Matthew Sovine joins the pod for a quick conversation about research he's conducting into sustainment training for active duty flight medics. Have a listen and make sure to fill out the survey in your work email.

In this episode, Trooper Mike Allen joins us to discuss the Arizona State Police's Aviation Unit.Trooper Allen is a flight paramedic who came to AZDPS from the fire service. Mike discusses the history of the program, the criteria for flight medic selection, the types of missions they respond to, the types of continuing education they run, and some pearls of wisdom for medics looking to use their skills in the civilian sector. 

Canadian Army Master Corporal Justin Weiler joins Max and Trevor to talk about his new country's rotary-wing medical program. Canada is one of our closest allies, but they have taken a different approach to clearing the battlefield. Listen up for interesting differences in how they equip and crew their aircraft.You can learn more about CMERTs capabilities at aerospace medicine.ca, and you can reach the CMERT team at fwdaeops&[email protected] a listen and let us know what you think!

Seain, Keegan, and Joe were the last three DUSTOFF medics in Afghanistan during the 2021 U.S. withdrawal. In this episode, they describe their experience during the attack at Hamid Karzai International Airport's Abbey Gate.

Seain, Keegan, and Joe were the last three DUSTOFF medics in Afghanistan during the 2021 U.S. withdrawal. In this episode, they describe their experiences in the days and weeks leading up to the attack at Hamid Karzai International Airport's Abbey Gate.ProPublica is a non-profit news site that published a comprehensive account of the Abbey Gate attack earlier this year; you can read it here. The U.S. Central Command conducted an investigation into the facts and circumstances surrounding the attack; that report is available on the U.S. Naval Institute's website.

Max sits down with US Air Force Lt. Col. Michael Policastro, MD for a capabilities briefing on the Air Force's Critical Care Air Transport Team program. CCATT is a team of highly skilled clinicians who provide enroute treatment to our sickest patients, and Dr. Policastro goes in depth into not only CCATTs medical skills, but also their selection process, training, and team dynamics.Have a listen, share the podcast with colleagues who might enjoy it, and let us know what you think!

COL (ret.) Jonathan Newmark, MD finishes up a fascinating conversation with Max on nerve agents. Dr. Newmark is a true expert in this subject and his depth of knowledge makes this episode a must-hear. Have a listen, and let us know what you think!

COL (ret.) Jonathan Newmark, MD sits down with Max for an in-depth discussion of nerve agents. Dr. Newmark dedicated much of his career to researching the treatment of chemical and biological casualties, giving him an extraordinary depth of knowledge on this topic. Dr. Newmark retired from the military in 2013, but continues to serve as a professor of neurology at the Uniformed Services University of the Health Sciences. This is a rare opportunity to hear from one of the nation’s leading authorities on the medical response to chemical and biological warfare, and despite his extensive, high-level knowledge, Dr. Newmark tailors his comments very effectively to the role of the paramedic in these events. Have a listen, and let us know what you think!

Max sits down with David Shablak to discuss how to conduct high-quality training at the unit level. David is the co-host of the SimGeeks Podcast, a paramedic, and an expert in healthcare simulation. This is a great conversation for Medical NCOs and platoon-sized unit leaders who build and conduct training at their level. During the conversation, David mentions a number of different resources for training, including the "This Old Man Manikin" series on his own YouTube channel, the Laerdal LLEAP software (we're not sponsored by them or anyone else), and the International Nursing Association for Clinical Simulation and Learning. David also discusses credentialing in the simulation profession and opportunities for more learning through the Society for Simulation in Healthcare. Have a listen, share this episode, and let us know what you think!

Sgt. 1st Class Christopher A. Celiz was awarded the Medal of Honor for heroic acts during an engagement with the enemy in Paktia Province, Afghanistan, on July 12, 2018. SFC Celiz saved the life of a wounded soldier from a partner force, and later used his body as a shield to cover the DUSTOFF aircraft that arrived to retrieve the wounded. SFC Celiz was mortally wounded during the engagement.In this episode, we finish our conversation with the lead flight medic and pilot in command of the aircraft present that day. SFC Celiz is an American hero, and his actions saved many lives. The DUSTOFF crew from had a unique perspective, and by hearing from them we can both gain first-hand insight into SFC Celiz's bravery, and honor his memory.

Sgt. 1st Class Christopher A. Celiz was awarded the Medal of Honor for heroic acts during an engagement with the enemy in Paktia Province, Afghanistan, on July 12, 2018. SFC Celiz saved the life of a wounded soldier from a partner force, and later used his body as a shield to cover the DUSTOFF aircraft that arrived to retrieve the wounded. SFC Celiz was mortally wounded during the engagement.In this episode, we talk with the lead flight medic and pilot in command of the aircraft present that day. SFC Celiz is an American hero, and his actions saved many lives. The DUSTOFF crew from had a unique perspective, and by hearing from them we can both gain first-hand insight into SFC Celiz's bravery, and honor his memory.

