This podcast episode explores the innovative use of maggot therapy in wound care, discussing its historical context, benefits, and applications in various medical settings, particularly in austere environments. The conversation highlights the importance of maggot therapy as a cost-effective and efficient treatment option, especially in the face of rising antimicrobial resistance. The speakers emphasize the need for proper sourcing, preparation, and application techniques for maggot therapy, as well as the potential for integrating this method into modern medical practices.

Takeaways

• Maggot therapy has historical roots dating back thousands of years.
• Maggots effectively debride wounds and promote healing.
• Maggot therapy is cost-effective, especially in low-resource settings.
• Chronic wounds often develop biofilms that resist antibiotics; maggots can help.
• Maggots can be used in both chronic and acute wounds, including burns.
• Maggot therapy can be implemented in austere environments with proper training.
• Specific fly species are required for effective maggot therapy.
• Maggots can be sourced locally in various environments.
• Maggot therapy can be a sustainable alternative to antibiotics in combat situations.
• Documentation and sharing of experiences are crucial for advancing maggot therapy.

Chapters

00:00 Introduction to Maggot Therapy

01:16 Historical Context of Maggot Therapy

04:41 Benefits of Maggot Therapy

08:39 Application in Various Wound Types

11:14 Maggot Therapy in Austere Environments

15:32 Sourcing and Preparing Maggots

23:33 Application Techniques for Maggot Therapy

29:32 Patient Management and Treatment Regimens

35:06 Future of Maggot Therapy in Medicine

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In this episode of the PFC Podcast, Dennis and John Dominguez discuss the complexities of combat medicine, the challenges faced by military medics, and the importance of professionalizing the medical force. They explore the balance between training and operational readiness, the role of paramedic certification, and the lessons learned from historical conflicts. The conversation emphasizes the need for effective mentorship, resource management, and the integration of lessons from global conflicts to enhance the capabilities of military medics in future engagements.

Takeaways

The professionalization of military medics is crucial for future conflicts.

Training for medics must balance time constraints with skill requirements.

Paramedic certification may not fully prepare medics for combat situations.

Tactical medicine requires a unique skill set that differs from civilian practices.

Mentorship plays a vital role in developing competent medics.

Resource management is essential for effective medical care in combat.

Lessons learned from past conflicts can inform current medical training.

The importance of mastering the basics cannot be overstated.

Combat medicine is a problem within the tactical mission framework.

Future conflicts will require innovative approaches to medical care.

Chapters

01:04 Professionalizing the Medical Force

05:16 Challenges in Combat Medicine Training

10:51 The Role of Medics in Future Conflicts

15:34 Paramedic Certification in Military Medicine

19:05 The Importance of Tactical Medicine

23:34 Lessons from Historical Conflicts

27:56 Mentorship and Leadership in Medical Training

32:59 The Balance of Skills and Time in Training

39:39 The Future of Combat Medicine

45:55 Integrating Lessons Learned from Global Conflicts

51:14 The Importance of Resource Management in Medicine

55:53 Final Thoughts on Medical Training and Readiness

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In this episode of the PFC Podcast, Rick Kelly, a retired 18 Delta Special Forces medic, shares insights into the unique challenges faced by Special Forces medics in austere environments. He discusses the critical role these medics play in providing life-saving surgical procedures in areas lacking medical infrastructure, emphasizing the importance of understanding their training and operational constraints. Kelly highlights the evolution of medical practices within Special Forces, particularly the adoption of methods from the International Committee of the Red Cross (ICRC) to improve patient outcomes in combat situations.

Kelly elaborates on the specific surgical techniques taught to Special Forces medics, including wound excision, closure, and amputation, all tailored to the limited resources available in the field. He contrasts these practices with conventional medical approaches, underscoring the necessity for adaptability and efficiency in high-pressure environments. The episode concludes with a call for healthcare providers to better understand the realities of austere medicine, enabling them to support Special Forces medics more effectively.

Understanding austere medicine is crucial for effective healthcare delivery.

The ICRC's methods have significantly influenced Special Forces medical training.

Infection rates can be drastically reduced with proper wound management.

