Prolonged Field Care Podcast

Phil Gonzalez, a combat medic, shares his experiences in Vietnam and his journey to becoming a medic. He discusses the intense situations he faced in Vietnam, including being in dangerous situations and witnessing the horrors of war. He also talks about the importance of medics in Special Forces and the impact they have on the people they treat. After Vietnam, Phil pursued a career in medicine and worked in various locations, including Panama and Salvador, providing medical care to those in need. Dennis shares his experiences working as a medic in remote areas, including his time in Panama and Colombia. He recounts the challenges he faced and the impact he made on the communities he served. Dennis emphasizes the importance of empathy, communication, and adaptability in providing effective medical care. He also highlights the power of mentorship and the need to pass on knowledge and skills to future generations. Dennis concludes by encouraging aspiring medics to never stop learning and to always seek out those in need. Takeaways The role of medics in Special Forces is crucial, as they provide medical care to those in need in intense and dangerous situations. Phil Gonzalez's experiences in Vietnam shaped his desire to become a medic and make a difference in people's lives. Phil's journey took him to various locations, including Panama and Salvador, where he provided medical care to those in need. The importance of compassion and bedside manner in being a medic and building trust with patients. Empathy and caring for fellow human beings are essential qualities for a medic working in remote areas. Effective communication and adaptability are crucial in providing medical care in challenging environments. Mentorship and passing on knowledge and skills are important for the future of healthcare in underserved communities. Continuous learning and seeking out those in need are key to making a lasting impact as a medic. 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

The conversation discusses patient positioning during procedural sedation and the use of Versed (Midazolam) as a sedative. The speakers explore the importance of patient positioning and the need to have a plan for airway management in different positions. They also provide insights into the mechanism of action and dosing of Versed, highlighting the importance of individual patient factors and context in determining the appropriate dose. The conversation emphasizes the need for a staged approach when using sedatives and the importance of communication with the patient to assess their response. In this conversation, Dennis discusses the use of different medications for sedation and anesthesia, focusing on the challenges and considerations involved. He explains that there is no specific dose for achieving amnesia with medications like Midazolam, Propofol, and Ketamine. The dose depends on various factors, including the patient's physiological state and the presence of alcohol in their system. Dennis emphasizes the importance of closely monitoring vital signs and respiratory rate during sedation to ensure the patient remains comfortable and ventilating properly. He also discusses the use of analgesics and local anesthesia to manage pain during procedures. The conversation concludes with a discussion on the reversal agent for sedatives and the importance of considering the set and setting when administering medications like Ketamine. Takeaways Consider patient positioning during procedural sedation and have a plan for airway management in different positions. Understand the mechanism of action and dosing of Versed (Midazolam) as a sedative. Take into account individual patient factors and context when determining the appropriate dose of Versed. Use a staged approach when administering sedatives and communicate with the patient to assess their response. There is no specific dose for achieving amnesia with sedative medications like Midazolam, Propofol, and Ketamine. The dose of sedative medications depends on various factors, including the patient's physiological state and the presence of alcohol in their system. Monitoring vital signs and respiratory rate is crucial during sedation to ensure the patient remains comfortable and ventilating properly. Analgesics and local anesthesia can be used to manage pain during procedures. The reversal agent for sedatives, such as Versed, is Ramazicon, but it should be used cautiously and only after ruling out other causes for the patient not waking up. Consider the set and setting when administering sedative medications, especially in high-stress environments like combat situations. 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