Dr. Haney Mallemat, a triple-boarded critical care physician and Editor-in-Chief at criticalcarenow.com, joins us to discuss all things vasopressor related. During the interview, Dr. Mallemat mentions the Arginine Vasopressin During the Early Resuscitation of Traumatic Shock (AVERTShock) trial. You can find a summary of that study here, and deployedmedicine.com has a good video discussing the trial as well.Dr. Mallemat also mentions a study describing a "central line-less" ICU while discussing the safety of vasopressin administration through peripheral IVs. You can find that study here:Cardenas-Garcia, J., Schaub, K. F., Belchikov, Y. G., Narasimhan, M., Koenig, S. J., & Mayo, P. H. (2015). Safety of peripheral intravenous administration of vasoactive medication. Journal of hospital medicine, 10(9), 581–585. https://doi.org/10.1002/jhm.2394

There's a new Training Circular 8-800, Medical Education & Demonstration of Individual Competence (MEDIC), and it is a major change from the last version. This episode is a deep dive into the new TC with the primary enlisted authors, MSG Kaleb Twilligear and MSG Hunter Black. Listen up as they talk about returning the responsibility for a ready medical force to the NCO level. Much of the conversation involves focusing on basic skills, from TCCC at deployedmedicine.com, to the 8-Step Training Model, to Troop Leading Procedures, the 68W STP, and even the Warrior Tasks and Battle Drills in STP 21-1-SMCT. F2s are the most highly trained medics in the conventional force, and we have a responsibility both as medics and NCOs to be familiar with these documents and ensure that we are meeting the standards they set forth. The conversation also includes some strategies on how to work with your leadership on improving medical training at your unit, with a mention of a study linking a provider's familiarity with TCCC to the proficiency of the medics they supervise. There's also a discussion of a study from the Government Accountability Office detailing shortcomings in military medical training.Have a listen and let us know what you think!

Dr. Steven Schauer returns to the podcast with Trevor and Morgan to talk about pain management. Managing pain is a complex topic involving both different types of pain and different medications. During the conversation, Dr. Schauer mentions JTS CPG 61, Analgesia and Sedation Management During Prolonged Field Care. You can find this on the link at our website, or by searching "JTS CPG." Military members, use your free UpToDate access to read their article entitled "Pain Control in the Critically Ill Adult Patient." If you don't have UpToDate access yet, read the article at nextgencombatmedic.com on how to get an AVL account. It's worth your time. Finally, Dr. Schauer mentions an article he co-authored last year:Bebarta, G. E., Bebarta, V. S., Fisher, A. D., April, M. D., Atkinson, A. J., McGhee, L. L., & Schauer, S. G. (2021). An Analysis of Ketamine Doses Administrated to Nonintubated Casualties Prehospital. Military medicine.Have a listen, and let us know what you think!

Dr. Sean Stuart finishes up a discussion on chest tubes with Claire and Morgan.This episode discusses some of the finer points of the procedure. Dr. Stuart also describes how to make an inexpensive task trainer so you can practice thoracotomies at your unit.  Finally, he describes an improvised Heimlich valve that you can make with an exam glove if you're in a pinch and don't have a chest drain system immediately available. Photos on our website!Have a listen and please let us know what you think!

Dr. Sean Stuart joins Claire and Morgan for the first in a two-part series about chest tubes. Dr. Stuart is a Navy emergency medicine physician and is the Research Director of the Combat Trauma Research Group.This first episode covers a lot of ground, from a detailed discussion of the procedure itself to a thorough exploration of a recent paper contrasting the efficacy of traditional chest tubes against pigtail catheters. Dr. Stuart calls out a couple important pearls, notably that oxygenation status is a very late finding for tension hemo/pneumothorax, and separately, that breath sounds are unreliable in determining whether a patient has this type of injury.A recent paper gets some attention in this episode, and really illustrates why it's important to dig deeper than the abstract and conclusion: Kulvatunyou, N., Bauman, Z. M., Zein Edine, S. B., de Moya, M., Krause, C., Mukherjee, K., Gries, L., Tang, A. L., Joseph, B., & Rhee, P. (2021). The small (14 Fr) percutaneous catheter (P-CAT) versus large (28-32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. The journal of trauma and acute care surgery, 91(5), 809–813. You can find this paper through your free (to the military) institutional login via OpenAthens. There's also a good summary at criticalcarenow.com.Have a listen and let us know what you think!