Chapters

05:30 Adopting ICRC Methods

10:39 Challenges in Austere Environments

16:46 Conclusion and Key Takeaways

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In this episode of the PFC Podcast, Dennis speaks with Rima, a combat medic in Ukraine, about the critical aspects of unit safety, tactical training, and the challenges faced in medical evacuations during an active war zone. Rima shares insights on the importance of personnel over equipment, the necessity of telemedicine, and the realities of training medics under resource constraints. The conversation also delves into wound management, infection control, and the unique challenges posed by winter conditions in the field.

Takeaways

The priority in combat medicine is personnel over equipment.

Training for medics is often condensed due to active war conditions.

Telemedicine plays a crucial role in providing care in remote areas.

Wound management and infection control are critical in combat situations.

Adapting to resource limitations is essential for effective medical care.

Basic skills in combat medicine can save lives more than advanced techniques.

The drone threat complicates medical evacuations significantly.

Improvisation is key when standard resources are unavailable.

Understanding the basics of medicine is vital for effective care.

Every situation in combat medicine requires quick and adaptable responses.

Chapters

00:00 Introduction to Combat Medicine in Ukraine

02:57 Unit Safety and Tactical Training

06:00 Challenges of Medical Evacuations

08:47 Training Medics in Active War Zones

12:02 Telemedicine in Combat Situations

14:57 Wound Management and Infection Control

17:55 Prioritizing Gear and Equipment

21:10 Adapting to Resource Limitations

23:46 Winter Challenges in Hemorrhage Control

27:01 Concluding Thoughts on Tactical Medicine

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This conversation delves into the critical aspects of tourniquet management in trauma care, focusing on the distinction between tourniquet conversion and replacement, the importance of resuscitation, and the physiological implications of prolonged tourniquet use. The speakers discuss techniques for safe conversion, the challenges faced in the field, and the assessment of limb salvageability, emphasizing the need for preparedness and patient assessment in high-stress environments. This conversation delves into the complexities of patient care in trauma situations, focusing on the challenges faced by medics in making critical decisions about limb salvage, managing acidosis, and understanding reperfusion injury. The speakers emphasize the importance of resuscitation, the need for adequate resources, and the moral dilemmas that arise in emergency medical situations. They provide practical advice for medics on how to navigate these challenges effectively while ensuring patient safety and care quality.

Takeaways

• Tourniquet conversion is essential in trauma care.
• Understanding the difference between conversion and replacement is crucial.
• Resuscitation is a key factor before converting a tourniquet.
• The two-hour mark for tourniquet use is based on physiological considerations.
• Prolonged tourniquet time can lead to significant metabolic issues.
• Be prepared for reperfusion injury when converting a tourniquet.
• Confidence in tourniquet conversion skills is often lacking among providers.
• Patient assessment is critical before converting a tourniquet.
• Limb salvageability can vary and should be assessed carefully.
• The decision to convert a tourniquet should prioritize patient stability. Imperfect situations require difficult decisions in patient care.
• Triage decisions are crucial when resources are limited.
• Resuscitation is the primary goal in trauma care.
• Understanding reperfusion injury is essential for medics.
• Managing acidosis can significantly impact patient outcomes.
• Blood transfusions are critical in trauma situations.
• Medics must be prepared for potential complications.
• Always monitor and assess the patient's condition continuously.
• Reading medication labels is vital for safe practice.
• Confidence in converting tourniquets is essential for medics.

Chapters

00:00 Introduction to Tourniquet Management

02:56 Understanding Tourniquet Conversion vs. Replacement

06:10 Resuscitation Goals and Tourniquet Timing

08:58 Physiological Implications of Prolonged Tourniquet Use

11:47 Techniques for Safe Tourniquet Conversion

15:09 Challenges in Tourniquet Management

17:53 Assessing Limb Salvageability and Patient Stability

25:44 Navigating Imperfect Situations in Patient Care

30:32 Triage Decisions: When to Save a Limb

31:03 Understanding Reperfusion Injury and Its Challenges

35:43 Managing Acidosis in Trauma Patients

46:34 Advice for Medics: The Importance of Conversion

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The conversation delves into the complexities of end-of-life care, emphasizing the importance of thoughtful training and education in healthcare. It highlights the potential moral injuries that can arise from decisions made in this sensitive area, particularly when medics are tasked with determining the futility of care without adequate resources.

