Podcasts about Tactical combat casualty care

This week, we have another MiM25 presentation from Dr John Quinn discussing Damage Control Resuscitation in large-scale combat operations, particularly in Ukraine. He shares insights from his extensive experience in emergency medicine and highlights the unique challenges faced in combat medicine, including medical logistics, terminology, and telemedicine. Dr. Quinn emphasises the importance of training, clinical governance, and the need for effective blood supply management in austere environments. The conversation also touches on the evolving practices in casualty care and the impact of modern warfare on medical operations.TakeawaysUkraine has surpassed NATO in counterinsurgency experience.Effective medical planning is crucial for combat operations.Telemedicine enhances clinical decision-making in remote areas.Logistical challenges significantly impact casualty evacuation.Understanding the terminology is essential for interoperability.Innovations like RBOA are being utilised in combat medicine.Training and capacity building are vital for partner forces.Blood supply issues are critical in combat settings.Tourniquet management is a significant concern in Ukraine.Plasma is being used due to a lack of blood supply.Chapters00:00 Introduction to the CoROM Podcast00:45 Dr. John Quinn's Background and Experience02:13 Key Assumptions in Damage Control Resuscitation03:42 Medical Planning in Large-Scale Combat Operations05:11 Challenges in Medical Logistics and Command07:35 Understanding Terminology and Echelons of Care09:58 Tactical Combat Casualty Care and Innovations11:52 Telemedicine's Role in Combat Medicine13:47 Challenges in Casualty Evacuation15:40 Logistical Challenges in Blood Supply17:34 Wounding Patterns and Weapon Systems19:50 Medical Evacuation in Challenging Environments22:35 Training and Capacity Building in Ukraine24:59 Clinical Governance and Standards in Ukraine27:39 Transfusion Practices and Challenges30:54 Addressing Tourniquet Issues and Training33:39 Plasma Use and Blood Supply Challenges36:51 Conclusion and Future Directions

This week, Dr Sean Keenan gives the keynote address for the Medicine in the Mediterranean 2025 conference held last week in Malta. He discusses the evolution and current practices of Prolonged Field Care (PFC) in military and austere environments. Dr Sean Keenan discusses the importance of adapting medical practices to meet the challenges of remote and resource-limited settings, emphasising the need for comprehensive training and guidelines. The discussion highlights the difficulties with transitioning from Tactical Combat Casualty Care to Prolonged Field Care, the significance of clinical practice guidelines, and the ongoing efforts to improve emergency medical response in various contexts. This conversation delves into the development and implementation of Prolonged Casualty Care guidelines, focusing on the challenges faced in training and the importance of mastering basic medical skills. The discussion highlights the need for effective logistics, the significance of the golden hour in trauma care, and the evolving nature of warfare that impacts medical practices. The speaker emphasises the importance of continuous education and adapting to operational needs while maintaining sound medical principles. Takeaways Prolonged Field Care has evolved significantly over the past decade. The importance of audience participation in understanding medical terms. Learning from past experiences is crucial in medical practices. The Joint Trauma System collects data to improve best practices. Pre-hospital care is often overlooked in trauma literature. Human physiology remains constant regardless of the environment. Prolonged Field Care addresses the gaps in emergency medical response. Training and equipping personnel is essential for effective care. The transition from Tactical Combat Casualty Care to Prolonged Field Care is vital. Understanding the context of care is key to effective medical response. Prolonged Casualty Care guidelines are evolving to meet modern warfare needs. Curriculum development requires feedback from experienced practitioners. Basic medical skills are crucial for effective, prolonged field care. The golden hour is critical for reducing mortality in trauma cases. Logistics play a significant role in successful medical interventions. Training must adapt to the realities of current combat situations. Understanding human physiology is essential for effective medical care. Expecting casualty care is a new concept that needs training. Continuous education is vital for paramedics and medical personnel. Operational needs drive the development of medical guidelines. Chapters 00:00 Introduction to Prolonged Field Care 07:03 The Evolution of Prolonged Field Care 29:04 Current Practices and Guidelines in Prolonged Field Care 31:55 Prolonged Casualty Care Guidelines Overview 35:49 Curriculum Development and Feedback Process 40:12 Challenges in Prolonged Field Care Training 44:01 Extending the Golden Hour in Trauma Care 49:34 Current Practices and Future Directions in Prolonged Field Care 54:44 Mastering the Basics of Prolonged Field Care 01:00:42 Future Warfare and Operational Considerations

  What if the lessons learned from a conflict zone could transform military medicine worldwide? Join us as we promise to reveal groundbreaking insights into combat casualty care with John Quinn, MD, MPH, PhD, EMT-P, a leading voice in Emergency Medicine and Combat Casualty Care. Dr. Quinn shares his experiences and pivotal lessons from the war in Ukraine, providing an in-depth look at how military medical operations have evolved in response to the challenges faced in high-stakes environments. Gain valuable knowledge on damage control, resuscitation, and the strategic decisions made from the point of injury to more advanced medical roles.    The complexities of combat medicine are not for the faint-hearted. In this compelling episode, we confront the realities of triage and care under fire, with medical personnel often working without senior guidance amidst the chaos of large-scale combat. Our discussion sheds light on the critical importance of Tactical Combat Casualty Care and the intricate decisions around tourniquet use when resources are stretched thin. Dr. Quinn emphasizes the skills required to manage such intense scenarios, ensuring listeners understand the vital balance between operational readiness and effective medical intervention.     Handling pain management and blood supply logistics in conflict zones is no small feat. We explore the intricate challenges of ensuring adequate supplies and effective pain medication, particularly in the context of Ukraine's ongoing conflict. Dr. Quinn delves into the necessity of a robust supply of universal donor blood and the pressing need for improved clinical governance to support pre-hospital blood transfusion capabilities. The episode addresses the pressing issue of antimicrobial resistance and antibiotics' critical role in these settings, highlighting the need for structured guidance and oversight to navigate the complexities of treating diverse patient populations. Chapter Timestamps 00:02 Military Medicine and Operational Readiness 09:30 Combat Medicine and Triage Challenges 14:08 Challenges in Pre-Hospital Pain Management 17:43 Combat Medic Challenges and Solutions   Chapters with Summaries (00:02) Military Medicine and Operational Readiness This chapter explores the insights and experiences shared by Dr. John Quinn, the lead author of a pivotal article on pre-hospital lessons from the war in Ukraine, focusing on damage control, resuscitation, and surgery from point of injury to role two. Dr. Quinn, with a background as a paramedic and emergency medicine physician, recounts his involvement in Ukraine since 2014, highlighting the evolution of military medical operations up to the large-scale invasion by Russia. We discuss the collaborative effort behind the article, featuring a diverse team of experts, including traumatology surgeons, paramedics, and academic figures, all working to enhance combat casualty care. Dr. Quinn emphasizes the importance of incorporating Ukrainian academics' insights and using NATO's terminology for lessons learned, providing a comprehensive look at the on-the-ground experiences and challenges faced in providing timely and effective medical care in conflict zones.   (09:30) Combat Medicine and Triage Challenges This chapter addresses the complex challenges faced by medical personnel in large-scale combat operations, particularly in the context of the ongoing conflict involving Russian forces. We explore how medical workers, including international volunteers, are specifically targeted, necessitating unique approaches to operational security, communication, and personal protective equipment. The discussion emphasizes the importance of tactical combat casualty care, especially in making critical triage decisions without the guidance of senior clinical decision-makers. With an overwhelming number of patients and limited evacuation capabilities, medical personnel must navigate the intricacies of tourniquet use, balancing between preventative application and conversion to pressure dressings as per TCCC protocols. The chapter highlights the essential skills required to manage care under fire and the need for timely assessment by qualified providers to reduce morbidity and enhance force effectiveness in the battlefield.   (14:08) Challenges in Pre-Hospital Pain Management This chapter addresses the challenges and intricacies of pain management and blood supply logistics in conflict zones, particularly focusing on the context of Ukraine. We explore the inadequacies of certain medications like Nalbuphine, which can complicate effective pain management when transitioning patients to higher levels of care. The importance of having access to more effective drugs such as ketamine and fentanyl is emphasized, although logistical challenges in their distribution are acknowledged. Additionally, we highlight the critical need for an ample supply of universal donor blood and low-titer O blood products during large-scale combat operations. The chapter underscores the logistical hurdles in ensuring these supplies are available before they spoil and discusses the inadequacy of traditional walking blood banks in high-casualty scenarios, advocating for improved clinical governance to enable broader pre-hospital blood transfusion capabilities.   (17:43) Combat Medic Challenges and Solutions This chapter highlights the critical importance of antibiotics in deployed medical settings, emphasizing the challenges of antimicrobial resistance, particularly in Ukraine. We explore the need for a structured antimicrobial guidance system, informed by biogram data, to prevent inappropriate dosing and resistance. The discussion extends to the complexities of treating diverse age groups, including elderly and pediatric patients, who may have additional medical conditions or require specialized care. Additionally, we stress the significance of clinical governance in ensuring that medical personnel, whether affiliated with NGOs or the military, operate under proper oversight and standards. Finally, we identify the top three priorities for improvement: ensuring an unlimited supply of low-titer universal donor blood, enhancing training and clinical decision-making, and leveraging data for effective medical logistics and planning.   Take Home Messages: Evolving Military Medical Practices: The podcast delves into the evolution of military medical operations in Ukraine, highlighting the lessons learned from the ongoing conflict. It emphasizes the importance of adapting medical practices to the realities of modern warfare, particularly in large-scale conflicts where traditional medical procedures may not suffice. Challenges in Battlefield Medicine: Listeners are exposed to the myriad challenges faced by medical personnel in combat zones, including the complexities of tactical combat casualty care and the necessity for rapid, autonomous decision-making under fire. The episode underscores the need for enhanced training and preparation to handle these high-pressure situations effectively. Pain Management and Medical Logistics: The discussion reveals significant hurdles in managing pain and logistics in conflict zones, with specific reference to Ukraine's current crisis. It stresses the need for reliable access to effective medications and blood supplies, highlighting the logistical challenges that can impact patient outcomes. Antimicrobial Resistance and Clinical Governance: The episode sheds light on the critical role of antibiotics in deployed medical settings and the growing concern of antimicrobial resistance. It advocates for structured guidance systems and emphasizes the importance of clinical governance to ensure high standards of care are maintained, especially when relying on NGOs and international volunteers. Data-Driven Medical Improvements: The conversation calls for the collection and analysis of medical data to enhance military medical practices. It stresses the importance of leveraging lessons learned from current conflicts to refine medical logistics, decision-making processes, and training, ensuring better preparedness for future challenges.   Episode Keywords: Military Medicine, Operational Readiness, Combat Medicine, Triage, Ukraine Conflict, Russian Invasion, Damage Control, Resuscitation, Surgery, Battlefield, Tactical Combat Casualty Care, Tourniquets, Pressure Dressings, Pain Management, Logistical Hurdles, Antimicrobial Resistance, Clinical Governance, Medical Logistics, Training, Data Analysis   Hashtags: #CombatMedicine #UkraineConflict #BattlefieldHealthcare #MilitaryMedicine #EmergencyCare #TacticalCombatCasualtyCare #FrontlineMedicine #WarfareInnovations #ConflictZoneMedicine #DrJohnQuinn   Article Citation: Quinn J et al. Prehospital Lessons From the War in Ukraine: Damage Control Resuscitation and Surgery Experiences From Point of Injury to Role 2. Mil Med. 2024 Jan 23;189(1-2):17-29. doi: 10.1093/milmed/usad253. PMID: 37647607.   Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield,demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast  

     What if the training that saves lives on a battlefield could be applied to your everyday world? Retired Navy CAPT Dr. Frank Butler joins us on War Docs to unravel how the rigorous life of a Navy SEAL shaped his journey into pioneering military medicine. Hear firsthand how Dr. Butler transitioned from the relentless demands of SEAL training to medical school, contributing to the development and implementation of Tactical Combat Casualty Care (TCCC). He offers a unique perspective on the historical evolution of military medical practices and their profound impact on survival rates in combat situations    Dr. Butler takes us through the history, challenges, and triumphs of TCCC, shedding light on its rocky beginnings and eventual adoption post-9/11. With stories ranging from the life-saving use of tourniquets during D-Day to modern-day practices in Afghanistan and Iraq, this episode highlights the need for evidence-based practices and the importance of learning from historical medical knowledge. Moreover, Dr. Butler emphasizes how TCCC's success has transcended military lines, influencing tactical law enforcement and first responders nationwide.    As we dive into the practical applications of TCCC, we explore the importance of balancing medical care with tactical advantage in combat, illustrated by real-world examples and personal anecdotes from military leaders and medics. The episode closes with a call to action to sustain these medical advances and ensure that the lessons learned are not lost in peacetime. Join us for this engaging conversation with Dr. Frank Butler and discover how the lessons from the battlefield continue to shape and save lives, both in military and civilian contexts.   Chapters Military Medicine Evolution and Impact (00:04)    Retired Navy SEAL Dr. Frank Butler discusses TCCC, combat medics, Stop the Bleed, Hartford Consensus, and refractive surgery in military medicine. Medical Innovations Impacting Battlefield Medicine (18:30)     Tourniquets and whole blood's historical evolution and usage in military medicine, emphasizing the importance of time and evidence-based practices. TCCC Evolution and Preventable Death Analysis (26:02)     TCCC faced resistance but was adopted after 9/11, highlighting the need for improved trauma care. Tactical Combat Casualty Care Expansion (33:10)   TCCC principles have been adopted by law enforcement and first responders, saving lives beyond the battlefield. Improving Medical Care in Combat (38:24) TCCC prioritizes threats over immediate medical intervention, using field experiences to improve guidelines for better outcomes. Sustaining Tactical Combat Casualty Care (54:19) TCCC's role in military and civilian medical practices, ownership by combat commanders, and learning from past conflicts.   Take Home Messages: Advancements in Tactical Combat Casualty Care (TCCC): The podcast highlights the significant evolution of TCCC, emphasizing the importance of evidence-based practices in saving lives on the battlefield. The development and widespread adoption of TCCC principles have been crucial in reducing preventable deaths during military operations. Integration Beyond the Military: The principles of TCCC have transcended military applications and are now integral to tactical law enforcement and first responder protocols. Initiatives like Stop the Bleed have demonstrated the impact of military medical advancements on community safety and emergency response, illustrating the broader influence of these practices on civilian medical care. The Role of Combat Medics: The episode underscores the unique position of combat medics as both healers and warriors. Their critical role in providing immediate care in combat scenarios and the trust and respect they command within their units are highlighted. Learning from Past Conflicts: A key takeaway is the necessity of learning from past combat experiences to continually improve medical care practices. The importance of understanding each combat fatality and integrating those lessons into future strategies is emphasized to ensure ongoing advancements in military medicine. Balancing Medical Care and Tactical Advantage: The podcast discusses the challenges of providing medical care in high-pressure combat situations while maintaining tactical advantage. It stresses the importance of prioritizing threats over immediate medical intervention to ensure the safety and effectiveness of operations.   Episode Keywords: Military Medicine, Navy SEAL, Medical Innovation, Tactical Combat Casualty Care, TCCC, Combat Medics, Evidence-based Practices, Stop the Bleed, Hartford Consensus, Specialized Training, Trauma Care, Preventable Deaths, Committee on Tactical Combat Casualty Care, Chicago Police Department, Law Enforcement, Emergency Response, Tactical Advantage, Combat Commanders, Combat Fatality, Podcast Support   Hashtags: #BattlefieldMedicine #MilitaryInnovation #TCCC #FrankButler #WarDocsPodcast #CombatCare #StopTheBleed #HartfordConsensus #NavySEAL #TraumaCare Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield,demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast

Anyone familiar with tactical medicine knows the name Dr. Frank Butler—Navy SEAL, captain, ophthalmologist, former director of the SEAL biomedical research program, and one of the founders of tactical combat casualty care (TCCC). Butler's new book Tell Them Yourself: It's Not Your Day to Die is the extraordinary account of how a small group of world-class trauma experts joined forces with America's best combat medics to rewrite the rule book in battlefield medicine—and then to sell these revolutionary new concepts to a disbelieving medical world. Mike McCabe gets some time with one of the most distinguished, decorated and influential medical minds in TCCC to discuss challenges and innovations in battlefield medicine and what those lessons can bring to civilian EMS.

   Embark on a journey to the front lines of military medicine with our esteemed guest, retired Army Lieutenant Colonel Dr. Randi Schaefer. With her wealth of experience, Dr. Schaefer takes us through the intense world of emergency trauma care and her personal evolution from a college student to an accomplished military nurse and emergency medicine expert. We explore the educational paths and specialization opportunities within the military nursing field and the life-saving innovations in pre-hospital blood administration that have triumphed on the battlefield and transformed civilian emergency care.    Dr. Schaefer pulls back the curtain on the progressive tactics and challenges that have shaped blood transfusion practices over the years. From the early days of relying on hospital staff donors to the current state-of-the-art application of whole blood in the thick of combat, we discuss the critical observations and strategic collaborations that have driven these practices forward. The role of STRAC in revolutionizing pre-hospital care and the crucial impact of timely blood transfusions in saving lives take center stage in this compelling narrative that intertwines military precision with medical breakthroughs.    Our final moments with Dr. Schaefer reveal the innovative solutions combat medics deploy to save lives under the most extreme conditions, including providing blood transfusions amidst the chaos of active fire. We also shine a light on the advancements that continue to elevate the field, like the Vampire Program and the Tactical Combat Casualty Care training. Dr. Schaefer's ongoing consulting work and vision for emergency medicine not only reflect her unwavering dedication but also promise to guide the future of trauma care to even greater heights. Join us for this captivating episode where valor meets the rigor of medical science, and discover the incredible impact of one woman's journey on the world of emergency medicine.   Chapters: (00:00) Addressing Hemorrhage in Trauma (07:22) Early Blood Transfusion in Emergency Settings (15:49) Pre-Hospital Blood Transfusion and Innovations (27:57) Enhancing Pre-Hospital Blood Transfusion Rates (37:26) Consulting on Pre-Hospital Blood Administration   Chapter Summaries: (00:00) Addressing Hemorrhage in Trauma Army nurse Randi Schaefer discusses pre-hospital hemorrhage control and the potential for future improvements in military and civilian sectors.   (07:22) Early Blood Transfusion in Emergency Settings Nature's role in trauma care: reliance on hospital staff, evolution of transfusion practices, and efforts to improve pre-hospital capabilities.   (15:49) Pre-Hospital Blood Transfusion and Innovations Nature's emergency blood transfusion process in pre-hospital settings, including training, logistics, and clinical guidelines for improved trauma care outcomes.   (27:57) Enhancing Pre-Hospital Blood Transfusion Rates TCCC training, missed transfusion opportunities, and improvements in pre-hospital blood programs for combat medics.   (37:26) Consulting on Pre-Hospital Blood Administration Practical aspects of pre-hospital blood product administration, logistics, military background, and legacy of service. Take Home Messages: Military medicine has played a critical role in innovating trauma and emergency care, specifically in the field of pre-hospital blood administration, due to the need for immediate life-saving measures in combat scenarios. Career progression within the Army can lead to educational opportunities and specializations in emergency medicine and trauma care, as evidenced by the journey of a retired Army Lieutenant Colonel and military nurse. The shift in blood transfusion practices, such as the transition from crystalloids and component therapy to the use of whole blood, has been influenced by clinical observations and the necessity for timely interventions to reduce mortality rates. The Southwest Texas Regional Advisory Council (STRAC) has been instrumental in connecting military and civilian trauma care practices, especially in pre-hospital blood administration. Training and protocols developed for combat medics, such as Tactical Combat Casualty Care (TCCC), have resulted in innovations that guarantee timely and safe blood transfusions even in active combat situations. The logistical challenges of storing and transporting blood products in combat situations have spurred innovative solutions, like the use of drones and advancements in non-liquid blood products such as spray-dried plasma. Clinical guidelines, such as using the shock index, assist medics in making decisions about when blood transfusions are necessary, leading to improved patient outcomes in pre-hospital trauma care. Doctoral research focused on increasing pre-hospital blood transfusion rates highlighted the significance of training, refining dispatch operations, and managing distractions during emergencies to prevent missed opportunities for life-saving transfusions. The practical implementation of pre-hospital blood product administration involves navigating logistical challenges, adhering to blood bank and FDA requirements, and ensuring the proper storage and temperature maintenance of blood products. The episode underscores the significance of continuous innovation and adaptation in emergency medicine, using lessons learned from military experiences to enhance civilian trauma care and ultimately save more lives. Episode Keywords: Military Medicine Innovation, Trauma Care Advancements, Blood Transfusion Practices, Pre-Hospital Care Strategies, Emergency Medicine Podcast, Combat Medics Training, Dr. Randi Schaefer, Tactical Combat Casualty Care (TCCC), Whole Blood Transfusion, Medical Frontiers in Trauma, Battlefield Medicine Developments, Civilian Emergency Care Techniques, Military Nurse Education, Southwest Texas Regional Advisory Council (STRAC), Vampire Program Army, Pre-Hospital Hemorrhage Control, Trauma Care Lessons from Military, Blood Product Administration, Paramedic Blood Transfusion Training, Innovation in Military Healthcare. Hashtags: #wardocs #military #medicine #podcast #MilMed #MedEd #MilitaryMedicine #TraumaCareInnovation #DrRandiSchaefer #EmergencyMedicine #BloodTransfusion #CombatMedics #PreHospitalCare #MedicalFrontiers #TCCC #VampireProgram #MilitaryNurse #LifesavingInnovations #WholeBloodAdvancement #EmergencyCarePodcast #MilitaryHealthcare   Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/episodes Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast    

Dr. Andrew D. Fisher (MD, PA-C) is the patron saint of fresh whole blood transfusions. He is a graduate of Texas A&M University College of Medicine and is currently a general surgery resident at the University of New Mexico School of Medicine in Albuquerque, New Mexico. He served in the US Army as a Physician Assistant assigned to the 75th Ranger Regiment prior to medical school where he pioneered the use of whole-blood transfusions at the point of injury and contributed to research for the utilization of low titer O-negative whole blood in trauma. His influence on tactical medicine in the world today through research, teaching, training, and medical practice is impossible to overstate.

