Prolonged Field Care Podcast

By Dennis

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Number 1: 295- Logistics For LSCO: Why SOF Med Supplies Fail When The War Changes
Medical logistics was an afterthought for a lot of us in GWOT. You submitted a request, something showed up, and everyone joked that the warehouse never read the order. That model does not survive large-scale combat operations. In this episode, Dennis sits down with Jesse Bashel, a medical logistician and acquisitionist, to walk through how SOF medical supply is supposed to work—pre-deployment, on deployment, and after the first 15 days. They cover NSNs versus product names, automatic in-lieu substitutions, Theater Lead Agents for Medical Materiel (T-LAM), the shift from OCO “easy button” money to MFP-2 vs MFP-11 rules, statements of requirement, and why most medical items are service-common (GCC problem) while a tiny slice of SOF-peculiar items stay on MFP-11. The conversation then turns practical: MedLog personnel usually have zero clinical training. How do you teach them why a 6.0 tube matters for a surgical airway instead of an 8.5 ET tube? How do you get logisticians into Ridge Healer, unit training, and field exercises so they stop treating the property book as the mission? And why, in LSCO, logistics itself starts looking like a combat MOS—because the side that can feed, fuel, and bandage longer usually wins. If you are an 18 Delta, flight medic, battalion PA, group surgeon, this one is for you. Key takeawaysOrder by NSN (or full product name + manufacturer), not the nickname you use in the aid bag. Vendors should put NSN placards on tables at SOMA.The system will auto-accept “in-lieu” substitutes unless the logistician blocks it. That is how you get Halo chest seals when you wanted HyFin.SOF units are required to deploy with 15 days of supply. After that, the Geographic Combatant Command (usually MFP-2 / service-common) is supposed to resource the rest; SOCOM MFP-11 covers only SOF-peculiar items (certain CASVAC sets, freeze-dried plasma in some cases, specific antivenoms, etc.).A Statement of Requirements (class I–IX) should be built jointly by the team and the TSOC 180–270 days out when possible, validated by surgeon + J4, then sent to the GCC for a service lead to resource.Most medical products are MFP-2. Do not default everything to “SOCOM will pay.”Close the gap: five-minute education sessions when medics hit the cage, bring logisticians forward on training events, and treat enablers like part of the team instead of a battle squire.In LSCO, supply lines will be targeted. Logistics personnel need to be trained and treated as if they will be on the battlefield—not just in an office. Visit prolongedfieldcare.org, follow @prolonged_field_care, and subscribe so you stay on the bleeding edge of combat medicine. Chapters 02:02 – Pre-deployment ordering done right: NSNs vs product names and why you get the wrong chest seal 04:24 – In-lieu / substitute items and how to stop the system from auto-accepting them 05:24 – Theater Lead Agent for Medical Materiel (T-LAM) catalogs and how they get built 07:09 – MFP-2 (service common / common user) vs MFP-11 (SOF peculiar) 08:27 – Joint pub requirement: SOF deploys with 15 days of supply 10:07 – Who pays for days 16–60? GCC vs US SOCOM headquarters 12:10 – Statement of Requirements process: team + TSOC + GCC J4 validation 15:58 – MedLog has no medical training—how to educate them before they send the wrong tube 21:17 – Closing the operator–logistician distance; policy is not always law 26:00 – Retaining SOF-enabler talent instead of rotating everyone back to conventional force 28:22 – SUBACUS lessons and why enablers must not be a liability forward 30:29 – Two LSCO paradigm shifts: SOF as supporting force + logistics as a combat MOS 32:08 – Positional warfare, endurance, and targeting supply lines (bullets, batteries, bandages) 32:50 – Where to do the work: put a logistician on the DTS for Ridge Healer and big exercises 34:25 – Flip side: teach operators the fiscal and appropriation reality so they can advocate overseas
September 07, 202636min
Number 2: SOMA 26' - Role 1.5: Fighting Tourniquet Syndrome at the Forefront
Ukrainian orthopedic and reconstructive surgeon describes what prolonged field care actually looks like when evacuation from the front line to Role 2 takes three to four days, and sometimes longer. After years of Role 1, Role 2, and evacuation-stage work, he focuses on a problem that now drives limb outcomes: tourniquet syndrome. TCCC made rapid tourniquet application routine; the neglected next step is conversion, replacement, and complication prevention when the casualty remains in the field for hours to days. He shares a three-week Role 1 case series, frontline protocols for resuscitation, antibiotics, and multimodal analgesia, and why communication between echelons is no longer optional. Sponsored by the Special Operations Medical Association. Key TakeawaysCombat has outpaced doctrine: drones, delayed evacuation, and shifting surgical capability forward mean medics now make high-stakes decisions that used to wait for the hospital.In summer–autumn 2025, movement from the front line to Role 2 commonly took three to four days. Complications of prolonged tourniquet time develop during that window, not after arrival.Forces have become highly proficient at rapid tourniquet application for hemorrhage control. Far less attention has been paid to when, how, and under what conditions to convert or remove a