Prolonged Fieldcare Podcast

Mike Weisman — 25 years as a Navy Corpsman and SARC, 27 years on a busy Vegas fire department, now clinical education at Celox — does not sell magic dust. He sells a hydraulic problem.A femoral-rate bleed can dump on the order of 500 mL a minute. The clotting cascade is a 14-step masterpiece built for arterioles, not that jet. Early platelet plug gets blown off the vessel wall unless something holds equal pressure against it. Tourniquet, packed gauze, or packed hemostatic gauze: all of them are pressure tools. The chemistry is the advantage on top.Two families, two jobs. Kaolin (Combat Gauze class) is a clay mineral that lights up Factor XII and accelerates your cascade — which means it still needs time and a body that can clot. Chitosan / cellulose dressings work off the cascade. They absorb fluid, grab red cells by charge, and build a viscous mucoadhesive plug. Granules and sprays exist. Mike's line stays the same: if you do not back them with pressure, you bought a show booth.Then the part schoolhouses skip. The product has to touch the bleeding vessel, not the pool in the hole. Three to six minutes of hold time on a kaolin dressing feels short on the pouch and endless on a screaming casualty. Hemorrhage control is not a monkey skill. Blood programs without packing reps are the cart in front of the horse. Read mechanisms, not company PDFs. Deployed Medicine and independent retrospectives beat the booth.Listen, then pack something that bleeds.prolongedfieldcare.org | @prolonged_field_care | PFC PodcastTop 5 takeawaysIt is a hydraulic problem. Fight pressure with pressure. Chemistry cannot replace a packed tract or a tourniquet.Know the two mechanisms. Kaolin accelerates Factor XII / your cascade. Chitosan-type polysaccharides work independently and form a mucoadhesive plug.Contact the vessel or you wasted the dressing. Clot in a basin of blood is not hemostasis. Anatomy and packing skill are the product.Hold the clock. Kaolin-class products typically need on the order of 3–6 minutes of continuous pressure. The pouch lie is that this is short.Unconscious competence beats the brand. Schoolhouse reps expire. Blood on the truck does not save the casualty if the medic cannot pack. Understand the mechanism, then pick what your system will actually issue.Chapters00:00 Cold open00:19 Dennis + Mike (SARC, Vegas FD, Celox education)01:25 Why not just pressure and plain gauze?02:16 Hydraulic problem: cascade vs femoral-rate bleed03:42 What a hemostatic actually adds03:54 Kaolin: Factor XII, still gauze, still pressure04:54 Chitosan / cellulose: cascade-independent mucoadhesive plug06:03 Charge, RBCs, dual action with the gauze07:07 Granules, sprays, “hummus” pastes — still need pressure08:20 No good hemorrhage control without pressure. Period.08:47 Does it have to touch the vessel? Yes.09:34 Anatomy, packing method, skill — not the brand10:07 Why the 3–5 minute hold feels like an hour10:42 Kaolin activation window (~3–6 min)28:57 Know every item in the bag the way you know a drug29:26 You can spot a professional by the pouch30:11 Hemorrhage control is not a monkey skill31:04 Unconscious competence: pack it blind31:56 Blood programs without packing reps33:04 Schoolhouse months do not last a career34:32 How to read studies that are not the company PDF35:37 Deployed Medicine, JTS workload, mechanisms over marketing37:48 Close: keep getting the reps

OTFC is gone. That was not a small supply hiccup. It punched a hole in the old TCCC pain plan.George Barbee, a PA and co-author of TCCC Guideline Change 25-03, walks Dennis through why the committee rebuilt battlefield analgesia instead of patching the old triple-option chart.They screened 56 analgesics. They built an objective matrix. They landed on suzetrigine: non-opioid, mentation-sparing, slow onset, long duration — a drug that can keep a still-fighting casualty in the fight and then carry them into prolonged care.The bigger shift is the fork in the road. Not “mild / moderate / severe” as four overlapping options. Can they stay in the fight, or not? Functioning casualties get a non-sedating pack. Non-functioning casualties get a shock-agnostic pathway so you are not stacking drugs blindly down the continuum.Ketamine is still the drug you reach for when you have almost no information. Nystagmus is not the goal. It is the “you gave too much, back off” line. Option 4 sedation is being pulled out of TCCC and written into PCC, where it belongs.If you still teach OTFC, still dose to shaking eyes, or still treat every casualty like they need a narcotic, this episode is the update.Read the change paper @ ⁠www.prolongedfieldcare.org⁠or ⁠https://jsomonline.org/⁠Follow @prolonged_field_careTop 5 takeawaysThe change was forced. OTFC disappeared, GWOT safety data said the old plan was too loose, and LSCO needs mission-capable pain control plus a safer path for people who cannot stay in the fight.Suzetrigine is the new stay-in-the-fight drug. Non-opioid. Cognition and blood pressure mostly spared. About a 2-hour onset, long duration. Pair it with meloxicam and acetaminophen for the functioning casualty. Muscle spasm in 1–10% is not a seizure and does not get benzos.Stop using four overlapping “options.” Define pain with the Defense and Veterans Pain Rating Scale. Rough cut: 1–6 can often still function and self-declare. 9–10, polytrauma, multi-amp — they are out of the fight. Medics already know this on sight. The guideline finally says it.Ketamine stays, but the endpoint is not nystagmus. If you have almost no information, ketamine is still the safest narcotic start. Reduction of pain means the casualty and the medic can both manage the situation. Nystagmus means you crossed the line. Fixed-dose ketamine in a bleeding patient can get weird as volume drops — not usually lethal, still a problem.Option 4 is leaving TCCC. Heavy sedation and procedural endpoints are being moved into the PCC update. TCCC keeps the systematic, stack-aware, evidence-based path so the next provider is not surprised by what you already gave.Chapters00:00 — Disclaimer and open00:23 — Dennis and George: who wrote the change02:10 — If it ain't broke, why touch analgesia?02:56 — We lost OTFC03:11 — Safety, LSCO, and early pain vs PTSD04:27 — Mission-capable control and a shock-agnostic path05:48 — How suzetrigine beat 56 other drugs09:38 — Why this non-opioid survived the matrix11:33 — Spasm vs seizure: do not reach for benzos13:33 — Stay in the fight vs cannot14:20 — The old “triple option” was actually four15:06 — Defining pain with the DVPRS16:10 — The stay-in-the-fight pack: suzetrigine, meloxicam, Tylenol17:20 — What “reduction of pain” actually means18:15 — Esketamine: more analgesia, fewer side effects27:38 — If you only get one narcotic, start ketamine28:56 — Esketamine, IN 28 mg, and the 4PANE study30:15 — IV, IO, IM, IN: why they kept the nose33:07 — Pain control vs nystagmus35:26 — Option 4 is moving to PCC36:41 — Chest tubes, crics, and the sedation gap37:54 — Next: backing the PCC analgesia update38:48 — Read JSOM Change 25-03 and close

Recorded live at SOMA 26In a near-peer MASCAL, one medic and one junior medic may face twenty penetrating torso casualties, one unit of blood, and no time to empirically needle or finger-decompress every chest. This SOMA presentation argues that formal triage algorithms are already giving way to intuitive, intervention-first decisions—and that point-of-care ultrasound can make that second pass objective. The proposed two-pass model keeps MARCH as a fast first pass (urgent vs non-urgent), then uses a three-view POCUS exam—parasternal or subxiphoid cardiac motion, pericardial effusion, and bilateral lung apices—completed in under 30 seconds to decide who gets blood, who needs targeted decompression, who needs a surgical airway to thoracotomy or pericardiocentesis, and who is unsurvivable cardiac standstill. Speakers review trauma-arrest survival data, needle-decompression overuse, SOF medic training at Henry Ford (RUSH exam and the abbreviated 30-second protocol), and civilian paramedic programs showing that short courses can produce usable scans that change management. Sponsored by the Special Operations Medical Association.Key TakeawaysEmpiric bilateral chest decompression and “treat everybody” TCCC habits will not scale in large MASCALs when blood, time, and procedural capacity are scarce.Formal algorithms are often unused in real events; medics already default to intuitive triage. The missing piece is an objective tool that separates salvageable from unsurvivable casualties.Published decompression data show low response rates, high practice variation, and procedures performed on patients who did not meet criteria—driven by subjective breath sounds.Cardiac motion on ultrasound is the strongest practical field marker of salvageability in pulseless trauma; standstill without tamponade is associated with essentially no survival and should conserve blood and procedures.A three-view exam (cardiac motion, pericardial effusion, pneumothorax) can be completed in ~25–30 seconds. SOF medics approached expert performance after focused training; civilian paramedics have shown usable accuracy after 4–8 hour courses.Positive findings should drive action: motion → consider blood; effusion + access to thoracotomy/pericardiocentesis → prioritize evacuation/intervention; no lung slide → targeted decompression rather than bilateral empiric procedures.Chapters00:00 – Introduction, disclosures, and the MASCAL problem01:00 – Case: 20 casualties, one unit of blood, empiric procedures02:40 – Intuitive triage vs formal algorithms03:20 – Why empiric needle/finger decompression falls short05:10 – Scarce blood and the need for a modified LSCO triage approach05:50 – Two-pass model: MARCH first, POCUS second07:20 – Three-view exam: motion, tamponade, pneumothorax08:00 – Pulseless trauma survival: civilian and military data11:00 – Cardiac views and what “salvageable” looks like15:20 – Field case: ultrasound guiding thoracotomy and blood use16:00 – Can medics do this? SOF RUSH pathway since 201717:30 – Abbreviated 30-second protocol: retrospective and prospective times19:30 – Civilian 4-hour training and New Orleans scan performance22:40 – Putting it together in MASCAL: salvage the survivable24:00 – Resource rules: motion vs standstill vs tamponade25:30 – Questions and closeListen / follow: podcast → ⁠prolongedfieldcare.org⁠ → ⁠@prolonged_field_care⁠

Medical logistics was an afterthought for a lot of us in GWOT. You submitted a request, something showed up, and everyone joked that the warehouse never read the order. That model does not survive large-scale combat operations.In this episode, Dennis sits down with Jesse Bashel, a medical logistician and acquisitionist, to walk through how SOF medical supply is supposed to work—pre-deployment, on deployment, and after the first 15 days. They cover NSNs versus product names, automatic in-lieu substitutions, Theater Lead Agents for Medical Materiel (T-LAM), the shift from OCO “easy button” money to MFP-2 vs MFP-11 rules, statements of requirement, and why most medical items are service-common (GCC problem) while a tiny slice of SOF-peculiar items stay on MFP-11.The conversation then turns practical: MedLog personnel usually have zero clinical training. How do you teach them why a 6.0 tube matters for a surgical airway instead of an 8.5 ET tube? How do you get logisticians into Ridge Healer, unit training, and field exercises so they stop treating the property book as the mission? And why, in LSCO, logistics itself starts looking like a combat MOS—because the side that can feed, fuel, and bandage longer usually wins.If you are an 18 Delta, flight medic, battalion PA, group surgeon, this one is for you.Key takeawaysOrder by NSN (or full product name + manufacturer), not the nickname you use in the aid bag. Vendors should put NSN placards on tables at SOMA.The system will auto-accept “in-lieu” substitutes unless the logistician blocks it. That is how you get Halo chest seals when you wanted HyFin.SOF units are required to deploy with 15 days of supply. After that, the Geographic Combatant Command (usually MFP-2 / service-common) is supposed to resource the rest; SOCOM MFP-11 covers only SOF-peculiar items (certain CASVAC sets, freeze-dried plasma in some cases, specific antivenoms, etc.).A Statement of Requirements (class I–IX) should be built jointly by the team and the TSOC 180–270 days out when possible, validated by surgeon + J4, then sent to the GCC for a service lead to resource.Most medical products are MFP-2. Do not default everything to “SOCOM will pay.”Close the gap: five-minute education sessions when medics hit the cage, bring logisticians forward on training events, and treat enablers like part of the team instead of a battle squire.In LSCO, supply lines will be targeted. Logistics personnel need to be trained and treated as if they will be on the battlefield—not just in an office.Visit prolongedfieldcare.org, follow @prolonged_field_care, and subscribe so you stay on the bleeding edge of combat medicine.Chapters02:02 – Pre-deployment ordering done right: NSNs vs product names and why you get the wrong chest seal04:24 – In-lieu / substitute items and how to stop the system from auto-accepting them05:24 – Theater Lead Agent for Medical Materiel (T-LAM) catalogs and how they get built07:09 – MFP-2 (service common / common user) vs MFP-11 (SOF peculiar)08:27 – Joint pub requirement: SOF deploys with 15 days of supply10:07 – Who pays for days 16–60? GCC vs US SOCOM headquarters12:10 – Statement of Requirements process: team + TSOC + GCC J4 validation15:58 – MedLog has no medical training—how to educate them before they send the wrong tube21:17 – Closing the operator–logistician distance; policy is not always law26:00 – Retaining SOF-enabler talent instead of rotating everyone back to conventional force28:22 – SUBACUS lessons and why enablers must not be a liability forward30:29 – Two LSCO paradigm shifts: SOF as supporting force + logistics as a combat MOS32:08 – Positional warfare, endurance, and targeting supply lines (bullets, batteries, bandages)32:50 – Where to do the work: put a logistician on the DTS for Ridge Healer and big exercises34:25 – Flip side: teach operators the fiscal and appropriation reality so they can advocate overseas

Ukrainian orthopedic and reconstructive surgeon describes what prolonged field care actually looks like when evacuation from the front line to Role 2 takes three to four days, and sometimes longer. After years of Role 1, Role 2, and evacuation-stage work, he focuses on a problem that now drives limb outcomes: tourniquet syndrome. TCCC made rapid tourniquet application routine; the neglected next step is conversion, replacement, and complication prevention when the casualty remains in the field for hours to days. He shares a three-week Role 1 case series, frontline protocols for resuscitation, antibiotics, and multimodal analgesia, and why communication between echelons is no longer optional. Sponsored by the Special Operations Medical Association.Key TakeawaysCombat has outpaced doctrine: drones, delayed evacuation, and shifting surgical capability forward mean medics now make high-stakes decisions that used to wait for the hospital.In summer–autumn 2025, movement from the front line to Role 2 commonly took three to four days. Complications of prolonged tourniquet time develop during that window, not after arrival.Forces have become highly proficient at rapid tourniquet application for hemorrhage control. Far less attention has been paid to when, how, and under what conditions to convert or remove a tourniquet during extended delayed evacuation.Incorrect application, delayed conversion, and early reperfusion errors at Role 1 create complications that later echelons often cannot fully reverse. Prevention at the first capable point is easier than correction later.Over three weeks at one Role 1, the team reviewed 27 tourniquet cases: 18 already removed before arrival, 5 converted on site, 4 replaced, and 8 presenting with established tourniquet syndrome.A tourniquet left on too long can function as a venous tourniquet. In one ~12-hour case, conversion and wound care were possible; the patient still spent a full day at Role 1 because evacuation remained unsafe.Role 1 care in this environment combines hemostatic resuscitation, Ukrainian MoH / JTS-aligned antibiotic prophylaxis, and multimodal analgesia to reduce opioid dependence while waiting for movement.Drones, shelling, and remote mining remain constant threats to both casualties and medical teams. High-quality Role 1 care still depends on continuous risk assessment and tactical awareness.Continuous case review, data capture, and closed-loop communication from prehospital to hospital are essential so frontline observations can change tactics in real time.Chapters00:00 – Introduction and speaker background 01:50 – Evolving war, prolonged field care, and higher medic responsibility 04:10 – Why tourniquet syndrome now dominates limb outcomes 05:30 – TCCC taught application; the neglected next step is conversion 06:20 – Drones, delayed evacuation, and care shifting pre-evacuation 07:40 – 3–4 day timelines from front line to Role 2 in 2025 08:30 – Role 1 errors that later hospitals cannot fully fix 09:10 – Role 1.5 mission: assess, convert, prevent, stabilize11:50 – Resuscitation, antibiotic, and multimodal analgesia approach 13:10 – Three-week tourniquet case series (27 TQs, 8 syndromes) 15:00 – Case example: 12-hour venous-effect tourniquet conversion 16:20 – When conversion is no longer possible 17:40 – Ongoing battlefield threats to evacuation and medics 18:30 – Continuous learning and echelon-to-echelon feedbackFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Antibiotics are not magic. In this episode of the PFC Podcast, Dennis sits down with Ryan to cut through the common myth that “I've given antibiotics, so the wound is protected.” They unpack why vigorous wound care—irrigation, debridement of dead tissue, clean dressings, and early surgical washout—remains the foundation of infection prevention in combat and prolonged field care, while antibiotics only shift the probabilities after the basics are done.Drawing on historical military medicine (pre-antibiotic eras through GWOT), observational data from the TIDOS study, sepsis timing principles, and real-world experience from Ukraine's prolonged timelines, Ryan explains why mortality is a limited endpoint, why more broad-spectrum antibiotics are not the answer in high-resistance environments, and how medics and corpsmen at the point of injury make the biggest difference.Key TakeawaysAntibiotics help only after good wound care; they never replace irrigation, debridement, and clean dressings.Dead or grossly contaminated tissue will not respond to antibiotics no matter how many doses you give.Mortality is a blunt and uncommon endpoint in modern combat trauma—look instead at reduced wound infections, osteomyelitis, reoperations, and amputations.Practical timing for prophylaxis: ideally within 1 hour, at least within 3 hours (extrapolated from sepsis data).Superficial wounds may need wound care alone; deeper or contaminated wounds benefit from antibiotics once cleaned.Shorter courses (roughly 3–5 days) are often sufficient in stable patients without established infection—stop when the benefit is exhausted.In prolonged or delayed-evacuation settings (Ukraine lessons), vigorous bedside wound care outperforms escalating antimicrobials amid rising resistance.Guidelines often assume basic wound care knowledge; that assumption may need to be made more explicit.The medic or corpsman at the point of injury is the decisive factor; higher-echelon care is supportive.Go to ⁠www.prolongedfieldcare.org⁠ for more austere and prolonged field care resources. Follow @prolonged_field_care on Instagram, subscribe on your preferred platform, and stay on the bleeding edge of combat medicine.Chapters00:00 – Intro & Disclaimer00:21 – Welcome and the Core Question: Do Antibiotics Actually Matter?01:18 – “Antibiotics Aren't Magic” – Historical Context and the Penicillin Era02:17 – What Antibiotics Actually Do (and Don't Do) in Infected Wounds03:14 – Wound Care Has the Bigger Impact04:00 – Pre-Antibiotic Military Medicine Lessons05:04 – Why Guidelines Don't Emphasize Wound Care Explicitly06:49 – Fungal Prophylaxis Debate and “Hot Lights and Cold Steel”09:02 – Combat Medicine as Its Own Specialty and the Loss of Institutional Memory13:17 – Why We Don't Have Clear Mortality Data on Prophylactic Antibiotics16:21 – What Antibiotics Actually Prevent (Complications, Not Early Death)18:48 – TIDOS Study, Observational Evidence, and Current Guidelines21:39 – Ukraine Lessons: Prolonged Care, Resistance, and Wound Care Priority24:31 – King for a Day: Would You Change Prehospital Teaching?27:42 – Timing of Antibiotics: 1-Hour Ideal, 3-Hour Reasonable Window30:03 – When Antibiotics Are (and Aren't) Needed – Superficial vs Deep Wounds32:29 – Withdrawing Antibiotics in the Field – Duration Principles34:16 – Final Thoughts: Wound Care First, Antibiotics Second