Episode Summary This week on Live Like the World is Dying, Inmn is joined by Carrie and Korin from the Glia project to talk about some of their projects and specifically to talk about why 3D-printed medical devices are really cool and how they help get medical devices to places where they are not otherwise easily accessible. They talk about Glia's work on 3D-printed tourniquets, stethoscopes, otoscopes, and dialysis machines. Also, please give them $5 million. You won't regret it. Host Info Inmn can be found on Instagram @shadowtail.artificery. Guest Info Glia can be found at www.glia.org or on Twitter @Glia_Intl Publisher Info This show is published by Strangers in A Tangled Wilderness. We can be found at www.tangledwilderness.org, or on Twitter @TangledWild and Instagram @Tangled_Wilderness. You can support the show on Patreon at www.patreon.com/strangersinatangledwilderness. Transcript Glia on 3D Printing Medical Devices Inmn 00:15 Hello, and welcome to live Like the World is Dying, your podcast for what feels like the end times. I'm your host Inmn Neruin. And this week we're going to be talking with Glia, a rad organization that designs 3D printed medical devices so that no matter where you are, you can access basic and quality medical devices. But first, this podcast is a proud member of the Channel Zero Network of anarchists podcasts. And here's a jingle from another show on the network. Doo doo doo doo doo. [Singing a simple melody] Inmn 01:17 And we're back. Thanks so much, y'all, for coming on the podcast today. Would y'all like to introduce yourselves with your name, pronouns, nd what you what you're here to talk about or what your role is in Glia. Carrie 01:45 Okay, I'll go first. My name is Carrie Wakem and she/her and my role at Glia is executive director. It sounds very flashy. It's not. We're all team players here at Glia. Korin 02:00 My name is Korin, my pronouns are she and they. I'm a volunteer with the Glia project, particularly focused on the tourniquets, and specifically with regards to manufacturing instructions and quality control documentation. Inmn 02:13 Cool. And would you want to kind of introduce what Glia is? Carrie 02:20 Absolutely. So Glia is a medical device manufacturing company. We do lots of research and we build and research devices that are considered high quality, open source, and at cost. And that's sort of the stuff that we do. Inmn 02:42 How did Glia come to get started? Also, does Glia stand for anything? Is it an acronym? Or is it just a fun word? Carrie 02:50 Everybody asks that question about the acronym and how we became Glia or where the name came from and really there's no interesting story behind it. I think the original team on the Glia project just basically said, "What should we call this?" Somebody throw it the name Glia. And then it stuck as far as I know. But that was before my time. I can absolutely speak to a bit of the history of Glia and how it came to be. So, our founder Tarek Loubani is in emergency medicine physician in London, Ontario in Canada. And he works frequently in the Gaza Strip. And quite a few years ago he was there during the war and he was responding to a large amount of casualties. And he was in a room with a whole bunch of patients that needed to be seen. And when he looked around, he saw that there were only two stethoscopes being used in that room and one of them was around his own neck. And literally people had blood on their ears because they were putting their ear to the chest of patients to hear if there were heartbeats. And it occurred to him that some other places in the world don't have access to even basic medical tools like stethoscopes. And then after that trip, he was home and he was playing with one of his nephews and he was using the little toy plastic stethoscope doctor kit--I think Fisher Price used to make one when I was a kid. Anyway, that's who made one. I'm sure there's a lot of knock offs now. But, they have a little toy stethoscope. And he put it to his ears and he was listening and he was like, "This thing actually works. You can actually hear a heartbeat through this plastic toy." And he just had an interest in 3D printing at the time and he thought to himself, "I wonder if I could create a stethoscope using a 3d printer that would be more accessible, lower cost, and hopefully as high a quality as the Littmann cardiology iii, which is what our stethoscope now compares to. So Glia does have a 3D printed stethoscope today. It was our first product that was developed and it's based off of that experience of our founder. Inmn 05:00 Cool. Is that is that...[incoherent starting and stopping and stuttering] That makes sense how that would prompt an organization like Glia. But it is...That's really grim that that is how these organizations start. Carrie 05:15 Yeah. Unfortunately. Though, those are the stories that probably motivate people to do something about these scenarios, right? So, you see a problem and you want to solve it Inmn 05:27 Is Glia, like, I guess....So from there, this person started 3D printing stethoscopes and then how did the larger structure of Glia kind of start from there? Was it like people just being like, "Oh, that's really cool. Could we also make this other thing?" or? Carrie 05:43 Um, yeah, so a lot of what we've done...There's parts of it that's have been strategic and parts of our projects that have been organic. The first stethoscope, I believe, was developed in 2014. I didn't come into the project full time myself until 2017. So this is a little bit before my time. Stethoscopes were the thing that we were sort of working on, at the moment that I joined Glia myself. And we started with the stethoscope specifically because it's an iconic device, right? Like everybody recognizes it. So, there was some strategy into picking a device to get started on the topic of "How can an open source stethoscope really changed the world? How can that provide better access to quality health care?" It's a talking point and it still is to this day. From there, though, it was the experiences of the people that were working or associated with the project--collaborators, we've had a lot of collaborators, a lot of volunteers over the years--that sort of drove the direction of some of these projects. And the one that Korin mentioned at the beginning when she introduced herself was the tourniquet project. And that was actually originally developed by the engineers that were working for Glia back in 2017, a group there. And they saw a need for tourniquets in the Gaza Strip. They just couldn't access this type of device. And as we know in Gaza, there's constantly the threat of war. So, they needed to be able to come up with something that they could get access to. And so they designed this tourniquet--and we can probably get into that a little bit later--but that was something that organically happened from our remote office. Other projects like our otoscope. We have a 3d printed otoscope. This project was literally designed by a guy that was attending audiology school. So a gentleman that was in his early 20s had a fondness again for 3D printing and he was sitting in class going, "Why does an otoscope cost $400. I'm a student. I'm on a student budget. I can't access this general piece of equipment." And, and we're not talking about the Welch Allyn otoscopes that are attached in your doctor's office. We're talking about just you know, a plain handhold regular tool to look into somebody's ear. And so this guy, his name's Frankie Talarico, he actually sought us out and he was like, "I want to make this otoscope. And I want to just design it quickly on some software. And I want to make it open source so that anyone else can access that source code and copy it from anywhere else in the world." And he looked out to see who else was doing things like him. And it just so happened, we were in the same exact city, literally like a 10 minute drive from each other. And he reached out and he said, "I have this device that I've been working on. I want it perfected. You guys seem to be a little bit more ahead of of the game in terms of open source medical devices. How can we help each other?" And so he brought this idea, this concept, this design. We had it, you know, sort of perfected in a couple of different versions. And now what you see on our website is working a portable otoscope for...It's $100 for that device and we're hoping to improve our manufacturing process in the next year when we have people like Korin involved to help those processes get a little bit more efficient, we can lower the price even further. So its cost right now is 1/4 of what it does for the comparable gold standard model on the market. Inmn 09:35 Wow. Yeah, that is...I mean, that's a significant difference. If someone downloaded it and printed it themselves, would it be cheaper for them to print it themselves then? Carrie 09:49 Yeah, so yeah, in a sense it would be. So there's...So what Glia does is we take our designs that we make--all of our medical devices are located in our public repository on GitHub--and people can access those files and make them themselves. So there's no, you know, limit to what people can do with these things. They can redevelop them and make them better. That's what we really love is when people come into our feedback cycles and we see improvements for devices. That's one benefit of having it open source. But people certainly can take the device and make it. And in fact, if somebody copies what we're doing, that is a success to us. That's what we want to happen here, which is probably much different from many of the other medical device companies you think you might know. We measure our success based on how much it's replicated. And so somebody can take that device, they can make it on their printer. It really does cost cents to print with the plastic that we're using. There's a few electronic components and batteries. There's a lens that you need to source. So that might be you know...You could get that somewhere between $5 and $20 USD, to get a lens that goes into this. Not very expensive pieces. And then it's your time of putting it together. But I must say, the one caveat in all of this being, is that if you are building and replicating medical devices and using them on patients, you have to have proper compliance in your area. So Glia holds a Medical Device Establishment license, which is a Health Canada license that we have to make sure that all of our devices that are going out are safe to use on patients. And we would encourage anyone else to do the same thing if they were really making these things to use on patients, to sell to others to use on patients, etc. Inmn 11:47 Yeah, I was gonna ask, not in like a skeptical way or anything, but like in a....How do the devices that y'all make compare to professional medical devices that are produced in factories? Which I mean, this is just...Yeah, it doesn't seem all that different, just a different means of manufacturing.... Carrie 12:10 Great question. I love this question. So what Glia is trying to do is to make our devices as close in functionality to the gold standard devices that you would see. So we don't compare ourselves to cheap plastic shit that's built elsewhere, or knock offs, or crap that you can find all over Amazon, you know. We want to make sure that we are building high quality devices. So we do real research backed by real institutions on that. And then we publish real papers in reputable journals about the research that we do. So, the idea here is to make something in a different way that lowers the cost, increases the access, but does not touch the standard of quality. So quality is number one for us. And then alongside quality is safety. So that's where the question of compliance sort of comes in. We encourage anyone that's producing medical devices to make sure they understand proper compliance in their area. And really in the world right now there are four main places to get compliance. One is Health Canada, which is where we...our home offices is in Canada. There's also the FDA. There is one--and I'm not sure of the exact name--but there's one for the European Union that qualifies. And then I believe there's one in Australia as well. So for the countries that don't have these types of governing bodies, where often these devices are needed most, they would follow compliance from one of those other countries that provide that service. And if they are then you could trust that you're being safe with what you're doing. Inmn 14:03 Cool. Cool. Yeah. So in contrast, y'all are producing these medical devices for very little money, but it is without the sacrifice of quality and so it's...like, is that kind of...[starts over] Does that offer a good alternative to if people are like, "Oh, I need cheap medical supplies. I will go buy them on Amazon." Carrie 14:33 Yeah, I wouldn't recommend doing that specifically, but it doesn't mean there aren't good quality medical devices on Amazon. Okay, so I can just say that for sure. The difference...So the point of this all is to make a sustainable business model where people get paid fair wages to build build high quality devices. And the point here is not to gouge people that need these devices to improve their health. What Glia is trying to do, and say, and change in the culture of the way our health system operates today is that nobody should be making money on the backs of people's health care. And so we should charge what it costs to produce these devices. That's what the customer should pay at the end, not that price plus investments--like paying off investors--paying off people so that they can have their Lamborghinis and their yachts and go out and do all these things, right? Like, this is not the place for that. If you want to make a designer t-shirt and sell that to someone and they want to pay, you know, $500 for a t-shirt, that's up to them. That's not something they need. But people need access to health care and there's a lot of inequity in our world today with accessing even these simple devices as I said in my very first example of how the company came to be. Like why is it in 20--I believe that happened in 2012--why was it in 2012 that stethoscopes weren't available in a place in this world? Like quality stethoscopes. And that just doesn't make any sense. And the three of us, we may have had enough privilege to be able to understand what a stethoscope was from the minute we could walk or talk--thanks to Fisher Price too--but also, you know, like it's not an issue for us to really get some simple tools, but that's not everywhere in the world. Inmn 16:54 How then do devices make it from y'all to places like Gaza? Or anywhere where people who need to be able to access them? Yeah, how does that that flow path work? Carrie 17:11 This can happen in a couple of different ways. Our preferred method is for people to adopt what we're doing and do it themselves. You know, this is...I was talking a little bit about the measurement of success for Glia and one of those things is getting people to replicate what we're doing. And so if they decide, "I need access to a particular device, anywhere in the world," it really, for our devices right now, the way they stand, it's mostly about having access to a quality desktop printer, and having the source code, having a little bit of expertise, proper compliance, and you've got the recipe to start building your own devices. So whether that be 100 devices or 100,000 devices, you can really do that based on this model. It is scalable. I mean, but it's not meant to be massively scalable, right? It's about keeping the decentralized manufacturing model alive and only filling the need in communities as they need things, not over producing. You know, like, we don't want to throw a whole bunch of crap into the landfill. That's not one of our objectives. Our objective is to fill the needs of the people who need what they need. Now Glia...That doesn't mean that Glia doesn't ship things. You know, like we will...Some people can't, or don't have interest, or don't want to, or it's not feasible. An example of that is sending tourniquets over to Ukraine for some response there. There are...We also had an initiative--we're working on it again this year--but a couple of years ago we sent out 200 stethoscopes to medical students graduating from their class. So fourth year medical students still did not have access in Kenya and Zambia to a simple stethoscope. So, we worked with a group over there called Myka Medic--or sorry, they're in the UK--and we collaborated with them to send these stethoscopes over. They weren't necessarily interested in that moment in starting their own lab, getting proper compliance, you know, getting all those tools. But getting that conversation started by sending over a couple of hundred units means that we can talk about those things in the future. Now we have these stethoscopes And now, when something happens to one of these stethoscopes, how do we repair it? Right? And that's what's beautiful about the model if you actually do, you know, invest in a $1,400 (Canadian) printer and teach somebody a little bit about what we're doing, give them the access to be able to build it themselves, and then they can go ahead and make more, repair what they have, you know? It just makes it just makes sense. Korin 18:29 You mentioned a little bit about Gaza, specifically. Those are produced in Gaza. And the reason for that was because there was a dire need for them. And attempting to get medical supplies through that blockade is very difficult without paying exorbitant fees. They would cost...To get a CAT tourniquet here in the US cost about $30 and to get it into Gaza would be about $40 USD even if you're buying in massive bulk quantities. Carrie 20:23 For a single tourniquet? Korin 20:37 Yeah, about $40 each. Inmn 20:52 Oh, my God, Carrie 20:53 Yeah, that's, a lot of money in Gaza to pay for medical devices. And not only that, but there's another huge issue we can bring in, if it's time to do that, which is talking a little bit about donation culture and how a place like Gaza, especially, deals...I mean, I've learned a lot about this, especially in the last year, but the health system in Gaza right now is reliant on donations so much so that it's hard for them to steer out of any other path. And they can't even, you know, fathom the idea sometimes about being empowered to build their own stuff because they're so used to receiving basically other people's secondhand items. But what this does is it creates this dumping culture where devices will get dumped into an area because another place doesn't need it. So they'll say, "Oh, who wants this? We don't want to throw it away. So let's go put it somewhere where people can't have access." So there's a whole bunch of problems with that system, especially in Gaza. One of the things is they get a lot of stuff they don't need or don't want. They can't store it. They have inventory crisis constantly because of all of this dumping that happens of things they don't need or don't want. And then they become reliant on something. So for example, one of the ideas that Glia has down the pipeline is creating a dialysis machine. And we don't really want to reinvent dialysis. What we want to do is to take an existing type of dialysis machine and build an adapter to fit on that existing machine that will speak to any one of the disposables that may be used for the purpose of dialysis. So right now, those things are manufactured in a way that if XYZ company makes it, you have to get XYZ disposables to be compatible with that machine in order to use it. So, what's happening in Gaza is that there is literally a gymnasium full of dialysis machines that are unusable and another gymnasium full of disposables that are unusable because those two units are not compatible. So Glia's idea for a device--now this is going to be a $5 million project and you know, if any of your listeners have access to that type of cash, we would absolutely love to begin this project--but, you know, we want to build an adapter that will speak to those two pieces so that people can actually use the stuff that is donated to them, that is given to them, because it...And you can imagine, so now they have storage issues and they become reliant on these people that are feeding them the donations, right? So it's just there's so many problems with that. Now, if you look at what Glia is trying to do, we have an office in Gaza. We have an office with several printers running. We build our own turkeys locally there. So we build our own medical devices there. So they're already there, you know, and people can purchase or use what they need. They don't need to rely on somebody else's handouts to get them in there. And there's a lot more that we could do there as well. But it's difficult. It's difficult to even negotiate with those governing bodies that make those decisions in Gaza because they're so used to dealing with these donations and that's kind of the system they're relying on right now. Inmn 24:33 Yeah. I cannot imagine being a medical practitioner in Gaza and being, "Well, we need dialysis machines," and having an entire gymnasium full of dialysis machines that you can't use that. Wow, I hope that y'all get to start that one soon. Carrie 24:52 And like Korin was saying, it's extremely difficult to get things in. I worked on a project in 2016 I want to say--yes 2016-- where I moved 10 dialysis machines from Northern Ontario. So for your US listeners, Ontario is in central Canada and northern Ontario is somewhat remote. Okay. And this is going to fill all the stereotypes that people think of Canada right now what I'm going to say. Where I moved these, I work with a nephrologist and he wanted me to take--he did some work in Gaza--and he saw that there were some machines that were at this northern Ontario hospital that were compatible with some of the disposables that were already in Gaza. And they weren't being used by us. So he said, "Let's pay to get these 10 machines that are basically obsolete for Canadians." Okay, "Let's move them to Gaza." This project took me nearly 12 months to get these in. They had to come from this hospital via Ice River, onto a train, onto another train, onto a plane, and then perhaps a ship--I can't remember, it was a while ago--I don't know if we had it on a ship to get across. But then of course, it had to wait. To get this in through the blockade was terribly difficult. But we were able to get the Ministry of Health in Gaza on board and, you know, they let them in eventually. It also cost us $10,000 Canadian in shipping. So, what are we doing here, folks? This makes no sense. And all just because "Oh, somebody donated some disposables and they don't talk to any of the machines we have here. So let's dig out these ones out of the basement of northern Ontario and move those over." You know, it's just so frustrating because think about how far $10,000 would have gone in terms of buying any type of medical device if they had the market to do so in Gaza. It would be...It's just there's nothing that can can really be said about that. It's... Inmn 27:15 Yeah, that is maddening. I know that...I mean, not to relate things back to things in the United States, but I remember when, you know, early, early COVID times, there was a serious lack of ventilators and all the car companies were going on strike to have the car company factories make ventilators instead. And I don't really know where I'm going with this, but just maybe for people in the United States to think about a comparable or semi-comparable situation of like absurdity that we have all these means of production and we're using them to make cars or we're using them to make stuff that people don't need instead of getting basic medical...having basic medical supplies be accessible to people who need basic medical supplies. I don't know, it just it hurts my brain a lot. Korin 28:30 Not to, again, not to directly compare these two things because they are different, but even here in the US, you know, glucometers, the things that are used to measure your blood sugar, the the strip and I think the lancet and the unit itself, same kind of razor and blades model where one does not work with every other type of glucometer. So, it's exactly like manufacturers just love to do the whole razor and blades thing with people's health because at the end of the day, if it make some money, they will do it. Inmn 29:07 Yeah, yeah. And that is the wild thing too when I think about it, is that all these medical industries, they exist to make people money not to necessarily get people medical supplies. Carrie 29:23 Yeah, yeah. It's sadly true. And so...So I guess the question is then what can you do about that to change that culture? And to start thinking about this in a way that's more about sharing what you know versus holding it tight to your vest to serve yourself? How do you really serve other people with the information that you have? And so that's what Glia is really trying to do is just to show that there are...there's a different business model for this, folks. It doesn't mean that people need to be making no money or that it needs to be charitable. There's a system that could be in place where people just get paid to build stuff fairly. Maybe even just add a little bit to that so it's a nice cushy job, you know, like, give them extra vacation time, or give them just a couple of extra bonuses per year for just being great people. And you can do all of that and not gouge people at the end for all that that upfront R&D (Research and Development) that's done at the beginning. Because that's kind of, you know, fluffy, in and of itself, all of the R&D. We really don't need to redo R&D every time we do it if we just share the information we learned the last time we did it. Right? So why are we reinventing the wheel? Like really why did Glia have to come in and take a device like the stethoscope--that has seen no improvements since the 1970s in terms of its functionality, or design, or anything--and say we have to start from scratch and build this? Because, you know, like we took something that was off patent and looked at that design and replicated it. But why are we hiding behind patents here? You know, like it doesn't...it doesn't really make much sense when people need health care. Okay, I have an example. I will share a personal example. I talk about this sometimes when I give presentations. So, my personal experience isn't actually about medical devices, it's about pharmaceuticals. And I think the thing is, is that people in the US and Canada...There's a difference between the relation for a lay person in the US and in North America, especially, probably other places in the world, too, but I know here. I know our neighbors here. And everybody in North America has a relationship with pharmaceuticals, whereas not everybody in North America has a direct relationship with medical devices. Medical practitioners do. Medical administrators do or people that are making decisions on purchases, or people that are building these things. But not necessarily. Like my mother doesn't have any personal connection to a stethoscope, even though I'm sure her physician uses it on her every time she goes and sees her. But I think the thing about pharmaceuticals is that everybody's accessing this. So we all know about how much of an upcharge there is on certain medicines. And so for example, I have a sister who has a very serious heart condition, and she needs to take medicine in Canada that it costs $40,000 a year for her lung health. And without that she wouldn't be here. So because of where we live in the world, she's able to access that through a community, like through the Trillium program that's in Canada that supports people who, who can't afford it. And she can't, you know, she's on disability here in Canada because she can't work because of her condition. It's quite severe. And without this life saving medication. But $40,000 a year? How on earth would anyone without a health care system like we have in Canada be able to live? You would die. You would die, right? So what are we doing when we don't have working dialysis machines, you know, that are not talking to each other. People need dialysis or they die. A lot of people need dialysis. And so the thing is is that the technology exists, the manufacturing of these things can exist. This is not like brand new science. This is stuff that people can do now. We're not talking about building a dialysis machine on Mars. We're talking about just building it here on Earth. And then the problem here is that, you know, but this one has to be compatible with that one. Anyway. It's it's just a mess. Inmn 34:18 I know that a big project that y'all have currently is tourniquets. And corn, I was wondering if you could tell us a little bit about that project. Korin 34:28 Yeah, the Glia tourniquet, I believe, started in Gaza as well. And that was due to necessity. This happens very frequently, where Israel will start waging war on on the Gaza Strip and that causes a lot of casualties. And due to the blockade, it's very difficult to get like commercially manufactured tourniquets in and so the solution that came up--and this was before I joined the project--but the solution that happened there was to make this tourniquet that can be 3D printed and sewn together with locally available materials. And that's...It works. Yeah. Inmn 35:10 That's awesome. And I know you're saying the price comparison of like If you wanted to buy one, it's like $30-40 bucks and then like to get it into Gaza, it would be a lot more? Korin 35:24 Yeah, absolutely. I mean, getting it in there, from what I've heard from Tarek, it's about $40 US if you have a bulk order to get it into Gaza and the time that that would take is variable. Depends on a number of factors. Here in the United States, you can get them for about $30 give or take. Some models are more expensive, but that's about what you're looking for. The Glia tourniquet, I think we've run the numbers a little bit. Depending on where you source your materials, how you do it, in theory, you could manufacture it for about $7.50. But that is before any compliance or overhead. That's just materials and assuming you have the equipment ready to make it. Inmn 35:24 Yeah, cool. I guess beyond the obvious of like putting the means into people's hands to produce their medical supplies, like why is tourniquets a big deal? Korin 35:43 So just in general, what they're used for, I guess, for folks who don't know, it's basically a big strap that gets tightened around a limb and it occludes all blood flow to that. So in the event of like a massive hemorrhage, a massive amount of bleeding, these can save lives. These have been gaining popularity over the last, I want to say about 20 years, I think it's largely due to the forever wars, unfortunately. That's where a lot of trauma medicine winds up coming out of. And so there's been a huge resurgence of interest in them. And at this point, they are now very popular and they're very much used to stop massive hemorrhage. For non military applications, there's any number of them here in the US. We have to contend with a large number of mass shootings. So aside from mass shootings, there's a number of other situations where you might need a tourniquet. You can have accidents with cooking, accidents with knives, or power tools, lawnmowers, chainsaws, things of that nature, natural disasters, which are unfortunately becoming more common. Those are all situations where folks might need tourniquets, Carrie 37:25 I would also add to that industrial accidents and a lot of back country activities. So things like your friends in the north doing a lot of snowmobiling, those types of people, a lot of those types of sports have been reaching out to us with interest in the tourniquet as well. So it's becoming an item that really should be in every first-aid kit. And one of Glia's goals in the next, let's say year to two years, is to start diving in a little bit more into the US market with these items and making sure they're in every public space. So for example, every school needs one of these tourniquets in the US. Every mall. But even in Canada, where we don't have as many mass shootings, these things are useful for all those other reasons. If you work in a facility--lots of people still work online, so you know, machines are doing stuff for us, but there's a lot of people doing factory work--tourniquets need to exist there. Inmn 38:27 Yeah, yeah. I remember seeing this kind of shift. As you know, in 2020, when there was a lot of gun violence happening at large protests and stuff, and just like seeing people...everyone had tourniquets strapped to their belts and stuff, but I also remember talking to people who were like, "Oh, I'm maybe not going to go to the thing because I don't have a tourniquet and spending that much money on a tourniquet right now sounds overwhelming. Carrie 39:08 That's so interesting. Yeah, so it's becoming way more commonplace I think, with tourniquets, and it's becoming something that your regular EMS isn't just carrying because the other big issue with tourniquets and why the hill is so steep for Glia is not just all of the R&D, and the manufacturing, and the governing body approval--which I think we might get into a bit--but you know, all the certifications and things that you might need for these types of devices, or what you would assume you may need, aside from all of those tricky things, the steepest hill for us is that lay people don't know how to apply tourniquets properly. So, unless you're a trained person in the use of tourniquets, then it's hard to just put a tourniquet in a public space and know how to use it. So, part of Glia's endeavor is never just to make a device and be like, "Oh, we made our device. That's it. Here you go." No, no, no, we have to do the full package. So likely, you know, we might seek out educational companies that are interested in open source as well and provide educational material to people so that you can become fluent in using a device like this. Inmn 40:28 Cool. Korin, I know we were talking a little off-air about this, but you mentioned that--I guess maybe the right word is compliance--for civilian grade tourniquets doesn't really exist or something? Korin 40:49 There is no standard for a tourniquet. So the way I actually got into the project was Tarek Loubani did an interview on It Could Happen Here, where he talked about 3D printed tourniquets. And I said, "Well, that's very interesting." And so I go, when I look through the GitHub and look through all the resources and couldn't find like, 'What standard does this meet? How is this being tested?" And after some further back and forth and discussion, it turns out, there isn't a standard for tourniquets. That does not exist. ASTM, which is a standards making body, is I think, working on one, but it's not released yet. And it's extremely new, if that ever does come out. There literally just is no standard that you can say, "Well, I've done this. And so therefore, it's a good tourniquet." Yeah. And, the way you kind of determine whether or not your tourniquet works is, I think, largely by comparison. And there is some testing that's done, but it's by comparison to what's being used currently. And does it work as well as that? Carrie 41:56 Yeah, I was just gonna add to that again, like Glia doesn't just stop at like, "Oh, let's take a medical device and reproduce it or build it again." We have to do...we have to go to all the lengths to make sure that this thing can get out there and people can use it safely. So one of the things we needed to do was to partner with somebody that was willing to design a tester for the type of tourniquets that we were making. And that's been a massive project. And actually, it was designed by the Free Appropriate Sustainable Technology Research Group at Western University. And they just published the tester that they developed to test not only the Glia tourniquet, but any tourniquet that works in the way that the Glia tourniquet works. So now we can start developing some sort of standard because when you make a device like this and then you realize that the only thing that really gave it any clout was some panel that decided that these particular tourniquets were the one we were going to use and then because of mass production built a reputation, even though, you know, the CAT tourniquet, actually, in the field is only something like 55% effective when it's applied. And it's the most well known gold standard tourniquet out there today on the market that people trust the most. But you know, half the time you're going to put that on, it's going to fail. So you, Glia dives into, like, why does it fail? What is the test being done on that? Is it actually the education of the user? Does the user know how to apply the tourniquet? You know, we don't we don't just stop at, "Oh, here's the device now for the market. You can buy it. Do what you will with it," you know, like all those other checkboxes are applicable. Inmn 43:47 Yeah. Yeah. Is like...I guess, because...Is the CAT VII, is that the tourniquet that like the military uses, or do they? Korin 43:58 I think this is maybe a good time to explain what COTCCC is if that? Korin 44:03 Yeah, okay, there is this panel called COTCC, Committee on Tactical Combat Casualty Care. It's a military panel. And I'm actually gonna quote from their website, it says, "The Committee on Tactical Combat Casualty Care is the pre hospital arm of the joint trauma system for the Department of Defense." So what it is, is it's about 40 something folks who are various types of medical professionals, or some doctors, surgeons, nurses, combat medics, special operations medics, things like that. And these folks, at some point, some years ago--I don't have the exact article here in front of me--they evaluated some number of tourniquets, and they said, "Okay, here's, based on what we've been using in combat, and based on our examination of them, we recommend the following tourniquets," and they had the Combat Application Tourniquet generations Six and Seven by North American Rescue, that's the CAT by NAR. There was also the SOF-T-Wide by TacMed Solutions. And there was a third one that's a pneumatic tourniquet that we don't need to talk about. And so for the longest time, just those two tourniquets were the only ones that this this panel said you should buy. Now, that makes plenty of sense. They're a military panel. They are interested in serving the military. They're interested in military procurement systems. So, they want to go to a company who can produce an enormous quantity of them and certify that they are good and will work and supply them in bulk. That's what they're interested in. They are not so much interested in civilian applications. That's not their concern because they serve the Department of Defense, right? So, that's their concern. That's why they had only those, like those three tourniquets because that's all they needed. Now, more recently, they released another journal article in which they--which when I say more recently, I mean, it's still several years ago at this point--where they expanded that list of recommended tourniquets substantially. But they don't evaluate every single tourniquet on the market. A lot of their recommendations are based on combat experience. So, if the tourniquet hasn't seen combat, they're not necessarily going to recommend it. And there's no other things like that. At the end of the day, they are still a military panel interested in making decisions for and about the military. Inmn 44:03 Oh, yeah. Inmn 46:37 Yeah, yeah. So Glia is kind of offering like a much better alternative for civilian use tourniquets than currently exists? Korin 46:49 Yeah. And that's actually one of the design criteria in the Glia tourniquet was that it works better on children. From the experience of folks, medical professionals in Gaza, they found that the CAT tourniquet didn't necessarily work as well on people who had very small limbs. So young children in general. One of the design criteria that then came out of that was that it works better on children. So some of the design decisions on the Glia tourniquet, particularly the separation of the backplate and the clip, came as a result of wanting to make the tourniquet work better for children. Inmn 47:29 Can I ask you all a kind of, I guess, maybe a little bit funny, like kind of a theoretical question? Carrie 47:35 Course. Inmn 47:36 Cool. Or just some things that are going through my head when I think about, like Glia's project and open source pharmaceuticals and open source medical equipment in general is that if we start seeing more parts of society, kind of like collapse or breakdown or like infrastructure breakdown more, is this open source medical equipment something that is going to be useful for people like in, I don't know, in 10 years--God, I hope it's more than 10 years--when the North American governments collapse and we're in some kind of hellish civil war and people are like, "Oh, medical...like the military has stuff. And that's it." Carrie 48:27 Yeah, I mean, I think the nice thing about the model that Glia is developing is that it's really adaptable by many different types of scenarios. So it's as relevant for what you've just said, and what you're just talking about now, as it is for some refined medical school somewhere in the world where they just want to do some good, and they want to lower costs, and they want to build their own medical devices and send them out to all their students for the incoming class that year. You know, we can set a lab up here in London, Ontario at our medical school that exists here and have those students build their own medical devices and have proper--as long as they have proper compliance. I'm not going to stop saying that--as long as they have proper compliance, then they can build their own devices. And the thing that's beneficial about that is that then you get up-and-coming medical practitioners thinking about their medical devices in a different way than they currently do today. They can make...they can see that they can customize, make modifications, be innovative, have a say, so they do not get into vendor lock-in with any of the products that they purchase. So I think that's one applicable scenario. And then you can go to some war-torn country, someplace that's desolate, and all they need is solar energy--which by the way, our Gaza office completely powers all of their printers with solar energy--and you can use a solar power energy in the middle of the desert and if you just are able to tent in that unit and get proper humidity under control then you can start building your own medical devices wherever you need them. And I mean, we're talking about stethoscopes, tourniquets, otoscopes...Glia also has a pulse oximeter coming down the road. We have a portable electrocardiogram that's coming out very soon. It's just entering clinical trials this summer. So there's lots of different types of devices that could be in these scenarios that you may need, like in something that's somewhat remote. And so it doesn't matter how remote the community or how vast and vibrant the community is, these devices can be used anywhere, and the process is applicable in all of the communities. Like really we should be making all our devices like this everywhere. Like why are we transporting shit halfway across the world anymore? It makes no sense. It makes no sense. Inmn 51:19 No, no, it truly does not. Korin 51:20 You asked in the context of societal collapse and there's a lot of areas even today where we can see that, for example, the wildfire smoke that's blanketing areas of Canada and even in the US. And I know that Margaret Killjoy, along with Robert Evans over at It Could Happen Here talked a bit about this and building Corsi-Rosenthal boxes, which are basically air filters made out of box fans and furnace filters. And so those boxes are a very good example of devices medically--we can call them medical supplies--that people right now may want to come together and make. Those are also a particular kind of device that lends itself to this kind of ad hoc, in the moment, production, where if everyone doesn't stick around and everyone kind of breaks off and goes and does their own thing later, that's completely fine. There's some medical devices, which are a little bit more critical, that have to be approached with a little bit more intention. But there's a number of things all across the spectrum that you could do right now, to things that maybe you should only do in an emergency, to things that we should start building the infrastructure for now so that we can use that later. Inmn 51:22 Yeah, yeah. And y'all have talked a lot about this, about compliance. And, I guess I'm just wondering, if you could explain for listeners, like what is involved in compliance? Like is it like testing it, the device, to make sure that it works? To make sure it works properly? Like, what goes on for compliance? Carrie 53:01 So proper compliance. Yes, we've mentioned it a whole bunch of times. It's very important. What that looks like in Canada is four different class levels. And it depends on what types of devices you're manufacturing as to which type of class level you fall into. So currently, Glia is only manufacturing devices that fall into class one. It's a fairly simple license for class one and it's very similar with the FDA, their class, one license looks a lot alike. It's a little bit more expensive to get a class one license from the FDA than it is in Canada. It's actually about double the price. But if you're selling multiple devices, or you have some pool of money to draw on from to get this. Usually these licenses last for a year, so you have lots of time to set up a manufacturer, learn what you need to do. The process is fairly straightforward. You often tend to learn things in North America after the fact. So you know, we set up our license, we got our approval, Health Canada said, "We trust you," and then they came knocking on our door and said, "Hey, by the way, we have an audit for you." And that's very common, you know, and especially for people that are doing stuff in their home basement labs, which at the time, that's what we're doing. So, you know, the point being that it's fairly straightforward. The most important thing to remember about compliance is that it's for the patient's safety. And you have to make sure that if for some reason there's a problem with what you've created, that you can issue a recall. And so, you know, recalls aren't just, "Oh, somebody was poisoned because they ate this bad bag of kale." It's also with medical devices. If there's a problem in that manufacturing process, we may distinguish that there's an issue and we need to take back those devices and inspect them. And it's important that you have a process to do that as swiftly as possible. So you know, sometimes depending on how dangerous the situation could be, you may have to initiate a recall within 48 hours of discovering the problem, and trying to retrieve those devices very quickly. So, it's about knowing those processes really well and protecting the patients, they're health and safety and life. Korin 55:28 And kind of going back to a little bit about what I said about there are some things where we might want to stand up the infrastructure now so we can use it later. If we're talking about a situation in which we think the government is going to break down or not function at all, some kind of collapse or a civil war or what have you, the FDA may not exist. And so in that case, if I'm making tourniquets, for example, then how do you know that these are actually well made and that they're going to work? And so having proper quality assurance processes in place is extremely important. And that's something you don't need a license to develop, I'm not recommending you go make these devices and distribute them without one. But when it comes to other things, you could do a trial run with Corsi-Rosenthal boxes and try and serialize every single one and send them out if you wanted. And that gives you some practice with with doing this because it is, as Carrie mentioned, extraordinarily important. You determine later, "Oh, oops, we sewed these tourniquets together with the wrong thread. Oh, we used the wrong plastic." I've seen these things happen in commercial environments, for not medical devices but for other things. That is absolutely critical that you have this relationship established with everybody that you might be giving these tourniquets to, or passing them along to, that you can contact them and they know you and you know them. And we're not just making a bunch of medical supplies, dumping them into a community and then disappearing and then hoping that no one gets hurt because that's just reckless. Carrie 57:13 Yeah, absolutely. And the other thing is, is people shouldn't be afraid of proper compliance. You know, it's not something to run from. Like any system, and especially as large as some of these systems we're talking about in terms of where to obtain proper compliance from, they're all going to have their pros and cons. But at the end of the day, this really is about making sure that companies are doing things in a safe manner. What I see a lot is that there's a lot of engineers out there that want to engineer things, right. So they want to build stuff. People love building. People love designing. People love adding their little flair to whatever it is they're doing. They want to contribute in that way. And then when it comes time for the paperwork, they get super bored. And so that's why they don't pursue these things. But, I can tell you from experience, I came into this job, I knew nothing about compliance, and I am now probably the expert on compliance in our group. And I had to figure it all out just on my own while doing a whole bunch of other things for the project at the same time. So, it's not impossible to figure out these systems. But also in addition, remember, I spoke earlier about how Glia doesn't just put the device code out there and say, "Here's the device world do what you will with it." We do the whole package. So you may not find all of our compliance records on our GitHub right this minute, it may not be there today, but it is our intention to make those things public so that people don't have to have that uphill struggle and figuring out how to do these systems because that's part of the issue, right, is that these systems are made to be somewhat convoluted and difficult to discern. And if you have a bit of an example of somebody else that did this for a tourniquet, and you want to go out and build some other type of device and innovate that and then get the compliance so you're doing it, you can come to Glia and say, "Oh, how did they do it with this device? Oh, this is what they did. Here's the roadmap for doing that. Okay, now I just have to put in my company name, copy these systems exactly. And off we go. I'm doing everything safe," you know, and they're not going to give you a license unless they think you're doing it safe. So you have that back to follow on. But why do you have to start from square one even with compliance? It's not just about building and innovating the device, it's the whole entire system that comes along with getting those devices from materials to actually treating patients. Inmn 59:50 Yeah, yeah. It's almost like y'all trying to build like a large community of people who are invested in each other's well being regardless of profit or something, which is really cool. Carrie 1:00:05 Yeah. And in terms of the societal breakdown scenario too and having compliance not really exist in that moment in the way that we see it today, I mean, that's already happening in the world, right? Like a lot of really amazing places and countries don't have these governing systems. And they have to go and borrow the roadmaps for that type of compliance from somewhere else. But there's likely no one in their own countries even governing that. So then, so then what are they doing? Are they being safe? Are they not being safe? You know, so making these processes as clear and transparent and accessible as possible makes sense because at the end of the day, we want to save people not kill people, right? Like, that's the plan here. Yeah. Inmn 1:00:57 Yeah. And I'm just going to retrospectively change the question that I asked, which is, yeah, what do we do when the compliance for these organizations don't exist or are not accessible? And I'm gonna pretend I asked y'all that and that we just got those lovely answers. Cool. Well, that about brings us to time. Is there anything else that y'all would like to say before we wrap things that we didn't talk about? Carrie 1:01:32 Well, I'm pretty sure I want to mention a call to action. So often when we meet people and people come to Glia...So Glia., first of all, I probably didn't explain this earlier on, but Glia has a very small staff. But in my time, in the last six years of being in this position, I've seen about 300 volunteers from all over the world get involved in many different ways. And our volunteers are really what fuels our company and what pushes things forward. Korin is a perfect example of somebody who comes in and becomes quite dedicated to the work that we're doing. And often, when we're talking to volunteers or people that are interested in Glia, they want to know how they can get involved and what they can do. So if you don't mind then I'm just gonna share those points. Inmn 1:02:30 Please. Plug. Plug the things. Carrie 1:02:31 Yes, yes, we have to plug Glia. That's something I can't go through this whole interview without. Inmn 1:02:39 Yeah, the end is always for plugs. Carrie 1:02:41 That's right. So of course, visit our website at Glia.org You're gonna find out about all of the projects that we're working on, and it doesn't stop with device work. We do education in 3D printing, we do other things, we'll come and we'll do a seminar for you, we'll talk to people about any of the topics that we cover. Of course, this project cannot run without funding, which is always kind of the thing that hurts me the most to have to say, but cash is king. And if you are willing to make a donation, you can do that through our website at Glia.org Inmn 1:03:20 Especially if you have $5 million to give them so that there can be dialysis machines. Carrie 1:03:23 Yes, absolutely. If you have access to $5 million, I promise you, we will make it work and really Glia is the most frugal project I've ever seen, you know. People are really good at wasting lots of money. We are very good at having the lowest budgets possible and making the most happen. So I mean, please trust me, I will make all of your dollars go as far as I possibly can stretch them. We always do that. We want to see our work continue into the future. Inmn 1:03:54 Cool. And are there ways for folks to get involved with? Like, I don't know, like, if they have, if there's listeners who are in places where people might have a hard time accessing medical supplies and they have 3D printers, is there other ways for those people to connect to y'all? 1:04:17 Yeah, we have a GitHub page. That's GliaX on GitHub. But all of that can be found through the website as well. So, glia.org, click on the products that you're interested in, and you will find the links to take you to all the information to get all of the roadmaps to be building these things yourself. And certainly if you cannot find those answers there, just reach out to us. We'll help you along the way for sure. 1:04:43 I also want to mention OpenSourceMedicalSupplies.org, all one word, all spelled out, opensourcemedicalsupplies.org. There's a number of plans and a lot of information about, as you would expect, open source medical supplies there. So that that may be helpful. Carrie 1:05:00 Yeah, absolutely. Inmn 1:05:03 Wonderful. Well, thanks you all so much for coming on today. And someone out there, please give them $5 million. Please. Carrie 1:05:14 Thanks so much for having us. Thank you. Inmn 1:05:16 Thanks so much for listening. If you enjoyed this podcast, 3D print a stethoscope and then tell us about it, but also tell people about the podcast. You can support this podcast by telling people about it. You can support this podcast by talking about it on social media, by rating, and reviewing, and doing whatever the nameless algorithm calls for. Feed it like a hungry god. And you can support us on Patreon at patreon.com/strangersinatangledwilderness. Our Patreon helps pay for things like transcriptions, or our lovely audio editor, Bursts, as well as going to support our publisher Strangers in a Tangled Wilderness. We put out this podcast and a few other podcasts including my other podcast Strangers in a Tangled Wilderness, a monthly podcast of anarchist literature, and the Anarcho Geek Power Hour, which is the podcast for people who love movies and hate cops. And we would like to shout out some of those patrons in particular. Thank you Trixter, Princess Miranda, BenBen, Anonymous, Funder, Jans, Oxalis, Janice & O'dell, Paige, Aly, paparouna, Miliaca, Boise Mutual Aid, theo, Hunter, Shawn, S.J., Paige, Mikki, Nicole, David, Dana, Chelsea, Cat J., Staro, Jenipher, Eleanor, Kirk, Sam, Chris, Miciahiah, and Hoss the Dog. We seriously couldn't do this without y'all. I hope everyone is doing as well as they can with everything that's happening and we'll talk to you soon. Find out more at https://live-like-the-world-is-dying.pinecast.co