We all learned it.We've all done it.And we (mostly) all know that it's wrong.Dr. Seth Collings Hawkins joins Trevor and Claire to discuss spinal immobilization. Rigid immobilization of trauma patients is entrenched dogma, but we've probably all heard that this procedure is not just without benefit, but is in fact harmful to our patients. Dr. Collings Hawkins is a leader in the wilderness EMS community, and he breaks down the reality of spinal immobilization and how we can all do better. Listen up as he talks about the history of this intervention, discusses appropriate uses for the rigid backboard and c-collar, and then shows how we can do better. This is important information for everyone to hear, from new medics to experienced flight surgeons. Have a listen and let us know what you think!

Captain Madison Anderson, RN, joins Claire and Morgan to discuss the pre-hospital care of sexual assault victims (SMOG SPECIAL POP V). It's a difficult topic, but it is critical for flight medics to understand the specialized care this patient population requires. CPT Anderson is a Sexual Assault Medical Forensic Examiner (SAMFE), and she makes important points about balancing patient care protocols with the need to minimize disturbing the victim. She also speaks extensively about the continuum of care for sexual assault victims, and gives important context to where pre-hospital care fits into a victim's path to healing. CPT Anderson frequently refers to MEDCOM Regulation 40-36, Medical Facility Management of Sexual Assault, which is available with a CAC at the Army's Office of the Surgeon General MEDCOM Publications Portal.Take the time to listen to this important conversation, and let us know what you think!

Lt. Col. Joe Maddry joins Max and Morgan to talk about SMOG Medical XIX, Toxic Ingestions. Toxicology is extraordinarily complex, and this discussion ranges beyond ingestions. Dr. Maddry is an emergency medicine physician and has completed a toxicology fellowship. Listen up as he breaks down initial treatment for a range of emergencies from reptile bites to rocket fuel inhalation to intentional overdose. Dr. Maddry is the Deputy Commander of the Walter Reed Army Institute of Research and is extensively published on a variety of topics, with much of his research devoted to pre-hospital and enroute care. If you don't have an account through the AMEDD Virtual Library yet, check out this article from nextgenerationcombatmedic.com on how to get access to the medical journals where Dr. Maddry and others publish their important research.And while there is not a poison control center exclusively for the military, all of the domestic poison control centers communicate with each other and can get you help with treating poisoned patients. Keep 1-800-222-1222 in your phone! And whether you're at home or deployed, you're not alone when you're trying to treat a complex toxic emergency. If you need a consult, call the DOD Advanced Virtual Support for Operational Forces program, or ADVISOR: 1-833-ADVSRLN (1-833-238-7756 or DSN 312-429-9089).

New Zealand Army Nursing Officer Captain Buffy Little joins Max and Trevor to talk about her service's rotary-wing MEDEVAC program. New Zealand is one of our closest allies, but their Army's small size and remote geography mean their operations are dramatically different from ours. Listen up for interesting differences in how they equip and crew their aircraft, as well as major differences in their pre-hospital training and certification levels.Captain Little is an inspiration. She's deployed with the New Zealand Army, beat cancer twice, and was one of the first rescuers on scene of the 2019 White Island volcano eruption. Now she's training to compete in the Invictus Games, and is a founding member of Kaitiaki Ora—Tactical Medicine New Zealand. Have a listen and let us know what you think!

This is a packed episode from one of the leaders in our field! Doc Rush joins us again to talk about traumatic brain injury, head injury, and why those two are not the same. Listen closely as Doc Rush boils down this complex topic to its essentials. First he hits on the three main causes of altered mental status in trauma:Hypoxemia from chest injuryHypoperfusion from hemorrhageA blow or jolt to headNext, he discusses the mortality associated with status epileptics, usually defined as a seizure that lasts longer than five minutes, or having more than one seizure within a five minute period, without returning to a normal level of consciousness between episodes.Doc discusses an article he co-authored about TBI and hypertonic saline in the last JSOM:DeSoucy, E. S., Cacic, K., Staak, B. P., Petersen, C. D., van Wyck, D., Rajajee, V., ... & Rush, S. C. (2021). 23.4% Hypertonic Saline: A Tactical Option for the Management of Severe Traumatic Brain Injury With Impending or Ongoing Herniation. Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals, 21(2), 25-28.And some final points: Note the subtle but important difference he recommends for target ETCO2 in TBI patients, and why—there is a difference in the values between blood gas and end-tidal.Make sure you're subscribed to @pjmedicine on Instagram, and that you're listening to PJ Medcast!