Whole Blood Is Not a Solution (Until Conventional Forces Can Deliver It)Recorded live at SOMA 26Dr. Vanessa Hanick (emergency physician, former active-duty Army, now National Guard) and 1SG Cy Clayton (Ranger Regiment veteran, currently a conventional Role 2 first sergeant) deliver a blunt assessment of a critical readiness gap: while whole blood is the agreed standard of care for damage control resuscitation, conventional forces remain largely unprepared to provide it in support of SOF or any large-scale operations. Drawing on recent deployment experience, unit surveys, and Joint Trauma System training observations, they outline three lethal capability gaps—planning, logistics, and training—and call for proactive SOF-conventional collaboration, institutional reform, and immediate use of available Joint Trauma System mobile training teams. Sponsored by the Special Operations Medical Association.Key TakeawaysThe 2021 Joint Trauma System / Defense Committee on Trauma position statement establishes whole blood as the resuscitative fluid of choice that must be available at every echelon and on every evacuation platform within 30 minutes of injury. This is an operational standard, not an aspiration.Conventional forces currently fail this standard across three critical gaps: failure to plan (MASCAL and walking blood bank plans are incomplete, unilateral, or nonexistent), logistical incompetence (unreliable cold chain, storage, transport, and warming), and inadequate training (high failure rates on whole blood transfusion even among medics who pass TCCC recertification).Survey data from conventional brigade-sized elements show near-zero SOPs for walking blood banks, minimal storage capacity, zero transport or warming capability in many units, and cold-chain training limited to vaccines rather than blood.SOF leaders and medics cannot assume conventional support will materialize when needed. Early, deliberate linking with conventional Role 1/2 counterparts—sharing knowledge, training together, and validating capabilities—is essential.Joint Trauma System mobile training teams (including the Blood Whole Blood Training Program) already exist and can travel to conventional units to build pre-hospital, Role 2, and Role 3 whole blood and walking blood bank competency. These resources should be used now.In future large-scale combat operations the problem only intensifies; the time to close the gap is before the emergency, not during it.Chapters00:00 – Introduction and disclosures01:30 – Why SOF–conventional collaboration matters now03:40 – The 2021 JTS whole blood standard and its implications05:50 – Three critical capability gaps in conventional forces06:50 – Gap 1: Failure to plan (Kuwait MASCAL and walking blood bank case study)11:20 – Gap 2: Logistical incompetence (cold-chain failures on deployment)13:20 – Gap 3: Training shortfalls (high failure rates on whole blood transfusion)15:40 – Survey data from conventional units: near-zero capabilities19:20 – Institutional, organizational, and individual solutions21:40 – SOF responsibility: link early, train together, validate capabilities24:40 – Joint Trauma System resources and call to action28:00 – Closing remarks

In this episode of the PFC Podcast, Dennis sits down with missionary surgeon Jason to cut through the noise on real-world wound care in austere and unconventional warfare environments. From the bridge two miles from the front to resource-scarce guerrilla settings, Jason shares hard-won lessons on getting tourniquets off, aggressive debridement, and keeping patients from dying of infection weeks later.You'll hear why most tourniquets can (and should) come off early, how to use the 4 C's (Color, Consistency, Contractility, Capillary bleeding) to decide what stays and what goes, why inactivity is harm, and how daily dressing changes plus early cleaning beat the classic “leave it alone for 5 days” approach in many field conditions. Jason also covers practical logistics, antibiotic reality checks, pain management during dressing changes, and when a wound is actually ready for delayed primary closure.Key takeaways:Get the tourniquet completely off and look—most wounds do not need it left on.Dead tissue, dirt, and debris are the real infection risk; antibiotics cannot fix what you leave behind.The 4 C's give medics a clear, actionable decision tool for debridement.Aggressive early cleaning usually means fewer later trips to the OR, less pain, and better long-term outcomes.In prolonged or definitive field care, the medic who stays with the patient for weeks must own the wound—not just the initial hemorrhage control.Beefy red granulation without cellulitis is the green light for closure decisions; high-tension or complex wounds may still do better left open.Practical, no-nonsense guidance for anyone who may have to manage wounds far beyond the golden hour.Chapters00:00 – Intro & welcome00:20 – Guest intro: missionary surgeon in UW environments01:04 – Tourniquet still on + nasty wound: what actually improves outcome?01:19 – Get the tourniquet off as soon as possible01:40 – Data point: ~70% of tourniquets not needed03:11 – Why taking tourniquets off feels so scary04:14 – Don't lower slowly—get past venous pressure fast05:00 – Simple method: fully loosen, look, reapply only if needed07:17 – Risk of a brief look is low; most bleeding is manageable09:07 – Care under fire vs. tactical field care / PFC mindset12:25 – System solutions for large-scale conflict (push capability forward)14:46 – Optimizing the patient after hemorrhage control15:03 – Minimal tools needed + goal of removing barriers to healing16:18 – The 4 C's of viable tissue (Color, Consistency, Contractility, Capillary bleeding)17:15 – Lean aggressive: dead tissue + debris kills more than a little extra muscle19:05 – Fungal/opportunistic infections and why clean tissue matters22:13 – Early and repeated debridement until only living tissue remains24:00 – How far to go: check compartments, cut questionable tissue30:33 – Dressing strategy after initial debridement30:38 – Copeland method vs. daily (or more frequent) changes33:12 – Checking the wound the next day in austere settings34:34 – Pain control and watching the patient's face during dressing changes37:01 – What the dressing and wound bed should tell you37:35 – Antibiotics: best antibiotic is good debridement40:27 – Logistics in UW: travel light, use partner supplies, stay off the radar42:47 – When is the wound ready for delayed primary closure?45:45 – What Jason wishes more medics would internalizeFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Recorded live at SOMA 26Pierre Pasquier (France) and his German counterpart deliver a clear-eyed assessment of how European military medical systems are preparing for large-scale combat operations and major engagements, drawing heavily on lessons from Ukraine. They examine the scale of expected casualties, the return of mass-casualty and prolonged-care realities, the threat of multi-drug-resistant organisms, the vulnerability of medical treatment facilities to deliberate attacks, and the urgent need for true multinational interoperability. The discussion covers doctrine updates, shared training, data collaboration, civilian-military integration, and the strategic value of medical readiness as a deterrent. Sponsored by the Special Operations Medical Association.Key TakeawaysUkraine has demonstrated casualty rates of several hundred per day—orders of magnitude higher than Iraq/Afghanistan—requiring European medical systems to plan for mass casualties, prolonged field care at scale, and significant disease/non-battle injury burdens, including older soldiers with chronic conditions.Multi-drug-resistant bacteria are already arriving in European hospitals via Ukrainian patients; mass-casualty flows will amplify this biosecurity challenge and demand coordinated infection-control strategies.Systematic attacks on healthcare facilities necessitate a shift to flexible, mobile, low-signature medical treatment facilities that can hide and defend themselves—something current large Role 1–3 structures are not yet optimized for.Lessons from long-evacuation environments (e.g., Sahel) must now be scaled from a handful of patients to dozens or hundreds simultaneously; prolonged care is no longer an exception but a planning assumption.True interoperability requires shared language, clear capability definitions across nations, joint data collection and analysis, and training that moves beyond parallel national exercises to actual patient and team cross-flow.Germany is positioned as a key NATO medical hub for strategic evacuation; France is actively building civilian-military pathways so that civilian systems can absorb returning casualties while military teams remain forward.Medical superiority and demonstrated preparedness function as a strategic deterrent; “stronger together” through SOMA, CMC, shared science, and multinational training is essential.Chapters00:00 – Introduction and European context01:50 – Ukraine as the current laboratory and weekly French/German learning process03:10 – NATO Eastern Front realities and multinational medical challenges05:00 – Casualty rate comparisons: WWII → Ukraine and implications for doctrine07:00 – Disease, non-battle injury, and the multi-drug-resistant bacteria threat09:50 – Attacks on healthcare facilities and the need for mobile, low-signature MTFs12:20 – Lessons from the Sahel: prolonged care scaled for LSCO14:50 – Interoperability experience and the value of shared data and science17:40 – Changing mindsets, nomenclature, and national doctrines (French Sauvetage au Combat update)21:40 – Training together: Vigorous Warrior and the next steps for joint exercises23:10 – Strategic MEDEVAC, Germany as hub, and civilian-military integration25:10 – Take-home messages: new/old challenges, medical superiority as deterrent, stronger together27:20 – Q&A: hospital capacity concerns and integrating U.S. physician assistants

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Mitch (U.S. family practice/ER physician) and Augustine (frontline surgeon with five years of experience) to unpack what it actually takes to build and sustain mobile surgical capability in a high-threat Asian conflict zone.They share the hard-won realities of operating close enough to hear the fighting—often within a mile—while remaining mobile enough to survive repeated bombings. You'll hear how a pre-war physician assistant training program created a ready pool of skilled local providers, how an engineering student turned a broken village diesel generator into life-saving power, and how two family tents duct-taped together became an operating theater.Key topics include life-saving procedures that can actually be done under those constraints (chest tubes, hemorrhage control, laparotomy, emergency C-sections), the critical role of a pre-arranged walking blood bank, the art of improvisation (urine catheter as chest tube), the security reasons civilians and fighters refuse local government hospitals, and why underground facilities are often impossible. Most importantly, they discuss the non-negotiable principles: local invitation and ownership, language and cultural integration, knowing why you are there, and the constant tension between capability and mobility.This is practical, unfiltered prolonged field care for anyone preparing to operate—or train others to operate—when the next facility is days away and the sky is full of drones.Key TakeawaysPre-war training programs (5-year PA model focused on the 80% of common regional problems + trauma) create the only sustainable talent pipeline.Mobility is survival: plan the next location before you need it; a full move still costs roughly one day to tear down and one day to stand up.Improvisation is a core clinical skill—urine catheters become chest tubes when the real ones run out.Walking blood banks beat stored products in this environment if you pre-type the team and cultivate local donors before the first patient arrives.Community ownership and language fluency are force multipliers and personal survival tools; operating without local invitation is a fast way to get people killed.Generators, headlights, and ambulance patterns create detectable signatures; concealment and rapid patient throughput matter more than concrete.Chapters00:40 – Why Mobile Surgical Teams Are Essential in Modern Conflict01:55 – Pre-War Training Program & Building a Ready Talent Pool03:00 – First Lessons from the Golden Week Reality04:30 – Improvising the Facility: Generators, Tents, and Operating Tables07:00 – The Mobility Dilemma: What You Carry vs. What You Leave09:30 – Life-Saving Procedures Actually Performed on the Front Line13:00 – Critical Thinking & Improvisation in Action (Urine Catheter Chest Tube)14:20 – Walking Blood Bank Strategy & Community Engagement17:00 – Language, Trust, and Why Local Integration Keeps You Alive19:00 – Why Patients Bypass Nearby Hospitals21:00 – Access, Invitation, and Working Under Local Leadership23:00 – How Close Is Too Close? Drones, Signatures & Site Selection26:00 – Triage, Patient Flow & Pre-Arranged Evacuation Pathways28:00 – Sourcing Supplies Without Becoming a Target32:00 – Faith, Motivation & Enduring Under Fire32:40 – Underground Facilities vs. Pure Mobility (Ukraine Comparison)36:00 – How Long Do You Stay? Reading the Threat & Knowing When to Move38:00 – Final Reflections: People Over AdrenalineFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Recorded live at SOMA 26Dr. Emily Johnston (Cascadia Mountain Institute) and SFC Ezequiel Mendoza (Arctic Dustoff, Fairbanks) deliver a hard-hitting, field-validated look at how standard tactical medical gear and medications actually perform—and fail—in true Arctic and extreme cold conditions. Drawing from cold-soak testing, simulated combat exercises, and real operational experience, they break down battery and fluid-warmer failures, rapid freezing of IV tubing and blood sets, medication storage realities, tourniquet performance, and the critical need for early frostbite interventions like ibuprofen and iloprost far forward. Practical fieldcraft solutions, insulation strategies, and clear calls for better-designed cold-weather medical systems are front and center.Key TakeawaysNo electronic or mechanical medical device (IV pumps, Buddy Lite warmers, etc.) can be trusted to operate unprotected in Arctic conditions—insulate everything, including fluids and tubing.Fluids and tubing freeze extremely quickly and become brittle; passive warming solutions using insulated containers + chemical heat packs can keep fluids viable for many hours even at –20°F to –30°F.Body heat (base-layer transport systems worn against the skin) is the only reliably consistent way to prevent medication freezing during multi-day cold operations; outer pockets, med boxes, and sling packs routinely fail.Current blood administration sets create major clotting and failure points in the cold; shorter, fully insulated, or redesigned kits are needed.Most common tourniquets performed adequately after freeze-thaw cycles; metal windlasses held up better than plastic ones under extreme cold.Reperfusion injury is the dominant mechanism of tissue loss in frostbite. Early NSAID (ibuprofen) loading and rapid iloprost administration dramatically improve outcomes, yet cold-chain and far-forward delivery of iloprost remain unsolved problems.Manufacturer claims about extreme-cold performance often do not match real-world Arctic testing. Independent field validation is essential before relying on any device or medication in these environments.Chapters00:00 – Introduction & Arctic strategic context04:45 – Operational realities: long evacuation times and limited cold-weather experience06:00 – Battery and device cold-soak testing (IV pump & Buddy Lite)09:20 – Functional testing: frozen pumps, ruptured warmer cartridges, and fluid output11:40 – Practical insulation and pre-warming techniques for fluids13:40 – Medication transport failures vs. base-layer body-heat solutions18:50 – Blood product challenges and call for redesigned cold-weather kits20:20 – Tourniquet performance after freeze-thaw cycles21:15 – Frostbite pathophysiology and the critical role of early ibuprofen + iloprost27:20 – Path forward: needed research, device redesign, and medication stability after freezing29:40 – Closing remarks and Q&A discussionFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠⁠

In this essential episode of the Prolonged Field Care Podcast, Dennis sits down with pediatric intensivist Dr. Sara Bibbens to tackle one of the most challenging and anxiety-inducing scenarios in austere medicine: pediatric burns. From initial trauma assessment using MARCH/ABCDE to nuanced airway decisions in small children, burn resuscitation formulas, fluid management pitfalls, hypothermia prevention, wound care, and safe pain/sedation strategies, this conversation delivers practical, downrange-applicable guidance every combat medic, flight medic, and austere provider needs.Key Takeaways:Stick to MARCH/ABCDE — don't get distracted by dramatic burns; treat life threats first.Pediatric airways swell faster — early intubation considerations (GCS

In this presentation, we take a deep dive into the 300-year history of mobile surgery supporting land campaigns — from Dominique Larrey's ambulance volantes through the Letterman system, Arnhem, the Falklands, Mali, and the current Russia-Ukraine war. Drawing on rare surgical memoirs, battle maps, and personal accounts, the discussion extracts the recurring problems that technology has never fully solved: logistics drag, extended timelines, signature management, and the tension between mobility and capability.We then turn to the horizon. In an era of mosaic warfare and large-scale combat operations, medicine cannot remain a drag factor. The talk explores contractile and expandable surgical systems, single-surgeon reach, austere armored resuscitation teams, underground and containerized facilities, emissions control, and how we expand the surgical workforce under resource constraints while still doing the most for the most.Whether you are preparing for LSCO, SOF support, or prolonged field care in denied environments, the hard-won lessons of the past remain the best preparation for the fight ahead.Key TakeawaysMobile surgery is not new — Larrey, Guthrie, Pirogov, and Letterman already solved (and documented) many of the mobility and triage problems we still face.Institutional memory fades fast. Rare single-edition war surgery texts must be digitized and pushed into training pipelines before the lessons are watered down.In mosaic warfare the linear Role 1–4 model is insufficient. Surgical capability must become a mesh: dispersed, diggable, low-signature, and able to expand or contract with the fight.Big fixed facilities and large tented Role 2/3s become high-value targets. Single-surgeon or small polyvalent teams, pre-dug containers, underground sites, and armored austere teams offer greater survivability and shorter wounding-to-surgery times.Blood, sterilizing capacity, anesthetic volume, and outflow remain the greatest logistic constraints. Expectation management and robust triage (including expectant) will be non-negotiable.Capability can be extended by bringing registrars, ODPs/CRNA-equivalents, and well-trained medics further forward earlier — but this requires deliberate peacetime training and wartime derogations.Command and control, decision-making loops, and the ability to cache or hand off casualties must be rehearsed now, not improvised under fire.Chapters00:00 – Introduction & Scope: 300 Years of Mobile Surgery02:00 – Institutional Memory, Rare Texts & the Risk of Forgetting05:25 – Dominique Larrey & the Birth of the Ambulance Volante07:00 – Guthrie, Napoleonic Lessons & Early British Mobility07:40 – Crimea, Pirogov's Forward Teams & Brunel's Prefabs08:15 – The Letterman System & the American Civil War08:50 – World War I: Auto-Chir, Operating Cars & the Limits of Static Warfare11:15 – Spanish Civil War: Civilian Surgeons & Fluid Fronts12:00 – World War II Desert, SAS & the Reality of Extreme Isolation13:40 – Arnhem, Market Garden & Improvised Care Under Fire16:00 – Varsity, Chindits & the Logistics Drag of Jungle Warfare18:00 – Falklands, Gulf War, Mali & Modern Mobility Challenges19:50 – Ukraine: Extended Timelines, Targeting of Medical Assets & Aged Injuries20:50 – Horizon Scan: Mosaic Warfare & Contractile Surgical Systems22:00 – Dispersion, Digging In, Underground Facilities & Signature Management24:00 – Capability Extenders, Team Composition & Decision-Making Under Constraint25:30 – Logistics, Blood, Sterilization & the Middle Ground Between Fixed and Tiny Teams27:00 – Closing Thoughts & QuestionsFollow @prolonged_field_care and visit prolongedfieldcare.org for more austere and prolonged field care education.

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Alex, CEO of Shannon Mechanics, a Ukrainian company that has produced more than 8,000 drag stretchers and over 330,000 immobilization splints for the front line since the full-scale invasion.Alex shares the raw story of how the company started with scrap materials and construction-store aluminum during the early chaos of 2022, scaled production while operating physically underground with independent power and battery-powered equipment, and refined products based on real soldier feedback. They discuss the BM splint (a more rigid, radiolucent alternative designed for Ukrainian conditions), the philosophy behind their rollable plastic drag stretcher optimized for one-person extraction under drone threat and complex terrain, quality control under resource constraints, the transition from pure volunteering to a sustainable business, and the deeper questions of dignity in life and death, PTSD, and long-term rehabilitation.This is practical, unfiltered insight into how medical manufacturing adapts when supply lines collapse, borders close, and every piece of gear has to work in the worst conditions imaginable.Key TakeawaysMedical equipment designed for true one-person drag evacuation becomes critical when vehicles and multi-person teams are unavailable under drone threat and destroyed terrain.Starting with simple, locally available materials (construction-store aluminum for splints) allowed rapid production when imports were impossible.Operating underground with independent power, internet, and battery-powered tools enables continuity during blackouts and air raids.Visual quality control plus a “donation pile” for minor cosmetic defects keeps functional gear moving to the front while supporting community needs.Sustainable production requires paying people and covering costs—pure volunteering burns out and collapses.Feedback loops from soldiers drive continuous product improvement (rigidity, size options, packing for NATO pouches).Beyond the gear itself, the conversation highlights the need for dignity in recovery of the wounded and the fallen, plus long-term psychological and prosthetic support for survivors.Chapters00:00 – Introduction & Disclaimer00:26 – Meet Alex: CEO of Shannon Mechanics01:15 – Company origins: Revolution of Dignity to 2014–202202:41 – Humble beginnings, scrap materials, and the siege of Kyiv04:55 – Building supply chains under closed borders07:18 – Starting with BM splints, then the Utah/drag stretcher08:06 – Material challenges and community-driven solutions11:20 – Learning the craft, teaching production, and favoring people over full automation13:26 – From volunteering to a sustainable business model16:21 – Quality control process for splints23:20 – Introducing the drag stretcher design philosophy24:02 – Why rigid NATO litters fail in modern Ukrainian conditions25:01 – One-person drag, complex terrain, drones, and secondary injury prevention28:15 – Limitations (sniper fire) and real-world evacuation stories (8 km drag, quad bike integration)30:32 – Hypothermia protection, mud/snow durability, and recovery of the fallen34:40 – PTSD as generational trauma and the need for long-term support40:00 – Managing supply chain volatility and building Ukrainian supplier capacity42:39 – What has allowed the company to succeed during warFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠⁠

In this episode of the Prolonged Field Care Podcast, Dennis sits down with J.R. Pickett — unpack the controversial and high-stakes topic of what used to be called excited delirium.They dig into the history of the syndrome (Bell's mania, acute exhaustive mania, agitated delirium), why major organizations including ACEP, ACMT, and the National Association of Medical Examiners have rejected the term, and the preferred modern language: hyperactive delirium with severe agitation. The conversation covers real-world presentation, the physiologic cascade that can lead to sudden cardiovascular collapse, the critical differences between a contained hospital environment and the uncontrolled street or austere setting, and the hard lessons from the Elijah McClain case.J.R. walks through practical decision-making for EMS and tactical medics: when de-escalation is possible, when sedation becomes necessary, why intramuscular ketamine remains the most forgiving and rapid option for the violently agitated patient, how to prepare for the predictable risks (brief apnea, loss of airway protection, metabolic derangement), and why continuous medical eyes-on monitoring after sedation is non-negotiable. They also address the dangerous intersection of law enforcement and medical care, the myth of “if they can talk they can breathe,” and the growing criminalization of medical decision-making that threatens providers' willingness to engage.Key TakeawaysThe condition is a true medical emergency with historically high mortality, even without restraint or intervention.Engagement ability is a practical field litmus test: if the patient cannot be redirected or answer basic questions, rapid intervention is usually required.Ketamine's wide therapeutic index and rapid IM onset make it the preferred agent for violent agitation when IV access is impossible — but it is not risk-free.Sedation is a procedure. Have airway equipment, monitors, and a clear team plan ready before the drug is given. Continuous medical provider eyes-on is mandatory in the early phase.“If you can talk, you can breathe” is dangerous teaching. Treat complaints of inability to breathe seriously.Noble intent + thorough preparation is the best defense against both bad outcomes and the growing criminalization of medical care.Chapters02:45 – What is (or was) excited delirium? History, physiology, and why the term is being abandoned09:30 – Real-world presentation vs. “just being a jerk” and the challenge of the uncontrolled environment15:20 – Elijah McClain case and the broader controversy around restraint, force, and medical justification21:00 – Causes of severe agitation and the difficulty of sorting them in the field26:45 – Clinical clues and the “can I engage?” litmus test32:10 – The physiology of sudden collapse: acidosis, rhabdomyolysis, and the danger of sudden quiet37:40 – “I can't breathe” and why that teaching is hazardous45:50 – Ketamine deep dive: dosing, therapeutic index, risks, and why it is still the safest rapid option55:20 – Comparison with benzodiazepines and antipsychotics; timing matters01:01:00 – Treating sedation like a procedure: airway readiness, monitoring, team roles, and continuous eyes-on01:10:30 – Police vs. medical roles, the myth of walking away, and the duty to act01:18:00 – Criminalization of medical care and final thoughts on honorable intentFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠⁠

In this raw and eye-opening episode of the PFC Podcast, Dennis sits down with Jason, a general surgeon who completed nine combat deployments (seven in special operations) and has since operated in caves, dirt-floored schoolhouses, living rooms, and active conflict zones across multiple countries with nothing but a small team and minimal kit.Jason breaks down the hard truths of “guerrilla surgery” — what actually happens when you strip away the three-truck, 21-person forward surgical team and force a four-person element to provide meaningful surgical care far forward in denied or unconventional environments. He explains why the biggest barrier to austere surgery is often the surgeon's own mindset, how he went from carrying 60 instruments down to the 10 he actually uses, and the critical (and often misunderstood) difference between damage control surgery and definitive field care when follow-on care is not guaranteed.Listeners will hear real-world lessons on space requirements, sterility compromises, anesthesia options with almost nothing, and the courage required to operate when the alternative is certain death for the patient.Key Takeaways:Reduced inventory forces reduced capability — fighting this reality gets people killedThe surgeon is frequently the biggest obstacle to effective austere operationsHow to ruthlessly pare down to the 10 instruments you will actually useWhy damage control surgery can be the wrong choice when you may never see the patient againThe 10 × 8 × 7 foot rule for creating a functional austere operating spaceHow to make sterility decisions when someone is bleeding to death in front of youAnesthesia progression from local blocks to ketamine, spinal, and general in denied environmentsThe mindset shift required to move from “we can do everything” to “what can we actually do here that adds value?”Whether you're a military surgeon, forward surgical team member, special operations medic, or anyone serious about prolonged field care and austere medicine, this episode will fundamentally change how you think about surgical capability in resource-poor, high-threat environments.Connect with Jason's work through the Four Winds Professional Guild at ⁠www.4wguild.org⁠.Chapters00:00 – Podcast Introduction & Guest Welcome00:55 – Jason's Background: 9 Combat Deployments (7 in Special Operations) & Global Missions02:22 – The Ghost Team Experiment: Why “We Can Do Everything with Less” Is Dangerous04:23 – Why Surgeons Themselves Often Block Effective Austere Operations05:43 – Military Training vs. The Harsh Realities of Austere & Unconventional Warfare08:04 – Paring Down from 60 Instruments to the 10 You Actually Use09:03 – The Hard Realities of War Zones: Doing No Harm When the System Doesn't Exist11:10 – Small Team Dynamics: You Are the Pre-Op, OR, and PACU13:35 – Damage Control Surgery vs. Definitive Field Care in Denied Environments16:42 – What Actually Drives Your Kit: Terrain, Evacuation Times, Aftercare & Patient Population21:08 – Longer Evacuation Times Change Everything About Your Surgical Approach22:17 – The Critical Decision: Quick & Dirty vs. All-In Definitive Care27:02 – The 10 × 8 × 7 Foot Rule: Minimum Space Requirements for Austere Surgery29:28 – Sterility in Austere Environments: Bare Minimum Standards That Actually Matter32:30 – When Non-Sterile Technique Is the Only Way to Keep Someone Alive35:43 – Anesthesia Options When You Have Almost Nothing (Local → Ketamine → Spinal → General)39:01 – Advice to New Austere Surgeons: Courage, Basic Principles & Trial & ErrorConsider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Alex to dissect a controversial claim that calcium is useless for hyperkalemia during cardiac arrest. What started as a social media post that "set his hair on fire" led to a full investigation: reading the primary paper, digging into its references, and uncovering how conclusions can get twisted.They break down the study's methods, limitations, and real applicability to austere, prehospital, and operational medicine — including crush injuries, medical CPR on base, and why black-and-white social media takes often miss the gray reality of medicine. Topics include cardiac membrane stabilization, physiologic mechanisms, JTS CPGs, confounders in resuscitation research, and why you should always chase the references.Key Takeaways:Calcium doesn't lower potassium — it stabilizes the cardiac membrane and buys critical time.The referenced paper has significant limitations (small hyperkalemia subgroup, very sick patients, poor outcomes overall) and does not support abandoning calcium.Medicine is gray: knowledge translation lags, and even published papers can overreach conclusions.In austere/prolonged field care, if your teammate is in arrest and it's safe to act, calcium + bicarb is still worth using while addressing reversible causes (Hs & Ts).Always evaluate studies with PICO, look for confounders, and consider functional outcomes (e.g., Modified Rankin Scale) over simple survival.Peak T-waves are unreliable — treat based on mechanism of injury and clinical suspicion.Whether you're a tactical medic, flight medic, or austere provider, this episode sharpens your critical thinking and reinforces why calcium remains in the toolkit.Resources & Links:JTS Clinical Practice Guidelines on HyperkalemiaProlonged Field Care website: www.prolongedfieldcare.orgFresh PFC Coffee & free downloadsSubscribe, share with your team, and stay on the bleeding edge of austere medicine.Episode Chapters00:00 – Intro & Welcome00:45 – The Social Media Post That Started It: “Calcium is Useless”02:18 – Knowledge Translation Lag & Gray Areas in Medicine06:05 – Why Dennis Dug Into the References08:21 – Does Medical CPR Apply to Operational Medicine?11:06 – PICO Breakdown of the Study (Taiwan Retrospective Review)15:50 – Better Outcomes Than Just “Dead vs Alive” – Modified Rankin Scale17:39 – Study Results: ROSC, Survival, and Neurologic Outcomes21:08 – Physiology: How Calcium & Sodium Bicarb Actually Work in Hyperkalemia28:52 – Field Recognition of Hyperkalemia (Crush Injury, Relative Bradycardia)31:58 – JTS CPGs, Treatment Thresholds (K+ >6.5), and Why Labs Aren't Everything35:40 – Very High Potassium Levels & Prognosis in Prolonged Arrest39:20 – Final Thoughts: Don't Abandon Calcium Based on Weak EvidenceFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Dr. Andre Cap to unpack the evolving role of calcium in trauma resuscitation. What started as the “new hotness” in forward blood transfusion protocols has become far more nuanced. They discuss the dangers of both hypocalcemia and hypercalcemia, how citrate in all blood products binds ionized calcium, cardiac effects, recent observational data showing worse outcomes with hypercalcemia, and practical guidance for when, how, and how much calcium to give in austere and prolonged field care environments.Whether you're running a Role 2, working prolonged field care, or just trying to keep your patient alive until definitive care, this episode challenges long-held assumptions and offers field-practical recommendations.Key Takeaways:All blood products contain citrate, which binds ionized calcium — expect hypocalcemia with significant transfusion.Both hypo- and hypercalcemia are bad; recent data shows hypercalcemia is associated with worse mortality than hypocalcemia.Current TCCC guidance (1g calcium after first unit) was written to fix under-use; it may now be too aggressive in some scenarios.Give calcium after blood products, not before. Consider waiting until after 2+ units in most cases.Slow IV push (over ~5 minutes) through a confirmed good peripheral line; calcium chloride is a vesicant — use caution (gluconate is safer).Avoid calcium chloride via IO if possible. Titrate to clinical response when monitoring isn't available.In refractory shock you can give more, but don't give calcium as a standalone resuscitation drug — it can be harmful without volume replacement.Ideal future state: Bring i-STAT capability forward when feasible and get better RCT data.Perfect for medics, PAs, physicians, and anyone managing hemorrhagic shock in austere environments.Links:⁠www.prolongedfieldcare.org⁠ | @prolonged_field_carePodcast Chapters (with Timestamps):00:00 – Intro & Welcome00:39 – Why Calcium Became “The New Hotness” in Trauma Care01:18 – The Joint Trauma System Audit That Started It All03:46 – Citrate in Every Blood Product – The Science Behind the Bind05:44 – Why We Actually Care: Cardiac Repolarization, Contractility & Vascular Tone08:49 – Hypocalcemia vs Hypercalcemia in Trauma Patients10:21 – Shocking New Data: Hypercalcemia Carries Higher Mortality13:14 – TCCC Guidelines – After First Unit? Is This Too Aggressive?14:03 – When Should You Actually Give Calcium in the Field?19:34 – Clinical Triggers Without Monitoring + Dosing Strategy24:56 – Safety First: IV Patency, Calcium Chloride vs Gluconate, IO Concerns28:44 – When to Stop Giving Calcium & Avoiding Over-Correction32:00 – Historical Lessons: When Calcium Alone Made Things Worse33:39 – Practical PFC Recommendations & Final Thoughts38:04 – Closing & Where to Find MoreFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Alex to break down a hot-off-the-press retrospective study from the Journal of the American College of Surgeons titled “Challenging Legacy Burn Resuscitation Paradigms with Fluid Restriction and Early Plasma.”They dismantle the decades-old “swell to get well” mentality and the classic Parkland formula that has led to dangerous fluid overload, massive edema, and compartment syndromes in burn patients. Instead, they explore a more physiologic approach using lower crystalloid volumes (starting at 2 mL/kg adjusted body weight) plus early fresh frozen plasma (FFP) for patients with larger burns.Key Takeaways:The Parkland formula (4 mL/kg/%TBSA) frequently causes massive over-resuscitation; the new restrictive approach delivered significantly less fluid while maintaining (and often improving) urine output.Capillary leak from glycocalyx damage is the real enemy in burn shock — plasma helps restore oncotic pressure and may reduce third-spacing.Titrate everything to urine output (target 0.3–0.5 mL/kg/hr). Formulas are only a starting point.Use adjusted body weight (ideal body weight + 0.4 × [actual – ideal]) instead of actual body weight for fluid calculations.Early plasma (1–2 units for >30% TBSA) showed a strong signal toward lower mortality, less ventilator days, and reduced renal failure in this study.The Joint Trauma System (JTS) Burn Care CPG still emphasizes early consultation with a burn center — phone a friend early.This approach has direct application for prolonged field care and austere environments, though the study is retrospective and should be implemented thoughtfully.Whether you're a special operations medic, flight paramedic, or managing burns in a resource-limited setting, this conversation will fundamentally change how you think about burn shock resuscitation.Resources:prolongedfieldcare.org (free downloads, worksheets & more)Follow @prolonged_field_care on InstagramJTS Burn Care CPG (CPG #12) – includes the excellent burn resuscitation worksheetChapters: 00:00 – Introduction: Why Burn Care Still Terrifies Experienced Medics03:09 – The Horrifying Reality of Over-Resuscitation (Edema Photos & Leaky Pipe Analogy)05:30 – Understanding the Glycocalyx and Why Crystalloid Leaks So Fast09:05 – The One-Third Rule Myth & Why Fluids Disappear in Sick Burn Patients11:14 – Parkland Formula Breakdown: History, Math & Its Biggest Flaw13:00 – The New Study: PICO, Methods & the Shift to 2 mL/kg + Early Plasma16:54 – Elevator Pitch: What This Paper Actually Found20:06 – Primary Results: Dramatically Less Fluid with the Restrictive Protocol21:24 – Urine Output Reality Check: Why the “Less Fluid” Group Still Hit Targets24:23 – Practical Protocol Breakdown: Who Gets 2 mL vs 3 mL + When to Give Plasma25:30 – Adjusted Body Weight Calculation Explained (and Why It Matters)27:26 – Titration to Urine Output is King – Stop Chasing Vitals29:55 – Dennis Rates the Evidence on the PFC Gestalt Scale30:38 – Why Plasma Makes Physiologic Sense (and Whole Blood May Be Next)35:30 – Study Limitations & Provider Bias Discussion37:30 – Can We Implement This in Prolonged Field Care Right Now?38:38 – JTS Burn Care CPG: The Burn Center Contact You Need to Save42:53 – Final Advice: Titrate Aggressively, Phone a Friend Early, Close the GapFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