   Discover the world of Marine Corps medicine as we engage in a powerful conversation with Senior Chief Petty Officer David Shepardson, a Navy Corpsman currently serving as the senior enlisted leader for the Sixth Marines at Camp Lejeune, North Carolina. Alongside guest host Chief Peter McGuire, an active-duty independent duty Corpsman and Senior Enlisted Leader with the 2nd Reconnaissance Battalion, we delve into Senior Chief Shepardson's journey to joining the Navy, his deployments with Marine units and the unique role of a Hospital Corpsman in Marine units.    Listen in as SCPO Shepardson shares his valuable experiences and insights into Corpsmen's challenges and the importance of medical knowledge. Learn how foundational courses like Corps School and Field Med training prepared him for Marine Corps culture and the demands of being a Corpsman. We also address the loyalty challenge that arises when faced with situations outside their scope of practice and explore the most critical areas that need to be trained to prepare medics and Corpsmen for real-world prolonged field care scenarios.   SCPO Shepardson emphasizes the importance of creating a warfighting mindset and the physical and mental challenges of training Corpsmen. We also explore the role of mentorship in shaping mindsets and ensuring success, as well as the significance of work-life synergy for maintaining balance in the demanding world of military medicine. Don't miss this captivating conversation full of invaluable lessons and advice for anyone interested in the field.   Chapters: (0:00:00) – Personal Pathway to Military Medicine (0:06:11) - Military Med Training for Corpsmen (0:16:41) - Preparing Corpsmen for Field Care (0:22:16) - Training for a Warfighting Mindset (0:32:08) - Navy Chiefs' Role in Warfighting (0:44:48) - Leadership and Work-Life Synergy   Chapter Summaries: (0:00:00) - Personal Pathway to Military Medicine (6 Minutes) We're joined by Senior Chief David Shepardson, a Navy Corpsman serving as the Senior Enlisted Leader for the Sixth Marines at Camp Lejeune, North Carolina. Dave shares his pathway to joining the Navy, his deployments with Marine units, his leadership philosophy, and the role of a Hospital Corpsman with Marine units. We also welcome guest host Chief Peter McGuire, an active duty Independent duty Corpsman and current Senior Enlisted Leader with the 2nd Reconnaissance Battalion. Together, we explore the mission, opportunities, and deployed experiences of the military healthcare team, from state-of-the-art hospitals in the US to austere environments around the globe.   (0:06:11) - Military Med Training for Corpsmen (10 Minutes) Senior Chief Shepardson shares his experiences of going through Corps School and Field Med training. He explains how these foundational courses prepared him for Marine Corps culture and the expectations of being a Corpsman. Dave also provides insight into the role of a Corpsman in a Marine unit and how he was trained by his squad leaders, fire team leaders, and seniors to use his skills in combat.   (0:16:41) - Preparing Corpsmen for Field Care (6 Minutes) Dave shares his experiences and insights into the unique challenges of being a Corpsman. We discuss the importance of medical knowledge and the need for corpsmen to seek out knowledge and stay engaged in their roles continually. We also explore the loyalty challenge corpsmen face when confronted with situations that are out of their scope of practice. Lastly, Chief Shepardson shares his opinion on what are the most critical areas that need to be trained to prepare medics and Corpsmen for real-world prolonged field care scenarios. He emphasizes the importance of mastering the basics of Tactical Combat Casualty Care and the need for humility and knowledge in order to be ready for the future fight.   (0:22:16) - Training for a Warfighting Mindset (10 Minutes) Dave discusses the importance of creating a warfighting mindset and how it is essential for buy-in in the line of work. We also explore the trauma lanes and the physical and mental challenges of training corpsmen. Finally, we stress the importance of mentorship in order to create an asset and the need to shape mindsets and help to create buy-in.   (0:32:08) - Navy Chiefs' Role in Warfighting (13 Minutes) SCPO Shepardson leveraged his knowledge and experience to help support the warfighter and teach others. He took what he learned in the infantry and adapted it to the clinic, and he talks about how mentors took him under their wing and showed him how to be successful.  We cover the leadership philosophy of situation-based servant leadership, and Dave shares his perspective on the uniqueness of the Chief Petty Officer.   (0:44:48) - Leadership and Work-Life Synergy (11 Minutes) Senior Chief David Shepardson shares some memorable experiences of being a Corpsman, exploring the unique challenges associated with the role. He recounts getting a tattoo with his fellow Marines as a way of connecting to their mission and how the phrase 'Die When I'm Done' became a badge of honor for the group. He also talks about the best leadership advice he's ever been given and his key to living a balanced life in a job that can be so consuming and has serious risks and costs associated with it. He emphasizes the importance of work-life synergy, and how leaders should prioritize their people over themselves and strive to provide them with whatever they need to be successful.   Episode Keywords: Navy Corpsman, Marine Corps Medicine, Chief David Shepardson, Chief Peter McGuire, Corps School, Field Med Training, Warfighting Mindset, Tactical Combat Casualty Care, Trauma Lanes, Mentorship, Leadership Philosophy, Work-Life Synergy, Die When I'm Done, Second Buried Division, Military Healthcare Team, Austere Environments, Prolonged Field Care, State-of-the-Art Hospitals, Loyalty Challenge   Hashtags: #wardocs #military #medicine #podcast #MedEd #MarineCorpsMedicine #NavyCorpsmen #MilitaryMedicine #FieldCare #WarfightingMindset #CorpsmanTraining #ProlongedFieldCare #Leadership #WorkLifeSynergy   Honoring the Legacy and Preserving the History of Military Medicine   The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/episodes Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you.   WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast

0:40 | It's been nearly a year since Russia invaded Ukraine, resulting in tens of thousands of deaths (including civilians) and Europe's largest refugee crisis since World War II. Ukraine's resolve truly is remarkable. We go live to an undisclosed location amidst a blackout for an update on a group of Canadians training new police officers and firefighters how to provide life-saving medical care in a combat scenario. But first... 3:42 | It's always cool to see somebody's dream come true in real time. That happened Saturday night when Matt Berlin, goaltender for the University of Alberta Golden Bears, was tapped on the shoulder to finish out the Oilers/Blackhawks game.  5:30 | Are you one of the Canadians who wouldn't pass a political purity test? Do your ideas and approaches to issues often fall outside rigid politics? Charles Adler spent the weekend thinking about his values, and how a chip on his shoulder steered him away from where he belongs. 36:35 | Ukrainian civilians are being called to the front lines of the war effort, many of them serving their country as new firefighters and police officers. A Canadian contingent is there right now, giving these recruits the tools to Tactical Combat Casualty Care. In the middle of a blackout, Nikki Booth and Vitalyi Gritsko explain what they're doing, and how it's saving lives.  SUPPORT FIREFIGHTER AID UKRAINE: https://www.firefighteraidukraine.com/ 56:16 | Joseph Cook is one of the good guys. The Florida resident recently manifested a $40,000 random act of kindness, which we highlight in this week's Positive Reflections presented by Kuby Renewable Energy.  SEND US YOUR POSITIVE REFLECTION: talk@ryanjespersen.com GET YOUR FREE SOLAR QUOTE TODAY: https://kubyenergy.ca/ WEBSITE: https://ryanjespersen.com/ TWITTER: https://twitter.com/RealTalkRJ INSTAGRAM: https://www.instagram.com/RealTalkRJ/ TIKTOK: https://www.tiktok.com/@realtalkrj PATREON: https://www.patreon.com/ryanjespersen THANK YOU FOR SUPPORTING OUR SPONSORS! https://ryanjespersen.com/sponsors The views and opinions expressed in this show are those of the host and guests and do not necessarily reflect the position of Relay Communications Group Inc. or any affiliates.

Episode 668 - Tommy Aceto is a First Class Father and former Navy SEAL.  He served for 16 years as a medic in the U.S. Navy SEAL Teams where he conducted many combat missions.  He deployed to Iraq, Afghanistan, Africa and the Pacific Islands.  Tommy became a Basic Underwater Demolition/Seal (B.U.D/S) instructor and also helped develop many training curriculums for Combat Diving, Close Quarter Combat, Tactical Combat Casualty Care, and Special Surveillance Operations.  Prior to joining the Navy and becoming a Frogman, Tommy was an NCAA Soccer player and State Champion wrestler. In this Episode, Tommy shares his Fatherhood journey which includes four children.  He describes his difficult divorce and ruthless custody battle which ended with him not being allowed to see his own children.  He discusses how his ex wife deceived him and how he lost his medical retirement, his Navy SEAL Trident and his kids in ten days.  He talks about his experience using psychedelics and why more research is needed for psilocybin to be used to help combat veterans with PTSD and civilians who suffer from mental illnesses and traumatic events.  He gives advice for dads about to go through the family court system.  He offers some great advice for new or soon-to-be dads and more! Tommy Aceto IG - https://instagram.com/flowstatefrogman?igshid=YTY2NzY3YTc= My Pillow - https://mystore.com/fatherhood Promo Code: Fatherhood  FamilyMade - https://familymade.com FamilyMade Newsletter - https://news.familymade.com First Class Fatherhood: Advice and Wisdom from High-Profile Dads - https://bit.ly/36XpXNp Watch First Class Fatherhood on YouTube - https://www.youtube.com/channel/UCCD6cjYptutjJWYlM0Kk6cQ?sub_confirmation=1 More Ways To Listen - https://linktr.ee/alec_lace Follow me on instagram - https://instagram.com/alec_lace?igshid=ebfecg0yvbap For information about becoming a Sponsor of First Class Fatherhood please hit me with an email: FirstClassFatherhood@gmail.com

COL (R) Dr. Sean Keenan served as Command Surgeon for Special Operations Command Europe, 10thSpecial Forces Group (Airborne), 1st Special Forces Group, and as a Special Forces Augmentee. He also served as a flight surgeon, Joint Special Operations Task Force Philippines Surgeon, Emergency Medical System Medical Director, and Chief of Emergency Medicine, in addition to multiple deployments. He was the founder and coordinator for the Special Operations Military Association Prolonged Field Care Working Group. He now serves as the Chief Medical Officer for Ragged Edge Solutions, providing medical exercises to Special Operations forces and he is the Assistant Director of Prehospital Trauma and Operational Strategy and the Center for COMBAT Research at the University of Colorado, Aurora Campus.       In this episode, Dr. Keenan discusses the unique aspects of special operations soldiers and the unique requirements for their medical training. He provides valuable insight into his career as a special operations surgeon at all levels and how he best supported his unit and soldiers. He also describes the needs, requirements, and unique challenges to prolonged field care- the need to provide the point of injury care when evacuation to medical or surgical facilities is delayed. He is committed to passing this knowledge to the next generation of medical providers and discusses the lessons he learned during his fantastic career and how he is developing research efforts to address known gaps in capabilities.     He shares many insights and lessons learned over his distinguished career and provides some insight and sage advice for all listeners. You don't want to miss this episode.                                     To find out more and join our mission to preserve military medicine achievements WarDocs at wardocspodcast.com. The WarDocs Mission is to improve military and civilian healthcare and foster patriotism by honoring the legacy, preserving the oral history, and showcasing career opportunities, experiences, and achievements of military medicine. Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible, and 100% of donations go to honoring and preserving the history, experiences, successes, and lessons learned in military medicine. A tax receipt will be sent to you.  WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.         Follow Us on social media. Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast

The boy's first medical episode!6 and 7 explain what TCCC (Tactical Combat Casualty Care) is, why it is used by our military, and then dive into the first phase of TCCC; Care Under Fire.Medical training is a severely underappreciated skill in society today, and we hope to change that. As with any concept that we introduce, we're starting with baby steps... Don't let your buddy bleed to death.(We cannot give you medical advice, but we can point you to doctrine. Check our references).References:TC 4-02.1 First AidJoint Trauma System – TCCC Guidelines 2021https://www.deployedmedicine.com/Tourniquets: North American Rescuehttps://www.narescue.com/combat-application-tourniquet-c-a-t.htmlhttp://linktr.ee/hardtimesstrongmenDark Angel Medicalhttps://darkangelmedical.com/sof-t-gen-5/

  Dr. Rhee is Board Certified in General Surgery and surgical critical care and is a Fellow of the American College of Surgeons.  He served in the Navy for 26 years in many important roles in the operational and training environments.   In the episode, he describes what it's like to be a physician on a nuclear aircraft carrier and perform surgeries while underway at sea.  He also relates his experiences helping design small forward surgical units that he would later deploy with to Southwest Asia.  He talks about lessons learned on the battlefield caring for casualties which led him to be involved in setting up the Navy Trauma Training Center in Los Angeles which sustains skills and prepares teams for downrange requirements.    Dr. Rhee recalls his experience with Mass Casualty incidents of more than 200 patients and provides a behind-the-scenes look into the challenges encountered by medical providers when needs overwhelm resources and how tough decisions have to be made.   CAPT Rhee explains how the lessons he learned during his training and during operational assignments led him to be a founding member on the Tactical Combat Casualty Care Committee    Following retirement, Dr. Rhee help prepare the trauma system to deal with a significant MASCAL situation in Tucson, AZ in 2014 during a mass shooting event at a political event.    He shares many insights and lessons learned over a distinguished career and provides some valuable advice for all listeners. You don't want to miss this episode! To find out more about Dr. Rhee at wardocspodcast.com/guest-bios and join our mission to preserve military medicine achievements WarDocs at wardocspodcast.com.                               The WarDocs Mission is to improve military and civilian healthcare and foster patriotism by honoring the legacy, preserving the oral history, and showcasing career opportunities, experiences, and achievements of military medicine.   Listen to the What We are For Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible, and 100% of donations go to honoring and preserving the history, experiences, successes, and lessons learned in military medicine. A tax receipt will be sent to you.    WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Doc" as a sign of respect, trust, and confidence on and off the battlefield that demonstrates dedication to the medical care of fellow comrades in arms.             Follow Us on social media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast

-Ramone Resop recently retired after 23 years of service in the U.S. Navy as a Chief Surface Forces Independent Duty Corpsman-Throughout his time in the military, he completed 2 combat tours in Iraq with the various Marine Corp expeditionary units including 2nd Battalion/7th Marines, 1st Air Naval Gunfire Liaison Company, 1st Special Operations Training Group, 3rd Force Recon Co, and Joint Task Force Guantanamo-As a Corpsman, he served onboard 5 Mine Counter Measure ships, 2 Zumwalt-Class Destroyers and 1 Arleigh Burke-Class Destroyer. He completed all 5 deployments as the Medical Department Head and lead trainer in Medical Emergency Operations, Anti-Terrorism Force Protection, Damage Control and Occupational Safety and Health.-A few of his completed training/instructor courses include: Mind Body Resilience Therapy, Occupational Stress Control, Advanced Trauma Life Support, Jungle Warfare, Cold Weather and Mountain Medicine Survival, Tactical Combat Casualty Care, Airborne Parachute Jumper, and Command Fitness Leader-He's also spent time as a volunteer firefighter in Pensacola, FL where he received his Florida State Firefighter 1 Certification. -Most recently he join our Business Development team at O2XFirstNet Built with AT&T:http://www.firstnet.com/healthandwellnessDownload the O2X Tactical Performance App:app.o2x.comLet us know what you think:Website: http://o2x.comIG: https://instagram.com/o2xhumanperformance?igshid=1kicimx55xt4f 

The closest many people ever get to Afghanistan is turning on the TV and watching events unfold as America tries to fully disengage from the conflict we've been fighting  for 20 years. From this viewpoint, many Americans form opinions about whether or not we should have stayed or exited like the Biden Administration did in recent weeks. This week we get the perspective of someone who has actually been there, multiple times, and has trained the Afghan military special forces in an attempt to keep their government from collapsing. Ret. MSG Mata goes through his experience in Special Forces and the mission America has had there for several presidencies. While we didn't spend much time assigning blame, you'll find his explanation of what the outcome would have been if we had a different president. Guest Bio:Retired Master Sergeant Juan Mata, served in the Green Berets for 14 years, and before that was a Ranger, and an Infantryman. He now runs a company called Quiet Pro Tactical, an organization dedicated to giving back to local communities and teaches law enforcement to be better protectors for their citizens. Juan Mata, the Principal Instructor, a former 14-year Green Beret Combat Veteran. He has numerous combat deployments including Iraq and Afghanistan. His qualifications include Special Forces Advanced Urban Combat Course, Survival Evasion Resistance and Escape, Tactical Combat Casualty Care, Special Operations Terminal Attack Controller, Technical Surveillance, Counter-surveillance, and U.S. Army Ranger School.Visit their website: https://www.quietprotactical.comSupport the show (https://www.buymeacoffee.com/faithpolitics)