Chief of the Joint Trauma System Colonel Stacy Shackelford joins Max and Claire to talk about the history, mission, and future vision for the organization singularly focused on reducing morbidity and mortality on the battlefield. During this wide-ranging discussion, Dr. Shackelford describes JTS initiatives directly relevant to our role in rotary-wing MEDEVAC. She also specifically mentions resources available on the JTS website, including Clinical Practice Guidelines, the Deployed Medicine app, and how to get access to the JTS' Thursday calls. Go to jts.amedd.army.mil or our show's website for more information.This is a great discussion with the leader of a pioneering entity dedicated to the most acute aspect of our role as flight medics. Take a listen, and we welcome your feedback! 

COL (ret.) Joseph DuBose joins Trevor and Max to provide an overview of ECMO, and discuss  its use in flight. ECMO isn't a new procedure, but it has become more visible in recent years as its use has expanded. In Europe, there are pre-hospital ECMO teams, and the US Air Force CCAT program has brought the technology far forward. Dr. DuBose has been involved with some of these efforts, along with research supporting its use. Recently, Dr. DuBose co-authored a paper describing a feasibility study of battlefield initiation of ECMO, with follow on rotary-wing evacuation (citation below).In addition to the ins-and-outs of ECMO, Dr. DuBose discusses the real-world challenges of bringing advanced procedures such as ECMO and REBOA to the battlefield, and makes a very compelling case that just because you can do something, doesn't mean you should.   Reva, V. A., Pochtarnik, A. A., Shelukhin, D. A., Skvortzov, A. E., Semenov, E. A., Emelyanov, A. A., Nosov, A. M., Demchenko, K. N., Reznik, O. N., Samokhvalov, I. M., & DuBose, J. J. (2020). Battlefield Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: A Feasibility Study During Military Exercises. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 20(4), 77–83.

Here's the second part of our interview with Joel. Listen as he describes conducting multiple hoists in combat, and listen for some valuable lessons learned. Joel talks about PACE planning, patient handoff techniques, and we explore the dogma that surrounds the transport of deceased patients. Have a listen, and let us know what you think. Our comments section, DMs, and email are always open!

We begin with a remembrance of our fallen Navy comrades.Today's episode is the start of our second AAR series. We talk with Joel, an Army flight medic who conducted a hoist mission in combat. His experience is important for several reasons, not least of which because we have a very frank discussion of what can happen when hoist training and maintenance is de-prioritized.Have a listen and let us know what you think!

Aebhric O’Kelly from the College of Remote and Offshore Medicine joins Max and Morgan to discuss medical training and education for austere settings. CoROM is a unique educational institution with many military alumni. Aebhric discusses opportunities at CoROM, including some important information on the number of credits required to apply (hint: you probably already have enough). The conversation progresses to austere critical care pearls, the importance of knowing how to treat disease and non-battle injury, and what is arguably the greatest medical mnemonic ever: SHEEPVOMIT. CoROMs website is at corom.edu.mt, and they are active on social media as well. Have a listen, and let us know what you think!

Rob Munday from Blackcomb Helicopters & SR3 Rescue Concepts, Jon, and Wayne wrap up their discussion of hoist techniques. This episode focuses on safety, training, and emergency procedures. It's a must-listen for pilots, hoist operators, and hoist riders alike, because the discussion has the potential to change your perspective on what makes a safe hoist both in training and during operations. 

Rob Munday from Blackcomb Helicopters & SR3 Rescue Concepts joins Wayne and Jon to discuss hoist techniques. Riding the hoist makes great social media posts, but behind the cool pictures is a skill that must be continuously honed and refined. The Army Hoist SOP is a relatively progressive document, but too many units ignore the important information in the SOP because of an ill-informed "belief there is greater risk involved." Setting aside certain hoist techniques as only suitable for combat is a surefire way to guarantee that we don't have the right skills when they're needed in the next fight. If your unit is only training static hoists at IGE altitudes, this episode is for you. Wayne and Jon give great perspective coming from the Navy and Coast Guard, and Rob's expertise is definitely worth a listen.

Dr. Steven Schauer joins us to discuss supraglottic airways. These devices are often considered to be 'rescue' adjuncts for a 'failed' airway, but this discussion may change the way you approach out-of-hospital airway control. Listen as Dr. Schauer talks about the types of patients who should receive SGAs, tips and tricks for using them, and the importance of training on these devices now matter how simple they appear.Dr. Schauer discusses why SGAs aren't prevalent yet in the furthest forward units and describes research done by his own team:Schauer, S. G., Naylor, J. F., Uhaa, N., April, M. D., & De Lorenzo, R. A. (2020). An Inventory of the Combat Medics' Aid Bag. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 20(1), 61–64.While discussing pitfalls of using SGAs, Dr. Schauer also mentions a very recent study discussing misplaced SGAs:Norii, T., Makino, Y., Unuma, K., Hatch, G. M., Adolphi, N. L., Dallo, S., ... & Braude, D. (2021). Extraglottic airway device misplacement: a novel classification system and findings in postmortem computed tomography. Annals of Emergency Medicine, 77(3), 285-295.Trevor makes reference to the AIRWAYS II Trial...:Benger, J. R., Kirby, K., Black, S., Brett, S. J., Clout, M., Lazaroo, M. J., Nolan, J. P., Reeves, B. C., Robinson, M., Scott, L. J., Smartt, H., South, A., Stokes, E. A., Taylor, J., Thomas, M., Voss, S., Wordsworth, S., & Rogers, C. A. (2018). Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. JAMA, 320(8), 779–791. https://doi.org/10.1001/jama.2018.11597...and he also mentions very well designed checklists in Airway Management in Prolonged Field Care, CPG 80.Have a listen and let us know what you think!