Dennis Price discusses his experiences in organizing rescues in Afghanistan and Ukraine. He attributes his success to the blessings of God and his strong faith. In Afghanistan, he formed a company called Polaris. They were able to save 55 Americans and CIV interpreters in two weeks. Later, he joined a committee called Save Our Allies and worked with the government to rescue and vet interpreters. In Ukraine, he formed a nonprofit called Heroes for Humanity and led a team to provide medical aid and assistance to special needs orphans. He describes the devastation of the war in Ukraine and the innovation of the local people in defending their towns. Dennis Price shares his experiences in Ukraine and his work in rescuing sexually trafficked children. He emphasizes the importance of doing the right thing for the right reasons and helping those in need. He also discusses the challenges of rescuing victims of human trafficking, including the influence of Stockholm syndrome and the need for a compassionate and nurturing approach. Dennis encourages listeners to get involved in organizations that are well-vetted and work closely with law enforcement. He also highlights the need to focus on the rescue mission and not engage in illegal activities. Dennis concludes by urging people to follow Heroes for Humanity on Instagram and support their efforts to make a difference. Click the link to support Heroes for Humanity https://www.zeffy.com/en-US/fundraising/a5925aa7-6994-4247-9271-527face51842 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, Evan, and Doug discuss the debate between intubation and cricothyrotomy (cric) in the field. Dennis confesses his belief that intubation is the better option, while Evan and Doug argue for the use of cric in certain situations. They discuss the resource limitations in the field, the need for resuscitation prior to intubation, the challenges of obtaining and administering sedation medications, and the potential complications of intubation. They also touch on the importance of training and maintaining skills in a resource-constrained environment. The conversation explores the challenges of airway management in austere environments and the training and resources needed to optimize patient care. The speakers discuss the importance of experience and judgment in performing airway procedures and the need for ongoing training and skill sustainment. They highlight the differences between intubation and cricothyrotomy and the factors to consider when choosing the appropriate procedure. The conversation also touches on the training of role-one providers and the need for educational materials on difficult airway management. Takeaways The decision between intubation and cricothyrotomy depends on the resources available in the field. Intubation requires the ability to resuscitate the patient prior to the procedure and access to suction. Obtaining and administering sedation medications can be challenging in resource-constrained environments. Intubation can lead to hemodynamic instability and worsen shock in already unstable patients. Training and maintaining skills in a resource-constrained environment is crucial for successful airway management. Airway management in austere environments presents unique challenges and requires experience and judgment. Training and skill sustainment are crucial for optimizing patient care in these environments. The choice between intubation and cricothyrotomy depends on various factors, including patient stability and available resources. Role one providers need training and educational materials on difficult airway management. Standard of care should be maintained even in field environments, with deviations made consciously and deliberately. 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 interviews Dr. Jim DuCanto, an anesthesiologist with a special interest in airway management. They discuss the decision-making process in emergency airway management, particularly in challenging situations such as facial trauma. Dr. DuCanto emphasizes the importance of assessing the patient's neurologic status and respiratory efforts, as well as considering the safety of the scene. He also highlights the need for clear communication with the patient and the use of appropriate techniques and tools for airway management. In this conversation, Dr. Jim DuCanto and Dennis discuss various aspects of airway management. They cover topics such as the importance of recognizing the signs of airway compromise, the stages of anesthesia, the role of the spinal cord and reflexes in anesthesia, and the use of different techniques and tools in emergency airway management. They also touch on the potential risks and complications of airway management procedures and the importance of thorough physical examinations. Overall, the conversation emphasizes the need for preparedness, clinical judgment, and the ability to adapt to different situations in airway management. Takeaways Assess the patient's neurologic status and respiratory efforts in emergency airway management Consider the safety of the scene and the need for patient mobility Communicate clearly with the patient and explain the procedure Use appropriate techniques and tools for airway management The patient's ability to hear may persist even when they are unconscious under anesthesia. Emergency airway management requires an understanding of the patient's reflexes and potential resistance. Clinical judgment and the ability to adapt to different situations are crucial in airway management. Thorough physical examinations can provide valuable information in assessing the patient's condition. Preparedness and having the necessary tools and equipment readily available are essential in airway management. 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 episode, Dennis, Doug, and Paul discuss how to treat expectant patients in a medical setting. They explore the concept of palliative care and its role in providing comfort to patients at all stages of care. They also discuss the challenges medics face when dealing with expectant patients and the importance of reaching out for support and guidance. The conversation emphasizes the need to prioritize efforts and provide pain control and symptom management to make the patient as comfortable as possible. The key takeaway is that even in difficult situations, medics should strive to do everything they can for their patients. Takeaways Palliative care is an important aspect of patient care at all stages, not just at the end of life. Medics should prioritize efforts and provide pain control and symptom management to expectant patients. It is crucial for medics to reach out for support and guidance when making difficult decisions. Even if the outcome is not favorable, providing closure and knowing that everything possible was done can bring comfort to everyone involved. 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

The podcast episode discusses the controversial topics of expectant care and end-of-life care in a role one setting. The panel of experienced medics and docs share their personal experiences and concerns regarding training and implementation of these types of care. They highlight the need for clear guidance and training for medics and corpsmen to make difficult decisions in the field. The panel also discusses the potential obstacles and unintended consequences of implementing clinical practice guidelines for expectant and end-of-life care. The conversation focuses on the need for guidance and training in making difficult medical decisions on the battlefield, particularly in the context of end-of-life care. The speakers discuss the importance of identifying patients who would most benefit from direct care and the potential moral injury that can occur when undertrained individuals are put in positions of medical directorship. They also explore the challenges of decision-making in mass casualty situations and the need for clear guidelines and policies. The conversation emphasizes the importance of having conversations about death and dying early in training and the need for realistic expectations and shared decision-making. Takeaways Expectant care and end-of-life care are important topics that need to be discussed and addressed in the role one setting. Training for medics and corpsmen in expectant and end-of-life care is currently inadequate and needs improvement. Clear guidance and clinical practice guidelines are necessary to help medics and corpsmen make difficult decisions in the field. Implementing expectant and end-of-life care guidelines may have unintended consequences and require careful consideration. Empowering medical directors to make decisions based on their unit's needs and training is important for effective implementation. The need for guidance and training in making difficult medical decisions on the battlefield, particularly in the context of end-of-life care The potential moral injury that can occur when undertrained individuals are put in positions of medical directorship The challenges of decision-making in mass casualty situations and the need for clear guidelines and policies The importance of having conversations about death and dying early in training and the need for realistic expectations and shared decision-making 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