TIME CODES: 0:00 - Intro 0:55 - Sheriff Alex Villanueva on CCW's in Los Angeles County 22:26 - Gear Review: NeoMag - A Minimalist's Concealable Pocket Magazine Holder 34:48 - Declaring San Clemente a 2nd Amendment Sanctuary City with Councilman Gene James 46:17 - The Case Against Bump Stocks 55:54 - Tactical Emergency Casualty Care from Academi Southwest 1:07:59 - Active Self Protection Instructor Training with Wendy Hauffen 1:20:42 - Stump My Nephew: What does SIG stand for in Sig Sauer? 1:26:34 - Mike Drop: El Cajon City Council 1:30:45 - Outro   Sheriff Alex Villanueva joins the show to talk about the multiple challenges he has faced and how he has improved the CCW process in L.A county.   https://alexvillanueva.org/ https://lasd.org/ccw/   Owner of NeoMag and inventor Graig Davis talks about his ingenious magnetic pocket magazine holder, sentry strap/scout sling, billeted aluminum EDC trays, and more.   https://theneomag.com/   10% off Discount Code: GUNOWNERSRADIO10   San Clemente declared itself a second amendment sanctuary city thanks to the efforts of City Councilman Gene James.   https://www.genewalkerjames.com/   Joe's talk explains why a lawsuit to save this plastic accessory used by a small percentage of gun owners is so important in this week's blog review, “The Case Against Bump Stocks”.   https://sandiegocountygunowners.com/the-case-against-bump-stocks-is-about-much-more-than-bump-stocks/   To continue our theme this month, here from Academi Southwest is Brian Allendorf to talk about the difference between TCCC, Tactical Combat Casualty Care and TECC, Tactical Emergency Casualty Care. Which one's for you?   https://www.instagram.com/academisouthwest/   https://www.constellis.com/events/tactical-emergency-casualty-care-tecc-2-2/   Did you know our friends at Active Self Protection also provide instructor training? Our very own Wendy Chou Hauffen has returned from their class to tell us about her experience.   https://activeselfprotection.com/   Stump my Nephew: What does SIG stand for in Sig Sauer?   Mike Drop: El Cajon City Council   -- The right to self-defense is a basic human right. Gun ownership is an integral part of that right. If you want to keep your rights defend them by joining San Diego County Gun Owners (SDCGO), Orange County Gun Owners (OCGO) in Orange County, San Bernardino County Gun Owners (SBCGO) in San Bernardino County, or Riverside County Gun Owners (RCGO) in Riverside. Support the cause by listening to Gun Owners Radio live on Sunday afternoon or on the internet at your leisure. Join the fight and help us restore and preserve our second amendment rights. Together we will win. https://www.sandiegocountygunowners.com https://orangecountygunowners.com/ https://sanbernardinocountygunowners.org/ https://riversidecountygunowners.com/ https://www.firearmspolicy.org/ https://www.gunownersca.com/ https://gunowners.org Show your support for Gun Owners Radio sponsors! https://365glacierpayments.com https://www.primeres.com/alpine https://dillonlawgp.com https://www.uslawshield.com https://www.nationalconcealedcarryassociation.com https://www.blackhoundoptics.com https://conservativeeconomy.com/gunownersradio

The Trauma Hemostasis and Oxygenation Research (THOR) Network including the 75th Ranger Regiment, NORNAVSOF, and others have led the way in re-implementing type-O, low titer fresh whole blood far forward with the Ranger type-O Low titer(ROLO) program. In 2015 the Ranger medical leadership along with founders of the ROLO program published the paper, “Tactical Damage Control Resuscitation” outlining in detail why they chose to bring back fresh whole blood at the point of injury. Since that time further studies have strongly suggested that the earlier fresh whole blood was transfused, the greater the benefit to the patient. Shackleford et al. demonstrated that the greatest benefit to a patient receiving fresh whole blood occurred within 36 minutes of injury. After 36 minutes no decrease in 24-hour mortality was found. Blood must be replaced as soon as possible. The Committee on Tactical Combat Casualty Care also recommends FWB as the first line intervention for patients in hemorrhagic shock with blood products in both second and third place. We cannot ignore whole blood any longer if we wish to deliver the best possible battlefield care possible. Excuses citing logistical difficulty, concerns about safety or lack of information are unfounded. There are multiple ways to ensure our casualties are receiving fresh whole blood. The first is through the Armed Services Blood Program (ASBP) delivering cold stored O-Low titer blood to a Role 2 facility where it is picked up and pushed forward from there. Refrigeration is necessary in order to keep it below 4°C. If going out on mission insulated containers such as the Golden Hour or Golden Minute containers can be used to keep the blood within temperature specs for 24 hours, 72 hours or longer. If dismounted, a transfusion can occur at or near the point of injury with pre-typed, screened and titered ROLO/SOLO donors. Other non-Ranger Special Operations units have since followed suit and have tweaked the name to suit them, hence the new SOLO (Special Operations Low-O) acronym. www.prolongedfieldcare.org

Dr. James Brasiel from Accredited EMS Fire Training comes back to the show to help discuss the recent active shooter incident in San Jose, California. He teaches Tactical Combat Casualty Care ("T Triple-C") classes to combined Police/EMS/Fire teams, the military, and other groups involved in active response to these incidents.