Our conversation  with Dr. Cap continues! There’s an in-depth discussion of blood physiology, a comparison of DOD blood protocols, and an interesting rethinking of blood as an organ. Dr. Cap also provides an important overview of how to train transfusions and walking blood banks. The information he shares can be a valuable  resource if your medical director isn’t quite onboard yet with training blood collection and administration. 

Dr. Andre Cap joins us for the first in a multi-part series covering the SMOGs En Route Damage Control Resuscitation, Blood Component/Fresh Whole Blood Use, and Blood Transfusion Related Reactions protocols. COL Cap is amongst the world's foremost experts on this topic, yet he is well aware of the capabilities and limitations of practicing pre-hospital medicine in flight. This is a detailed discussion that you'll definitely get a lot out of.Dr. Cap mentions the PAMPER trial as well as the COMBAT trial. Both are directly relevant to our work:Sperry, J. L., Guyette, F. X., Brown, J. B., Yazer, M. H., Triulzi, D. J., Early-Young, B. J., ... & Zenati, M. S. (2018). Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. New England Journal of Medicine, 379(4), 315-326.Moore, E. E., Sauaia, A., & Ghasabyan, A. (2015). COMBAT: A Prospective, Randomized Investigation of Plasma First Resuscitation for Traumatic Hemorrhage and Attenuation of Acute Coagulopathy of Trauma. University of Colorado Denver Aurora United States.Finally, Dr. Cap describes some soon-to-be published research by the Armed Forces Medical Examiner System that may challenges some conventional wisdom, and may have implications for how we practice in the future.Please give this episode a listen, and send us your questions and feedback via Instagram, Twitter, or Facebook!

Dr. Andy Fisher and Dr. Steve Schauer join us along with Sarah Johnson and Ryann Lauby to discuss their paper, "An Analysis of Conflicts Across Role 1 Guidelines." The paper, published last year in Military Medicine, compared a number of DOD pre-hospital care guidelines, including the SMOG. The authors concluded that "the reduction or elimination of conflicting information across the various guidelines, augmentation of guidance for pediatric care, more specific guidance for unique levels of care, and clear delineation of the Role 1 phases of care (as well as which guidelines are more appropriate to each) should be considered as urgent priorities within the military medical community."Our podcast has always tried to incorporate the perspective of rotary-wing flight medics from the different branches of service. When we discuss clinical topics, we survey guidelines and protocols across the DOD in an effort to identify conflicts and, hopefully, discern best practices. This paper is directly related to that work, and this conversation is a great way to understand the authors' intent as well as ways forward. Please give it a listen and let us know your thoughts!Johnson, S. A., Lauby, R. S., Fisher, A. D., Naylor, J. F., April, M. D., Long, B., & Schauer, S. G. (2020). An Analysis of Conflicts Across Role 1 Guidelines. Military Medicine.

In this episode, Trevor and Morgan talk to Dr. Whit Harvey, USN, about one of the foundational skills of out-of-hospital care: IV and IO access. Dr. Harvey has done important research on IO efficacy, and he shares some of his findings about the pressure required to keep IOs flowing, as well as techniques to generate that pressure (it's more than you think!).Additionally, Trevor mentions some critical points about flow rates through IV tubing and lock devices. This can be a blind spot for a lot of us; the convenience of a lock is great, but those couple inches of tubing can significantly reduce flow rates, and that is not ideal if you're infusing blood. There is some pain associated with flushing an IO, and this article has some good information about just how much Lidocaine you should be using to reduce your patient's discomfort.