Takeaways

• There's a ripple effect from each one of these decisions.
• We have to be very thoughtful about how we train and educate.
• Moral injury can result from poor decision-making in healthcare.
• Medics determining early futility may not have the necessary resources.
• Championing certain ideas can lead to operational inefficiencies.
• End-of-life care requires a balance of ethics and practicality.
• Training should encompass both education and practical skills.
• Healthcare decisions impact not just patients but the entire system.
• Moral injury is a significant concern in medical ethics.
• Operational effectiveness can be compromised by hasty decisions.

Chapters

00:00 Introduction to Palliative Care in Combat Medicine

00:29 Operational Effectiveness vs. Palliative Care Messaging

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In this essential episode of the Prolonged Field Care (PFC) Podcast, host Dennis sits down with CRNA Kevin to dive deep into one of the most overlooked yet critical issues in trauma care: Hypothermia prevention and management. Even in warm environments, trauma patients can rapidly become hypothermic—leading to coagulopathy, increased bleeding, wound infections, and worse outcomes. Dennis and Kevin break down the science, real-world lessons from deployments, and practical strategies for austere and prolonged field care settings.

Whether you're a medic, provider, or anyone involved in combat casualty care, this episode will change how you approach keeping patients warm under fire or in remote locations.

Episode Highlights:

• The four main mechanisms of heat loss: radiation (40-60% of total loss), convection, conduction, and evaporation—and how to counter each one effectively.
• Why even healthy patients cool rapidly under anesthesia, and why trauma patients in the field are at much higher risk.
• Practical tips for austere environments: using tents, inflatable structures, insulation from the ground, wool blankets, and body heat to raise ambient temperature.
• Common mistakes that actively cool patients: wet clothing, cold airways (LMAs/ventilation), uncovered exposure, and cold blood/fluid administration.
• Best bang-for-buck interventions: covering the head, minimizing exposure, drying the patient, using HME filters, and insulating from the ground.
• Real deployed experiences: keeping trauma bays warm, pre-warming gear, using camping pads on litters, and limitations of Ready-Heat and HPMKs at altitude or in extreme cold.
• Advanced rewarming techniques (when available): fluid warming, bladder lavage, peritoneal lavage, and ECMO.
• Temperature monitoring challenges in the field: esophageal, nasopharyngeal, rectal, Foley, and forehead strips—plus how to interpret trends.

Chapters:

• 00:00 – Introduction & Why Hypothermia Matters in Trauma Care
• 02:30 – Heat Loss in Anesthesia: Vasodilation and the First-Hour Temperature Drop
• 04:50 – Mechanisms of Heat Loss: Radiation, Convection, Conduction, Evaporation
• 07:10 – OR Strategies: Room Temperature, Head Covering, Fluid Warming, Bear Huggers
• 09:29 – Environmental Control in the Field: Raising Ambient Temperature & Reducing Wind
• 11:52 – Using Tents and Structures to Trap Body Heat
• 14:14 – Insulation from the Ground: Litters, Wool Blankets, Camping Pads, Air Mattresses
• 17:53 – Preventing Conduction & Pressure Sores with Padding
• 19:56 – Avoid Actively Cooling Patients: Cold LMAs, Unheated Ventilation, Wet Clothing
• 22:21 – Heat Moisture Exchangers (HME) & Humidified Gas
• 26:40 – Blood Resuscitation: Cold Fluids vs. Hypovolemia—What Kills First?
• 31:17 – Team-Based Rewarming: Minimize Exposure, Pre-Warm Gear, Dry HPMKs
• 35:22 – Limitations of Battery-Powered Warmers & Bear Huggers in Austere Settings
• 40:04 – Prevention First: Insulate, Cover, Dry—Then Active Rewarming Works Better
• 42:24 – Downstream Effects of Hypothermia: Lethal Triad & Wound Infections
• 44:51 – Aggressive Rewarming Options: Chest Tubes, Gastric/Bladder Lavage, ECMO
• 47:15 – Temperature Monitoring in the Field: Probes, Strips, and Trend Interpretation

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In this conversation, Jessica Patterson and Florian Schmitzberger discuss the evolution of clinical practice guidelines (CPGs) from the Department of Defense (DOD) and their application in different contexts, particularly in light of the changes from the Global War on Terror (GWOT) to new healthcare environments. They emphasize the need for data to understand how these guidelines will perform in varied systems.