Episode 24: Rescue Task ForceThis show is all about Rescue Task Force (RTF), their role in an Active Shooter Event, key tasks the RTF needs to execute, and lessons learned.Bill Godfrey:Welcome back to our next podcast. Today we are going to follow our pattern of going back to the basics here. As the country starts to get kids back into school, we're going back to the basics of actor shooter incident management. Today we are going to talk about rescue task forces, and we're going to dive in a little bit deeper than we have in the past. My name is Bill Godfrey. I'm the host of your podcast today. With me, I have Bruce Scott, one of our instructors here at C3. Bruce, thanks for coming in.Bruce Scott:Thanks for having me.Bill Godfrey:We have Tom Billington, another one of the instructors. Tom?Tom Billington:Hello, thank you.Bill Godfrey:And Terrance Weems. Terrance, this is your first time, another one of our instructors, but this is your first time doing one of the podcasts, isn't it?Terrance Weems:Yes, sir, it is. I'm glad to be here. Thank you.Bill Godfrey:Jealous of that deep bass voice he's got going on. Then also joining us by phone is Coby Briehn. Coby, thanks for coming in.Coby Briehn:Hey, thanks for having me, Bill. Good to be here.Bill Godfrey:Absolutely. Tom, I'm going to start off with you to talk a little bit about rescue task forces. It seems like a fairly simple concept. It's a medical team that has security on it that is able to go into a warm zone because they have their own security. Of course, the security kind of controls the movement of the team, but it's a medical mission. It turns out in practice, it gets a little more complicated than that.Tom Billington:Yes, it does, definitely. As we know, firefighters are conditioned where the longer an incident goes, the more dangerous it is for us, flashover, etc. A lot of us don't know that, as an active shooter, history shows that as that active shooter incident goes on, it's over pretty quick. So being educated about how the active shooter incidents from the past have turned out, it kind of helps us. Then we need to talk about what am I going to do if I'm a paramedic on a rescue task force, what's going to happen if somebody starts shooting when I'm going in this warm zone? What's going to happen if something happens where I feel afraid? What should I do? So making sure we talk to each other as a rescue task force team before we go in and then knowing what am I going to do when I enter the room? Hopefully the casualty collection point is already set up hopefully when I enter. What am I going to do as the first Rescue Task Force?Bill Godfrey:Well, that's a great introduction. Bruce, take us to the very first thing that we cover. You've checked in at staging, and you've been assigned as a rescue task force. What's the very first thing that need to happen in staging?Bruce Scott:Bill, thanks again, for having me today. I think the very first thing that really needs to happen when you get into staging is understanding that in that staging area, that staging manager's actually going to begin forming those rescue task forces, so combining that law enforcement element with your fire/EMS, your paramedics, and put those teams together and pre-form them. One of the things that we notice as we teach across the country is it's not something that's practiced. We haven't adopted it as policies. We haven't practiced it or exercised it in any way, shape, or form. So unfortunately, the first time that we actually have those introductions is on the scene. So as we pre-form those folks up in staging, your staging manager, when the triage calls for it, are ready to move those RTFs downrange with a task and a purpose. I think that's the most important thing is understanding that those teams are formed in the staging area ideally, and you have the opportunity introduce yourself to my law enforcement partners. My background is firefighter paramedic. If I was in a staging area with Terrance or Coby, we're very often going to have to make those introductions there, and we have to understand how we're going to business moving downrange. That has to happen in staging.Bill Godfrey:I think that's a great segue. Coby, Terrance, if you're responsible for escorting some medics that may or may not have had rescue task force training, you may not know you, you may never have met them, and they may be with other agencies, how important is it for you guys as law enforcement to have one or two minutes to do a quick briefing, to get the chance to talk to them?Terrance Weems:I think it's extremely important because if you don't have trust, then that person or that group of people, they're not going to follow me. They're not going to listen to what I have to say. One of the things that we do in my home area is we try to train together, so we'll do a number of different scenarios throughout the year in different times of the year. We may have one large event where we're working together. In addition to that, we have meetings regularly, so we may meet once a quarter. What that does is before an incident even occurs, we have an opportunity to build a relationship so that relationship is made. Even if I don't know that particular person, that person knows my department.Terrance Weems:Now that we have that relationship built, once we get into a situation, that helps ease all of that uncomfortableness when you're in a high-stress situation. So once you get into there and letting them know, if they know they can trust me, they know that I'm going to have their back and explaining to them that I'm not going to leave you. My goal is we're going to go in here together, and we're going to come out with however many people we need to bring out. But the five of us or the six of us that went in there together, we're coming out together. We might be bringing two or three people with us, but this five or six of us are coming out. Once they understand that, "Hey, if I tell you to move, move. If I tell you to stop, stop. If I tell you to duck, duck."Bill Godfrey:Coby, when you're doing those briefings in staging, what are the specific things that you like to cover? Is there a list that you want to hit with the firefighters and make sure they're on the same page?Coby Briehn:Not really lists. We'll do the introductions, just give them an idea of where we're going, what we expect to do. We'll guide them in. We'll guide them out. We'll guide them through the hallways to the rooms. They'll stay right not up on our backs. We may have them where they can always see our back or our feet at least so they're not right up on us so we don't look like a conga line going down the hallway. They give us a little room to manipulate walls and angles and stuff. So we'll bring them up as fast as we can to that area. Also when we're having them treat in certain areas, even though they may be focused on the medicine, which is a great thing, that's why they're there is to do some of those advanced skills going along with stuff the police can't do where they're starting to go to the [inaudible 00:07:06] routes.Coby Briehn:We may suggest something and actually want them to start moving victims out of the hallway if that's where we locate them. We call it getting off the X. It's an old LE term where if they're in a hallway, we don't like hallways because there's too many open angles, too many things that can happen, materialize right in there, but if we can just keep them in a room, then that's going to be even better where we can control what's coming in the room, what's going out of the room, and we're not exposed to all these angles. So we'll try and pull them out of that medicine hole and just suggest, "Let's move them over here," not just necessarily start the medicine but let's also do the [inaudible 00:07:47] because we don't want to incur any more damages as we're doing the work.Bill Godfrey:Yeah, that makes sense. Coby, I don't know that you remember this, but one of the first training sessions we ever did together, there were two things that you drilled into my head in that first session. One was in the pre-brief, not to actually hold on to you, but if I did, just to keep a soft touch but not grab on because if I jerked or you move suddenly, it could cause you to lose your aim.Bill Godfrey:The other one that just still makes me laugh to the day, you talked about getting off the X, I remember when we were doing the drill. I'm trying to treat a patient, and you're telling me, "Get off the X. Get off the X," I don't know what the hell the X is. The next thing I know I'm getting pulled off of what I later found out the X is where somebody was standing when they got shot. I happened to be trying to treat a patient in the middle of the T intersection with hallways and a whole bunch of doors. It turns out that that's not really a great place to be. But I didn't know that. I didn't know that till we went through that.Coby Briehn:Correct. Correct.Bill Godfrey:Yeah, absolutely. Tom, let me hand it back over to you. Let's talk. We've got our team formed up in staging. Everybody's had a chance to get introduced to each other. We've pre-briefed. Law enforcement typically, it's two or three. You're going to have one up front, one in the back, and the medics in the middle. So we're moving in. Law enforcement gets us to where we need to be. They get us to the casualty collection point, or they get us where the injured are. Tom, what does that look like?Tom Billington:Well, we go into the casualty collection point. As a paramedic, I know I'm pretty safe in that room now. I have the escort of my RTFs, but the casualty collection point has already established security at doors, windows, etc. So when I go in the room, my first job as the paramedic is take control of the medical needs in this room. Now, you may only have one other paramedic with you, so if you think one RTF's enough, it's not. You need two or three RTFs coming in there. But the first RTF that goes in that room, you take control of the room.Tom Billington:Hopefully, law enforcement has done some sort of triage. We teach green tag, red tag, and the green tag, in their opinion, is not too bad off. The person might be able to walk and talk. But the red tag in law enforcement's eyes is somebody that's very serious. So we walk in and we want to do our triage. Now, around the nation most agencies are using the START triage method, which can be sort of cumbersome.Tom Billington:What we teach is the field triage score. This was developed by the Joint Trauma System under the Department of Defense. By using 5,000 battlefield injuries from 2002 to 2008 in Iraq and Afghanistan, and this system of triage was 88% effective. It's very simple. If I have a patient, I just check the radial pulse. If they have radial pulse, I give them a one. If they have no radial pulse, they get a zero. Under Glasgow Coma, I just check their motor skills. Can they follow motor skill responses? Raise your hand, move your leg. If they can listen to my command and follow it, they get a one. If they can't, they get a zero. That's the end of that triage: zero, one, or two. You add the score up. It's either going to be a zero. It's going to be a one or a two. That's your red, yellow, green. Zero is red, one, yellow, two is green. That's a very quick method. It shows 88% effective.Tom Billington:There's one important thing to note. This was military age, mostly men in very good shape. Obviously, if you're at a school with pediatrics or you have elderly people somewhere, it's not going to also work out as good. But it's a good, quick system to learn to use in situations such as this.Bill Godfrey:Tom, I'm really glad you mentioned that because the START triage system, as you said, is the most common one used in the country. But Bruce, it's got a few problems with it, doesn't it?Bruce Scott:Absolutely it does. Number one, I think you could probably poll 95% of the fire/EMS folks that are out there in the country right couldn't tell you anything other than, "Hey, if you hear my voice, come to me," the very first part of START. As you go down the rest of that, it gets complicated. It's remembering all the aspects of it. I love the field triage score. I think it's a better way to do business especially when you're in the warm zone. You want something fast to be able to classify those injured folks. If we get outside and for some reason we're not able to get them off the field and we end up setting a treatment area, maybe we do a more detailed triage. But inside that warm zone, I don't think there's anything better than what we're teaching in the field triage score.Bill Godfrey:I think so as well. It's plagued with problems. I know it's the most common one out there. That doesn't always make it the best, and it suffers from a terrible over- and under-triage error rate that just leaves us with a lot of challenges. So we've talked about doing that initial triage, so hopefully your law enforcement team on the inside, your first couple contact teams have established a casualty collection point for you. Terrance, is that always possible? Are there going to be times when the first RTF might come up through the door and the CCP isn't established?Terrance Weems:That is always a possibility depending on the situation, but at the same time, even though it may not be as warm as you want it to be, but if we have it secure enough where nothing is getting in, there's no fire, we have whoever that suspect is, we have him pinned down, we're know where they're at, whether it'd one or two or more people and we know where they're at, we're able to provide a safe, sort of secure area for you to work on those survivors there and those that are injured so we can get them out. Even if it's a quick assessment, like you said, you're able to get them assessed, and we're able to pull them on out of there so we can to get to moving and moving them to the hospital.Bill Godfrey:Yeah, absolutely. Coby, if the first RTF is coming in and the CCP isn't set. Maybe the contact team just didn't have time or they don't have enough people to pull it off, what is that look like for that first RTF to be talking to that contact team to get that organization? We still want to do a CCP, right? We want to pick a location. What does that look like?Coby Briehn:Oh, certainly. We can back up even to the doorway coming in to the crisis sites. We would love to have the hallway cleared. We call this secured cordons to where the path to and hopefully out of the area is secured. But in certain worlds, certain areas it may not be able to happen where we've gone in or we've just been able to lock down a certain side of it. So the RTF may come in through the hallway where there's still victims in the hallway, much like an exterior mass casualty [inaudible 00:14:49], you want to start putting them in the best area possible and the same thing with what we're trying to do here is just get them into a room for security sakes and for just logistical management sakes is getting the best care to the worst injured as fast as possible doing the best we can with what we've got. Instead of them having them spread all over the place, we want to get them, like we said, put in to the fewest areas possible. There may be a time where you have one or two CCPs, but eventually we want to get them all into the area where, again, we're just doing the best we can with what we got.Bill Godfrey:I'm going to recap for us here. The call comes in to staging that they need an RTF stood up, so the staging manager picks some medical assets. They pick some law enforcement assets. They sign them to an RTF team. We get a pre-briefing while they're in staging. They get a chance to introduce themselves. Law enforcement gives them a chance to give them a briefing, tell them what to expect, who's going where, who's doing what, rules of the road, I like to call it.Bill Godfrey:Then they get the orders to deploy. They go downrange. They're going to link up with a contact team who's already going to be in there. Hopefully we've got a casualty collection point we're dropping into. So we drop into a CCP. If we're lucky, the law enforcement team, the contact team has had a chance to do at least a preliminary, quick triage: "If you're hurting, you're walking, you're able to walk, come over here against this wall. If you're uninjured, get up against this wall." You got the green on one wall, the uninjured on another wall, and the ones that are still laying on the floor that didn't move, those are the reds. So you drop in as your medical team. You get the lay of the land. You know you need to re-triage. You're obviously going to start with the ones on the floor that haven't moved. They're the reds and we're going to re-triage them between green, yellow, red, and black tag, and call for more resources.Bill Godfrey:Bruce, that's a lot for the first RTF team to accomplish, but it seems like sometimes when the additional RTF teams show up, it doesn't always smooth out. Let's talk a little bit about that hand off or that coordination that the first RTF who's already there who has a situation awareness in the room, what should that second RTF do? What should that look like? Let's talk a little bit that.Bruce Scott:Bill, that first RTF needs to take control of that room. You brought up a good point. Number one, I'm going to look around and see what I have and understand that I need more resources. Get those folks in there. That's step one to realize I need that help. Number two, give those folks direction when they get in the room, what your expectations are and what you want them to do. As another point, if you have an experienced staging manager out there, they're listening to what's going on and understanding the resource shortfalls and can already be leaning forward. As that RTF starts asking for those additional resources, they can have them ready to go. Again, taking charge of the room, prioritizing what needs to be done, getting that additional help in there. Then working with your law enforcement partners to... Coby brought up a good point. We like a single casualty collection point. They're easier to secure. But if we have multiple, that means not only means more RTFs, but that also means we need more law enforcement as well to secure that area.Bill Godfrey:Tom, talk a little bit about the... and I don't want to stereotype it here, but whoever the lead is of that first RTF, that lead medic or whoever's got that lead medical responsibility taking charge of the CCP and then directing the additional resources coming in. Talk to a little bit what that should look like and what we're hoping to see.Tom Billington:Well, again, like Bruce just said, you want to get the other RTFs in there to start treating people. But one main thing I'm concerned with with the first RTF, believe it or not, is ambulance exchange point. I need to know that one's getting set up because when we're done treating... Our first obstacle, the bad guy or the shooter is hopefully not around anymore or we're protected from that. Our second obstacle is the clock, and time is ticking. As we're treating these patients, I might look to my law enforcement partners on the contact team and say, "Hey, we came in and we noticed this was an exit out of front right to the driveway. Can you check it out and work with tactical or triage? Let's set up an ambulance exchange point there." Hopefully, they can handle that for you while you go back to work. Because, again, the minute we get these folks treated to the best of our abilities, we want them out of there. We want them in an ambulance on the way to the trauma center.Bill Godfrey:Let's pause there for just a second. Terrance, Tom says to you, you guys are working on the same RTF, and Tom says, "Hey, I know we came in through the front door and snaked through these hallways, but here's an emergency exit that goes out to this side parking lot or whatever, can we use that as an ambulance exchange point? What does that look like for you as a law enforcement officer that you need to work out? What needs to happen there before we get a "yes" or "no" and we can do that?Terrance Weems:The first thing I want to know if that area's been secured, if we have units in that area that have already swept it and made sure that that is a safe and secure area because we don't want to bring folk into an area where we can't say that it's already secure because now we've taken them literally out of the frying pan and put them into the fire. So if we can say that this is secure, I have the perimeter set, then, yes, we can set that up as an ambulance exchange point, and we can get moving on that. But if we can't say that, now I need to move a team to secure that area to make sure that we have that area secure. Once we have it secure, then we can do that.Bill Godfrey:Coby, let's say tactical gets that call in Terrance's example, we don't know whether it's been secured or not. We don't have a team out there. We obviously need some security. Let's say that you're on that contact team, Coby, that gets the call from tactical to go out and secure the ambulance exchange point. What does that mean to you? What are you thinking about? What are you looking for?Coby Briehn:So we get the call, we'd like to say that RTFs and the medical [inaudible 00:21:14] an event to happen, and law enforcement makes it happen. So if they want to move somewhere, we make sure it's secure before they go. If they want to go out any door, we're going to send a team out there. So if I'm part of that contact team, ideally we have a perimeter unit set up. Again, if we don't, we're going to push units out, officers out to secure that area, give us a protective bubble protecting that open air exchange point right there so the ambulances just can come in. It's a clear identification for them. The routes in and out are drivable. They're not covered in mud if it's raining outside. It's not locked up, or we make sure that that lock is now taken off so we can get out, certain barricades or wherever [inaudible 00:21:59] schools or businesses just so we can give them the best and easiest route out. We're going to do all we can to make that happen but we're not going to do it, we're not going to move them until we tell them that it's good to go.Bill Godfrey:I'm guessing that that doesn't happen in 30 seconds. That takes a little time to make that happen?Terrance Weems:Just a couple minutes after that.Coby Briehn:Everything takes time, yeah.Bill Godfrey:Tom, that's why that's one of the first things on your mind when you're landing in the CCP is... because you know it's only going to be a few minutes before you're going to be ready to start moving somebody. You don't want to be stuck waiting because the ambulance exchange point isn't set.Tom Billington:That is so true. The clock is ticking. People are bleeding. They're dying. We're doing the best we can. I want to know as soon as possible, as soon as we have a patient ready to go, a priority patient or red, I want them out of there. I want them to the ambulance. I want them on the way to the hospital. While we're in there, while the rest of the rescue task forces are in there, we do a little extra treatment. Obviously, we don't want to do too much. We just want to make sure we cover the basics. We want to make sure we do wound packing, hemostatic gauze, airway, very important, little decompressions. Things like that that will compromise the airway or not control bleeding we want to handle so that we can get the person to the trauma center in the best condition possible.Bill Godfrey:I think that's a great point. I don't believe we've mentioned TECC yet but the Tactical Emergency Casualty Care, which is the civilianized version of the military's Tactical Combat Casualty Care. Is that right, Coby? I got that right? The TCCC is the military one?Coby Briehn:Yes, sir. Tactical Combat Casualty Care, and the civilian is Tactical Emergency Casualty Care.Bill Godfrey:[crosstalk 00:23:43]-Coby Briehn:[crosstalk 00:23:43] combat out for the civilian.Bill Godfrey:The TECC model, if you're not familiar with it, I really encourage you to go Google that and look it up. It's all available for free. It outlines the differences in cold zone care, warm zone care, and hot zone care. There are a few things that we would still do in a hot zone that can happen from time to time. So it's probably a little bit too in depth for us to get in on this podcast, but if you're not familiar with that, please go check out Tactical Emergency Casualty Care. That's part of what guides our recommendations about what you do and don't do. A lot of that also has to do with the situation you're dealing with. You obviously want to provide life-threatening care or any stabilizing care but also the exigency or the urgency of the circumstances of how quickly you want to move them. As Tom has said, you want to get them out quick. Tom, I kind of interrupted you there. Where are we going after that? You got your other RTF coming in. You got the ambulance exchange point being worked on. Take me from there.Tom Billington:We're making sure our medical team is doing that treatment, as I mentioned. Then it's time. We work with the contact teams, and the rescue task force all work together. Like Terrance said, you want to make sure it's secure. When it's secure we want to start moving patients. Now, we want to move the patients that are going to get in an ambulance. We're not going to start stacking patients up outside of an ambulance exchange point because that's a security issue. If I'm in charge of that room, I'm going to pick out who I think is the highest priority, and we're going to send them out to the ambulance exchange point when we're told it's prepared. Prepared means security's in place. There's an ambulance sitting there with a driver. We're going to go right up to the ambulance and load the patients. Again, obviously, we have to be careful with loading. You can't put two reds in an ambulance. So we recommend maybe a red, a yellow on the second bench, and even a green in the passenger seat of an ambulance if they're stable enough.Tom Billington:Again, we also want to make sure that we're checking with our hospitals. Can a hospital take a red and a yellow? How many reds can this other trauma center take? So those are all things that are happening through transportation. It's all constant cogs in the wheel, continually working together. So once we get our patient out there, we want them in the ambulance. We want the doors shut. We want the ambulance to leave. We don't want it sitting there. Again, the clock's ticking. Minutes equal lives. Also we don't want to have the ambulance being a big target if there's another shooter or another obstacle in the way.Bill Godfrey:Which is an interesting point, Terrance, I was just going to ask you about that because one of the things that we teach is one ambulance in the exchange point at a time, two max. We don't want more than two up there. This is not some sort of forward ambulance staging point. Why for you as law enforcement is that so important to just have one or two ambulances max downrange in that exchange point at a time?Terrance Weems:A number of reasons. One, you're a target so you want to make sure... You don't want to add any more fuel to any fire. So if you're able to limit that to one, two if needed, then you're limiting any other opportunity. Not just that but there may be a need for another ambulance exchange point in another location. So if you're able to do that and you're able to have another ambulance exchange point stood up depending on the size and the scope of your detail, that gives you that opportunity. If you bring in all of those ambulances, now you have a problem with traffic. If you think about traffic during rush hour, that would be a perfect opportunity to have a messed up traffic [inaudible 00:27:20].Bill Godfrey:Absolutely. Bruce, Tom mentioned working with the hospitals on what they can take and what they can do. Of course, that's one of the things that we really harp on in class is distributing your patients evenly to the hospitals. Can you talk a little bit about the role of the RTF and coordinating with transport on what they've got and helping transport to get those ambulances distributed to the hospitals? Can you close that loop for me?Bruce Scott:Certainly. Most jurisdictions have a method where their 911 center has the ability to poll their hospitals about bed availability. Your bigger cities have multiple hospitals, and smaller jurisdictions, you probably don't have a lot of options. But the truth is you're doing disservice to the patients if you send more patients than what that hospital can handle safely.Bruce Scott:We have one of our instructors that teach with us from Las Vegas. His brother during the Las Vegas shooting was shot in the neck. They thought it was a really great plan to just put him in the police car and drive him over to the trauma center. Well, the trauma center was a war zone. They could not treat this police officer that was shot in the neck at that trauma center, and they ended up going to another facility. Obviously, thank the good Lord, and he's fine. It wasn't that significant of a wound as it turned out. But at the time the trauma center turned him down because they couldn't provide treatment for that. So we've done a disservice for our patients if we don't get those hospital counts, have the ability to get those folks where they're going to get the best care, or we're just doing a disservice.Bill Godfrey:Because of one of the points of confusion at least, Tom and Bruce, that I can remember coming up in class is we're teaching to establish a triage and a transport group supervisor along with the tactical group supervisor who are at the edge of the warm zone, let's say. They're outside. They're taking up position, but they're kind of the quarterback, quarterbacking the resources. A lot of times we get questions about, why do you need two? Why do you need triage and transport? The answer is because it's two very different functions. You just kind of hit on that. The triage group supervisor's job is to figure out how many are injured, where are they injured, and what are the severity. The RTF is the eyes and the ears for that. So you can't keep that information a secret. You've got to be communicative with your triage supervisor and tell them what you've got. Of course, the numbers are going to be a moving target. A lot of people don't realize that. They're like, "Well, what happened to that yellow?"Bruce Scott:I was going to bring that up.Bill Godfrey:You didn't account for the yellow. Well, that yellow turned into a red.Bruce Scott:Absolutely.Bill Godfrey:So it's a moving target, and you can't wrapped around the axle about that. But the triage group supervisor, as they're getting that information, has the opportunity to work with the transport supervisor right there who can begin to game-plan behind the scenes. So while the ambulance exchange point's being set up, the transport group supervisor can get the list of the bed counts or availability, if the jurisdiction does that, and then lay out their game plan for where they're going to send the various ambulances. So that information flowing from RTF about the nature and severity of the victims and then passing it on a transport, getting those loaded and the RTFs being aware of the loading. Tom mentioned, you don't generally want to put two reds in an ambulance. No. I can remember days when it happened to me. Male: Absolutely.Bill Godfrey:It's extremely, extremely difficult to do. You don't have enough equipment. You don't have enough hands. Now, if it's the only option you got, I mean I get that. Sometimes things happen. But generally speaking, you want to balance the load of the severity in the ambulance. Then once that ambulance leaves and calls transport, we want that transport group supervisor to spread those ambulances out to the various hospitals. So we just kind of rinse and repeat as we go through that until we get everybody off the scene.Bill Godfrey:One of the best things that the RTF can do is stay in touch with triage to let them know what they still have. If triage is not getting that, triage ought to call them and say, "Triage RTF One, what do you have left? Give me an update on what you have left." Don't worry about whether the numbers add up. That doesn't matter. Focus on what's left. So we finally get all the patients transported. The RTFs make the all-critical call to triage to say, "No more viable patients remain in my location. Then where else do you need me?" Tom, let's talk a little bit about that process.Tom Billington:Well, one thing to think about is this is a crime scene, without a doubt, so the minute the RTFs are done what they're doing, you want to check to make sure if they're needed anywhere else. If they're not, we need to try to get them off there and get them back to staging. Now, most scenes you're going to want to have an RTF there with the contact team in case something else happens. That's all right. As soon as we can get another assignment, it's up to the RTF to call triage and say, "Hey, we're done. All the patients are gone. All the treatment is over. Triage, what do you want us to do?" Because so many times the RTF's just hanging out. You have people everywhere. It's a crime scene. There's still unknown hazards. So we have to make sure triage knows what has happened and then we get direction.Bill Godfrey:Yeah, absolutely. Coby, Terrance, how do you feel about that idea of...? Let's say there's three or four RTFs downrange. You return most of them to staging, but you keep one of them back downrange with you guys as you begin to stabilize and go through your clearing operations. Coby, let's go to you first. Do you like that idea?Coby Briehn:I'm not opposed to it because it's good to have them close by there. We don't need a whole... We're not going to clear them [inaudible 00:33:07] to a secondary or tertiary search with the RTF unit following along behind us, but you get to have them close by when we needed it, if we do find some of those people that are hiding from whatever made them go into the closets or the caverns of the buildings. So I'm not opposed to it. Again, it's whatever that agency that those people are comfortable with, but it's certainly a great options to have those highly-trained medical guys downrange with us. They're already there. They're going to be doing the medicine anyway, so why have them go back when we could have them right there in a secure area while we're doing that search?Bill Godfrey:I think that's a great point. Coby, I'm glad you clarified that for me because I realize I didn't really say that very clearly in the way I implied that. I don't actually mean that the rescue task force forms up with the contact team and is part of the clean up operation. Not at all. That's not what I was saying. You keep one RTF that's still downrange in a warm zone, maybe still in the CCP. But if you have a problem, you don't have to wait for them to come back up from staging. Terrance, what are your thoughts on that?Terrance Weems:Actually I'm in agreement especially if we know that that area is secure, we know that the suspect is down, we can account for them whether it'd be one or multiple people, in that instance, sure, having one with you because we know in a lot of situations you're going to have people hiding in different places that may or may not be injured.Tom Billington:Bill, also to add, again, remember, an RTF is not just medical. It's your security system with law enforcement, so those law enforcement officers have to stay with that team. They have to keep protecting us. We cannot be left alone, so we don't want to just think we're going to take the law enforcement officers from the RTF, put them in a contact to search. They stay as a team together.Bill Godfrey:Yeah, absolutely, or else you have a medic that stands in the middle of a T intersection of a bunch of hallways and 20 doors and tries to treat somebody on the X.Bruce Scott:I'd just like to say that although I certainly understand the concept, I do that we continue to struggle around the country with fire/EMS chiefs are putting firefighters and paramedics into warm zones. Then we'd have those continued conversations. Terrance and Coby bring up a great point. We're going to leave them in that warm zone for an extended period of time. That's more conversations and more understanding that has to happen with those leaderships and those agencies. Because even if you get them to buy in, "Hey, we're going to commit them into a warm zone as long as we have that law enforcement protection," as most of your fire chiefs are going to say, "and I want them out of there as soon as possible till you tell me it's completely clear." So just more training and more understanding, more relationship building that has to take place on the front end.Bill Godfrey:I think that's a good point. I guess Terrance, Coby, that would probably also depend on what the lay of the land is: the building, what you've got secured, the configuration. Yeah, okay. We get the patients treated. We get them off the scene. We get our unneeded RTFs back to staging. We break those teams down and let people get reassigned. Is there anything else that we need to address? Because we've walked from A to Z, from getting the assignment in staging all the way back to staging. Anything you left out?Bruce Scott:A couple of things and I want to make sure that we... and I'm not sure we talked about it. Say, for example, you have two law enforcement folks and two fire/EMS folks as part of that RTF, you're understanding they work for triage. I think Tom mentioned that. But understanding that your communication, your law enforcement element still talks to tactical on their radio, and your fire/EMS are talking to triage. They get their direction from triage, and they get their approvement for movement from the law enforcement side. So you don't flip over to one channel or the other just because you're assigned on one RTF. You stay on your tactical channels.Bruce Scott:Bill, the second thing I want to understand from RTFs is you're going downrange. You're not taking every jump box, every trauma kits, your respiratory box, your oxygen, your stretcher. You're not taking a truckload of equipment with you. You're moving fast and light. The things that Tom brought up, that indirect threat care that you can do, that's not dependent on taking a whole lot of equipment with you.Bill Godfrey:Yeah, absolutely. Bruce, I really glad you brought up that bit about the radio channel because that is a source of questions and confusion from time to time: who's talking to who? It seems like we got the RTF reporting to two different bosses. It's really not that complicated when you look at... The RTF is a medical team with a medical purpose. It is run and managed by the triage group supervisor, plain and simple. But the law enforcement security detail on that RTF, they have to be on the radio with tactical. They have to be listening to what's happening on the tactical channel. They have to be able to update tactical about where they are in the building and what's going on and get any warnings or be able to convey any warnings. It's essential. But that's not a problem because you're standing together, so the security part of the detail is literally standing with the medical part of the detail. You can have them on two different channels. It's always interesting to me how that comes up as a point of confusion, so I think that's great. Tom, anything else from you?Tom Billington:No. Excuse me. I'm sorry. Just as Terrance pointed out to begin with, understanding each other, having relationships is so important. I know I would go anywhere with Terrance and Coby because I know their capabilities. Now, as Terrance said, in large jurisdictions that might not be possible, but if the jurisdiction has a reputation in our training with them that we know they're going to take care of us, it's very important to do that ahead of time. You don't want to be going in cold with somebody you have no idea who they are or what they're about. The lives of the paramedics are dependent on these law enforcement officers, and you want to feel secure when you're going in there.Bill Godfrey:I absolutely agree with you. The interesting thing, I think law enforcement by and large, and when I say that, I mean damn near every officer I've ever met understands that when they're asking for a medic to come downrange, I don't think they take that lightly. I think they are well aware that they're asking for an unarmed, non-law enforcement person to come downrange and that that complicates things a little bit for them because they've got somebody who may not know the tactical rules of the road coming down into their scene, and they got to manage that. I've never met any law enforcement officer anywhere in the country in our training or travels that hasn't understood the seriousness of that responsibility and that call. I feel really good about that.Bill Godfrey:You obviously want them to stay with you and not run away and all that kind of stuff, going and chasing the bad guy in the threat. I think most of them understand that pretty well. We probably need to continue to hammer on that message. But in terms of understanding when they're making that radio call saying, "Send me the medics," I think they get exactly what that means. So I think that's a great point. Terrance, any last things from you you want to throw in or out?Terrance Weems:No. I appreciate the opportunity. I enjoyed the conversation. You all are awesome. I just want to say that.Bill Godfrey:Well, it's good to have you on the team and glad to finally be able to get you into one of the podcasts. Coby, coming over to you? Anything you want to add?Coby Briehn:No, sir. Everything sounds great.Bill Godfrey:All right. Well, gentlemen, thank you very much for your time on this one. I hope everybody enjoyed it. If you haven't subscribed to the podcast, please do so. We are on our schedule to do new releases every Monday and holding up on that well. Until next time, stay safe.

March for Life Series: This is a four-part series that looks at the value of life through the various societal lenses of faith and politics. It's no secret that the United States is considered a global superpower. Part of the reason we have this designation probably has to do with our fascination, some say obsession, with the military–industrial complex. But are there situations where war is inevitable? How about assassinations? America spends roughly $700 billion on defense, yet also spends only a fraction of that on diplomacy. On this last installment of our March for Life series, we speak with recently Retired Green Beret Master Sergeant, and CEO of Quiet Pro Tactical, Juan Mata. MSG Mata gives us some unique insight into the decision making process involved in declaring war and how to take a life. We then discuss how politics plays a huge role in where our troops go and how voters can help if they want to see us involved in less conflict around the world. Guest Bio:Juan Mata is the CEO & PRINCIPAL of Quiet Pro Tactical. He is also the subject matter expert in special operations. Juan Mata, the Principal Instructor, a former 14-year Green Beret Combat Veteran. He has numerous combat deployments including Iraq and Afghanistan. His qualifications include Special Forces Advanced Urban Combat Course, Survival Evasion Resistance and Escape, Tactical Combat Casualty Care, Special Operations Terminal Attack Controller, Technical Surveillance, Counter-surveillance, and U.S. Army Ranger School.Quiet Pro Tactical LLC. employs U.S. Army Special Forces experience to promote community safety through weapons handling, armed self-defense instruction, and expert training to all law-abiding American citizens. Founded and operated by Special Forces veterans. Instructors have over a combined 60 years of relevant experience in firearms handling, CQB, long-range target interdiction, tactical combat casualty care (TCCC), surveillance and counter-surveillance, communications, and protective operations. Our staff comprised of U.S. Marine Corps & Navy veterans and private security contractors, keeping up to date with the most relevant experiences and training available.Support the show (https://www.buymeacoffee.com/faithpolitics)

Greybeard Performance: https://greybeardperformance.com Mike Simpson has served over three decades in the military as an Airborne Ranger, a Special Forces Operator, and finally as a Doctor of Emergency Medicine assigned to the Joint Special Operations Command (JSOC). Throughout his career, Mike has deployed to 17 different countries, from counter-narcotics operations in the jungles of South America, to the Global War on Terror (GWOT) in Southwest Asia and North Africa. Along the way, Mike has been trained as a demolitions expert, SWAT Sniper, High Altitude Low Opening (HALO) parachutist, civilian paramedic, Special Forces Medic, Operations and intelligence Sergeant, and finally, a board certified Emergency Medicine Physician. Mike is also a martial arts enthusiast, who trains in Brazilian Jiu Jitsu and Muay Thai. His passion for martial arts motivated him to become a practicing fight doctor. As one of the foremost experts in both tactical trauma medicine and combat sports medicine, Mike is highly sought after as a lecturer and instructor, working extensively with Mixed Martial Arts (MMA) fighters, law enforcement, and military organizations providing medical care and training. He co-stars on Hunting Hitler on the History Channel. Email: doc@drmikesimpson.com Facebook: https://www.facebook.com/DoctorMikeSimpson/ Instagram: @drmikesimpson Website: https://drmikesimpson.com Shop affiliates: https://drmikesimpson.com/new-page-1    Nutrition: https://www.freshly.com/subscriptions/1807965?clickid=SREyh7XScxyJTlPwUx0Mo3cTUknxrzxsKVe91A0&irgwc=1&utm_campaign=usa_plans_all-d_all-p_acq_cpa_Michael%20Simpson_&utm_medium=affiliate&utm_source=ignite&affsrc=1&utm_term=paid-affiliate&plan_id=422&promo_code=rad40 Merchandise: https://rangerup.com/collections/doc-simpson promo code: MOTW15 (Save 15%)

The most informative law enforcement tac med episode to date with Dr. Andrew Fisher.  Doc is one of the leading experts in the field of pre-hospital intervention.  He brings a substantial amount of experience from his time in 75th Ranger Regiment (8 deployments) with 26+ years in the military. He is the Chairman of the National Stop the Bleed Month and Day and is a voting member on the Committee on Tactical Combat Casualty Care.  Over the course of his career, he implemented SWAT Medic Programs, was promoted to the Regimental Physician Assistant for the 75th Ranger Regiment in Fort Benning, GA in 2015 and the list goes on. Fisher's knowledge and accomplishments are nothing short of impressive. Currently, Fisher holds the rank of Major and is currently in his first year of a general surgery residency in New Mexico.In this episode, we will discuss everything from tourniquets, common law enforcement myths, when it comes to pre-hospital intervention, Narcan, training, and more. Consider this a free training class. Go learn!