In this episode, Dennis sits down with Brock, a civilian critical care flight paramedic who flies Medevac in the States, to break down what it actually takes to move a sick patient from point A to point B — and why drone evacuations are nowhere near as simple as the headlines suggest.They cover the real decision matrix behind scene calls versus interfacility transports, why time-sensitive patients (STEMI, stroke, major trauma) get priority, and the constant safety calculus of weather, maintenance, and crew fatigue. Brock reveals the shocking frequency of “stable” hospital patients who decompensate the moment transport begins — and why the dynamic environment of movement, vibration, and altitude changes everything.They also tackle the hard questions around drone evac: What kind of patient is actually stable enough to fly without a provider? What technology gaps (remote vent/pump titration, redundant IV access, real-time monitoring) must be solved before drones can handle true critical care? And why drone resupply might be the capability we should be training on right now.If you're a medic, planner, or leader betting on unmanned systems to solve evacuation problems in austere or contested environments, this conversation is your reality check.Key Takeaways:Scene crews decide destination based on capability; interfacility decisions are physician-driven.Over-triage happens — CCT assets sometimes get used for patients who could go ground.The “3 to go, 1 to say no” rule keeps aircraft missions safe (weather, maintenance, fatigue).Patients stable in the static hospital environment frequently decompensate once transport starts.True ICU-level patients on vents and drips currently require human titration that drones can't provide.Drone resupply is already viable and should be trained aggressively now.Realistic logistics training prevents dangerous “training scars” in younger medics.Chapters00:00 – Welcome & Why Drone Evacs Are the New Hotness (But Not That Simple)00:27 – Guest Intro: Brock, Civilian Critical Care Flight Paramedic01:59 – Scene Calls vs Interfacility Transports: Who Actually Decides?03:45 – Over-Triage Problem: Using CCT Assets on Patients Who Could Go Ground04:46 – Key Decision Factors: Time-Sensitive Patients (STEMI, Stroke, Trauma, Burns)06:56 – Aircraft Safety Culture: Weather, Maintenance Packages & Crew Fatigue (“3 to Go, 1 to Say No”)09:31 – Ground Critical Care Trucks as Backup When Weather Grounds Flights11:12 – Drone Evacs: What Kind of Patient Is Stable Enough for Unmanned Transport?13:32 – The Core Problem: Static Hospital vs Dynamic Transport Environment15:57 – Why Patients Decompensate in Transport (Real Examples from the Street)18:48 – What Drone Critical Care Would Actually Require (Remote Titration, Redundancy, Monitoring)21:44 – When It's Safer to Leave the Patient Where They Are22:48 – Drone Resupply: Already Working and Why We Need to Train It Now27:03 – Logistics Nightmares in Critical Care Transport28:50 – Training Scars: Why Realistic Logistics Training Matters for Medics29:58 – Closing Thoughts & Where to Find More PFC ContentFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

In this high-yield episode, Dennis sits down with Dr. Jennifer Gurney, Army trauma/burn surgeon and Chief of the Joint Trauma System. They dive deep into the practical realities of wound management in prolonged field care when evacuation is delayed for hours or days.Dr. Gurney shares hard-earned lessons from years of combat casualty care, including:Why “dilution is the solution to pollution” and how to irrigate effectively with limited waterThe dangers of closing war wounds too early and the real risk of invasive infectionsDaily wound assessment, selective debridement, and wet-to-dry dressingsWhen (and how) to use Dakin's solution and medical-grade honeyThe tourniquet trap: why reassessment and early conversion matter more than everNutrition, anatomy awareness, and what actually helps wounds heal in austere environmentsWhether you're a combat medic, SOF provider, or austere medicine practitioner, this episode will change how you approach wounds downrange.Key Takeaways:Clean aggressively — soap + water is your best friendNever close contaminated war wounds early (wait at least 72 hours)Look at wounds daily and remove only clearly dead tissueHoney is a legitimate wound adjunct used even in military burn centersEducation on tourniquet risks is just as important as trainingFull show notes and resources at: ⁠www.prolongedfieldcare.org⁠Follow @prolonged_field_care for more austere medicine content.Episode Chapters 00:00 – Intro & Dr. Jennifer Gurney Introduction01:50 – Why wounds are often an afterthought in the field03:00 – Priority #1: Cleaning the wound (dilution is the solution)04:54 – The deadly mistake of closing wounds too early07:39 – Irrigation volumes and practical water use in austere settings09:45 – Wet-to-dry dressings and micro-debridement12:34 – Daily wound assessment and what a healthy wound looks like15:35 – Anatomy awareness and risks during aggressive cleaning18:42 – Dakin's Solution: History, use, and limitations24:08 – Selective debridement – what to cut and what to leave29:47 – The Tourniquet Trap and importance of early conversion35:03 – Post-conversion wound care timing and technique38:16 – Honey as a powerful wound adjunct (even in burn centers)45:29 – What Dr. Gurney wishes medics did better in the field50:37 – Future ideas: benign bacteria for wound management?51:38 – Final takeaways and closing For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCare⁠⁠Collective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠⁠

In this episode of the Prolonged Field Care Podcast, Dennis talks with Dr. Ryan Maves (infectious disease physician and retired military ID doc) about one of the biggest silent threats in modern combat casualty care: antimicrobial resistance.From the Acinetobacter outbreaks that hit U.S. forces in Iraq and Afghanistan to the even more extreme resistance patterns Ukrainian forces are facing today, Ryan breaks down what actually works (and what doesn't) when you're managing infections in truly austere environments. They cover the landmark TDOS study, why early broad-spectrum antibiotics at the point of injury often create more problems downstream, the practical field choices between cefazolin (Ancef) and ceftriaxone, exact timing for antibiotics in sepsis, push-dose administration hacks, and why “the knife is frequently the best antibiotic.”Ryan also explains that older drugs like doxycycline and minocycline still crush certain resistant organisms and drops the single most important intervention any medic can make to slow resistance.Whether you're a combat medic, flight medic, or just serious about prolonged field care, this episode delivers immediately usable knowledge.Key Takeaways:Broad-spectrum antibiotics (like ertapenem) at the point of injury do not improve outcomes and can drive more resistance later (TDOS data).For penetrating trauma prophylaxis: Cefazolin (Ancef) remains first-line. Ceftriaxone is the best field-friendly balance when you need something a bit broader.Septic shock = antibiotics within 1 hour. Hemodynamically stable but infected = up to 3 hours.Most beta-lactams (ceftriaxone, cefazolin) can be given as rapid IV push — ideal for the field.If the patient isn't clearly improving by 72 hours, stop reflexively adding more antibiotics and aggressively hunt for source control.The single highest-impact thing you can do: meticulous hand hygiene + early, high-quality wound care/debridement. It beats any antibiotic regimen.Old drugs (doxycycline, minocycline) still have real utility against certain MDR organisms when newer agents aren't available.Listen now and upgrade how you think about infection prevention and antibiotic use in prolonged field care.Chapters:00:00 – Welcome & Why Antimicrobial Resistance Should Scare Every Field Medic02:45 – The History of AMR: From Penicillin to Modern Superbugs05:10 – Acinetobacter in Iraq/Afghanistan: The USNS Comfort Story & TDOS Study09:40 – ESKAPE Pathogens & Why Ukraine's Resistance Problem is Next-Level13:20 – The Field Reality: No Microbiology Labs, No Easy Answers16:00 – Rethinking Prophylaxis: Why Narrower Spectrum (Ancef/Ceftriaxone) Often Wins19:30 – Wound Care in Austere Settings: Chlorhexidine vs Soap & Water vs Betadine23:10 – Post-Procedure Cleaning: Chest Tubes, Crikes, and Lines25:40 – Timing of Antibiotics: The 1-Hour Rule for Septic Shock28:20 – Push-Dose Beta-Lactams: Practical Administration in the Field31:00 – When the Patient Isn't Improving: Source Control & the 72-Hour Rule34:30 – Old Drugs That Still Work: Doxycycline, Minocycline & Linezolid37:50 – The #1 Thing That Actually Moves the Needle: Hand Hygiene & Infection Prevention39:40 – Final Thoughts & ResourcesFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

S-Ketamine is now part of the TCCC pharmacopeia; you'd better understand how to use it. Dennis sits down with Pat — a veteran military anesthetist, former Danish Special Operations medical leader, and decades-long ketamine expert — for a deep dive into S-Ketamine. From its development and real-world use in austere environments (including Afghan war wounded and British Field Hospital MERT ops) to practical dosing, side effect management, and why it outperforms morphine in many trauma scenarios, this conversation delivers battle-tested wisdom for medics, PAs, nurses, and SOF operators.Pat shares hands-on lessons from hospital, military, and austere settings: achieving the "thousand-yard stare," managing emergence phenomena, combining with regional anesthesia, IM/IN/rectal routes, and why ketamine shines for hemodynamically unstable patients, refractory asthma, and more. They also discuss training pitfalls, the value of hands-on experience (including vet collaboration ideas), and cultural differences in patient responses.Key Takeaways:S-Ketamine is roughly twice as potent as racemic ketamine — use ~half the dose, but expect the same onset, duration, and side-effect profile (with potentially milder psych effects at mid-doses).Excellent for analgesia and procedural sedation in austere settings; superior hemodynamic stability compared to opioids in hypovolemic trauma patients.S-Ketamine is now included in the 2026 TCCC updates — critical knowledge for every combat medic and austere provider.Practical tips: titrate slowly IV, watch for nystagmus/thousand-yard stare, prepare for emergence with low-dose midazolam + patience, consider regional blocks to reduce opioid needs.Training emphasis: objective endpoints, patient monitoring, planning for side effects, and real-world experience over rote memorization.Whether you're running a prolonged field care scenario, managing a screaming femur fracture, or preparing for the next deployment, this episode arms you with actionable strategies.Subscribe, share with your team, and visit prolongedfieldcare.org for free resources, downloads, and more. PFC Coffee links in the description — fuel for the fight.#ProlongedFieldCare #Ketamine #AustereMedicine #TCCC #SOFMedicineChapters:00:00 Intro & Sponsors + Guest Welcome (Pat's Background)03:30 S-Ketamine vs Racemic Ketamine: Potency, Dosing, and Myths08:45 Early Experiences – Afghan War Wounded & Mass Casualty Ketamine Sedation14:20 Sedation Technique: Thousand-Yard Stare, Nystagmus, Airway Management, Atropine20:10 Emergence Phenomena, Cultural Differences, and Midazolam Management25:50 Battlefield Analgesia – Ketamine Superiority Over Morphine (Bastion Study)30:40 Dosing Strategies: IV Titration, IM/IN/Rectal Routes, Bioavailability37:15 Training Realities – Avoiding the “Middle Zone,” Objective Endpoints, Vet Collaboration43:30 Regional Anesthesia + Ketamine Synergy (Chester Buckenmaier Influence)47:20 Special Populations: Kids, Hemodynamically Unstable, Asthma, Head Trauma, Seizures53:10 Practical Tips for New Providers, Mission Planning, and Austere Pearls58:40 Closing Thoughts & ResourcesFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

