Prolonged Fieldcare Podcast

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

In this episode of the PFC Podcast, Dennis interviews Andre Cap, a retired Colonel of the US Army and expert in combat casualty care. They discuss the innovative technology behind spray-dried plasma, its importance in military and civilian medicine, and the regulatory pathways it must navigate. Andre explains the manufacturing process, the safety measures in place, and the potential for this technology to revolutionize blood resuscitation in emergency situations. The conversation also touches on international collaborations and the future of plasma products in healthcare. TakeawaysAndre Cap is a retired Colonel and expert in combat casualty care.Spray-dried plasma technology is unique and US-based.The importance of domestic plasma production was highlighted by COVID-19.Distributed manufacturing of plasma enhances security and operational control.The manufacturing process is efficient and scalable with low capital expenditure.Regulatory pathways for spray-dried plasma include extensive clinical trials.The product can be reconstituted quickly for emergency use.International interest in the technology is growing among NATO allies.The technology is designed for use in both military and civilian settings.Training and familiarization with the new technology are essential for effective use.Chapters00:00 Introduction to Andre Cap and His Background02:48 The Unique Technology of Spray-Dried Plasma05:59 Importance of Domestic Plasma Production09:13 Manufacturing Process and Efficiency12:02 Regulatory Pathway and Clinical Trials14:57 Product Packaging and Reconstitution18:04 Comparison with Freeze-Dried Plasma21:03 Safety and Pathogen Reduction in Plasma23:52 International Interest and Collaboration27:10 Utilization in Military and Civilian Settings30:01 Logistical Considerations for Plasma Resuscitation33:10 Future of Plasma Products in Medicine36:07 Training and Familiarization with New Technology38:56 Conclusion and Future ProspectsFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

The conversation revolves around a complex trauma case involving a 26-year-old male who suffered severe injuries from a live round during a training exercise. The discussion covers the patient's initial assessment, the challenges faced during his treatment, the surgical interventions performed, and the lessons learned from the case. The speakers emphasize the importance of timely interventions, effective communication, and the need for continuous improvement in emergency medical practices.TakeawaysThe patient was a 26-year-old male with severe injuries.Initial assessment showed signs of shock despite normal blood pressure.CT scans revealed significant internal bleeding.Surgical interventions were complicated by the patient's deteriorating condition.Massive transfusion protocol was activated due to significant blood loss.Lessons learned include the importance of timely blood product administration.Pre-hospital care plays a crucial role in patient outcomes.Effective communication among medical teams is essential.The case highlights the need for continuous training and preparedness.The patient ultimately required extensive rehabilitation after his injuries.Chapters00:00 Introduction to the Case02:52 Patient Arrival and Initial Assessment06:05 CT Scan and Deterioration08:50 Surgical Interventions and Challenges11:58 Massive Transfusion Protocol and Outcomes14:58 Lessons Learned from the Case18:00 Discussion on Pre-Hospital and In-Hospital Care20:48 Final Thoughts and ReflectionsFor 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, Jesse Tafoya, a Senior Strategic Medical Planner at the US Department of State, discusses the complexities of medical planning within the State Department, particularly in crisis situations. He shares insights on the challenges of reopening embassies, the importance of evaluating local healthcare infrastructure, and the necessity of building relationships with local hospitals. The conversation highlights the critical role of communication and collaboration between military and State Department personnel in ensuring effective crisis response and medical planning.TakeawaysMedical planning is situationally dependent and varies by location.Reopening embassies involves extensive planning and coordination.Local medical staff play a crucial role in embassy operations.Evaluating hospitals requires understanding local healthcare systems.Building relationships with local hospitals is essential for effective medical planning.The process of hospital evaluations includes assessing capabilities and resources.Communication between military and State Department is vital for crisis response.Decision-making in the State Department is complex and consensus-driven.Collaboration between military and State Department enhances overall mission success.Chapters00:00 Introduction to Medical Planning