Prolonged Field Care Podcast

In this conversation, Kevin and Dennis discuss nursing care in a prolonged field care (PFC) setting. Kevin, an experienced nurse anesthetist, provides insights into when PFC nursing care begins and the importance of gathering data and assessing patients. He emphasizes the role of nurses in providing interventions such as pulmonary toileting, turning patients, skincare, dressing changes, medication infusions, and more. Kevin also discusses the challenges of training for PFC and the need to have a standard of care before entering the field. He shares practical tips for cleaning patients and changing interventions in a resource-limited environment. In this part of the conversation, Kevin and Dennis discuss the importance of getting to know the patient and recognizing when interventions are not working. They also talk about the need for clear guidelines and parameters for nursing care, as well as the challenges of providing nursing care in a prolonged field care setting. Kevin emphasizes the importance of turning patients, preventing skin breakdown, and doing proper pulmonary toileting. He also suggests learning from historical examples, such as the Navy's approach in the South Pacific during World War II, to solve the challenges of prolonged field care. Takeaways Prolonged field care nursing begins when life-saving interventions are complete and the patient is stable. Nursing care in PFC involves gathering data, assessing patients, and providing interventions such as pulmonary toileting, skincare, dressing changes, and medication infusions. Training for PFC should include working in an ICU to learn the standard of care and understand what gets degraded in the field. In a resource-limited environment, improvisation and prioritization are key in providing nursing care. Monitoring vital signs and recognizing changes is crucial in determining when to involve a provider in the patient's care. Getting to know the patient and recognizing when interventions are not working is crucial in providing effective care. Clear guidelines and parameters for nursing care are important to ensure proper treatment. Turning patients, preventing skin breakdown, and doing proper pulmonary toileting are essential nursing interventions. Learning from historical examples, such as the Navy's approach in the South Pacific during World War II, can provide valuable insights for solving the challenges of prolonged field care. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this podcast episode, Dennis and Andy Fisher discuss the co-administration of ketamine and Versed. They explore the reasons behind the common practice of adding Versed to ketamine, the concept of emergence reactions, and the appropriate use of Versed. They also touch on the potential risks and side effects of both drugs and the importance of individualized dosing. The conversation emphasizes the need for critical thinking and careful consideration when administering these medications. Takeaways The practice of adding Versed to ketamine is based on historical protocols and the belief that it provides amnestic properties and prevents emergence reactions. There is no clear definition of emergence reactions, but they can include unpleasant sensations, disconnection, hallucinations, and agitation. Ketamine itself has amnestic properties and should provide adequate amnesia without the need for Versed. The use of Versed should be based on individual patient needs, such as safety and mission comfort, and not protocolized. Careful consideration of dosage, administration speed, and patient physiology is crucial to avoid adverse events and ensure optimal outcomes. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this conversation, Dennis and Dave discuss procedures like cricothyroidotomy (cric) and chest tube placement in the context of extended care. They explore the challenges of managing patients with airway interventions and the importance of considering the context and resources available. They also discuss the criteria for removing a cric or chest tube and the potential complications that may arise. The conversation highlights the need for careful assessment and monitoring of patients to ensure optimal outcomes. Takeaways Context is crucial when considering procedures like cricothyroidotomy and chest tube placement in extended care settings. The decision to remove a cric or chest tube should be based on careful assessment of the patient's condition and the availability of resources. Monitoring the patient's airway and respiratory status is essential after removing a cric or chest tube. Consider the potential complications and risks associated with procedures and weigh them against the benefits. In resource-limited environments, training auxiliary personnel to perform non-clinical tasks can help alleviate the workload of medics. Ultrasound can be a valuable tool for assessing the placement and function of chest tubes and airway interventions. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this podcast episode, Dennis and Pac discuss the use of ketamine in medical settings, particularly in austere environments. They cover topics such as the differences between S-ketamine and R-ketamine, the dosing and administration of ketamine for sedation and analgesia, and its use in hemodynamically unstable patients and refractory seizures. They also touch on the importance of proper training and monitoring when using ketamine, as well as the potential benefits of combining regional anesthesia with IV sedation. Overall, ketamine is seen as a versatile and effective drug for pain management and sedation in various medical scenarios. Takeaways Ketamine, particularly S-ketamine, is a versatile and effective drug for sedation and analgesia in medical settings. The dosing and administration of ketamine depend on the patient's condition and the desired effect, and it can be given via various routes, including IV, IM, subcutaneous, oral, and rectal. Ketamine is especially useful in hemodynamically unstable patients and refractory seizures. Proper training and monitoring are essential when using ketamine, and it is important to have a plan and be prepared for potential adverse effects. Combining regional anesthesia with IV sedation can be beneficial in certain situations. Ketamine is commonly used in developing countries and can provide valuable hands-on experience for medical professionals. Collaborating with local doctors and clinics can offer valuable insights and knowledge about the use of ketamine in specific regions. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this conversation, Dennis and Monti discuss the process of product development. They cover topics such as generating ideas, validating ideas with potential customers, protecting intellectual property, and deciding whether to build a business or collaborate with another company. Monti shares his experience with developing the APRU and Delta Ice products, highlighting the importance of customer feedback and iteration. They also touch on the challenges and time commitment involved in bringing a product to market. The conversation explores the challenges and lessons learned in developing and bringing a medical device to market. The guest, Monti, shares his experience in creating a portable blood storage device for military use. He discusses the regulatory hurdles, the importance of listening to end-users, and the need for patience and perseverance in the business world. Monti emphasizes the significance of timing and market demand, as well as the need to continually innovate and expand product offerings. He also highlights the role of technology in improving medical care on the battlefield. Takeaways Generating ideas for product development often involves talking to potential customers and understanding their needs. Validating ideas with potential customers is crucial to determine if there is a market demand for the product. Protecting intellectual property through patents and non-disclosure agreements can help prevent others from stealing or copying your idea. Deciding whether to build a business or collaborate with another company depends on factors such as the scope of the product, market potential, and personal goals. Customer feedback and iteration are essential in the product development process to refine and improve the product. Bringing a product to market can be a time-consuming and challenging process that requires patience and financial resources. Developing and bringing a medical device to market requires navigating regulatory hurdles and addressing the needs of end-users. Timing and market demand are crucial factors in the success of a product. Patience and perseverance are essential in the business world, as it often takes longer than expected to achieve success. Continual innovation and expansion of product offerings are necessary to stay competitive. Technology plays a significant role in improving medical care on the battlefield. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this conversation, Rick, a senior medic for the 10th Special Forces Group, shares lessons learned from a mass casualty event in Eastern Afghanistan. He discusses the different types of mass casualty situations and the challenges faced in both reactive and proactive scenarios. Rick emphasizes the importance of realistic training scenarios and the need to think critically and adapt in high-stress situations. He also highlights the significance of effective communication, pre-coordination with medevac assets, and documenting patient information. Rick concludes by stressing the need to focus on good medicine rather than striving for perfection. In this conversation, Dennis discusses the importance of managing chaos and effective communication during mass casualty situations. He emphasizes the need to step back, take a breath, and develop a plan to ensure the best possible outcomes. Dennis also highlights the significance of triaging patients and categorizing them based on urgency. He stresses the importance of cross-training medics and being familiar with each other's roles and responsibilities. Additionally, he emphasizes the need for clear and concise communication and the importance of talking about traumatic experiences to promote healing and understanding. Takeaways Differentiate between reactive and proactive mass casualty situations and adapt accordingly Create realistic training scenarios to prepare for high-stress situations Think critically and prioritize patient care in chaotic environments Communicate effectively and pre-coordinate with medevac assets Document patient information and maintain accountability Focus on good medicine rather than striving for perfection Manage chaos by stepping back, taking a breath, and developing a plan Effective communication is crucial during mass casualty situations Triage patients and categorize them based on urgency Cross-train medics to ensure they can treat each other and their patients Talk about traumatic experiences to promote healing and understanding Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this podcast episode, Dennis, Rick, and Paul discuss the challenges of training in the field of prolonged field care (PFC) and advanced medical training. They address the common problems of miscommunication and unrealistic expectations when it comes to training requests. The conversation covers topics such as setting realistic goals, creating effective scenarios, and the importance of having flexible and experienced instructors. They also discuss the value of worst-case scenario training and the need for integration of medical training into combat training. Overall, the episode emphasizes the importance of effective communication, realistic planning, and collaboration in training scenarios. The conversation focuses on the challenges of training and leading medical teams in high-stress situations. The speakers discuss the importance of team leadership and decision-making, as well as the need for continuous training and learning. They emphasize the value of starting with the basics and building a strong foundation before tackling more advanced skills. The conversation also touches on the importance of understanding the purpose behind medical procedures and equipment, as well as the need for real-world experience and clinical decision-making. Overall, the speakers highlight the need for realistic and practical training that prepares medics for the unpredictable nature of their work. Takeaways Effective communication and realistic planning are crucial for successful training. Setting realistic goals and objectives is essential for effective training. Worst-case scenario training can be valuable in preparing for challenging situations. Integration of medical training into combat training is important for comprehensive preparedness. Flexible and experienced instructors are key to successful training. Team leadership is crucial in high-stress medical situations, and team members need to understand their roles and responsibilities. Training should start with the basics and build a strong foundation before moving on to more advanced skills. Understanding the purpose behind medical procedures and equipment is essential for effective decision-making. Real-world experience and exposure to different clinical settings can enhance a medic's skills and decision-making abilities. Training should be realistic and practical, preparing medics for the unpredictable nature of their work. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this podcast episode, Dennis and Ian discuss the process of disposition in emergency medical care. They explore how to transfer patients who cannot be evacuated to a higher level of care and instead need to be sent back to their families or local medical systems. The key steps in the disposition process include evaluating life threats, stabilizing the patient, determining if continuous medical care is necessary, assessing if the patient can be cared for at home, and ensuring they have access to follow-up care. The hosts also discuss the importance of patient education and communication in the disposition process. Takeaways The disposition process involves evaluating life threats, stabilizing the patient, and determining the appropriate level of care needed. Patient education is crucial in the disposition process, ensuring that patients and their families have the knowledge and resources to care for themselves at home. Communication and collaboration with local medical systems are important when transferring patients to ensure they receive the necessary care. The decision to transfer a patient to a higher level of care or to a local medical system depends on the patient's condition and the available resources. In some cases, transferring a patient to a lower level of care, such as an EMS system, may be appropriate if the necessary skills and equipment are available. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

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

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