In this powerful episode of the Prolonged Field Care Podcast, Dennis sits down with Viktoriia, Chief Medical Officer, responsible for medical care across more than 150 kilometers of active front line. A former OB/GYN who served as a combat medic in 2014–2015 and later on Medevac, Viktoriia shares the raw, real-time evolution of Ukrainian military medicine from outdated Soviet-era training to a battle-hardened system built for drone-saturated battlefields, prolonged evacuations, and extreme resource constraints.They dive deep into how Ukraine rapidly expanded medic scope of practice, trained every infantryman to Combat Lifesaver (CLS) level, pushed aggressive hypothermia management, and achieved a groundbreaking policy change allowing combat medics to deliver low-titer group O whole blood and dry plasma at the point of injury after a specialized 32-hour course.This podcast was recorded in partnership with Leleka Foundation, an American-Ukrainian charitable initiative committed to helping frontline medics in Ukraine save lives. This project creates a vital platform for Ukrainian frontline medics to share firsthand trauma care experience from the battlefield with their American counterparts, strengthening knowledge exchange. Key Takeaways:Train everyone to CLS level — it's the only scalable solution to medic shortages and the targeting of medical personnel.“Prolonged Field Care under fire” is the new reality: limited interventions, maximum security, and ruthless prioritization because the battlefield is completely transparent.Aggressive hypothermia management and intraosseous access have become frontline skills for regular infantry due to hours-to-weeks-long evacuations in freezing trenches.Decision-making under fire is the most critical (and trainable) skill — technical abilities mean nothing without the judgment of when to act.Other militaries should stop preparing for the last war. Use Ukraine's “lessons identified” now, while you still have time to adapt training proactively.Whether you're a combat medic, unit leader, medical educator, or just obsessed with what actually works when everything goes wrong, this episode delivers hard-won wisdom you won't find in any textbook.Chapters00:00 — Welcome & Introduction to Viktoriia Kovach, Chief Medical Officer02:03 — The Core Lesson of the War: Radical Adaptability to Save Lives03:11 — Pre-2014 Medical Training: Soviet-Era Foundations & “Grandfather's Bandages”06:36 — The 2014 Shift: NATO Cross-Training Lands in Ukraine09:38 — Expanding Medic Scope of Practice: Blood, IO Access & Advanced Interventions11:14 — The Modern Training Pipeline: 55-Day Basic General Military Training + Adaptive Period16:01 — Combat Lifesaver (CLS) for Every Infantryman — The Scalable Solution19:39 — Solving the Combat Medic Shortage: Positioning, Internal Instructors & CLS Emphasis23:52 — Drone Warfare Reality: Training Rapid Decision-Making Under Constant Aerial Threat29:07 — Prolonged Field Care Under Fire: Hypothermia Priority, Wound Care & Limited Interventions31:49 — The Blood Transfusion Revolution: 32-Hour Course, Low-Titer O Whole Blood & Dry Plasma36:23 — Lessons Identified: Advice for Commanders Preparing for the Next War39:39 — Closing & ResourcesFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Jeff to tackle one of the most time-sensitive and under-appreciated threats in tactical and austere medicine: anoxic brain injury. They break down exactly what it is, how fast it can progress from unnoticed hypoxia to devastating outcomes, and why the MARCH algorithm plus aggressive prevention of secondary injury are your most powerful tools when oxygen and resources are limited.Key Takeaways:Anoxic brain injury exists on a spectrum — brief drops in SpO2 can cause real damage, and recovery (when it happens) can take days, weeks, months, or even years of rehab.The landmark Arizona pre-post TBI study showed hypoxia and hypotension each increase mortality 2–3×; combined they increase it 5–6×. Updated analysis reveals harm begins at SpO2

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Dr. Mike Falk — pediatric ICU physician with multiple deployments to Iraq, Gaza, and Ukraine — for a raw, practical, deep dive into pediatric care when you're the only asset and evacuation is denied.Most combat medics carry 99% adult gear. Kids still show up. Dr. Falk breaks down the absolute minimalist kit that actually works in austere and combat environments: canine tourniquets for toddlers, the single blue IO you really need, simplified airway choices, push-pull resuscitation with a syringe and stopcock, and a field-expedient needle cric setup.Then he walks through three real cases that expose the brutal decision-making required in prolonged field care:A 4-year-old pulled from rubble with a head injury who decompensates from rising ICPAn 8-year-old with a penetrating chest wound and tension pneumothorax at the thoracoabdominal junctionA 4-year-old with an infected blast wound fracture who develops septic shock days later in a denied environmentYou'll learn weight-based dosing that actually works in the field, why kids decompensate differently, how to mix and run an epinephrine drip with limited supplies, the realities of black-tagging children in mass casualty events, and why these cases stay with providers long after the mission.Key Takeaways:The truly minimalist pediatric kit that won't break your weight limitPractical field management of rising ICP when you have no CT or neurosurgeryPush-pull volume resuscitation and epinephrine drip mixing for pediatric shockWhy penetrating trauma at the 6th–7th rib level is often thoracoabdominalThe emotional and ethical weight of black-tagging kids — and why you must train itMalnutrition's hidden impact on wound healing and sepsis in prolonged scenariosChapters00:00 - Welcome & Why Most Medics Are Unprepared for Pediatric Patients00:57 - The Bare Essential Pediatric Combat Medic Bag02:25 - Canine Tourniquet for Under-2s & Minimalist Hemorrhage Control02:25 - Vascular Access: Why the Blue IO is Usually All You Need03:22 - Simplified Airway: OPAs, NPAs & i-gel Sizes That Actually Matter03:22 - ET Tubes: Why Only 4.0, 5.0 & 6.0 Cuffed Are Necessary04:24 - Push-Pull Resuscitation Technique (Syringe + Stopcock)04:56 - Needle Cricothyrotomy Setup & Critical I:E Ratio Warning07:09 - Case 1 Begins: 4-Year-Old Blast Victim Pulled from Rubble08:47 - Initial Assessment, C-Spine Considerations in Kids & Access12:16 - GCS 11, Pain Control & Why Fluids Make Sense Early14:17 - Hours Later: Decompensation & Rising ICP18:17 - Positioning, Hypertonic Saline Dosing (5 mL/kg) & Decision to Intubate23:13 - Ketamine-Only Intubation, Permissive Hyperventilation & Realities27:51 - The Emotional Toll: Black Tagging Kids in MCI29:44 - Case 2: 8-Year-Old with Right Chest GSW & Tension Pneumothorax31:36 - Chest Seal + Needle Decompression (Anterior Approach Preference)34:23 - Blood Resuscitation (10 mL/kg) & Why Location Matters (Diaphragm Level)40:20 - Case 3: 4-Year-Old with Infected Blast Wound Fracture – Septic Shock42:51 - Broad-Spectrum Antibiotics & Source Control in Denied Environments45:26 - Push-Pull Boluses, Epinephrine Drip Mixing & Permissive Hypotension51:09 - Malnutrition's Impact on Healing & Infection in Prolonged Care56:49 - Final Lessons: Training Black Tags, Calling for Help & Provider PTSD57:32 - Outro & Where to Find More PFC ContentFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this deep-dive episode of the Prolonged Field Care Podcast, Dennis sits down with trauma and critical care surgeon Dr. John McClellan ( University of North Carolina) to cut through the noise on tranexamic acid (TXA) in trauma.They cover the mechanism, who actually needs it, why the dosing shifted from 1g + drip to 2g upfront, pre-hospital decision-making when bleeding is controlled, redosing in ongoing hemorrhage, IM/IO options, seizure and hypotension concerns, the critical 3-hour window, and practical advice for the medic who is truly alone and afraid.Whether you're a combat medic, flight medic, or trauma provider, this conversation delivers actionable clarity on one of the most studied — and sometimes misunderstood — tools in hemorrhagic shock resuscitation.Key Takeaways:TXA is a lysine analog that reversibly (and at higher doses irreversibly) binds plasminogen, preventing its conversion to plasmin and stabilizing clots. It is one of the most evidence-backed hemorrhage adjuncts available.The ideal candidate is any patient you suspect will trigger (or has triggered) a massive transfusion protocol — not just obvious amputations. Err on the side of giving it early in pre-hospital/austere settings to avoid missing occult bleeding.Modern trauma practice favors 2g IV push upfront over the older CRASH-2 regimen of 1g bolus + 8-hour drip because traumatic bleeding is an acute event that needs rapid high plasma levels. The 8-hour drip was designed for elective surgical cases with ongoing bleeding over hours.Overall safety is excellent. Large meta-analyses have not shown a clear increase in thrombotic events attributable to TXA. The bigger practical risks are seizures with doses significantly above 2g and accidental double-dosing due to poor handoff between pre-hospital and hospital teams.Transient hypotension can occur with rapid push, but causality is murky — it is often impossible to separate from the patient's underlying shock state.Redosing is reasonable (another 1–2g) if significant re-bleeding causes hemodynamic instability. Roughly 25% of active TXA can be lost in major hemorrhage/transfusion models.Give TXA within 3 hours of injury for maximum benefit. After 3 hours efficacy drops sharply and some data suggest potential increased bleeding risk.For the solo medic: Preload if your protocol allows. Make TXA automatic once you have access (alongside calcium and blood products). Prioritize rapid transport. TCCC supports IM if no IV/IO is possible, though delivering the full 2g volume can be challenging.Documentation and clear handoff are non-negotiable when pre-hospital TXA is given.Chapters:00:00 – Welcome & Podcast Disclaimer00:25 – Guest Introduction: Dr. John McClellan, Trauma Surgeon01:52 – What is TXA and How Does It Actually Work?03:28 – Who Should Get TXA? The Massive Transfusion Patient04:16 – Pre-Hospital TXA: Bleed Control First or TXA First?07:06 – Safety Concerns: Thrombosis, Seizures & Double Dosing Risks09:54 – Dosing Evolution: CRASH-2, 1g + Drip vs 2g Push in Trauma13:33 – Does TXA Cause Hypotension? Unpacking the Evidence19:12 – IO & IM TXA: Practical Routes When IV Access Is Tough21:46 – Redosing TXA in Ongoing Bleeding or Transport29:37 – Advice for the Medic Who Is Truly “Alone and Afraid”32:21 – The 3-Hour Rule: Why Timing Matters and What Happens After34:14 – Final Thoughts & Practical Takeaways from Dr. McClellanFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

In this episode of the PFC Podcast, Dennis sits down with David Plaster — former U.S. Army combat nurse, medic, and 68 Delta who has lived and worked in Ukraine since 2012, long before the full-scale invasion. David pulls back the curtain on one of the most remarkable stories in modern tactical medicine: how Ukraine built resilient, dispersed, underground manufacturing networks for hemostatic gauze and tourniquets when conventional supply chains collapsed or became targets.From the very first improvised IFACs in 2014 (duct-tape chest seals and all) to scaling production of Krovin Goss / Hemostat gauze at roughly $1 per meter and developing a functional “cat-style” tourniquet that Ukrainian and U.S. SOF tested and trusted, David shares the real mechanics of wartime medical logistics. He explains pre-planned basement factories, compartmentalized production across multiple hidden sites, the shift from volunteers to paid war widows and veterans' families, rigorous quality control, and the constant fight against opportunists, “carpet baggers,” and adversarial intelligence collection.This is far more than a war story — it's a masterclass in austere medical manufacturing, supply-chain resilience, and why training and knowledge will always outperform gear alone.Key Takeaways:Pre-war planning and deep personal networks (built years earlier) are the real force multipliers when supply chains get bombed or corrupted.Highly motivated local workforces — especially people with direct skin in the game (war widows, veterans' families) — can deliver exceptional quality and output even in dispersed, low-tech underground conditions.Dramatic cost advantages ($1/m hemostatic gauze vs. $10+ imported) free up resources to buy more of everything else and keep production sustainable.Dispersed, multi-site manufacturing with compartmentalized components dramatically increases survivability and operational security.Functional analogs that are properly tested (double-blind SOF trials included) can serve as effective bridges when premium Western gear is unavailable or too expensive.The biggest failure point in tactical medicine is almost never the gear — it's implementation and mastery of the basics by everyone, not just medics. Tourniquet application, conversion/repositioning, and preventive medicine thinking belong at the squad-leader level.Medics must operate as advisors and educators. Command emphasis on these skills across the force (not just in the aid bag) is what actually moves the needle on survival.Chapters:00:00 – Introduction & David Plaster's Background (U.S. Army combat nurse in Ukraine since 2012)02:30 – Early Days: 2014 Improvisation, First IFACs, and the Complete Absence of Western TCCC06:00 – The Krovin Goss / Hemostat Gauze Story: Chemistry, Corruption, and the Pivot Underground11:30 – Going Underground: Pre-Planned Basements, Plan B/C/D, and Dispersed Manufacturing Strategy16:00 – Why the Tourniquet Project Started: Fake Chinese Gear, Expensive CATs, and Local Demand23:30 – The Manufacturing Model: Volunteers to Paid Staff, War-Affected Workers, and Quality Control27:00 – Security Realities: Protecting Sites from “Carpet Baggers,” Visitors, and Adversarial Interest30:00 – Bigger Lessons: Training Failures, ASM/Tourniquet Conversion Changes, and Why Knowledge > Gear36:00 – Preventive Medicine Mindset, Medics as Advisors, and Building Systems That Actually WorkFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

In this episode of the Prolonged Field Care Podcast, Dennis sits down with trauma surgeon Mark Shapiro for a no-BS masterclass on wound ballistics. They break down why understanding the physics of penetrating and blast trauma matters in austere and combat environments — even when experience makes you cynical. From high-velocity rifle rounds and their massive temporary cavities to the infectious nightmare of shotgun wounds and the four phases of blast injury, Mark shares hard-won lessons from civilian Level I trauma centers and years training special operations medics and ground surgical teams.They tackle the myths around entry/exit wounds, when (and when not) to explore right upper quadrant gunshot wounds downrange, why you should almost never pack the abdomen or chest from the outside, how to assess neurovascular status in blast-injured extremities, and why bizarre bullet paths and “stable” patients with signs of life can still surprise you.Key Takeaways:Kinetic energy (½mv²) means velocity is king — high-velocity rifle rounds create devastating temporary cavities and fragmentation that can turn one projectile into many.Jacketed rounds still fragment at rifle speeds; never assume a clean through-and-through. Bone fragments act like secondary missiles and can create wounds up to 3x the size of the fragment.For stable patients with right upper quadrant GSWs in resource-limited settings, expectant management can be reasonable — but you must have a plan, know your limits, and be ready to move if things change.Never pack the abdomen or chest from the outside in most cases. It risks pushing debris deeper and worsening injuries. Cover exposed organs if needed, but don't shove gauze into body cavities.Shotgun wounds (especially buckshot/birdshot) are “mobile IEDs” — massive tissue destruction, heavy debris inoculation, and extremely high risk of infection, fistula, and devascularized tissue requiring serial debridement.In extremity blast trauma, assess vascular status (pulses, Doppler signals, color, warmth, capillary refill) and neurologic function. The ~6-hour window to revascularization is critical, but the decision point comes earlier.Training + common sense + adaptability beat rigid protocols when resources are limited. Sometimes the best move is observation.Chapters04:15 – Why Wound Ballistics Knowledge Still Matters (even when you're cynical)08:30 – High-Energy Rifle Wounds: Muzzle Velocity, Kinetic Energy & Spitzer Bullets13:45 – Fragmentation, Tumbling & Secondary Missiles (bone shards & unpredictable paths)18:20 – Clinical Reality: Multiple Injuries & Why “Small Entrance, Big Exit” Is a Myth22:50 – Entry vs. Exit Wounds: When Trajectory Actually Matters (and when it doesn't)26:40 – Right Upper Quadrant GSWs: Explore, Observe, or Expectant Management Downrange?31:10 – The Dangers of Packing Abdominal & Chest Wounds from the Outside34:55 – Low-Energy Pistol Wounds: How They Differ (or Don't) from Rifles37:20 – Shotgun Wounds: Close-Range Carnage, Debris & Infectious Nightmares42:40 – IEDs & Modern Explosives: Blast Physics, Ukraine Patterns & Hard-Ground Effects48:15 – Primary, Secondary, Tertiary & Quaternary Blast Injuries Explained52:30 – Neurovascular Assessment in Blast-Injured Extremities (Conscious & Unconscious Patients)56:45 – Lessons from the Trauma Bay: Common Sense, Training & Knowing When to Deviate from ProtocolFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this high-signal PFC Podcast episode, Dennis sits down with Dr. John Wightman — former 24th Special Operations Wing Surgeon, emergency physician, and one of the world's leading experts on blast injuries. Drawing from decades of clinical, combat, and academic experience (including co-authoring a seminal paper on blast injuries just before 9/11 and multiple combat deployments), Dr. Wightman breaks down the unique pathophysiology, recognition, and prolonged field care management of blast lung injury — the often-hidden threat that can kill even when penetrating trauma doesn't.From the physics of the supersonic pressure wave to practical field decisions on tension pneumothorax, ventilation strategies, fluid management, and avoiding air embolism, this is essential listening for medics, operators, and anyone preparing for large-scale combat operations, urban warfare, or confined-space blasts.Key Takeaways:Primary blast lung injury is caused by the blast wave itself — not fragments or being thrown — and creates unique pulmonary contusions, air leaks, and arterial air emboli risks.Most significant blast lung develops within the first 1–6 hours; subtle dyspnea on exertion can be an early warning.MARCH priorities still rule — aggressively rule out (or treat) tension pneumothorax, even bilaterally, before assuming blast lung.Positive pressure ventilation can worsen outcomes (especially air embolism risk) — use judiciously; CPAP or PEEP may be better bridges when possible.PAO₂/FiO₂ ratio (or SpO₂ on room air) helps stratify severity and predict need for advanced support.Tympanic membrane rupture proves blast exposure but is not required for blast lung.Fluid management must be careful — permissive hypotension may be dangerous in blast lung + shock.Don't forget occult blast bowel injury — delayed perforation is real (up to 8 days).Whether you're running a team in Ukraine-style trench warfare, preparing for mass casualty events, or just want to stay on the bleeding edge of combat medicine, this episode delivers critical, actionable knowledge.Chapters:00:43 - John Wightman Introduction: 32 Years as Air Force EM Physician & Blast Injury Expert02:54 - What Is Blast Lung? Defining Primary vs Secondary, Tertiary, Quaternary & Collateral Injuries05:23 - The Physics of the Blast Wave: Overpressure, Stress Waves & Alveolar Damage09:50 - Pathophysiology: Pulmonary Contusion, Pneumothorax, Air Embolism & Traumatic Pseudocysts12:30 - Timelines: When Does Blast Lung Declare Itself? (Israeli & Combat Data)15:56 - Epidemiology: Confined Spaces, Buses, Buildings vs Open-Air Blasts23:12 - Field Diagnosis & MARCH Priorities — Tension Pneumothorax First28:30 - Advanced Assessment: P/F Ratio, Ultrasound Findings, SpO₂ Guidance35:55 - Ventilation Strategies: When to Intubate, CPAP/PEEP, Lung Protective Settings41:18 - Oxygenation Goals, Fluid Management & Permissive Hypotension Risks52:16 - Air Embolism Management & Patient Positioning56:12 - Other Critical Considerations: Blast Bowel Injury, TM Rupture, Resource Triage01:04:36 - Final Thoughts & Key Advice for Deploying MedicsFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this episode, Dennis sits down with Reagan Lyon, an Emergency Medicine physician and 17-year Air Force veteran who spent the majority of her career in special operations, including time on Special Operations Surgical Teams. While at the Naval Postgraduate School, Reagan wrote a thesis on one of the hardest problems in military medicine: how do you actually build and sustain indigenous medical networks in unconventional warfare and denied environments?Drawing from the Yugoslav Partisan guerrilla hospitals of WWII, modern lessons out of Ukraine, and the harsh realities of occupied territory medicine (including Iran's protest crackdowns), Reagan breaks down why our current Role 1–4 doctrine collapses in these scenarios. She introduces a treatment-goal-based framework instead of capability-based tiers, uses systems dynamics modeling to expose the real chokepoints (training pipelines, blood, patient movement, and capacity), and makes a compelling case for radical cognitive agility and “MacGyver medicine” when the supply chain disappears.Key Takeaways:Why proximity to the fight is both your biggest advantage and fastest way to get compromisedHow to shift from “what gear do we have?” to “what treatment goals can we actually achieve?”The hidden choke points that will kill your casualty care system long before you run out of bulletsWhy forcing the “American way” on partner nations is arrogant and usually counterproductiveThe power (and ethical case) for open-source knowledge to enable a true whole-of-society medical responseWhat needs to change in training, authorities, and interoperability before the next fightIf you're a medic, planner, SOF leader, or anyone thinking seriously about large-scale combat operations or unconventional warfare medicine, this conversation is essential. Reagan doesn't just diagnose the problem — she gives a clear path forward.Chapters00:00 – Introduction & Reagan Lyon's Background (Special Operations Surgical Teams to Naval Postgraduate School)05:15 – Why Tackle an “Unanswerable” Problem? (Avoiding Pat-on-the-Back Academia)09:30 – Historical Context: WWII Guerrilla Hospitals & the Yugoslav Partisans15:45 – The Core Trade-off: Proximity to the Fight vs. Security & Sustainability19:45 – Modern Parallels: Iran Protests, Telemedicine Risks & Ukraine's Brutal Validation24:00 – Why Traditional Role 1–4 Doctrine Breaks in Denied/Unconventional Environments29:30 – A Better Framework: Treatment Goals Over Capability Tiers (Preventable Death Categories)33:45 – Systems Dynamics Modeling: Finding the Real Chokepoints in Casualty Flow38:45 – Model Validation with Ukraine + Limitations of Current Planning Tools42:45 – The Supply Nightmare: Caches, MacGyvering & Building Cognitive Agility49:30 – Partner Nation Engagement: Humility, Coordination & Avoiding the “American Way” Trap56:00 – Whole of Society Medicine: Empowering Civilians Through Open Source (Without Creating Liability)1:02:15 – Reagan's “King for a Day” Recommendations (Training, Interoperability & Authorities)1:07:30 – Closing Thoughts & Where This Work Needs to Go NextFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

