DUSTOFF Medic Podcast

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.2020.12.065

Ricky 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 Infusion
• 081-835-3002 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 Infusion
• 081-835-3000, Administer Blood
• 081-835-3054, 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.