Drs. Will Smith, Steve Rush, and Ben Walrath join us for a great conversation about the role of the military EMS director. These three men have accumulated significant experience leading MEDEVAC/CASEVAC organizations, and their perspective is valuable for flight medics and Flight Surgeons alike.During the episode, the conversation frequently emphasizes the importance of educational resources for flight docs, especially:deployedmedicine.comThe Joint Trauma System's Pre-deployment Prioritized Read Lists by Clinical RoleCOL Robert Mabry's seminal papers: Mabry, R. L., & De Lorenzo, R. A. (2011). Improving role I battlefield casualty care from point of injury to surgery. US Army Medical Department Journal, 87-92.Mabry, R. L., Apodaca, A., Penrod, J., Orman, J. A., Gerhardt, R. T., & Dorlac, W. C. (2012). Impact of critical care–trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan. Journal of Trauma and Acute Care Surgery, 73(2), S32-S37.Medical direction courses at SOMSAFurthermore, Dr. Smith highlights the National Association of EMS Physicians Military and Federal Agency Chapter, a relatively new effort in which Dr. Walrath has a leadership role.Thanks for listening, and be sure to share your thoughts with us via dustoffmedicpodcast.com, on Facebook, or @dustoff.medic.podcast!

Dr. Steven Bradley joins us to discuss the SMOG Propofol guideline, along with sedation and analgesia pearls.Lieutenant Commander Bradley is a U.S. Navy anesthesiologist, and he is very active in mentoring aspiring physicians.During the episode, Trevor mentions the Military Enroute Care Performance Improvement Report 2019 Events, as well as Tyler Christifulli's 2018 FOAMfrat article on post-intubation strategies. Trevor also discusses using the Richmond Agitation-Sedation Scale (RASS). You can find an easy-to-use version of the RASS on page 29 of the Joint Trauma System's Pain, Anxiety and Delirium Guideline (CPG ID: 29). It's definitely a good one to print out and keep handy.If you want to use this episode as part of your Table VIII medical training, use the following tasks per TC 8-800:081-831-0010, Measure a Patient’s Respirations081-833-0034, Manage an Intravenous Infusion

In 2019, Jamie and Jon flew a combat mission where they evacuated several patients. Later that day, they transported the same patients to a higher level of care. In this third and final episode, we hear about the interfacility transport phase of the mission, and we get some good wisdom as both men evaluate their own performance.

In 2019, Jamie and Jon flew a combat mission where they evacuated several patients. Later that day, they transported the same patients to a higher level of care. In this second episode, hear about the difficult landings Jon executed to pick up patients, as well as the textbook care Jamie provided in the back.

In 2019, Jamie and Jon flew a combat mission where they evacuated several patients. Later that day, they transported the same patients to a higher level of care. In this first episode, hear from both men as they describe how the mission dropped, and their initial actions at the point of injury. There are plenty of lessons to be learned from this call for pilots, medics, crew chiefs, and ECCNs.

In this episode, Trooper Adam Murray joins us to discuss the Maryland State Police's use of Trooper/Flight Paramedics in their Aviation Command.Trooper Murray is a critical care flight paramedic and field training officer for the Maryland State Police in southern Maryland. Adam discusses the history of the program, the criteria for flight medic selection, the types of missions they respond to, the types of continuing education they run, and some pearls of wisdom for medics looking to use their skills in the civilian sector. 

In this episode, Ricky Ditzel joins us to discuss the role of calcium in trauma patients. Ricky is a former critical care flight paramedic for the 160th Special Operations Aviation Regiment (SOAR), currently a pre-medical student at Colombia University, and the lead author of a groundbreaking paper on the role of calcium in the decompensation cycle in trauma. Ricky talks with us about how calcium works in the body, how trauma induces hypocalcemia, and how the flight medic can use calcium during trauma resuscitation.Ricky's original article in the Journal of Trauma and Acute Care Surgery: Ditzel RM Jr, Anderson JL, Eisenhart WJ, Rankin CJ, DeFeo DR, Oak S, Siegler J. A review of transfusion- and trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond? J Trauma Acute Care Surg. 2020 Mar;88(3):434-439. doi: 10.1097/TA.0000000000002570. PMID: 31876689.The recent article in the American Journal of Emergency Medicine:Wray JP, Bridwell RE, Schauer SG, Shackelford SA, Bebarta VS, Wright FL, Long B. The diamond of death: Hypocalcemia in trauma and resuscitation. Am J Emer Med. 2021 Mar;41(1):104-109. doi:10.1016/j.ajem.2020.12.065Ricky mentions a study in which 97% of transfusion patients were hypocalcemic. That study is here:Giancarelli, A., Birrer, K. L., Alban, R. F., Hobbs, B. P., & Liu-DeRyke, X. (2016). Hypocalcemia in trauma patients receiving massive transfusion. Journal of Surgical Research, 202(1), 182-187. If you want to use this episode as part of your Tables III medical training, use the following tasks per TC 8-800.081-833-0034 Manage an Intravenous Infusion081-835-3002 Administer Medications by IV Piggy Back