Hey listeners, welcome back! As you all know, America has been in one of the longest wars in our history. Since 911, we’ve had over 2.5 million service members in those conflicts in the Middle East with many soldiers returning home with devastating injuries. The signature wound of war has been dubbed PTSD but many have come home with traumatic brain injuries which in the long term has been a critical issue with servicemembers reintegrating back into civilian life. Are you a spouse or caregiver of a veteran who requires assistance but feel as though you need support too? Well we gotcha covered...today’s guest is Dan Arnold with Operation Family Caregiver which helps the families of returning service members and veterans by teaching them the skills they need to manage their challenges as they adjust to their “new Normal”. Guest Daniel Arnold married with four children. He is a 22 1/2-year Air Force Veteran from June 1984 – Jan 2007, retired in 2007 at the rank of MSgt, then after that for the next 10 years hw was a Military spouse following his wife around until she retired in 2017. Currently he works at Veterans One Stop Center, as a Military Family Caregiver Coach, where he works directly with Caregivers to our Veterans, to ensure that Military Family Caregivers are taking care of themselves so they can provide the best possible care for our Veterans. During his time in the service he was given a substantial amount of medical training as an enlisted member. He obtained my emergency medical certifications at the Basic, Intermediate, and Paramedic levels. He was trained as an Independent Duty Medical Technician, and as a Special Operation Forces Medical Element he was lucky enough to attend medical training at the Special Operation Combat Medic (SOCM) course at Fort Bragg. He was also trained as an Independent Duty Medical Technician. He deployed to OEF/OIF multiple times and have completed numerous Air Force Special Operations Command (AFSOC) specific missions in Bosnia, Africa, South America, and Southwest Asia. At the end of his military career he was the ASFOC Career Field Manager for Enlisted Medical personnel, Senior AFSOC Medic, and represented AFSOC and the Air Force in developing the Tactical Combat Casualty Care training criteria for Special Operation Medics. During his time as a Military Spouse he was lucky enough to continue serving by working as a Military Educational Specialist while stationed overseas. He started working at The Veteran One-stop of WNY where he completed training as a Military Caregiver Coach in May 2018, through the Rosalynn Carter Institute for Caregiving. Currently they partner with the Rosalyn Carter Institute and he serves our Military Veteran Caregivers here in Buffalo and the Northeastern United States. He also helps run a Veteran Peer support program through the PFC Joseph P Dwyer Program at the Veterans One-stop Center of WNY.

Coco Tang has traveled the world as a Nationally Registered Paramedic and a DOD-trained Tactical Combat Casualty Care (TCCC) instructor, and she is currently on contract working the night shift in New York City treating COVID-19 patients. She joins Jason and Emily for episode 011 to talk about the similarities and differences in her medical mission work from Africa to Afghanistan to here at home. Their conversation covers her ground truth at the epicenter of the current pandemic, her unique perspective as a Chinese American in the time of COVID, tales from her trips abroad, and what drives her to serve and help others in some of the most challenging spots around the globe. Coco was born in Fushun, China - not far from the North Korean border - and moved to the US when she was 12. She is a naturalized US citizen who speaks fluent Mandarin Chinese and has a working proficiency of Arabic, German, Russian, and Japanese. In 2013, she moved to Jordan as a Fulbright Scholar to conduct academic research on ISIS and Syrian refugees. During that time, she began volunteering medically at the refugee camps. Since then, she has worked all around the world including: community outreach initiatives in Sierra Leone during the height of the Ebola crisis in 2014; the Nepal earthquake response in 2015; and Syrian refugee camps in Greece and Iraq. Last year, she led humanitarian and medical assessment trips to the remote mountainous regions of northern Ethiopia and to the Democratic Republic of Congo due to another Ebola outbreak in South Kivu. She most recently returned from a medical deployment in Kandahar, Afghanistan. Links: Coco Tang GORUCK Events Learn more about GORUCK Glorious Professionals podcast website

This PMC is a former Marine, amateur YouTuber, EMT, Range Safety Officer, STB, and Tactical Combat Casualty Care instructor, Operation Enduring Freedom, Kosovo 16-17, Operation Inherent Resolve. This is our first conversation. We get to know each other a bit. We talk deployments, blood/guts, and everything in between. PMC Podcast on LinkedIn: https://www.linkedin.com/company/34676753 PMC Podcast on FB: https://www.facebook.com/pmcpodcast/ PMC Podcast on Twitter: https://twitter.com/pmc_radio Listen Here: RSS: https://anchor.fm/s/125be37c/podcast/rss iTunes: https://lnkd.in/gWPwbYg Anchor: https://lnkd.in/gDHzdyD Spotify: https://lnkd.in/eGR5BUB Breaker: https://www.breaker.audio/pmc-podcast-1 Google Podcasts: https://www.google.com/podcasts?feed=aHR0cHM6Ly9hbmNob3IuZm0vcy8xMjViZTM3Yy9wb2RjYXN0L3Jzcw== Overcast: https://overcast.fm/itunes1495248259/pmc-podcast Pocket Casts: https://pca.st/lmxau5ko RadioPublic: https://radiopublic.com/pmc-podcast-69lDL9 --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/pmc-podcast/message Support this podcast: https://anchor.fm/pmc-podcast/support

This is our second episode with Dan Irizarry, an expert in Tactical Combat Casualty Care. In part two of the conversation we discuss what Dan sees for the future of SOF medicine, the Alan Babin Rule, and freeze-dried plasma. Listen and learn with Dan Irizarry!GSF Corporate Partner Highlight: Aero Pioneer Grouphttps://aero-pioneer.com/Alan Babin on the Gary Sinise Foundation:https://www.garysinisefoundation.org/specially-adapted-smart-homes/alan-babin/Stop the Bleeding: http://stopthebleedingcoalition.org/iSupport the show (https://gsof.org/individual-membership/)

Stu and Chelsea of the GSF met with Dan Irizarry, an expert in Tactical Combat Casualty Care. We had such a good conversation that it was worthy of two episodes... this is Part 1. In this episode we discuss NATO SOF medics, the crazy advancements in simulated training, and tourniquets... lots of tourniquets. Listen and learn with Dan Irizarry!GSF Corporate Partner Highlight: AC4Shttps://www.ac4s.com/Support the show (https://gsof.org/individual-membership/)

  INTRO Eric –Welcome to episode #31  of the Canadian Prepper Podcast, recorded July 31  2019. My name is Eric, and I’m the host of the show.  I am based in southern Ontario. I’m a hunter, target shooter, HAM radio operator (VE3EPN), and computer geek. I got into preparedness when I was working front line in emergency services and witnessed an over reliance on Emergency Services during major events, such as ice storms, power outages, etc. I started a small preparedness company to help get people prepared and able to look after themselves for at least 72 hours, if not longer. Alan - I’m Alan, and my friends and family call me a safety nerd. My background as a First Responder developed a mind for safety. I teach first aid and coach family and friends to be better prepared. I'm a locksmith by trade and have worked in the physical security industry for more than 20 years now. Andrew - Normally you can listen to me hosting Canadian Patriot Podcast. I’m  a recovering libertarian, competitive shooter, and firearms instructor at Ragnarok Tactical. Use the discount code “patriot” at checkout on Ragnarok Tactical to save 10%. We specialize in selling traumatic first aid supplies, and I’m a Stop the Bleed instructor.    Gavin - Business owner, gun owner, volunteer first responder, regular CPP Panelist, Instructor with Ragnarok Tactical and International man of mystery Eric – We have some critical care  content for you in this episode,  We’re going to start off with some news articles relating to preparedness and the outdoors. Next we will be letting you know how we’ve improved our preparedness since our last episode.  Then we’ll get into the main topic for this episode - Individual First Aid kit contents and construction.     News - Alan - https://globalnews.ca/news/5705538/garlic-festival-shooter/ Kudos to the reporter at Global for identifying the firearm used as a ‘semi-automatic rifle’ and nothing else. The event was protected by fences and metal detectors. Police on site killed the shooter within a minute. It does go to show that when seconds count, the police are only minutes away. Andrew -  Gavin -  Eric -  https://ottawa.ctvnews.ca/mobile/acute-intoxication-blamed-for-massive-fish-kill-in-ottawa-river-1.4514243?cid=sm%3Atrueanthem%3Actvottawa%3Apost&utm_campaign=trueAnthem%3A+Trending+Content&utm_content=5d3132850ca7240001cbb17a&utm_medium=trueAnthem&utm_source=facebook&sfns=mo WHAT WE’VE DONE LATELY for preps Andrew - This week is loading more 223 rifle ammo.  Alan - been a long week of school and training. I can throw hose like champ now, and every muscle in my body hurts. I did some fire tinder prep cutting up limbs and clearing the property of further hazards Gavin - bought a giant berky Eric - Got out on the range and took the AR-15 for a spin. . . also gave the 9mm and 22 pistol some attention as well   Main Topic -  Eric - Alright, it’s time to move onto the main topic of the show. (Each host insert talking points here) Alan - What is an IFAK? Individual First Aid Kit is a fairly generic term, but the essence is that it’s the tools you need to save a life (your own, mostly).  Basic contents:  Tourniquet Pressure Dressing Hemostatic Gauze Chest Seal Medical gloves (not black. Any colour but black. The lighter the better) If you don’t know how to use these things, take a StopTheBleed class (if you’re Toronto way, Ragnarok Tactical offers them, if you’re in SouthWestern Ontario, message me and I’ll set one up) Chest seals: not covered by the STB curriculum, but an important tool to have. It’s a one-way valve that allows air to escape a penetrating chest wound without allowing air to enter the plural space between the lung and the chest wall from the outside. A combat medic told me once that the best tool to help with a chest seal is duct tape. On hairy or wet (sweaty/bloody) skin, they can fail. Duct tape around the edges keeps them in place. The guy who’s bleeding won’t mind the wax job on his chest, I promise. I challenge everyone who owns a gun, hunts, fishes, hikes, camps, or spends any time more than 3 minutes from an ambulance to build and know how to use an IFAK. There are a million stories of unintentional trauma that causes death because someone couldn’t stop the bleeding.    Andrew - First off, I’m not an expert, but I am a Stop the Bleed Instructor, and I have received training on all the products I sell and some we don’t. I’m not a doctor, nurse, EMT, and odds are you aren’t either, so get training and understand what you are able and qualified to do. The time to make decisions is now, not when you see someone bleeding to death Why do you want an IFAK? What is an IFAK? Improved First Aid Kit, Blowout Kit, Ventilated Operator Kit. A first aid kit that is able to address massive traumatic injury. What are you trying to do? Keep someone from dying until you can hand them over to a higher level of care. How do we go about that?  MARCH Protocol vs ABCs Airway Breathing Circulation  Major Hemorrhaging Airway Respirations Circulation Head Injuries, Minor Hemorrhaging, Hypothermia/Shock Major HemorrhagingMassive hemorrhage is managed through the use of tourniquets, hemostatic dressings, junctional devices, and pressure dressings.Tourniquet. CAT, SOFTT-W, or SAM.Hemostatic dressings. Celox vs Quickclot AirwayAirway is managed by rapid and aggressive opening of the airway Nasopharyngeal Airway, NPA. Standard size is 28 Fr. Get lube. OPA get training RespirationsRespirations and breathing is managed by the assessment for tension pneumothorax and aggressive use of needle decompression devices to relieve tension and improve breathing.Not breathing - Rescue Breaths, pocket mask, or BVMTension pneumothorax - Chest Seal or Needle Decompression Kit CirculationTCCC promotes the early and far forward use of blood and blood products if available. Standard methods for circulation improvement, such as laying the patient flat, maintaining body temperature and careful fluid resuscitation all apply Head Injuries & Hypothermia/Shock Where to keep your IFAK Car Home Bag/Purse/Pocket/Ankle holster Range bag/belt/plate carrier Building your IFAK Pick a size, set a budget, expand later.  US Army IFAK - The Granddaddy of IFAKS - Iraq circa 2003 1 Tourniquet 1 Elastic bandage kit (this is similar to a field dressing) 1 Bandage GA4-1/2” 100’s 1 Surgical adhesive tape 1 Nasopharyngeal airway kit 4 Surgical gloves 1 Combat gauze dressing Minimum IFAK Contents Tourniquet - Massive Hemorrhage pressure dressings. - Massive Hemorrhage Additional IFAK Contents Shears Gloves Sharpie/Permanent marker Sterile/non-sterile gauze Pocket mask - Respiration hemostatic dressings - Massive Hemorrhage Advanced IFAK Contents NPA - Respiration Decompression Needle - Respiration Other goodies Splints Sutures  Tape Burn treatments BVM IVs/Fluids Emergency Blanket/Reflector Blanket Cervical collar Medications; Epinephrine, Naloxone  On purchasing first aid supplies; Some items requires the buyer to have training (quikclot) Other items are frequently counterfeit (tourniquets on Amazon) Some items expire or lose efficacy over time (medications/hemostatic) Some expiration dates don’t necessarily mean the product is no good (expiration dates on sealed sterile bandages) Naloxone is free in Ontario Tourniquets may degrade over time if exposed to UV light or other conditions There are other kinds of tourniquets. Refer to the Council on Tactical Combat Casualty Care for a list of tourniquets that meet their requirements, get a good one If a tourniquet does not work, apply another  Tourniquets should never be lossend, only removed in a hospital setting More is always better, bigger is almost always better  Shipping packaging should be removed before packing a kit, sterile packaging should remain sealed and staged appropriately  Ian questions -    Brand preferences for IFAK pouches, shears…..ie CTOMS, etc? Any training available for TCCC? Rough cost to budget for a proper IFAK?   Where do the hello kitty bandages and tampons come into play? PODCAST CHALLENGE Get a tourniquet. A real one. Not an amazon POS that will break the first time it’s used. Make it part of your EDC whether it’s in your backpack, car, cargo pocket, whatever. Think about your worst case scenario and be able to control bleeding.  Get a Naloxone kit from your local pharmacy   Episode Closing Upcoming events Eric - Last episode on google hangouts.   If we miss a week, we have not quit!  . Just pls standby while we work out an alternative.  We plan to continue to publish on iTunes and YouTube. Just need to test the new platform. Shout Outs Alan -  Eric -  Guests -  Email / Itunes reviews? Alan -  Eric - 27 5* 1 4* and oh no! A 1* Outro Eric -  I’m going to bring episode 31  of the Canadian Prepper Podcast to an end.   You can find the podcast on Itunes, Podbean, Spotify or your favourite podcast app.  Please help us out take a few minutes and submit a review! It helps other people find us.  You can also find us at prepperpodcast.ca and on Facebook! Alan - We record these shows on Youtube live chats.  If you want an early peek at the shows, please subscribe to the YouTube channel “Canadian Prepper Podcast“, and click the notifications tab.  That gives you alerts when we are going live. You can contact me directly on Instagram, @ PPSWO Andrew- Canadian Patriot Podcast, discount code “patriot” on www.RagnarokTactical.ca    Gavin -  Eric – Please  check out Rapid Survival www.rapidsurvival.com and get me there on live chat while buying some prepper gear, or you can also email me at feedback@prepperpodcast.ca (while still buying prepper gear at Rapid Survival) Eric - Thanks for joining us, and tune in for the next episode,  (Tips for the lazy Prepper?) ie - minimal effort for easy gains in preparedness . Eric - Until next time, be prepared, stay safe, and (Alan) keep learning!

SURVIVAL MEDICINE HOUR PODCAST with JOE ALTON MD and AMY ALTON ARNP   In survival scenarios, you can bet that there will be lots of injuries that break the skin, your body's natural barrier. Joe and Amy Alton, aka Dr. Bones and Nurse Amy, discuss various considerations with regards to wound closure in austere settings, including infection, bleeding, delayed closure, and some different would closure techniques. Also, Amy Alton ARNP talks about her recent video on the newly approved tourniquet by the Committee on Tactical Combat Casualty Care, the SAM XT tourniquet, and her opinions regarding its usefulness for the average person. Another concern involves the constant battle between natural healers and conventional healthcare providers, and why it's ridiculous to be dogmatic about what medical therapies make the most sense in times of trouble. Joe Alton MD suggests the active use of all the tools in the medical woodshed. Lastly, Dr. Alton welcomes Wes Peters of Gold Wealth International to discuss some concerning events on the world stage, plus the advantages of physical gold in the uncertain future. All this and more in the latest Survival Medicine Hour with Joe and Amy Alton! Wishing you the best of health in good times or bad, Joe and Amy Alton Don't forget to stock up on medical kits and supplies at store.doomandbloom.net!    

SURVIVAL MEDICINE HOUR PODCAST with JOE ALTON MD and AMY ALTON ARNP   In survival scenarios, you can bet that there will be lots of injuries that break the skin, your body's natural barrier. Joe and Amy Alton, aka Dr. Bones and Nurse Amy, discuss various considerations with regards to wound closure in austere settings, including infection, bleeding, delayed closure, and some different would closure techniques. Also, Amy Alton ARNP talks about her recent video on the newly approved tourniquet by the Committee on Tactical Combat Casualty Care, the SAM XT tourniquet, and her opinions regarding its usefulness for the average person. Another concern involves the constant battle between natural healers and conventional healthcare providers, and why it's ridiculous to be dogmatic about what medical therapies make the most sense in times of trouble. Joe Alton MD suggests the active use of all the tools in the medical woodshed. Lastly, Dr. Alton welcomes Wes Peters of Gold Wealth International to discuss some concerning events on the world stage, plus the advantages of physical gold in the uncertain future. All this and more in the latest Survival Medicine Hour with Joe and Amy Alton! Wishing you the best of health in good times or bad, Joe and Amy Alton Don't forget to stock up on medical kits and supplies at store.doomandbloom.net!    