at the State Department03:11 Navigating Medical Planning in Crisis Situations05:59 Reopening Embassies: Challenges and Strategies08:49 Hospital Evaluations: The Process and Importance11:58 Understanding Local Medical Infrastructure15:01 Engaging with Local Hospitals: Building Relationships17:50 Assessing Medical Facilities: A Detailed Approach21:12 The Role of Medical Staff in Crisis Management23:56 Evaluating Diagnostic and Surgical Capabilities26:46 Post-Surgery Care and Patient Management30:09 Communication and Coordination with Military33:12 Decision-Making Dynamics in the State Department36:13 Facilitating Interactions Between Military and State Department39:05 Conclusion: The Importance of CollaborationFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

This episode features an in-depth discussion on the use of vasopressors in critical care, focusing on epinephrine, norepinephrine, and fluid resuscitation strategies in sepsis and anaphylaxis. Learn about drug choices, side effects, and practical tips for managing shock in austere settings. Key topicsVasopressor selection in shock managementEpinephrine's versatility and side effectsFluid resuscitation guidelines in sepsis and anaphylaxisMonitoring and adjusting vasopressor therapyBalancing fluid therapy with vasopressor useChapters00:00 Introduction and Guest Credibility01:20 Why Epinephrine Is the Go-To Vasopressor02:58 Confusing Nomenclature and Alternatives to Epinephrine04:12 Side Effects of Epinephrine: Heart Rate and Blood Pressure Risks07:04 Lactic Acidosis and pH Considerations09:25 Fluid Resuscitation in Sepsis and Anaphylaxis11:50 When to Move from Fluids to Vasopressors13:53 Guidelines for Fluid Administration and Response18:13 Recognizing When Fluids Are Not Enough20:29 Dosing and Monitoring Push Dose Epinephrine23:17 Endpoints for Vasopressor Therapy and Safety Limits28:49 Managing Tachycardia and Heart Rate Responses30:03 Norepinephrine as the First-Line Vasopressor31:11 Controlling Shock with Limited Resources33:15 Summary: Choosing the Right Vasopressor Strategy34:19 Final Tips for Emergency Vasopressor UseFor 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 and Doug discuss the critical importance of analog monitoring in intensive care settings. They explore how healthcare professionals can effectively assess patients without relying solely on digital tools, emphasizing the need for hands-on skills and clinical judgment. The conversation covers various aspects of patient assessment, including hemodynamic stability, the impact of pharmacological agents, and the value of traditional tools like the stethoscope. Doug shares insights from his experience in the ICU, highlighting the significance of recognizing trends and treating patients based on their clinical presentation rather than just numerical data. The episode serves as a reminder of the essential skills that healthcare providers must maintain, especially in challenging environments where technology may fail.TakeawaysAnalog assessment is crucial in critical care settings.Visual assessment often provides more insight than numbers.Mental status is the most important vital sign.Pharmacological effects can complicate patient assessments.Guiding therapy requires clinical judgment, not just numbers.Stethoscopes remain valuable despite advanced technology.Respiratory rate and work of breathing are key indicators of lung issues.Blood pressure measurements can vary; mean arterial pressure is critical.Trends in patient data are more important than isolated numbers.Practicing analog skills is essential for all healthcare providers.Chapters00:00 The Importance of Analog Monitoring in Critical Care04:12 Assessing Hemodynamic Stability10:25 Navigating Pharmacological Effects on Patient Assessment15:25 Guiding Therapy Without Digital Tools21:16 The Role of the Stethoscope in Modern Medicine27:10 Recognizing and Responding to Respiratory Distress34:09 Manual Blood Pressure Measurement and Its Relevance37:10 The Value of Analog Skills in Rugged EnvironmentsFor 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, the discussion revolves around pneumothorax and hemothorax, focusing on their definitions, causes, and management strategies. The speakers delve into the implications of tension physiology, the importance of patient assessment, and the role of ultrasound in diagnosis. They also explore the complexities of trauma management, emphasizing the need for vigilance and preparedness in emergency situations. TakeawaysPneumothorax can become an emergency due to oxygenation issues.Tension physiology occurs when blood return to the heart is impaired.Stable patients with pneumothorax can often be observed.COVID-19 led to increased cases of pneumothorax due to lung scarring.Traumatic pneumothorax usually indicates damage to the thorax.Ultrasound is the preferred diagnostic tool for pneumothorax.Medical management focuses on minimizing positive