In this raw and unflinching episode of the Prolonged Field Care Podcast, Dennis sits down with Thad Snyder (physician, former medic, and brigade surgeon) to tackle one of the most uncomfortable topics in combat medicine: what happens when resources run out, evacuation timelines collapse, and “doing everything” is no longer possible.Drawing from a 72-page crisis standards of care memo (originally written for flu and updated for COVID), Thad explains the shift from standard → contingency → crisis care, the ethical duty to plan for no-win scenarios, and why medics, teams, and leaders must have real conversations about capabilities, limitations, and what “living” actually means after catastrophic injury. They explore palliative/comfort care in austere environments, the emotional weight of those decisions, and practical ways to share the burden so the medic isn't left carrying it alone.Essential listening for medics, operators, team leaders, and anyone preparing for large-scale combat or prolonged operations where the next casualty might not get a bird out for days or weeks.Key TakeawaysThere is a duty to plan for crisis standards of care before you're in the middle of it.Leaders and teams must understand the real capabilities and limitations of their medics—not the 437-task training list.Pre-mission conversations about quality of life, advanced directives, and unacceptable outcomes give medics a moral framework when they have to make the hardest calls.Palliative/comfort care is already happening in modern conflicts (Ukraine, etc.) even if no one wants to talk about it.The emotional and moral burden of end-of-life decisions cannot fall solely on the medic—teams and leaders must share ownership.Staying busy to “do something” can sometimes cause more harm than shifting to dignity-focused comfort care.Chapters00:00 – Intro & Pulling the Crisis Standards Memo from the Closet00:56 – Standard, Contingency, and Crisis Care: What Changes When Resources Vanish02:51 – The Duty to Plan: Preparing for No-Win Scenarios04:55 – Why Commanders Need Brutally Honest Briefs on Medic Capabilities06:20 – Surgical Team Limitations, Non-Survivable Injuries, and Realistic Expectations08:40 – Advanced Directives, Quality of Life, and “Living vs. Being Alive”11:36 – Palliative Care in Large-Scale Combat (Ukraine, Future Conflicts)13:15 – How (and When) to Have These Conversations with Your Team14:38 – The Emotional Reality: Holding Someone's Hand While They Die Is Harder Than Any Procedure20:33 – Real Hospital Examples of Hard End-of-Life Discussions25:58 – What Outcomes Actually Matter to Warriors? (Walking, talking, independence)32:00 – Using Patient Values as a Moral Framework in Crisis35:04 – Offloading the Burden: Team Ownership of Comfort Care Decisions40:43 – Shared Responsibility, Rituals, and Preventing Moral Injury43:14 – Final Thoughts + Where to Get the Crisis Standards DocumentThis episode is heavy, honest, and desperately needed. Share it with your team.For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this powerful episode of the Prolonged Field Care Podcast, Special Forces Detachment Commander Nate shares his journey from medical novice to building a highly effective team clinic SOP. With only one 18D on the team, Nate realized that top cover and systems thinking were critical for success in austere environments. He discusses creating, testing, and refining a practical clinic layout, the "Care Chain" concept, realistic PFC training under fatigue, honest medical risk assessment for commanders, and breaking down the mystique of medicine for the entire team.Key Takeaways:Why commanders must dive into medical capabilities and challenge assumptions instead of leaving it solely to the medic.How to design an efficient SOF clinic using systems thinking and proxemics to reduce friction during prolonged care.The critical importance of testing medical plans with full rehearsals and pushing to realistic limits (fatigue, resource constraints).Treating prolonged field care like any other battle drill: train to standard, not convenience.Strategies for communicating medical limitations honestly to higher command and building a culture of openness.Expanding medical knowledge across the entire ODA to increase team resilience.Whether you're a commander, medic, or operator preparing for austere operations, this episode delivers practical, battle-tested insights on turning medical readiness into a true force multiplier.Podcast Chapters:00:00 - Introduction & Guest WelcomeHost Dennis introduces Nate, SF Detachment Commander, and sets the stage.00:00 - Nate's Medical Journey & First PFC ExerciseHow a failed 24-hour PFC exercise exposed gaps in equipment familiarity, charting, and leadership involvement.03:30 - The Suffolk Experience & Understanding 18D CapabilitiesKey training that gave Nate better appreciation for medics and his own limitations.06:00 - Why Create a Team Clinic SOP?The first overseas deployment, poor rehearsal results, and the lack of existing doctrine for ODA-level clinics.09:00 - Designing the Ideal SOF ClinicSystems-based approach, "Care Chain" concept, layout, storage, vampire kits, proxemics, and reducing friction.13:30 - Testing & Iterating the SOPMoving the entire clinic, rehearsals, learning from failures, and refining based on real feedback.17:00 - Training to Standard vs. Training to ConvenienceComparing medical training to breaching, CQB, and other skills. Why PFC needs to be treated as a battle drill.21:00 - The Power of Realistic, Fatigue-Based TrainingLessons from Suffolk, Rangers' approach, and pushing teams to their actual limits.25:30 - Planning Challenges & Honest Risk AssessmentCommon failures in CONOPs, evac planning, the "death of the golden hour," and testing medical capabilities early.29:00 - Convincing Command & Building a Culture of HonestyCommunicating limitations, resource requirements, and fostering intellectual openness.33:00 - Expanding Medical Knowledge Across the TeamDemystifying medicine, operator-level training, and treating it like ballistics or demolitions.36:30 - Final Thoughts & Call for FeedbackNate's request for community input on the clinic SOP and closing remarks.For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

What happens when a sharp-eyed cruise ship doctor spots a hantavirus amid a sea of hangovers and flu symptoms? In this high-stakes episode of the Prolonged Field Care Podcast, Dennis sits down with Dr. Ryan Maves — combat-experienced infectious disease expert and military medicine veteran — to break down the shocking recent Andes virus outbreak.Far from the next global pandemic, hantaviruses are a real, rodent-borne threat that has hit soldiers before (Korean War, anyone?) and can strike deployed units in austere environments. Ryan delivers hard-hitting insights on rapid diagnosis, the “off-script” decompensation that screams hantavirus, supportive care when there's no magic antiviral, and — most importantly — prevention strategies that actually work in the field.If you operate in rodent-infested buildings, set up in abandoned structures, or just want to trust your gut when a patient goes south fast, this episode is required listening. Real talk from the A-team who are currently managing these patients stateside.Key TakeawaysClassic presentation: Flu-like prodrome (fever, fatigue, myalgias, GI upset) for a few days followed by sudden shock, respiratory failure, and decompensation.Bedside diagnostic gold: Thrombocytopenia (low platelets) + hemoconcentration (elevated hematocrit) in a previously healthy patient = major red flag.Treatment reality: Purely supportive — fluids, pressors, oxygen, renal support. No silver-bullet antiviral; ribavirin has limited data at best.Prevention beats everything: Humans are dead-end hosts. Avoid aerosolizing rodent urine/feces/droppings (no dry sweeping!). Use bleach, N95 (or equivalent), gloves, and gown.Human-to-human spread: Extremely rare except with Andes virus (this outbreak strain). Still, treat unknowns with respect.Military relevance: Endemic in deployment zones worldwide; occupying previously rat-infested buildings is a classic risk. History tied directly to U.S. troops in Korea.Mindset: When things go “off script,” trust your clinical instincts over machines. The best tool in the field is still an experienced medic's gut.Chapters00:00 – Welcome back to the PFC Podcast00:26 – Introducing Dr. Ryan Maves & the cruise ship outbreak00:55 – Why this isn't the next pandemic… but still matters03:04 – Military relevance: hantaviruses in deployment zones03:51 – How the cruise ship doc nailed the diagnosis05:27 – Clinical syndrome & the “virus-y” prodrome07:04 – Key labs: thrombocytopenia + hemoconcentration explained09:42 – Disease progression and why young healthy people can still crash10:50 – History of hantaviruses (Korean War → Sin Nombre → Andes)12:21 – Who actually dies and why14:50 – Biocontainment units and the military experts on the case17:35 – Treatment in the field: supportive care only19:35 – Shock management: distributive + capillary leak20:55 – Prevention is king: rodent control & PPE tactics24:22 – Human-to-human transmission (Andes virus exception)27:31 – Infection control, differential diagnosis, and real-world precautions30:08 – Final thoughts: clinical acumen, zoonoses, and trusting your instincts32:32 – Closing & where to find more PFC contentGrab your N95 and hit playFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this hard-hitting episode of the PFC Podcast, Dennis sits down with Doug, a cardiothoracic ICU physician, for a no-fluff deep dive into ACLS with a heavy focus on pulseless VT and VFib in austere, military, and prolonged field care environments.From deciding when CPR is worth it under fire or in a mass casualty scenario, to running a lean team code with minimal personnel, nailing high-quality BLS, working the H's and T's under chaos, post-ROSC pitfalls, antiarrhythmics, and the gut-wrenching decision of when to call it — this conversation delivers practical, experience-based wisdom you won't find in standard ACLS class.Whether you're a medic, PA, physician, or team leader operating far from a hospital, this episode gives you the mental framework and tactical edge to give your teammate the best possible shot at survival.Key Takeaways:Scene safety and triage realities — when not to start CPRHow one knowledgeable person can effectively run an entire code by delegating roles (CPR rotations, timer, airway, meds, defibrillator)Prioritizing actions in resource-limited environments: early high-quality CPR + epi > everything elseWhen and how to practically apply the H's and T's (especially hypovolemia, acidosis, hypoxia, and tension pneumo)Post-ROSC critical care: preventing rearrest, airway management, sedation, and treating the “two patients” (heart + brain)Amiodarone vs Lidocaine — when to use whatRealistic termination of resuscitation guidelines, the difference between witnessed vs unwitnessed arrest, and the value of objective outside input (telemedicine)The power of bringing the team in for closure when the fight is overChapters00:00 – Intro & Welcome00:57 – Can you really do CPR in the field? Safety, triage, and mass casualty realities02:57 – Running a code with minimal trained personnel – how one leader directs chaos06:02 – Essential team roles: CPR rotation, AED/pads, airway, access, and early epi09:08 – Making the H's and T's actually useful (hypovolemia, acidosis, hypoxia, tension physiology)16:53 – Post-ROSC care: Preventing rearrest, airway security, sedation, and neuroprotection20:41 – Antiarrhythmics – Amiodarone vs Lidocaine, dosing, and post-arrest infusions22:53 – The hard call: When to terminate resuscitation (witnessed vs unwitnessed, resources, hypothermia exception)28:19 – Emotional reality of coding teammates and giving families/teammates closure33:21 – Final pearls: Telemedicine, ultrasound/video for handoff, STEMI considerations, and medevac prep36:03 – Closing thoughts & resourcesFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this no-fluff, high-stakes episode of the PFC Podcast, Dennis sits down with Patrick Liebel - trauma/ICU surgeon to tackle the injury that makes every medic's stomach drop: penetrating abdominal trauma.When the golden hour stretches into days, evacuation is delayed, and your patient's belly is a black box of bleeding, contamination, and impending sepsis, what do you actually do? Patrick delivers hard-earned, practical wisdom on hemorrhage control, evisceration management, permissive hypotension, antibiotics, nutrition, peritonitis, and abdominal compartment syndrome — all tailored for the austere, resource-limited prolonged field care environment.If you carry a medic bag and might one day face a guy with his guts hanging out and no surgeon in sight, this episode is required listening. Real talk, real decisions, real consequences.Key Takeaways (Actionable Gold for Every Medic):Mesenteric torsion = widespread ischemia → never spin the bowel for hemorrhage control. Clamp or ligate targeted vessels instead.Clamping is fine in the heat of the moment — revise to ligation later when safe. Remember: every vessel has two ends.Eviscerated bowel is happier inside the abdomen. Tuck it back if you can (keep it wet, protect it). Only widen the defect if ischemia is imminent and you're in a controlled setting.Solid organ (liver/spleen) bleeding → permissive hypotension is your only friend. Titrate to mental status + palpable radial pulse. Track trends, not single numbers.Assume hollow viscus injury until proven otherwise. Hit it hard and early with antibiotics (Ceftriaxone + Flagyl is the practical winner most teams actually carry).Nutrition: If they're hungry, stable, soft abdomen, and no peritonitis after 1–2 days → feed them. Start slow, listen to the patient.Peritonitis = bad news. You've done everything possible with antibiotics and resuscitation — now you're buying time for definitive surgery.Abdominal compartment syndrome is rare with whole blood resuscitation but lethal if it develops. Watch for progressive distension + organ dysfunction (urine output drop + respiratory failure).Document everything. Trends in vitals, urine output, mental status, and abdominal exam are your lifeline in PFC.Chapters:00:00 – 01:30 Welcome & Patrick Liebel Introduction01:30 – 08:00 Hemorrhage Control: Clamping, Ligating, and Why You Should Never Spin the Bowel08:00 – 14:30 Evisceration Management — Tuck It, Widen It, or Leave It?14:30 – 25:00 Solid Organ Injuries & Permissive Hypotension in PFC25:00 – 35:00 Prolonged Critical Care Monitoring, Urine Output, and Trend Analysis35:00 – 42:00 Contamination Control, Antibiotics, and Hollow Viscus Injuries42:00 – 49:00 Nutrition, Ileus, and When to Feed49:00 – 57:00 Peritonitis, Sepsis, and Abdominal Compartment Syndrome57:00 – End Final Pearls, Nursing Care, and Closing ThoughtsFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this episode of the PFC Podcast, Dennis sits down with Kevin — a Nurse Anesthetist (CRNA) with deep experience in hospice/oncology floors, Level I trauma ICUs and ERs, military nursing, and years in austere environments, including a Role III in Baghdad. Kevin delivers straight talk on the most overlooked, time-consuming, and life-saving phase of Prolonged Field Care: nursing care.He answers the exact question every medic wants to know: When does nursing actually start? Then he walks through the full reality of what “nursing” means in the field — from relentless data gathering and charting, to turning patients, pulmonary toileting, skin care, oral care, managing the mess (yes, including bowel movements on litters), and preventing the downstream killers like pressure ulcers, ventilator-associated pneumonia, and sepsis that can undo even perfect damage-control surgery.You'll get practical austere hacks (including Kevin's legendary Barbasol shaving cream trick), training advice that actually works, how to know when the patient is truly stable, when to escalate to a provider, and why evacuation must remain the primary plan — not prolonged field care.Key Takeaways:PFC nursing starts the moment life-saving interventions (hemorrhage control, surgery, cric, chest tubes, etc.) are complete and the patient is stabilized — not during the gunfight or initial resuscitation.Skin care and turning patients prevents deadly complications — pressure ulcers, infections, and sepsis can kill a patient with otherwise survivable injuries.Austere game-changer: Barbasol shaving cream + washcloths cuts through blood, stool, grease, and debris without drying out skin. Bring cheap bottles.First hour priorities: frequent vitals/assessments, confirm stability, get fluids/sedation/maintenance running, then move to the full nursing checklist.Set clear “left and right limits” / parameters for teammates or non-nurses so you can actually rest, rearm, or plan the next mission.Best training: Work real ICU/floor shifts (especially weekends when staffing is thin) — mannequins and sims don't teach the time sink or the “why.”Mindset shift: Move from high-speed, high-adrenaline interventions to the “boring but essential” maintenance phase. If it feels boring, you're probably doing it right.Strategic reality: Evacuation (Medevac or CasEvac) should stay the P in your PACE plan. Prolonged field care with high casualty volumes and limited resources is an enormous time and math problem — history (WWII South Pacific, etc.) proves it.Chapters:01:50 – When Does Prolonged Field Care Nursing Actually Start?04:39 – The Foundation: Data Gathering, Assessments & Charting07:03 – The Full Laundry List of Bedside Nursing Interventions09:26 – How to Train Real Nursing Care (ICU Shifts Beat Mannequins)11:46 – The Critical First Hour: Settling In & Confirming Stability14:04 – Head-to-Toe Assessment, Pulmonary Toileting, Oral Care & Eye Care16:16 – Real Talk: Skin Care, Turning Patients, Bowel Movements & Preventing Ulcers/Sepsis20:50 – How Long Until the Patient Is Truly Stable? (The Pregnant Pause)34:49 – Patient Changes: When to Call the Provider & Setting Left/Right Limits41:34 – Common Pitfalls Medics & Teams Make in PFC Nursing48:59 – Nursing Care Plans, Early Ambulation & Broader Patient Needs54:26 – PACE Plan Reality Check: Why Evacuation Must Stay Priority #1For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