Bryce, an 18 Delta out of the Special Forces group, discusses the challenges and strategies for training non-medics in medical skills. He emphasizes the importance of building a culture of medical training within the team and the benefits of cross-training. Bryce also highlights the impact of medical training on operational readiness and risk mitigation. He shares insights on mentorship, humility, and the progression of medical training for non-medics. Takeaways Building a culture of medical training within the team is essential for operational readiness and risk mitigation. Mentorship and humility play a crucial role in the progression of medical training for non-medics. Cross-training non-medics in medical skills enhances the team's capability and confidence in providing patient 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 episode of the PFC Podcast, the speakers discuss the state of medics in Special Operations Medicine and offer recommendations for improvement. They highlight the importance of regular and realistic medical training at the unit level, as well as the need for feedback and accountability. The speakers also address specific issues such as lack of familiarity with protocols, equipment shortfalls, and training scars. They emphasize the need for critical thinking and individualized patient care rather than relying on algorithms. Overall, the podcast aims to improve the quality of medical training and performance among medics in Special Operations. Takeaways Regular and realistic medical training at the unit level is crucial for improving the skills and performance of medics in Special Operations. Feedback and accountability are essential for medics to identify and address their shortcomings. Familiarity with protocols, equipment, and drug administration is crucial for effective medical care. Training should focus on critical thinking and individualized patient care rather than relying on algorithms. Unit leaders and commanders should prioritize and support medical training to ensure the readiness of their medics. 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, Doug, and Justin discuss the development of a Sepsis Clinical Practice Guideline (CPG) for prolonged field care. They highlight the importance of early recognition and antibiotic administration in sepsis management. They also discuss the use of scoring systems like QSOFA and NEWS2 to aid in the identification of septic patients. The conversation covers the role of lactate monitoring and the potential confounding factors. They emphasize the need for a comprehensive assessment of the patient and the importance of not relying solely on one marker or number. The conversation also touches on the importance of proper catheter insertion and the consideration of prophylactic catheter replacement in austere environments. They discuss the use of fluids as the first-line treatment in septic patients and caution against over-resuscitation. The conversation concludes with a reminder to pay attention to the patient's response and not blindly adhere to formulas or protocols. In this conversation, the speakers discuss various aspects of sepsis management, including fluid resuscitation, the use of colloids, the importance of monitoring urine output, and the decision to initiate vasopressors. They also touch on the use of antibiotics and wound management in sepsis cases. The conversation provides valuable insights and practical tips for healthcare providers in austere environments. Takeaways Early recognition and timely administration of antibiotics are crucial in sepsis management. Scoring systems like QSOFA and NEWS2 can aid in the identification of septic patients. Lactate monitoring can be confounded by various factors, and a comprehensive assessment of the patient is necessary. Proper catheter insertion and prophylactic catheter replacement should be considered in austere environments. Fluids are the first-line treatment in septic patients, but over-resuscitation should be avoided. Pay attention to the patient's response and use clinical judgment rather than blindly following formulas or protocols. In sepsis cases, fluid resuscitation is crucial, and the choice of fluid depends on availability. Balanced electrolyte solutions like Ringer's lactate or plasma light are preferred, but normal saline can be used if that's all that's available. Colloids may be used in sepsis patients with high output losses or compartment syndrome. Options include FFP, albumin, or freeze-dried plasma. Monitoring urine output is important in assessing the response to fluid resuscitation. If urine output increases, it indicates a positive response. However, if urine output remains high despite fluid administration, it may indicate over-resuscitation. When considering the use of vasopressors, the decision should be based on the patient's blood pressure and mental status. If the patient remains hypotensive and shows no improvement after a substantial amount of fluid, vasopressors may be initiated. Antibiotics should be given empirically in sepsis cases, and the choice of antibiotic depends on the suspected source of infection. Wound management, including effective debridement and irrigation, is crucial in preventing infection. Regular assessment of wounds is important to identify any signs of infection or non-viable tissue. In austere environments, it may be necessary to make treatment decisions based on the patient's clinical presentation and endemic risk, even without confirmatory tests. The conversation highlights the importance of collaboration and mentorship in developing clinical practice guidelines and acknowledges the contributions of healthcare professionals in the field. 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