://corom.edu.mt/ Lots of tidbits for you to refine your game. Enjoy

Dennis, Doug, and Paul talk through the PFC Analgesia and Sedation CPG

Dennis had the honor of interviewing Dr. John Quinn who's on the  ground working Role 1 medical operations for an NGO somewhere in  Ukraine. The lessons being learned by John and others during the early days of  this conflict and the past 8 years can be used to help those on the  ground now and into the future. This is an amazing opportunity to stay  informed of current events and prepare ourselves  by narrowing expectations and tweaking training. During the interview John stated that anything that can be done to  further enable FWB availability and knowledge would be greatly  appreciated.  In particular, when asked what we could translate, he  asked for: Damage Control Resuscitation guidelines to be  translated, Prehospital Blood guidelines, anything on Damage Control  Surgery for non-surgeons (they have a lot of OB/GYNs and others like  OMFS functioning as DCS surgeons at Role 2s).  He also stated that  they're seeing a TON of TBI "walking wounded" and anything  on mild to moderate TBI management would be great. When asked about a trauma registry, John stated that the Ministry of  Health is attempting to catalogue all civilian casualty numbers.  The  Ministry of Defense is VERY close-hold with any info and it would be  very hard to elicit the ground-truth there for  the time being. John stated that many organizations are using the TCCC cards and all  documentation is trying to be written in BOTH Ukranian and English, due  to the large number of non-native providers helping in country.  They  LOVE the DeployedMedicine app, the translation  of TCCC and Emergency War Surgery and absolutely look to US and NATO  standards of care.

This is our 100th episode! Today I speak with the Godfathers of the  Prolonged Fieldcare Working Group and talk about how things got started  and where things are going in the future.

Jamie, Paul, and Dennis, discuss a difficult scenario with a crush injury patient.

Coadministration of Ketamine and Versed has been practice for quite awhile, but is it best practice?

I realized there are some really good podcasts that haven't seen the light of day in a long while. The is no exception, Jamie discusses crush syndrome and lays out very well how to get it done. I will continue to label all of the reruns and continue to get new podcast out to you guys every two weeks. Enjoy

Of course you could pack the kitchen sink, but....Why? How about we start learning what labs are important, so that we can plan and pack better.