pressure ventilation.Emergent interventions may be necessary for significant pneumothorax.Understanding the difference between pneumothorax and hemothorax is crucial.Vigilance is key in managing chest trauma effectively.Chapters00:00 Understanding Tension Physiology and Shock03:10 Management of Pneumothoraces and Haemothoraces06:09 Impact of COVID-19 on Lung Health09:02 Trauma and Pneumothorax: Diagnosis and Treatment11:39 Ventilation Strategies in Pneumothorax Management14:58 Assessing Patient Stability and Intervention Timing17:41 Complications of Chest Trauma and Hemothorax20:53 Vigilance in Trauma Management24:04 Final Thoughts on Chest Trauma ManagementFor 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 and a panel of experts discuss the intricacies of facial trauma management, focusing on the use of anesthesia and nerve blocks. They explore various techniques for achieving effective pain control in trauma situations, emphasizing the importance of understanding facial anatomy and the application of dental blocks beyond traditional uses. The conversation also highlights the significance of multimodal pain management strategies and the role of cross-training in enhancing trauma care skills.TakeawaysFacial blocks can be used for more than just dental procedures.Understanding the anatomy of facial nerves is crucial for effective anesthesia.The infraorbital block is essential for mid-face trauma management.Lidocaine with epinephrine can provide longer-lasting anesthesia in vascular areas.The mandibular nerve requires precise techniques for effective anesthesia.Ring blocks are effective for ear and nose trauma.X-Brow is a long-acting anesthetic that can reduce narcotic use post-surgery.Cross-training with dental professionals can enhance trauma care skills.Multimodal pain management is key in treating facial injuries.Effective pain control can significantly improve patient outcomes in trauma situations.Chapters00:00 Introduction to Facial Trauma and Anesthesia03:37 Understanding Facial Blocks and Their Applications10:31 Anatomy of Facial Nerves and Block Techniques24:32 Mandibular Nerve Considerations and Techniques40:34 Special Considerations for Facial Injuries54:49 Multimodal Pain Management in Facial TraumaFor 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 interviews Steve, an active duty member of the US Army and a critical care fellow at the University of Colorado Denver. They discuss a recent study on calcium levels in trauma patients, exploring the effects of trauma on calcium derangements, the challenges of conducting trauma research, and the importance of pre-hospital care. Steve shares insights on the administration of calcium in emergency settings, the prioritization of treatments in trauma care, and the future of research in this area.TakeawaysCalcium levels can be affected by trauma and pre-hospital care.The study aims to determine how many trauma patients arrive with calcium derangements.Data collection in trauma research can be logistically challenging.Calcium is essential for the coagulation cascade in trauma patients.TXA is important for preventing the breakdown of clots during trauma care.Prioritizing blood transfusions is critical in trauma situations.Understanding the differences between military and civilian trauma is essential for research.The study has exceeded its enrollment goals, indicating strong interest in the topic.Future research will provide more concrete data on calcium's role in trauma care.Medical practices and recommendations continue to evolve based on new research findings.Chapters00:00 Introduction to the Calcium Study02:58 Understanding Calcium's Role in Trauma06:03 Challenges in Trauma Research08:56 Pre-Hospital Care and Calcium Levels11:56 Data Collection and Patient Enrollment15:12 Calcium Derangements in Trauma Patients17:47 Calcium Administration in Emergency Settings21:01 Prioritizing Treatment in Trauma Care24:12 Future Research and ConclusionFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this episode of the PFC podcast, Dennis and Rick discuss the current state of medic training, improvements made since previous presentations, challenges faced by medics, and the standards and grading criteria that have been established. They delve into common failures observed during training, the selection and training of instructors, and potential future adjustments to the training programs. The conversation highlights the importance of continuous improvement in combat medicine and the need for effective training to ensure medics are prepared for real-life scenarios.TakeawaysSome units have improved their medic training significantly.Competency in medical training is essential for effective performance.Training issues persist in some units despite improvements in others.The grading sheet for medics is now published and accessible.Common failures include difficulties with IVs and delays in treatment.Instructor