This week Andrew is back! Things get quickly derailed. Fortuanly Marty and Tim are in practice on how to podcast and try to keep things moving. Andrew talks about his social media break, Discipline Equals Freedom, and an anecdote on situational awareness. In the news Instagrammers from Toronto close a farm, basic income pilot in Ontario is cancelled, and there is speculation on uniform changes for the Canadian Forces. The panel also covers gun control as proposed by the NDP, buck a beer on Ontario (Thanks Doug!), victim hierarchy, and Saudi Arabia's expulsion of Canadian diplomats. Intro Hello to all you patriots out there in podcast land and welcome to Episode 145 of Canadian Patriot Podcast, the number one LIVE podcast in Canada. Recorded Monday August 6 2018. Andrew - I’m a recovering libertarian, competitive shooter, and firearms instructor at Ragnarok Tactical Liberal Tim - sport shooter, husband and father of three, owner and operator of Tim’s Good T Shirts, they’re quite good.  Also the proud decendant of immigrants Marty - Hunter Sport shooter in rural southern ontario We’d love to hear your feedback about the show. Please visit  canadianpatriotpodcast.com/feedback/ or email us at feedback@canadianpatriotpodcast.com A version of the show is Available on Stitcher at and iTunes http://www.stitcher.com/s?fid=77508&refid=stpr and iTunes at https://itunes.apple.com/ca/podcast/canadian-patriot-podcast/id1067964521?mt=2 Check the podcast out on http://facebook.com/canadianpatriotpodcast and Instagram  https://www.instagram.com/canadianpatriotpodcast/ We need your help! To support the show visit https://www.patreon.com/cpp and become a patreon. You can get a better quality version of the show for just $1 per episode. The more you pledge the better the rewards are. Show your not a communist  buy a CPP T-Shirt, for just $19.99 + shipping and theft. Visit the http://canadianpatriotpodcast.com home page and follow the link on the right.   Arrowhead Coffee Arrowhead Coffee is Owned and Operated by Canadian Armed Forces Veterans. They love our Country, the True North Strong and Free, their family and friends. Join Arrowhead Coffee on their hunt for the perfect brew to raise morale and bring that feeling of home to you, no matter where you are. A portion of all profits helps Canadian Armed Forces Members, Veterans and their Families. What Are We Drinking Andrew - Forty Creek Liberal Tim - 40 Creek Copper pot, sans shot glass Marty - Coors Banquet Andrew’s Back! Andrew needed a little social media break. The New Brunswick trip for the 8th Annual Canadian Firearms Podcast Network Charity shoot burned him out. Reading tons of news was getting depressing. Being new parents and travelling for work has been challenging.   Ragnarok Tactical is going strong with a big focus on adding new products and brands this year. In addition to first aid supplies like bandages and tourniquets, HSGI tacos, and special order of 5.11 and Tru-Spec clothing we have added some new lines. We have footwear from Original SWAT, Altama, and Smith & Wesson. Hard and soft cases from Black Bear Gear. Kydex accessories from Grey Fox Strategic. The MantisX Shooting performance system. Matador Arms muzzle devices. We just received our initial order of AR15 barrels from International Barrels Inc. This past weekend Andrew and Gavin completed evaluation of some products from Warrior Assault Systems, and you can expect to see those on the store in the coming months.   We have a Tactical First Responder Trauma Course in Mississauga October 13 & 14. Course fee will be $450 USD. The course is two days. Crecencio “VAL” Valenzuela of Spent Brass Training Solutions, LLC from California will be instructing. Val is currently a NAEMT Affiliate Faculty member, Course coordinator and Instructor for Tactical Combat Casualty Care. As a former High Threat Security Contractor for Private Security Company in Iraq, Val has been a Personal Security Detail member, and team medic. He holds a National Registry for Emergency Medical Technician and U.S. Army Tactical Combat Casualty Care. A combat veteran with the U.S. Army Infantry, Val served 5 and half years with multiple combat and NATO tours to include Macedonia, Kosovo and Iraq. While on active duty in the Infantry as a fire team leader, Val was a weapons and tactics instructor at the company level. Val also has time spent as a civilian military weapons and tactics based instructor for Federal, State and Local entities. Former Staff Instructor for Suarez International Inc. and Current Affiliate Staff instructor for Phokus Research Group and ZERT.   Advice for listeners - go read “Discipline Equals Freedom” by Jocko Willink. It’s not complicated but it’s not easy. Get up, work out, do work.   A short story on situational awareness; TLDR; Andrew almost got to physically remove a drunken asshole. Moral of the story don’t be a dick, moral of the moral be ready to do work. News ‘We’re closed forever!’: How the search for the perfect selfie led to bedlam at an Ontario sunflower farm https://www.theglobeandmail.com/canada/article-how-the-quest-for-the-perfect-selfie-forced-an-ontario-sunflower-farm/ -Andrew can relate   Ontario government defends move to cancel basic income pilot project https://globalnews.ca/news/4365399/ontario-cancels-basic-income-pilot-project/ “It’s reprehensible, reprehensibly irresponsible to announce the end of the pilot without thinking those things through about how they’re going to wind up the program and how they are going to support people,” he said.  “This is the government taking a political course of action without thinking things through the ramifications (for) these real people who have huge stresses in their lives now.” Tom Cooper, director of the Hamilton Roundtable for Poverty Reduction.   Sheila Regehr, chair of the Basic Income Canada Network, said demographic groups such as seniors and parents with young children receive support that follows the basic income model, with better outcomes than social assistance. Basic income programs give people “the ability to have some security, to have some autonomy, to have the feeling that you’re in control, that you are making decisions that are best for your life, not some bureaucracy that thinks it knows best,” she said. “It’s not just about money, it’s about security,” she said. “It’s knowing that no matter what else happens in life, you’ve got something that helps you deal with that.”   Christie Blatchford: Defence chief wants to toss Canadian-made uniforms for U.S. version — at a cost of $500M https://nationalpost.com/opinion/christie-blatchford-defence-chief-wants-to-toss-canadian-made-uniforms-for-u-s-version-at-a-cost-of-500m   NDP Leader Singh urges feds to immediately allow cities to ban handguns https://www.cp24.com/news/ndp-leader-singh-urges-feds-to-immediately-allow-cities-to-ban-handguns-1.4037835 That's because some measures, such as street checks and carding, have amplified distrust between police and racialized communities, Indigenous peoples and those struggling with mental illness. Instead, he says allowing cities to ban handguns would help municipal authorities deal with the fact that many gun crimes are committed with legal guns. In awkward moment, Singh seems unsure about caucus support for gun control bill https://globalnews.ca/news/4169609/jagmeet-singh-unsure-gun-control-bill/ -Timemachine April 2018   Premier Doug Ford says buck-a-beer coming by Labour Day https://toronto.citynews.ca/2018/08/03/premier-doug-ford-says-buck-beer-coming-labour-day/   Forced to share a room with transgender woman in Toronto shelter, sex abuse victim files human rights complaint https://nationalpost.com/news/canada/kristi-hanna-human-rights-complaint-transgender-woman-toronto-shelter#Echobox=1533258015 -Victim blaming? Victim Hierarchy?   Saudi Arabia expels Canadian ambassador, freezes trade in human rights dispute https://www.thestar.com/news/canada/2018/08/05/saudi-arabia-to-expel-canadian-ambassador-and-freeze-trade-in-human-rights-dispute.html Petitions Oneclearvoice.ca http://oneclearvoice.ca/ Rapid Fire Feedback From: Todd Subject: 144 Guys great coverage of Danforth.  I have come to the belief that the real issue is twofold; we are allowing a culture that is the antithesis of Western Society colonize Canada, and Permitted cultural marxists and outright communists in positions of influence in government and academia.  We will not survive unless we Eliminate immigration and ban Islam. We must also purge the marxists and communists. We can start with the fucktard in 2019. Seriously the best part of him ran down his mother’s leg   iTunes Alexg36C My Favourite Podcast 5 stars I can’t think of a better podcast to listen to during my commutes back and forth between petawawa and Ottawa. Its entertaining but also keeps me up to date on events and politics Outro Andrew - https://ragnaroktactical.ca/ Visit us at www.canadianpatriotpodcast.com like us on Facebook at www.facebook.comcanadianpatriotpodcast We value your opinions so please visit www.canadianpatriotpodcast.com/feedback/ or email us at feedback@canadianpatriotpodcast.com and let us know what you think.   and remember “You are the True North Strong and Free”   Music used under Creative Commons licenses The last ones by Jahzzar http://freemusicarchive.org/music/Jahzzar/Smoke_Factory/The_last_ones Epic by Bensound http://www.bensound.com/royalty-free-music/track/epic

Doctor Sherman House on Being the First Responder David and Mark sit down with Doctor Sherman House of the CivilianDefender.com to talk about his experiences in the arena of trauma medicine and what emergency medical skills everyone should possess.  This is an excellent start to our recurring series on medical skills for the average citizen and Dr. House provides a lively and very informative dialogue on the subject.   About Doctor Sherman House: Dr. House is currently in his 22nd year as a healthcare provider, and is a Hospital, Special Needs and General Dentist just outside of Nashville TN. Prior to his career in dentistry, Dr. House was a Fireman and Emergency Medical Technician in Washington State. Concurrently, he was a Shotgun Messenger for several West Coast Armored Truck companies. He holds undergraduate degrees in Law Enforcement, Cell Biology and Philosophy from Gonzaga University. He completed his Doctorate of Dental Surgery at the Meharry Medical College with Honors in Nashville, TN. He earned a Hospital Dentistry Certificate as the Chief Resident from the Metro General Hospital also in Nashville. Dr. House is the originator of the CIVILIAN DEFENDER training concept. He has personally saved lives using CPR, Rescue Breathing, Automated External Defibrillator, Tactical Combat Casualty Care, Advanced Cardiac Life Support, Prehospital Trauma Life Support, and Heimlich Maneuver techniques. He has studied extensively in the defensive arts, both armed and unarmed, as well as self-defense law, emergency medicine, criminal psychology, tactical driving and other survival skills from a list of instructors, which reads like the Who’s Who of the training industry. For those interested in Dr. House’s complete biography, you should head over to www.CivilianDefender.com and view the About page!   Connect With Us After the Show! Follow us on Instagram and Facebook! Instagram: @ShootersNationRadio Facebook: https://www.facebook.com/shootersnation/   Get News and Special Offers! Be sure to sign up for the Shooters Nation Mail Blast newsletter.   Got an idea for a future episode?  Let us know at https://www.shootersnation.com/idea   Sponsors: Squared Away Customs Quality Custom Kydex Holsters and Carry Gear Be sure to use discount code "SHOOTERSNATION" when ordering!   Are you interested in sponsoring an episode?  Contact us!  We'd love to chat with you about it.     Like what you're hearing? Want to support the podcast and help make future episodes possible?  Every dollar donated helps make this show possible. https://www.shootersnation.com/donate  

The Tactical Hemostasis, Oxygenation and Resuscitation(THOR) Group including the 75th Ranger Regiment, NORNAVSOF and others have led the way in re-implementing type-O, low titer fresh whole blood far forward with the Ranger type-O Low titer(ROLO) program. In 2015 the Ranger Medical Leadership along with founders of the ROLO program published the paper, "Tactical Damage Control Resuscitation" outlining in detail why they chose to bring back fresh whole blood at the point of injury. Since that time further studies have strongly suggested that the earlier fresh whole blood was transfused, the greater the benefit to the patient. Shackleford et al demonstrated that the greatest benefit to a patient receiving fresh whole blood occurred within 36 minutes of injury. After 36 minutes no decrease in 24-hour mortality was found. Blood must be replaced as soon as possible. The Committee on Tactical Combat Casualty Care also recommends FWB as the first line intervention for patients in hemorrhagic shock with blood products in both second and third place. We cannot ignore whole blood any longer if we wish to deliver the best possible battlefield care possible. Excuses citing logistical difficulty, concerns of safety or lack of information are unfounded. There are multiple ways to ensure our casualties are receiving fresh whole blood. The first is through the Armed Forces Blood program delivering cold stored O-Low titer blood to a Role 2 facility where it is picked up and pushed forward from there. Refrigeration is necessary in order to keep it below 4°C. If going out on mission insulated containers such as the Golden Hour or Golden Minute containers can be used to keep the blood within temperature specs for 24, 72 hours or longer. If dismounted, a transfusion can occur at or near the point of injury with pre-typed, screened and titered ROLO/SOLO donors. Other non-Ranger Special Operations units have since followed suit and have tweaked the name to suit them, hence the new SOLO(Special Operations Low-O) acronym.

The World Trauma Symposium:  https://www.naemt.org/events/world-trauma-symposium NAEMT:  http://naemt.org/ EMS World Expo: http://www.emsworldexpo.com/   Episode #66 Latest on Pelvic Binders from Both Military and Civilian Perspectives #WTS17 #PHTLS #EMSWorldExpo17 with Col. Stacy Shackelford, MD Col. Shackelford is the chief of performance improvement at the Joint Trauma System Defense Center of Excellence for Trauma Joint Base in San Antonio, Texas.  She is also an attending trauma surgeon at the San Antonio Military Medical Center. Col. Shackelford is a member of the Committee on Tactical Combat Casualty Care, led the TCCC guideline review and update for pelvic binders, and has deployed four times as a combat surgeon and as the director of the Joint Theater Trauma System.  Col. Shackelford was commissioned through the U.S. Air Force Academy, attended medical school at Tulane University and general surgery residency at the University of Utah.  After completing a Trauma and Critical Care fellowship at the University of Southern California, Col. Shackelford was assigned as Director of Education at the Air Force Center for Sustainment of Trauma and Readiness Skills at the R. Adams Cowley Shock Trauma Center.  She is an instructor for the Defense Institute for Medical Operations.   Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org  

En este episodio discutimos las diferencias y similitudes entre los cursos Tactical Combat Casualty Care y Tactical Emergency Casualty Care. En esta ocasión me acompaña Elkin José Fuentes Ballestas, de Colombia.

This is a two part podcast with Dr. Daved VanStralen discussing the topic of evidence based medicine and TCCC. We have taught and "preached" TCCC for over a decade, while defending the guidelines, equipment, and recommendations with the "mantra" evidence-based medicine. After years of unexplained failures and issues, we take a look at what "EBM" actually is, and whether its performance parameters are relevant to your operational parameters.

This is part II of a two part podcast with Dr. Daved VanStralen discussing the topic of evidence based medicine and TCCC. We have taught and "preached" TCCC for over a decade, while defending the guidelines, equipment, and recommendations with the "mantra" evidence-based medicine. After years of unexplained failures and issues, we take a look at what "EBM" actually is, and whether its performance parameters are relevant to your operational parameters.

A simple vista, ambos libros parecen lo mismo. De hecho, en su gran mayoría, son el mismo libro. La única diferencia es que el libro verde tiene unos capítulos adicionales. Pero existen unas diferencias trascendentales entre la versión regular y la versión táctica.   Quien no conoce su historia está condenada a repetirla. El ejército indentificó una lista de problemas en el contenido y la metodología de enseñanza. Cuando se mejoraron esas deficiencias, las estadísticas de sobrevivencia de pacientes severamente heridos mejoró significativamente. El resultado ha sido que hoy día tenemos las mejores estadísticas de sobrevivencia dentro de situaciones de combate en la historia reciente (desde WWII en adelante). Muchos de los problemas que el ejército encontró son también aplicables al entorno civil y urbano. En adición, muchas de las soluciones que el ejército implementó son igualmente aplicables en las operaciones cotidianas. No me refiero a la respuesta a incidentes de tirador activo en áreas urbanas... me refiero a las operaciones rutinarias prehospitalarias e intrahospitalarias. Sería un error ignorar estas lecciones aprendidas simplemente porque son del "ejército" y "no me aplican a mi". Quien no conoce su historia está condenado a repetirla. El problema En situaciones de combate, el cuidado médico puede ocurrir bajo circunstancias extremas tales como fuego cruzado, poca iluminación, múltiples víctimas y poco equipo. En adición, en algunas ocasiones la extracción y transporte se puede retrasar si el hacerlo pone en peligro la misión y más soldados. Las guías de tratamiento que han sido diseñadas en ambientes civiles no se traducen adecuadamente a este tipo de escenario. Aunque fuera "sentido común" desarrollar guías más específicas, el cuidado médico bajo estas circunstancias había estado basado en los mismos principios civiles: Proveer cuidado médico sin ninguna consideración a la situación que se desenvuelve alrededor. El mundo no se detiene porque alguien resultó herido. Las operaciones de combate continuan alrededor del herido. No usar torniquetes para controlar hemorragias. A pesar de que los tenían en sus equipos, los cursos iniciales enfatizaban en no usarlos, creando conflicto y retrasando su implementación. No usaban vendajes hemostáticos. Todas las víctimas de trauma significativo debían tener 2 accesos IV. En esa época se enfatizaba hacer esto en la escena aunque cada uno de los accesos vasculares tomara tiempo en lograrse. Tratamiento de shock hipovolémico con grandes volúmenes de cristaloides. En esa época no pensábamos que subir rápidamente la presión puede provocar la ruptura del coágulo y que grandes volúmenes diluyen los factores de coagulación. Ningún método de acceso IO. El acceso intravenoso no siempre es una opción. Manejo de la vía aérea en trauma facial mediante intubación endotraqueal. Hay pacientes que son inintubables. Precauciones espinales aplicadas universalmente. Prevenir las complicaciones de lo que no ha ocurrido es tan lógico como permitir que el fuego cruzado nos mate mientras le colocamos una tabla larga. Ninguna consideración a prevenir la hipotermia. Lo que no se mide no se puede mejorar. La hipotermia ocurre. Haga la prueba: acuéstese con ropas mojadas sobre una superficie fría y beba 1 litro de agua a temperatura ambiente (que de por sí ya están más fríos que su cuerpo). Dejo a su discreción si deja el aire acondicionado prendido o apagado. Si no siente frío, visite a su endocrinólogo favorito. En muchos lugares esto todavía puede sonar familiar...aún hoy día. Evolución urbana --> evolución táctica Los cambios en la medicina urbana no provienen exclusivamente de la medicina táctica. Es decir, no hemos progresado exclusivamente por lo que el mundo militar nos ha enseñado. También ha ocurrido al revés. El mundo militar ha adoptado conceptos donde el mundo civil ha sido pionero. Lo que el mundo de trauma en combate nos está enseñando es que tenemos que desarrollar la capacidad de adaptarnos a las circunstancias del entorno y del paciente para proveer la mejor medicina posible. Nos enseña que no siempre el mismo abordaje es la solución a los problemas de un paciente determinado. Aunque suena lógico, la realidad es que el sentido común es el menos común de los sentidos. El término táctico no significa combate La definición de táctica es el método empleado para lograr un objetivo. Cuando decimos táctico rápido pensamos en el color negro (o verde olivo), y en combate. Sin embargo, el término medicina táctica realmente debe evocar lo que está verdaderamente ocurriendo. Las necesidad obliga a adaptarse. Esa adaptación significa escoger los pasos necesarios para lograr los objetivos. La medicina táctica significa que nos estamos adaptando a las circunstancias para lograr los objetivos. Lo que todo proveedor urbano debe aprender La siguiente lista detalla algunos de los principios de la medicina de combate que muy bien podrían aplicar a cualquier paciente en un escenario urbano. No estoy diciendo que aplica a TODOS los pacientes en un entorno urbano. Hay un sinnúmero de circunstancias que pueden imitar el entorno de combate lo que nos obliga a usar tácticas similares. ESCENARIOS - Ningún plan sobrevive al contacto con el enemigo. Siempre es necesario adaptarse. Si el proveedor no se puede adaptar, posiblemente todos sufrirán las consecuencias. Torniquetes - Existen muchas razones en el entorno urbano por las cuales podemos querer detener un sangrado AHORA MISMO. La primera razón es obvia: el sangrado amenaza la vida. ¿Cuánta sangre tenemos que dejar salir antes de decidir que llegó el momento de cerrar la llave? Igualmente existen otras circunstancias tales como la necesidad de realizar otras intervenciones. A diferencia del torniquete, la presión directa requiere presión continua. Es decir, el proveedor tiene que quedarse con el paciente haciéndole presión directa. El torniquete, en cambio, se coloca y libera al proveedor para hacer otras intervenciones tales como manejar la vía aérea, respiración y circulación. En adición, permite al proveedor atender otras víctimas dentro de un incidente con múltiples víctimas que requieran atención inmediata. Antibióticos - Los transportes urbanos suelen ser lo suficientemente rápidos como para requerir antibióticos, pero las operaciones dentro de un desastre, o un incidente en un lugar remoto, pueden extenderse al punto donde las complicaciones asociadas a las infecciones sean la causa del compromiso del paciente. Resucitación con fluídos - La administración de fluídos busca lograr el mínimo de perfusión adecuada. La primera transfusión debe ocurrir luego de 1 litro de solución isotónica en pacientes con shock hemorrágico mientras se logra el control definitivo del sangrado. Manejo de vía aérea efectivo - El manejo de la vía aérea es una de las destrezas fundamentales del proveedor de resucitación, esté donde esté. Los pacientes con trauma maxilofacial severo con obstrucción de la vía aérea pueden necesitar una vía aérea quirúrgica. ¿Existe alguna otra opción cuando el paciente no puede proteger su propia vía aérea (incluyendo reposición) y no existe método que funcione Combinar buenas tácticas con buena medicina. Otros puntos importantes que la medicina ya conoce pero que se enfatizan dentro de las operaciones de combate son: Diagnóstico y manejo inmediato del pneumotórax a tensión - TODOS los pacientes con pneumotórax a tensión deben ser descomprimidos inmediatamente. Esto aplica a todos los escenarios. Analgesia apropiada - El dolor y sufrimiento no es necesario para nada. Si el paciente es capaz de sentir dolor, el tratamiento del dolor debe comenzar de inmedidato. Medicina Operacional Existen muchas circunstancias donde tenemos que adaptar nuestras tácticas a diferentes circunstancias. En cada uno de los siguientes ejemplos las circunstancias imponen restricciones que, de ignorarlas, pondrían al mejor proveedor médico en aprietos si no puede adaptarse. Medicina de combate - todo este artículo está dedicado a esto. En el ambiente urbano, los incidentes con tiradores activos y los incidentes con múltiples víctimas son aplicables. Medicina de desastres - tiempos prolongados hasta el cuidado definitivo Medicina en lugares remotos - operaciones de búsqueda y rescate Conclusión El Tactical Emergency Casualty Care, el Tactical Combat Casualty Care y el Prehospital Trauma Life Support son mutuamente complementarios. Todo profesional de la salud que provea cuidados a pacientes de trauma debe tener en su bagaje de conocimientos y experiencias las destrezas necesarias para adaptarse a las necesidades del entorno y de su paciente.

Today's episode will cover Tactical Combat Casualty Care (TCCC), aka Care Under Fire, aka Care in the Immediately Unsafe Environment.  Dr. Andy Bohn, a residency colleague, recorded today's episode to talk about the basics of taking care of any patient in an unsafe environment.  While the military connotations of this may make you uncomfortable, the techniques and protocols he discusses can be directly translated into any civilian mass casualty scenario such as the Boston Marathon bombing or the fertilizer plant explosion in West, Texas.  Andy will discuss how to stay safe in these hostile environments, how to perform the right interventions that will save lives while elimintating the useless interventions that won't (I'm looking at you- c-collars...), and how to get the casualty to the next level of care safely.