Takeaways

This isn't GWOT, this isn't Iraq, this isn't Afghanistan.

Clinical practice guidelines (CPGs) evolved during GWOT.

The performance of CPGs in different systems is uncertain.

Data gathering is essential to assess guideline effectiveness.

Understanding ground truth is crucial for guideline application.

The DOD's CPGs were refined for specific contexts.

New healthcare environments may challenge existing guidelines.

The evolution of CPGs reflects changing military and healthcare needs.

Questions arise about the adaptability of CPGs.

Future research is needed to evaluate guideline performance.

Chapters

00:00 Introduction to the Podcast and Guests

00:32 Data Collection and Research Methodology

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In this episode of the PFC Podcast, Dennis and John discuss the ongoing updates and changes within the Tactical Combat Casualty Care (TCCC) guidelines. They delve into the role of the TTC Committee, the importance of literature reviews in developing algorithms for trauma care, and the proposed changes to the March algorithm, emphasizing the need for resuscitation before decompression. The conversation also covers the overhaul of the analgesic section, the recommendations for antibiotics, and the role of TXA in treating hemorrhagic shock. Additionally, they touch on the significance of triage in mass casualty situations and the future directions of the committee's work.

Takeaways

TCCC is continuously updated to reflect new research.

Resuscitation should be prioritized over decompression in trauma care.

The March algorithm may undergo significant changes to improve outcomes.

Analgesic options are being re-evaluated due to supply issues.

Rocephin is being recommended as a primary antibiotic.

TXA is crucial for managing hemorrhagic shock in trauma patients.

Triage protocols are essential for effective mass casualty management.

The committee is open to innovative ideas and solutions.

Training and education are vital for implementing new guidelines.

Future meetings will focus on finalizing and voting on proposed changes.

Chapters

00:00 Introduction to the PFC Podcast

02:46 Understanding the TTC Committee and Its Role

06:06 Literature Review and Algorithm Development

09:00 Resuscitation vs. Decompression in Trauma Care

12:07 Proposed Changes to the March Algorithm

15:06 Analgesic Section Overhaul and Alternatives

18:09 Antibiotic Recommendations and Changes

20:54 TXA and Its Role in Hemorrhagic Shock

23:51 Triage in Mass Casualty Situations

26:45 Future Directions and Upcoming Votes

30:06 Conclusion and Final Thoughts

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In this episode of the PFC Podcast, Victor, a former Ranger medic, shares his experiences and lessons learned from a mass casualty event during a humanitarian mission in Burma. He discusses the historical context of the conflict, the challenges faced in providing medical support, and the innovative solutions developed in a denied environment. The conversation emphasizes the importance of training, adaptability, and building sustainable medical practices to empower local medics in future conflicts.

Takeaways

Victor shares his experiences as a former Ranger medic.

The humanitarian mission in Burma faced severe challenges.

The conflict in Burma has historical roots dating back to World War II.

Training focused on hemorrhage control and casualty extraction techniques.

Two casualty collection points were established during the operation.

The team had to adapt to carrying casualties over long distances.

Blood transfusions were successfully conducted in the field for the first time.

Building sustainable medical practices is crucial for future operations.

Empowering local medics is essential for effective care.

The mission was guided by a sense of love and purpose.

Chapter

00:00 Introduction to the Humanitarian Mission

02:54 The Conflict in Burma: Historical Context

05:52 Training the Rangers: Preparing for Combat

08:55 The Medical Support Operation: Initial Challenges

11:49 Casualty Management: Triage and Evacuation

14:55 Adapting to the Battlefield: Lessons Learned

17:54 Blood Transfusions in the Field: A New Capability

20:45 Building Sustainable Medical Practices

23:48 Empowering Local Medics: The Future of Care

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