selection is crucial for effective medic training.Future adjustments to training programs are always being considered.The failure rate for first-time runs is notably high, but improves with practice.Standards for medic training are being standardized for consistency.Communication and feedback are vital for improving medic performance.Chapters03:01 Improvements in Medic Training and Competency06:00 Challenges in Medic Training and Personnel Changes08:56 Standards and Grading Criteria for Medics12:09 Common Failures in Medic Training14:58 Instructor Selection and Training18:02 Future Adjustments in Medic TrainingFor 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 and Justin discuss the critical aspects of analgesia and sedation in emergency medical situations. They explore common mistakes made by medics, particularly in drug selection and administration, and emphasize the importance of understanding medications like ketamine. The conversation highlights the necessity of having a solid plan for drug administration, monitoring patients effectively, and setting measurable goals for pain management. Through case studies and personal experiences, they share valuable lessons learned and provide advice for new medics entering the field.TakeawaysMedics often rely on unrealistic training scenarios that don't reflect real-life situations.Understanding the pharmacology of drugs is essential for effective patient care.Having a clear plan for drug administration is crucial to avoid complications.Monitoring and assessing patients is vital to ensure proper pain management.Goals for pain management should be specific and measurable, not just about eliminating pain.Experience is key to understanding how different patients respond to medications.Trends in medication use can lead to dangerous practices if not understood properly.Always have a variety of medications available for different situations.Communication during handovers is critical to avoid medication errors.Building a strong foundation in medical knowledge is essential for effective practice.Chapters00:00 Introduction to Analgesia and Sedation01:14 Common Mistakes in Drug Administration05:42 Understanding Ketamine and Its Limitations12:11 Planning for Medication Administration16:13 The Importance of Monitoring and Assessment20:08 Goals for Pain Management25:04 Case Studies and Lessons Learned32:11 Advice for New Medics40:02 The Dangers of Following TrendsFor 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, we delve into the critical topic of facial trauma, particularly in the context of modern combat scenarios. Andrew, a program director in oral and maxillofacial surgery, shares his expertise on managing severe facial injuries, emphasizing the importance of pre-hospital care and the need for effective training in jaw wiring techniques. Burjor, with his extensive background in maxillofacial surgery, raises pertinent questions about the lack of training in jaw wiring for medics and trauma surgeons, highlighting its significance in emergency situations. The discussion also covers the challenges faced in treating penetrating injuries, especially those resulting from drone attacks, and the innovative techniques being developed to manage these complex cases.TakeawaysJaw wiring is a vital skill for managing facial trauma.Injuries from drone attacks are leading to higher rates of facial trauma.Effective hemorrhage control is crucial in facial injuries.Training in jaw wiring should be prioritized for medics and trauma surgeons.Innovative techniques like Minitize are revolutionizing jaw stabilization in the field.Chapters05:15 Challenges of Facial Trauma in Modern Warfare11:10 Innovative Techniques for Hemorrhage Control19:51 Practical Applications of Foley Catheters in Trauma38:10 Airway Management in Trauma45:36 Managing Tongue Bleeds52:05 Wound Care and Infection Control01:06:12 Innovative Jaw Stabilization TechniquesFor 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, Dr. Lee Cancio, a surgeon and director of the U.S. Army Institute of Surgical Research Burn Center, discusses the complexities of white phosphorus burns. He explains the mechanisms of injury, initial care, and the urgency of treatment for such injuries. The conversation delves into surgical interventions, wound management, and the importance of monitoring patients for complications like hypocalcemia. Dr. Cancio emphasizes the need for a thorough understanding of these injuries to provide effective care in combat and austere environments.TakeawaysWhite phosphorus is a significant concern in combat medicine.Understanding the mechanisms of injury is crucial for treatment.Immediate immersion in water is essential for managing burns.Hypocalcemia can occur rapidly and is life-threatening.Surgical intervention may be necessary for severe injuries.Monitoring for ongoing burning is critical in patient care.Whole blood is not ideal for burn shock