In this episode, Dennis from the Prolonged Field Care Podcast joins us to discuss the basics of prolonged field care on medics and their patients. Dennis is a Special Forces Medical Sergeant and an instructor at the Special Warfare Medical Group. In this podcast we talk about the definition of prolonged field care, the operational considerations, and the specific considerations when picking up patients who have received care under PFC conditions.Check out the Prolonged Field Care Working Group website. If you want to use this episode as part of your Tables V medical training, use the following tasks per TC 8-800.081-831-0011 Measure a Patient's Pulse 081-833-0145 Document Medical Care: SOAP Note Format 081-833-0156 Perform a Medical Patient Assessment 081-831-0012 Measure a Patient's Blood Pressure 081-833-0247 Perform a MACE Screening for Traumatic Brain Injury 081-833-3017 Insert a Urinary Catheter 081-833-0006 Measure a Patient's Intake and Output 081-833-0012 Perform Wound Irrigation 081-833-0165 Perform Patient Hygiene 081-833-0090 Apply Local Anesthesia 

In this episode, Dr. Ben Walrath joins us to discuss the SMOG Shock/Hypotension guideline. The conversation focuses on hypovolemic shock, but also includes a discussion of other types of shock that sometimes get less attention in the tactical setting. Commander Walrath is a U.S. Navy emergency medicine physician and the EMS Director at Navy Medical Forces Pacific. He has made major contributions to military medical literature. Here's his Google Scholar citation list. Trevor mentions an episode of Heavy Lies the Helmet. This is a great episode, and you should definitely subscribe to the podcast. Max discusses Jamie Eastman's recent paper in the Air Medical Journal, Point-of-Care Laboratory Data Collection During Critical Care Transport. Jamie is a friend of our podcast, and we will be hearing more from him soon. The article is behind a paywall, but you can use your OpenAthens account from the MEDCoE/AMEDD Virtual Library (AVL) to log in and read it free. Read this piece from Next Generation Combat Medic for step-by-step instructions on how to get access to AVL. If you want to use this episode as part of your Table VIII medical training, use the following tasks per TC 8-800:081-833-0047, Initiate Treatment for Hypovolemic Shock 081-833-0034, Manage an Intravenous Infusion081-835-3000, Administer Blood081-835-3054, Administer Blood Products

Dr. Will Smith joins us to discuss the SMOG Altitude Illness guideline. COL Smith, MD, brings his decades of military and wilderness medicine experience to bear in a discussion of "mountain sickness."  Altitude illnesses have a significant spectrum of symptoms and severity, and this episode's conversation ranges from initial diagnosis to evacuation strategies. Keep the SMOG handy during this episode, and find more detailed information in the Wilderness Medical Society's (WMS) Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update. Additionally, our friends at Next Generation Combat Medic (NGCM) have an excellent summary of the issues in "High and Sick: Altitude Illness." We've got a link to both the WMS CPG page and NGCM at dustoffmedicpodcast.com There are a number of medications that are useful for treating altitude illness, but remember this key point from the WMS: "As with AMS and HACE, descent remains the single best treatment for HAPE." So, if you're flying on a critical patient with suspected altitude illness, load, go, and get low!This episode relates to TC 8-800, Table VI, task 081-833-0035 Initiate Treatment for Altitude Illness.

Dr. Seth Assar joins us to discuss the SMOG Respiratory Distress guideline. This is a wide-ranging discussion that covers many of the differential diagnoses for a patient who is having difficulty breathing. Listen closely for a use of Ketamine that you may be less familiar with.Dr. Assar points out the inherent risks of intubation and mentions a study identifying a real risk of mortality with the procedure: Schwartz, D. E., Matthay, M. A., & Cohen, N. H. (1995). Death and other complications of emergency airway management in critically ill adults: a prospective investigation of 297 tracheal intubations. The Journal of the American Society of Anesthesiologists, 82(2), 367-376.  The risk is further increased in patients in hemorrhagic shock and an article in the last JSOM makes this clear. See:Thompson, P., Hudson, A. J., Convertino, V. A., Bjerkvig, C., Eliassen, H. S., Eastridge, B. J., ... & Rappold, J. F. (2020). Risk of Harm Associated With Using Rapid Sequence Induction Intubation and Positive Pressure Ventilation in Patients With Hemorrhagic Shock. Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals, 20(3), 97-102. Finally, be on the lookout for Dr. Assar's forthcoming article in the JSOM on mechanical ventilation.This episode relates to TC 8-800, Table II and IV.

We're stepping back from our clinical medical discussions this week to hear from Los Angeles County Sheriff's Deputy Stephen Doucette. In this episode, Dep. Doucette talks about his role as a tactical medic on the LASD Special Enforcement Bureau. SEB has a comprehensive tactical medical program that includes SWAT medicine, mountain rescue, and rotary-wing capabilities. Dep. Doucette gives a great overview of his Department's program, talks about some critical patients that he has treated in flight, then wraps up with some advice for anyone interested in career opportunities with LASD.