In this high-yield, no-fluff episode, Dennis is joined by Dr. Michael Falk, a pediatric emergency medicine physician, former academic, and combat-experienced relief worker who has run airways in Haiti post-earthquake, Mosul during the ISIS fight, Ukraine, and Gaza. They break down exactly why pediatric airways are a completely different beast in prolonged field care and give you field-proven tactics that actually work when you're the only one there with a BVM and a prayer.Key Takeaways You Can Use TomorrowPositioning is everything: One to two inches under the shoulders (or whole body) prevents automatic obstruction from the massive occiput.Adjuncts > early tube: NPA or OPA + side-lying (gravity is your friend) can keep you from tubing in the field.Tube sizing rule: Child's pinky ≈ ET tube diameter. Depth = 3× tube size. Always go smaller — you can ventilate, you can't un-damage a ripped airway.Intubation mindset: Kid airway is more anterior and cephalad. Slow down, work your way in, or you'll be in the esophagus.GCS decision:

In this high-value episode of the PFC Podcast, Dennis reconnects with Brad for a no-fluff, combat-medic-focused breakdown of fentanyl—the fast, predictable, cardiovascularly stable synthetic opioid that belongs at the front of every aid bag. From its 1950s Belgian lab origins to real-world battlefield use, Brad shares hard-earned lessons on why fentanyl beats morphine and Dilaudid in trauma, how to titrate it safely in the dirt, and why it's the perfect partner for procedural sedation. Whether you're pushing IV doses, deploying lollipops, or wondering why patches are a bad idea, this is the practical, experience-packed guide every prolonged field care provider needs.Key TakeawaysFentanyl is your new “run-home-to-mama” opioid—faster, more predictable, and more stable than morphine in trauma.Titrate aggressively but smartly: 50 mcg IV bumps every few minutes guided by respiratory rate; cut to 25 mcg if hypotensive.Perfect for both analgesia AND procedures—pair with Versed for synergy and ketamine for deeper sedation without burning through your supply.Lollipops work great when used correctly (800 mcg is the money dose); add Zofran for the second one and wet the mouth if dry.Ditch the patches for acute care—they're slow, unpredictable, and risky in the field.Protect your supply: Prefer vials over ampules and store smart—fentanyl is too valuable to lose to breakage.Bottom line: Understand the drug, respect the respiratory depression, and you'll have one of the most powerful, titratable tools in modern combat medicine.Chapters00:00 – Welcome back to the PFC Podcast01:20 – History of fentanyl: Developed in Belgium to beat morphine & Demerol03:35 – Why fentanyl was engineered as the ideal titratable opioid (onset, peak, duration)05:52 – Pharmacology advantages: 100× potency of morphine, 50 mcg = 1 cc, CV stability, no histamine release08:12 – Side effects, respiratory depression, and debunking “wooden chest syndrome” in field doses11:39 – Real-world IV titration: Start at 50 mcg, titrate to respiratory rate in the dirt16:13 – Fentanyl for pain control vs. procedural sedation (Versed + fentanyl + ketamine combos)19:01 – Strategy debate: Versed first or fentanyl first?23:27 – Best patients for fentanyl (and who to skip it on)26:47 – Why fentanyl is the trauma opioid of choice27:29 – Routes: IV is king, IM works but…27:48 – Fentanyl lollipops (Actiq): 800 mcg sweet spot, proper technique, “poor man's PCA,” Zofran hack36:42 – Fentanyl patches: Why they're a terrible idea in acute/trauma settings44:08 – Final pearls: Vials vs. ampules, protecting your supply, and why you need this drug47:53 – Wrap-up and outroFor more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this must-listen episode, Dennis sits down with Dr. Jon Andrews—former 5th and 20th Group Special Forces medic turned Duke-trained anesthesiologist (pediatric & cardiac fellowships)—to tackle one of the biggest headaches in austere medicine: you have a tiny box of opioids and ketamine, a long mission, and a patient who needs to stay alive AND comfortable.They break down exactly how to stretch every milligram using real OR strategies adapted for prolonged field care: patient-specific planning, smart titration, multimodal synergy, regional blocks, ketamine myths, and when (and how) to layer non-narcotics without crashing your patient or your supply.Why this episode matters: Acute pain becomes chronic pain. Chronic pain leads to opioid dependence, PTSD, and worse outcomes. In the field, your choices today shape your patient's tomorrow—and whether you still have meds left when the next casualty shows up.Key TakeawaysStart low, titrate smart. Cut your first dose in half on sick or unstable patients. You can always give more—never the other way around.Multimodal is mission-critical. Hit pain from every angle (blocks + ketamine + acetaminophen + judicious NSAIDs) to dramatically reduce opioid requirements and prevent chronic pain pathways.Ketamine IS an analgesic. It's not just dissociation—it's an NMDA antagonist that blunts central sensitization and has proven opioid-sparing effects.Schedule your non-opioids. Acetaminophen (1 g IV/PO/PR q6h) and longer-acting adjuncts form your baseline; use fentanyl or morphine only for breakthrough.Blocks beat everything—if you can do them. Pre-emptive regional anesthesia (when feasible) is the single highest-yield move before surgical stimulus hits.Monitor like your life depends on it. Heart rate, blood pressure, and respiratory rate are your best pain score when the patient can't talk.Plan for worst-case evacuation. Bring more than you think you'll need and dose for the opioid-naïve or opioid-tolerant reality in front of you.Why treating hypertension in the OR (or field) almost always starts with fixing pain firstThe “start low, see response, add more” mantra every austere provider needsWhy Tylenol often performs as well as morphine in blinded ED studies (and why your patients still doubt it)Real talk on ultrasound-guided blocks in 2011 vs. today—and why proficiency still mattersThe dangerous synergy of opioids + benzos + ketamine on respiratory driveWhy you must get comfortable decreasing doses, not just ramping them upChapters01:55 – The austere reality: limited narcotics and why your favorite med won't last forever03:37 – OR planning vs. field reality: opioid-naïve vs. chronic users05:57 – Multimodal analgesia explained (blocks, ketamine, Tylenol, NSAIDs, dexmedetomidine)08:28 – Patient & mission factors that should drive your loadout12:23 – Golden rule: start low, titrate to effect, monitor vitals15:05 – Sick-patient hack: cut your mental dose in half16:01 – Is ketamine actually an analgesic? (NMDA, opioid-sparing, PTSD data)19:12 – Extending your supply: bolus vs. infusion, redosing strategy24:27 – First-line multimodal choices in the field27:43 – Juggling multiple agents: timing, scheduling, and longer-acting blocks30:15 – Regional anesthesia timing—pre-emptive is king (post-injury limitations)32:48 – Ultrasound & blocks in the current PFC world35:08 – Safety considerations for adjuncts (liver, kidneys, bleeding, alcohol)36:59 – Bang-for-buck data on Tylenol vs. morphine38:55 – Practical integration: layering Tylenol/ketamine with fentanyl titration41:54 – Getting comfortable titrating down (and why pain scores can lie)42:53 – Final wisdom: use everything you're comfortable with.For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

This was my Favorite Presentation from SOMSA '25. Check back for the latest updates from SOMSA '26.In this episode of the PFC Podcast, Victor, a former Ranger medic, shares his experiences and lessons learned from a mass casualty event during a humanitarian mission in Burma. He discusses the historical context of the conflict, the challenges faced in providing medical support, and the innovative solutions developed in a denied environment. The conversation emphasizes the importance of training, adaptability, and building sustainable medical practices to empower local medics in future conflicts.TakeawaysVictor shares his experiences as a former Ranger medic.The humanitarian mission in Burma faced severe challenges.The conflict in Burma has historical roots dating back to World War II.Training focused on hemorrhage control and casualty extraction techniques.Two casualty collection points were established during the operation.The team had to adapt to carrying casualties over long distances.Blood transfusions were successfully conducted in the field for the first time.Building sustainable medical practices is crucial for future operations.Empowering local medics is essential for effective care.The mission was guided by a sense of love and purpose.Chapter00:00 Introduction to the Humanitarian Mission02:54 The Conflict in Burma: Historical Context05:52 Training the Rangers: Preparing for Combat08:55 The Medical Support Operation: Initial Challenges11:49 Casualty Management: Triage and Evacuation14:55 Adapting to the Battlefield: Lessons Learned17:54 Blood Transfusions in the Field: A New Capability20:45 Building Sustainable Medical Practices23:48 Empowering Local Medics: The Future of CareFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

What happens when the battlefield drops 30 feet underground into a collapsed building, ancient tunnel system, or booby-trapped basement? You don't just “clear” it — you assess it like a critical trauma patient while everything tries to kill you.In this raw, no-fluff episode, Dennis sits down with Sean McKay — 20+ year veteran of dynamic high-threat rescue, nonlinear physics guy, and the man who turns “impossible” subterranean ops into repeatable TTPs. Fresh off 48 hours with zero sleep (and still caffeinated to the gills), Sean drops a masterclass on why underground environments are exponentially more dangerous than anything on the surface.From atmospheric sucker punches (O₂ depletion, CO₂ buildup, toxic off-gassing) to structural collapses, comms blackouts, mental exhaustion, and the brutal reality of casualty extraction in spaces tighter than a coffin, this episode is packed with battlefield-proven principles you won't find in any manual.If you run rescue, work in SOF, or just want to understand what happens when the fight goes subterranean — this is required listening. Key Takeaways1. Treat the subterranean environment like a patient — use the exact same rapid/ongoing assessment template medics already know by heart. 2. Atmospheric threats (O₂ depletion, CO₂, displacement gases) are silent killers; monitor early and often. 3. Speed is security, but only after deliberate recon — one small “worm” goes first, the team enlarges behind him. 4. Improvise like your life depends on it: rubble, wood studs, high-lift jacks, and building debris become your cribbing and shoring. 5. Plan for mental exhaustion — 45 minutes underground feels like 8 hours; isolation and darkness will mess with your head. 6. Always identify safe havens and load-bearing walls as you move; never trust foreign engineering. 7. Casualty extraction multiplies complexity exponentially — every medical intervention costs time and movement. 8. Worst-case heuristics save lives: assume the worst, then back out from there. 9. Geology and soil type tell you whether a collapsed structure is worth occupying or a death trap. 10. Best practices are written in blood — create your own on the spot using context and innovation.Chapters- 03:10 – Why Subterranean Is the Ultimate Nonlinear Nightmare - 05:29 – Real-World Examples: Afghanistan Karez, Tunnels, Collapses - 07:25 – Atmospheric & Environmental Pathology (The Silent Killers) - 09:09 – Structural Collapse, Shoring & Improvised Solutions - 11:41 – Scenario: Occupying a Collapsed Multi-Story Basement - 13:36 – Patient-Assessment Template for the Environment - 15:31 – Tunnel Rat Recon Tactics & Atmospheric Monitoring - 17:56 – Sustainment, Mental Exhaustion & Comms Hell - 20:22 – Heuristics, Worst-Case Planning & Spidey Sense - 23:16 – Real Heuristic Examples from the Field - 26:11 – Destabilization, Cribbing & Load-Bearing Principles - 27:19 – Fire Chief Mindset – Maintaining Global Awareness - 29:45 – Safe Havens, Injuries & Team Support - 30:56 – Gases, Ventilation & Natural Airflow Hacks - 35:12 – Fans, Vertical Ventilation & Building Features - 38:52 – When to Walk Away – Red Flags & Geology Clues - 41:31 – Water, Electrical & Urban Subterranean Hazards - 44:48 – Casualty Extraction in Confined Spaces - 48:39 – Creating Best Practices on the Fly For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