resuscitation.Fluid resuscitation should be adjusted based on burn depth.Knowledge of injuries helps in making informed decisions.Prolonged field care requires constant assessment and monitoring.Chapters00:00 Introduction to White Phosphorus Burns02:48 Understanding White Phosphorus and Its Uses05:39 Mechanisms of Injury from White Phosphorus08:11 Initial Care and Management of White Phosphorus Injuries11:00 Urgency in Treatment and Evacuation13:53 Surgical Interventions and Wound Management16:51 Case Studies and Practical Applications19:49 Post-Injury Care and Monitoring22:15 Final Thoughts on White Phosphorus InjuriesFor 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 and Emily Johnston delve into the critical topic of cold weather medicine, specifically focusing on the newly submitted Cold Weather Clinical Practice Guidelines (CPG) for the Arctic. Emily emphasizes the importance of these guidelines as adjuncts to existing protocols, highlighting the unique challenges posed by extreme cold environments, such as the constant threat of hypothermia and frostbite. She explains how the guidelines are designed to enhance existing trauma care practices by incorporating specific considerations for operating in frigid conditions, ensuring both the caregiver and the casualty are adequately protected and treated.The conversation also touches on practical strategies for managing injuries in cold weather, including the use of tourniquets and the importance of maintaining body heat. Emily shares insights on nutrition for both rescuers and patients in extreme cold, emphasizing the need for high-calorie, easily consumable foods. The episode concludes with a discussion on the latest advancements in frostbite treatment, including the use of ibuprofen and isoprost, and the significance of timely intervention in preserving tissue viability. Overall, this episode serves as a vital resource for medical professionals operating in cold environments, providing them with essential knowledge and tools to improve patient outcomes.TakeawaysHypothermia and frostbite are constant threats in extreme cold.Nutrition is crucial; high-calorie foods are essential for survival.Timely intervention is key in frostbite treatment.Patient packaging must be done carefully to prevent heat loss.Chapters00:00 Introduction to Cold Weather Medicine01:10 Understanding the Need for an Arctic CPG10:14 Nutrition in Extreme Cold Environments27:06 Advancements in Frostbite Treatment35:15 Patient Packaging and Communication in Cold EnvironmentsFor 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, Dr. DeMello discusses the complexities of managing burn injuries in a pre-hospital setting. He emphasizes the importance of following established guidelines, understanding the nuances of fluid resuscitation, and the critical role of pain management. The conversation also covers the indications for escharotomy, the significance of cooling burns, and common mistakes made in burn management. Dr. DeMello shares valuable insights from his extensive experience in military medicine, highlighting the need for compassion and effective communication in trauma care.TakeawaysBurns are a major cause of panic in trauma situations.Follow the MARCH guidelines for initial assessment.TBSA calculations are often overestimated in pre-hospital settings.Fluid resuscitation should be based on available resources.Pain management is crucial and should prioritize patient comfort.Escharotomy should be performed with careful planning and timing.Cooling a burn can significantly reduce its severity if done promptly.Compassionate care can greatly improve patient outcomes.Monitoring urine output is essential for assessing kidney function.Avoid common mistakes like neglecting the back in assessments.Chapters00:00 Introduction to Burns and Trauma Care02:07 Initial Assessment and Management of Burns05:58 Fluid Resuscitation Strategies09:58 Pain Management in Burn Patients21:57 Escharotomy: Indications and Techniques34:10 Cooling Burns and Managing Hypothermia40:10 Common Mistakes in Burn ManagementFor 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 interviews Jeremy Pamplin, a retired Colonel and program manager at DARPA, who discusses his extensive experience in military medicine and the development of advanced medical technologies. The conversation focuses on the DARPA Triage Challenge, which aims to improve casualty identification and triage using robotics and AI. Jeremy explains the integration of autonomous systems with human medics, the challenges faced in mass casualty events, and the future of AI in medical decision-making. He emphasizes the importance of trust in technology and the need for accurate assessments to save lives in combat situations.Links to DARPA Triage Challenge:DARPA Triage Challenge YouTube videos: ⁠https://www.youtube.com/playlist?list=PL6wMum5UsYvYlCNFhd9Y7MMURvPKbh07J⁠DARPA Triage Challenge website: ⁠https://www.darpa.mil/research/challenges/darpa-triage-challenge⁠TakeawaysThe DARPA Triage Challenge aims to enhance casualty triage using technology.Integration of robotics with human medics is crucial for effective casualty care.Mass casualty events are chaotic, and seconds matter in decision-making.AI can assist in prioritizing patient care but should not replace human judgment.Trust in technology is essential for medics to effectively use new tools.The future of combat medicine involves compressing capabilities to save lives.High fidelity simulations are necessary for training and assessment in mass casualty scenarios.The live chain concept focuses on delivering care as quickly as possible to save lives.Future challenges include ensuring technology is reliable and safe for use in medical settings.Chapters02:51 Overview of the DARPA Triage Challenge03:36 The Role of Autonomous Systems in Triage10:54 Integration of Medics and Technology18:16 Challenges in Identifying Casualties21:01 Data Collection and AI Training25:55 Medics' Trust in Technology30:40 The Importance of Training in Telemedicine33:19 AI in Medical Decision Making36:42 Human-Machine Collaboration in Triage40:53 Challenges in Mass Casualty Management45:39 The Future of AI in Medicine52:32 The Live Chain: Enhancing Survival RatesFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

This podcast episode explores the innovative use of maggot therapy in wound care, discussing its historical context, benefits, and applications in various medical settings, particularly in austere environments. The conversation highlights the importance of maggot therapy as a cost-effective and efficient treatment option, especially in the face of rising antimicrobial resistance. The speakers emphasize the need for proper sourcing, preparation, and application techniques for maggot therapy, as well as the potential for integrating this method into modern medical practices.TakeawaysMaggot therapy has historical roots dating back thousands of years.Maggots effectively debride wounds and promote healing.Maggot therapy is cost-effective, especially in low-resource settings.Chronic wounds often develop biofilms that resist antibiotics; maggots can help.Maggots can be used in both chronic and acute wounds, including burns.Maggot therapy can be implemented in austere environments with proper training.Specific fly species are required for effective maggot therapy.Maggots can be sourced locally in various environments.Maggot therapy can be a sustainable alternative to antibiotics in combat situations.Documentation and sharing of experiences are crucial for advancing maggot therapy.Chapters00:00 Introduction to Maggot Therapy01:16 Historical Context of Maggot Therapy04:41 Benefits of Maggot Therapy08:39 Application in Various Wound Types11:14 Maggot Therapy in Austere Environments15:32 Sourcing and Preparing Maggots23:33 Application Techniques for Maggot Therapy29:32 Patient Management and Treatment Regimens35:06 Future of Maggot Therapy in MedicineFor 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 and John Dominguez discuss the complexities of combat medicine, the challenges faced by military medics, and the importance of professionalizing the medical force. They explore the balance between training and operational readiness, the role of paramedic certification, and the lessons learned from historical conflicts. The conversation emphasizes the need for effective mentorship, resource management, and the integration of lessons from global conflicts to enhance the capabilities of military medics in future engagements.TakeawaysThe professionalization of military medics is crucial for future conflicts.Training for medics must balance time constraints with skill requirements.Paramedic certification may not fully prepare medics for combat situations.Tactical medicine requires a unique skill set that differs from civilian practices.Mentorship plays a vital role in developing competent medics.Resource management is essential for effective medical care in combat.Lessons learned from past conflicts can inform current medical training.The importance of mastering the basics cannot be overstated.Combat medicine is a problem within the tactical mission framework.Future conflicts will require innovative approaches to medical care. Chapters01:04 Professionalizing the Medical Force05:16 Challenges in Combat Medicine Training10:51 The Role of Medics in Future Conflicts15:34 Paramedic Certification in Military Medicine19:05 The Importance of Tactical Medicine23:34 Lessons from Historical Conflicts27:56 Mentorship and Leadership in Medical Training32:59 The Balance of Skills and Time in Training39:39 The Future of Combat Medicine45:55 Integrating Lessons Learned from Global Conflicts51:14 The Importance of Resource Management in Medicine55:53 Final Thoughts on Medical Training and ReadinessFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