DUSTOFF Medic Podcast

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.com
• The Joint Trauma System's Pre-deployment Prioritized Read Lists by Clinical Role
• COL 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 SOMSA

Furthermore, 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 Respirations
• 081-833-0034, Manage an Intravenous Infusion