Dr. Jeffrey Siegler joins us to discuss the SMOG Airway Confirmation guideline. The first half of this episode follows the SMOG, then we pivot to discuss "the sledgehammer." Dr. Siegler has conducted important research on the excessive tidal volumes delivered by the "adult" BVM. After you've listened to this episode, watch his presentation to the Joint Trauma System, and read Siegler, J., Kroll, M., Wojcik, S., & Moy, H. P. (2017). Can EMS providers provide appropriate tidal volumes in a simulated adult-sized patient with a pediatric-sized bag-valve-mask?. Prehospital Emergency Care, 21(1), 74-78.Trevor mentions the difficulty of effective lung auscultation. StatPearls has a good summary.We've posted a great ETCO2 waveform reference from the PFC Airway Management CPG under 'Resources' at dustoffmedicpodcast.com. Use the cheat sheet, but read the CPG too—it's an excellent document.Ultrasound may be a faster method to confirm airway placement that end-tidal capnography. Take a look a this recent article:Chowdhury, A. R., Punj, J., Pandey, R., Darlong, V., Sinha, R., & Bhoi, D. (2020). Ultrasound is a reliable and faster tool for confirmation of endotracheal intubation compared to chest auscultation and capnography when performed by novice anaesthesia residents-A prospective controlled clinical trial. Saudi Journal of Anaesthesia, 14(1), 15.Finally, ultrasound is proven to be safe and effective for use inside helicopters. The earliest reference we can find for this is below, and many studies since have bolstered this.Lichtenstein, D., & Courret, J. P. (1998). Feasibility of ultrasound in the helicopter. Intensive care medicine, 24(10), 1119.

MAJ Lani Pineda, RN, joins Max and Wayne to discuss Clinical Practice Guideline 27, Interfacility Transport of Patients Between Theater Medical Treatment Facilities.Wayne mentions several studies that preceded the most recent update to this CPG. These include:JROCM 026-12, Tactical Critical Care Transport DOTMLPF Change Recommendation (click 'Resources,' at dustoffmedicpodcast.com)Mabry, R. L., Apodaca, A., Penrod, J., Orman, J. A., Gerhardt, R. T., & Dorlac, W. C. (2012). Impact of critical care–trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan. Journal of Trauma and Acute Care Surgery, 73(2), S32-S37.Dickey, N. W. (2015). Combat trauma lessons learned from military operations of 2001-2013. Defense Health Agency/Defense Health Board Falls Church United States.Dickey, N. W. (2011). Tactical Evacuation Care Improvements Within the Department of Defense. Defense Health Agency/Defense Health Board Falls Church United States.The entire Clinical Practice Guideline library is on the Joint Trauma System website. We've got a link to it under 'Links' at dustoffmedicpodcast.com.

Dr. Jennifer Gurney joins us to discuss the SMOG Multiple Trauma guideline. Dr. Gurney discusses challenges in military pre-hospital documentation. Schauer, et al discuss this at length: Schauer, S. G., April, M. D., Naylor, J. F., Oliver, J. J., Cunningham, C. W., Fisher, A. D., & Kotwal, R. S. (2017). A descriptive analysis of data from the Department of Defense Joint Trauma System Prehospital Trauma Registry. US Army Medical Department Journal.Dr. Gurney further emphasizes the need for military-civilian partnerships to ensure medical providers maintain their skills. If your unit has an effective partnership in place for pre-hospital providers, please let us know about it at dustoffmedicpodcast.com.Max mentions literature describing the effects of hypothermia on traumatic brain injury. More information: Jeremitsky, E., Omert, L., Dunham, C. M., Protetch, J., & Rodriguez, A. (2003). Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. Journal of Trauma and Acute Care Surgery, 54(2), 312-319.This episode relates to TC 8-800, Table I, III, and VII.

Dr. Andy Fisher joins us to discuss the SMOG Hemorrhage guideline. Dr. Fisher mentions a case involving manual compression of a patient's aorta: Lewis, C., Nilan, M., Srivilasa, C., Knight, R. M., Shevchik, J., Bowen, B., ... & Kreishman, P. (2020). Fresh Whole Blood Collection and Transfusion at Point of Injury, Prolonged Permissive Hypotension, and Intermittent REBOA: Extreme Measures Led to Survival in a Severely Injured Soldier-A Case Report. Journal of special operations medicine: a peer reviewed journal for SOF medical professionals, 20(2), 123-126.This episode relates to TC 8-800, Table I

Welcome to the podcast. Listen to the introductory episode at https://feeds.buzzsprout.com/1316548.rss