If you've ever said “We'll just set up a walking blood bank when we need it,” this episode will make you rethink everything. Dennis and Andrew Fisher drop straight fire on how to actually build, stock, train, and run a real walking blood bank on a FOB, Firebase, or any austere base — not just theory, but the exact steps special operators and conventional medics are using right now to save lives when the next mass casualty hits.No fluff. No “somebody else will handle it.” Just battle-tested, practical guidance on turning your team (and the units around you) into a living blood bank that can deliver fresh whole blood in under 30 minutes.Key Takeaways You Can Use TomorrowPre-type every donor (especially O's) and keep the roster with key leaders and medics — Medpros + secondary confirmation beats dog tags every time.Distribute kits across the team so one casualty doesn't wipe out all your supplies.Practice full collections with non-medics — they can (and will) be your force multipliers.Have donor questionnaires filled out in advance for anyone outside your unit; do Eldon cards in calm conditions, never under fire.Plan for 20–30 minutes from alert to transfusion — that window dictates how long you have to bridge with other resuscitation tools.Principles over perfection: good stick + patent line + practiced team beats fancy equipment every single time.Chapters00:00 – Welcome & Why Most Walking Blood Banks Stay TheoreticalThe dangerous gap between “we have a plan” and actually practicing it.02:30 – Preferred Blood & ABO Typing Your Entire ForceLow-titer O whole blood, Medpros screening, lab vs. Eldon cards, and why you double-type.08:45 – Eldon Cards: When They Work (and When They Don't)Calm pre-mission testing vs. chaos — real talk on reliability.13:20 – Supplies & Logistics: Bags, Kits, Refrigeration & Cold ChainFenwal vs. Terumo, how many kits to order, and smart storage hacks.19:10 – Point-of-Injury Kits & Load DistributionWhat medics carry, what teammates carry under plates, and spreading risk.24:40 – IV Technique, Saline Locks & Point-of-Care TestingWhy 18-gauge + PRN adapter wins, donor screening, and host-nation considerations.31:15 – Donor Questionnaires & Pre-ScreeningWhen to use them, multilingual options, and why you do this before the fight.35:50 – Selling It to Commanders & Multi-Unit CoordinationRisk-benefit talk that actually works: mutual support, 100+ years of history, and 10,000+ units transfused.41:20 – Real Timelines: 20–30 Minutes from Call to TransfusionTraining goals, the 15-minute bag-fill rule, and why practice beats classroom speed.47:30 – Closing Principles & Final ThoughtsForce multiplication, non-medics stepping up, and adapting under pressure.Whether you're ODA, Ranger, conventional, or just preparing for the next deployment — this is the episode that turns “we should do a walking blood bank” into “here's exactly how we're doing it.”For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this episode of the PFC Podcast, Dennis is joined by Dr. Brigham Au — 10-year orthopedic trauma surgeon, former Parkland trauma faculty, and fellowship-trained at the Florida Orthopaedic Institute — for a no-fluff masterclass on pelvic fractures. From high-energy MVCs and falls to sneaky low-energy geriatric injuries, Dr. Au breaks down exactly what matters in the prehospital/prolonged field care environment: stability, pain control, binders, and what actually saves lives.Whether you're a combat medic, critical care paramedic, or wilderness provider, this is the episode that turns pelvic fractures from “scary” to “manageable.”TakeawaysPhysical exam beats imaging every time in the field — Gross manipulation is overrated; gentle leg positioning and pain response tell you more than you think.Pelvic binders WORK. Institutional protocols using them early cut mortality in half. Stop quoting tiny European studies — read the full papers.Simple field hack: Pull both ankles together, internally rotate, and secure the legs (sheet, belt, ACE wrap, buddy-tape style). Uses the good leg to splint the bad one and dramatically cuts pain during movement.Don't hesitate — if you even suspect an unstable pelvis (or the patient is hemodynamically unstable), slap the binder on tight over the greater trochanters. Life > skin necrosis in the first 24–48 hours.Geriatric ground-level falls are DEADLY — higher mortality than many gunshots once they decompensate. Treat them like the sickest patient in the room.Read beyond the abstract. Small studies make for great Instagram soundbites but terrible clinical decisions.Improvised binders? Belt around the trochanters, cut pant legs, or a rolled sheet — just get it low and tight. Patient comfort during movement is your best feedback.The cowboy with the 20–30-year-old open-book pelvis whose plates kept breaking because “his pelvis didn't want to close.”Why Dr. Au stopped doing aggressive stress exams after the 8-pound ankle test story.Why binders should be first-line, not optional — and exactly when/how to loosen them in austere environments.Brutal reality check on geriatric pelvic fracture mortality vs. modern gunshot wounds.Chapters00:00 – Welcome & Dr. Brigham Au intro (Parkland + trauma fellowship)01:27 – High-energy vs. low-energy pelvic fractures (what you're actually seeing)02:40 – Open book, closed book, lateral compression, vertical shear — why mechanism still matters04:31 – Field assessment & why physical exam is king06:25 – Yes, patients can still walk with a pelvic fracture (don't get fooled)08:02 – What “gross manipulation” actually means (and how little you need to do)11:51 – Leg-positioning trick that reduces pain and acts like a temporary binder14:31 – The pelvic binder debate: evidence, myths, and why Dr. Au is a huge believer20:08 – Improvised binders, proper placement & tension (even without a commercial device)23:41 – When and how to loosen/remove a binder (especially in prolonged care)25:43 – One thing Dr. Au wants every field provider to do better28:17 – Real risks of binders (and why you still shouldn't hesitate)29:27 – Final thoughts + why reading full studies mattersFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

“Nothing gets easier in flight.”That single line from today's guest says it all. Dennis is joined by Rich — SOF medic and flight medicine veteran — for a no-fluff masterclass on preparing patients for rotary-wing, ground, or even submarine evacuation. From rotor wash nightmares to 48-hour critical care handovers, this episode is pure gold for medics who want their patients to survive the bird, not just board it.Whether you're a ground medic with 30 seconds to hand off or a flight crew managing vents at altitude, these lessons will tighten your game, cut preventable errors, and keep aircraft off the deck longer than they need to be.KEY TAKEAWAYS YOU CAN USE TOMORROWAccurate MIST saves airframes and lives — over-triage or fake intel has real consequences.Document what the flight medic can't see (drugs, last dose/time, hidden injuries).Get access and secure everything on the ground — nothing magically gets easier at 500 feet and 120 knots.Stage 5–10 minutes early when possible. Headspace + rehearsed handover beats chaos every time.Redundancy is king in prolonged/critical care handovers: bring backups to the backups.Trend vitals and nursing care — clean the patient, position them, prevent DVT, manage contamination.Know your receiving asset — a vented patient handed to someone who's never touched one is now your problem again.Balance speed vs. life-saving interventions — don't skip a finger thoracostomy just because the bird is 30 seconds out.CHAPTERS00:00 – Welcome back to the PFC Podcast00:06 – Introducing Rich: soft medic & flight medicine expert01:44 – The brutal environment of rotary-wing medicine (lost senses, airspace surveillance, cable chaos)04:08 – Classic ground-medic mistakes (and how to stop making them)06:24 – Why accurate MIST actually matters (and how bad intel wastes lives & airframes)09:05 – The moped-vs-gunfight story every medic needs to hear13:55 – Standard aircraft loadout + what “special equipment” really means17:39 – Bare-minimum documentation when rotors are inbound (what to write in 30 seconds)20:02 – Handover acronyms that actually work (MIST vs. CIT-D + physical pointing trick)22:28 – Trust but verify: how flight medics reassess once the patient is aboard24:28 – Why ground access & securing lines is non-negotiable26:45 – Staging early, litter drills, and not racing to the rotor wash30:40 – Prolonged field care → critical care transport handovers31:30 – Is the patient ever “too unstable” to fly? (battlefield reality check)34:41 – Prepping the patient like you're handing off an ICU bed37:08 – Self-evac gear philosophy: treat the patient as if nothing was done yet41:32 – Pain management in the air — when to bump vs. load long-acting44:31 – Monitoring in flight (what still works when your senses are gone)46:58 – Over-optimizing for transport: trending, nursing care, contamination control49:25 – Know who you're handing off to (and why it matters for the truck ride)49:58 – Outro & resources For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

This interview with Aryna, a tactical medic with extensive experience in Ukraine, explores the rapid evolution of battlefield medicine amidst the ongoing Ukraine conflict. Topics include changes in medic training, gear, drone warfare, blood transfusions, and prolonged field care.This podcast was recorded in partnership with Leleka Foundation, an American-Ukrainian charitable initiative committed to helping frontline medics in Ukraine save lives. This project creates a vital platform for Ukrainian frontline medics to share firsthand trauma care experience from the battlefield with their American counterparts, strengthening knowledge exchange.  Key topicsChanges in medic training due to war dynamicsImpact of drone warfare on medical evacuationAdvancements in blood transfusion techniques in combatProlonged field care and long-term casualty managementGear and vehicle protection improvements for medicsChapters00:00 Introduction to Tactical Medicine and Personal Background06:04 Adapting to Modern Warfare: Drones and Medical Evacuations11:59 Prolonged Field Care: Challenges and StrategiesFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

In this episode of the PFC Podcast, Noel discusses the complexities and challenges of maritime medicine, emphasizing the importance of training, knowledge, and operational flexibility. He shares insights from his extensive experience, highlighting the unpredictable nature of the ocean and the necessity of effective communication and integration with host nation partners. Noel advocates for a focus on practical training and the need for a forward-thinking approach to tackle operational challenges in a collaborative manner.TakeawaysCourage in the absence of fear is stupidity.Training should focus on knowledge, not just equipment.The ocean's unpredictability complicates operations.Effective communication is crucial in maritime environments.Over-planning can lead to operational failures.Training is essential for operational success.Integrating with host nation partners enhances effectiveness.Technology should be a last resort solution.Operational flexibility is key in dynamic environments.A joint effort is necessary for tackling complex challenges.Chapters00:00 Introduction and Context of the Mission02:53 Challenges in Maritime Operations05:38 Operational Planning and Flexibility08:30 Communication Strategies in Maritime Environments11:15 Training and Integration with Host Nation Partners14:12 Operational Autonomy and Cross-Training16:50 Emphasizing Training Over Technology19:25 Conclusion and Call to ActionFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

In this raw, no-BS conversation, PFC Podcast host Dennis sits down with Justin Ball — licensed clinical social worker, former Green Beret, and one of the most insightful voices on military mental health — to unpack the often-ignored second war.Justin brings both battlefield experience and clinical expertise, while Dennis shares unfiltered war stories and hard-earned lessons. They draw on Homer's Odyssey, Achilles in Vietnam, modern family systems theory, emotion-focused therapy (EFT), anthropology of tribal hunters returning to the village, and brutally honest spouse perspectives (shoutout to Angela Ball for the coffee-table truth bombs).This isn't another “do these 5 things and you'll be fine” checklist. It's a real talk about why coming home is hard — for the service member, the spouse, the kids, and the whole damn family system — and how to navigate it with eyes wide open.Key Takeaways- The transition home starts **before** you leave the sandbox — unrealistic expectations (“If I can just make it home…”) set most people up for failure.- Anger is often the only “socially acceptable” emotion for warriors; underneath it usually lies fear, sadness, shame, or grief over missed time/missed life.- Military and home are **competing tribes** with conflicting values, boundaries, and shame triggers — yelling works at work, but it nukes the dinner table.- Spouses aren't “just holding it down” — they've built an entire functioning system. Coming home = deliberate, careful re-entry, not storming the castle.- Chronic leaving-and-returning (TDYs, schools, exercises) is as damaging as combat deployments — families don't care if it's “just training”; absence is absence.- Healthy reintegration means **we** not **me** — appreciation, lowered expectations, co-regulation in traffic rage moments, and honest communication about what's really happening emotionally.- There is no smooth road. The healthiest couples/families acknowledge it's bumpy, forgive missteps quickly, and keep talking.Whether you're an OGA guy with 15 TDYs, an infantryman coming off your first rotation, a spouse reading this description in tears, or a leader wondering why your guys are angry all the time — this episode is for you.Chapters - 00:26 – Justin returns; setting the stage for “coming home”- 03:16 – Evolution of post-deployment screening — what's better now vs. then- 09:59 – Acute vs. chronic homecoming — one big event vs. a lifestyle of constant comings & goings- 13:18 – The spouse perspective (Angela drops truth bombs over coffee)- 19:46 – Don't discount non-combat deployments or training risks — it's all cumulative family stress- 22:38 – Emotion-Focused Therapy (EFT) basics — emotions are older than words- 27:05 – Anthropology: hunters leaving the tribe, returning changed, and the danger of re-meeting- 36:55 – Shame culture in the military vs. home — competing tribal expectations create anger & failure loops- 42:25 – Anger as secondary emotion — fear, sadness, shame underneath- 45:03 – Mismatched expectations on both sides (warrior welcome vs. “don't touch my schedule”)- 50:31 – Operator syndrome vs. spouse high-stress reality — high stress is high stress- 54:29 – Ego check: coming home with an inflated “war hero” self vs. careful re-entry- 59:23 – The minivan road-rage story — tribal rules don't switch off overnight- 01:05:35 – Building a culture of appreciation (Gottman style) without knife-handing it- 01:09:43 – Listening without fixing — emotional acknowledgment firstFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

This presentation was recorded during SOMSA '25. Register now to get your spot for SOMSA '26. https://specialoperationsmedicine.org/soma-2026/This conversation highlights a harrowing experience of combat medics during a mission, detailing the challenges faced during a life-threatening incident. The speakers share their personal accounts of injury, rescue, and the critical medical response that followed. They emphasize the importance of teamwork, humor, and training in high-stress situations, as well as the emotional and physical toll of such experiences. The discussion also touches on lessons learned for future operations and the significance of mental health in recovery.TakeawaysThe importance of highlighting the care delivered by medics in combat.Humor can be a vital tool in high-stress medical situations.Immediate response and teamwork are crucial in life-threatening scenarios.Training and preparedness can significantly impact outcomes in emergencies.The emotional toll of trauma affects both patients and medics.Effective communication is essential during medical emergencies.Cross-training among team members enhances operational effectiveness.Understanding the patient's perspective can improve care.The role of advocacy and support in recovery is critical.Future training should focus on pain management and patient comfort.Chapters00:00 Introduction to Heroism in Combat Medicine02:46 The Incident: A Life-Altering Explosion05:00 Immediate Response: Rescue and Treatment08:06 The Journey to Safety: Evacuation Challenges10:52 Reflections on Pain and Recovery13:50 Lessons Learned: Training and Preparedness16:39 The Role of Humor in High-Stress Situations19:39 Final Thoughts and Future ImprovementsFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

This podcast was recorded in partnership with Leleka Foundation, an American-Ukrainian charitable initiative committed to helping frontline medics in Ukraine save lives. This project creates a vital platform for Ukrainian frontline medics to share firsthand trauma care experience from the battlefield with their American counterparts, strengthening knowledge exchange. Discover key insights on medical evacuation and combat experiences from Maria Litha, a combat medic. Learn how to handle critical situations under fire and improve emergency response strategies.In a world where the realities of war often remain hidden, the experiences of those on the front lines reveal critical lessons that can save lives. In this post, we dive into the insights shared by Maria Litha, a combat medic who has been on the front lines since 2022, as she recounts her experiences in medical evacuation and the challenges faced in high-stress environments.The Reality of Medical EvacuationsOne of the most critical aspects of battlefield medicine is the evacuation process. Maria highlights the importance of understanding the environment in which evacuations take place. Conditions can vary significantly depending on the location and intensity of conflict.Case Study: Evacuating LeonidMaria recounts a harrowing case involving a patient named Leonid, who suffered a severe injury after stepping on a mine. After enduring 12 hours in a precarious position, he was finally evacuated under the cover of darkness. The challenges faced during this evacuation included:- Massive blood loss: Leonid required immediate attention due to his condition.- Road conditions: The evacuation vehicle had to navigate bombed-out and rugged terrain, complicating the medical team's efforts.- Limited resources: With only one bottle of plasma available, the team had to carefully manage Leonid's care without exacerbating his injuries.Challenges Faced by Combat MedicsCombat medics like Maria often face unique challenges that require quick thinking and adaptability. Some of the key issues include:- Drone and artillery threats: Medics must constantly be aware of their surroundings to avoid being targeted while providing care.- Equipment limitations: The unstable environment can render medical monitors ineffective, making it difficult to gauge a patient's condition accurately.- Time constraints: Evacuations must often be conducted rapidly, where every second counts.Strategies for Effective EvacuationsTo improve the success of medical evacuations, Maria shares several strategies:- Preparation: Understanding the layout of the battlefield and potential threats is crucial for planning safe evacuation routes.- Team coordination: Effective communication and teamwork can enhance the efficiency of care during emergencies.- Utilizing technology: Employing drone detection systems and other technological aids can help medics stay safe while performing their duties.Key Takeaways- Adaptability is vital: Each evacuation scenario presents its own unique challenges that require quick adjustments.- Collaboration is essential: Working closely with team members ensures that all aspects of patient care are addressed effectively.-Continuous learning: Combat medics must stay updated on new techniques and technologies to improve their response in the field.For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠⁠

This conversation focuses on the implementation of a cold blood protocol for military training, emphasizing the importance of whole blood transfusions in preventing deaths from hemorrhagic shock. The discussion covers the logistics of blood availability, the challenges of storage and transportation, and the establishment of a pilot program for blood donation. The speakers highlight the collaboration with blood banks and the regulatory hurdles faced, while also outlining future directions for expanding the program to enhance medical support during training events.TakeawaysHemorrhage is the leading cause of preventable death on the battlefield.Whole blood is recognized as the superior resuscitation fluid.Logistics and availability of blood during training are critical issues.Cold blood storage can be effectively implemented in training environments.A pilot program for blood donation has been established to support training needs.Collaboration with blood banks is essential for successful blood storage and use.Regulatory challenges complicate blood storage and transportation.Training medics to use cold stored blood is a priority.Future expansion of the program is necessary to meet training demands.Increased knowledge of blood protocols enhances medic preparedness.Chapters00:00 Introduction to Cold Blood Protocol03:02 Understanding Hemorrhagic Shock and Blood Transfusion06:07 Logistics of Blood Availability in Training08:55 Implementing Cold Blood Storage in Training Environments12:11 Pilot Program for Blood Donation and Storage14:50 Collaboration with Blood Banks and Regulatory Challenges18:14 Future Directions and Program Expansion20:58 Conclusion and Key TakeawaysFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