tourniquet during extended delayed evacuation.Incorrect application, delayed conversion, and early reperfusion errors at Role 1 create complications that later echelons often cannot fully reverse. Prevention at the first capable point is easier than correction later.Over three weeks at one Role 1, the team reviewed 27 tourniquet cases: 18 already removed before arrival, 5 converted on site, 4 replaced, and 8 presenting with established tourniquet syndrome.A tourniquet left on too long can function as a venous tourniquet. In one ~12-hour case, conversion and wound care were possible; the patient still spent a full day at Role 1 because evacuation remained unsafe.Role 1 care in this environment combines hemostatic resuscitation, Ukrainian MoH / JTS-aligned antibiotic prophylaxis, and multimodal analgesia to reduce opioid dependence while waiting for movement.Drones, shelling, and remote mining remain constant threats to both casualties and medical teams. High-quality Role 1 care still depends on continuous risk assessment and tactical awareness.Continuous case review, data capture, and closed-loop communication from prehospital to hospital are essential so frontline observations can change tactics in real time. Chapters00:00 – Introduction and speaker background 01:50 – Evolving war, prolonged field care, and higher medic responsibility 04:10 – Why tourniquet syndrome now dominates limb outcomes 05:30 – TCCC taught application; the neglected next step is conversion 06:20 – Drones, delayed evacuation, and care shifting pre-evacuation 07:40 – 3–4 day timelines from front line to Role 2 in 2025 08:30 – Role 1 errors that later hospitals cannot fully fix 09:10 – Role 1.5 mission: assess, convert, prevent, stabilize 11:50 – Resuscitation, antibiotic, and multimodal analgesia approach 13:10 – Three-week tourniquet case series (27 TQs, 8 syndromes) 15:00 – Case example: 12-hour venous-effect tourniquet conversion 16:20 – When conversion is no longer possible 17:40 – Ongoing battlefield threats to evacuation and medics 18:30 – Continuous learning and echelon-to-echelon feedback For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
September 03, 202622min
Number 3: SOMA 26' - Fresh Whole Blood is Not The Answer: It's Still a Question
Whole Blood Is Not a Solution (Until Conventional Forces Can Deliver It) Recorded live at SOMA 26 Dr. Vanessa Hanick (emergency physician, former active-duty Army, now National Guard) and 1SG Cy Clayton (Ranger Regiment veteran, currently a conventional Role 2 first sergeant) deliver a blunt assessment of a critical readiness gap: while whole blood is the agreed standard of care for damage control resuscitation, conventional forces remain largely unprepared to provide it in support of SOF or any large-scale operations. Drawing on recent deployment experience, unit surveys, and Joint Trauma System training observations, they outline three lethal capability gaps—planning, logistics, and training—and call for proactive SOF-conventional collaboration, institutional reform, and immediate use of available Joint Trauma System mobile training teams. Sponsored by the Special Operations Medical Association. Key TakeawaysThe 2021 Joint Trauma System / Defense Committee on Trauma position statement establishes whole blood as the resuscitative fluid of choice that must be available at every echelon and on every evacuation platform within 30 minutes of injury. This is an operational standard, not an aspiration.Conventional forces currently fail this standard across three critical gaps: failure to plan (MASCAL and walking blood bank plans are incomplete, unilateral, or nonexistent), logistical incompetence (unreliable cold chain, storage, transport, and warming), and inadequate training (high failure rates on whole blood transfusion even among medics who pass TCCC recertification).Survey data from conventional brigade-sized elements show near-zero SOPs for walking blood banks, minimal storage capacity, zero transport or warming capability in many units, and cold-chain training limited to vaccines rather than blood.SOF leaders and medics cannot assume conventional support will materialize when needed. Early, deliberate linking with conventional Role 1/2 counterparts—sharing knowledge, training together, and validating capabilities—is essential.Joint Trauma System mobile training teams (including the Blood Whole Blood Training Program) already exist and can travel to conventional units to build pre-hospital, Role 2, and Role 3 whole blood and walking blood bank competency. These resources should be used now.In future large-scale combat operations the problem only intensifies; the time to close the gap is before the emergency, not during it. Chapters00:00 – Introduction and disclosures 01:30 – Why SOF–conventional collaboration matters now 03:40 – The 2021 JTS whole blood standard and its implications 05:50 – Three critical capability gaps in conventional forces 06:50 – Gap 1: Failure to plan (Kuwait MASCAL and walking blood bank case study) 11:20 – Gap 2: Logistical incompetence (cold-chain failures on deployment) 13:20 – Gap 3: Training shortfalls (high failure rates on whole blood transfusion) 15:40 – Survey data from conventional units: near-zero capabilities 19:20 – Institutional, organizational, and individual solutions 21:40 – SOF responsibility: link early, train together, validate capabilities 24:40 – Joint Trauma System resources and call to action 28:00 – Closing remarks
August 27, 202629min
Number 4: 293 - Dead Tissue Kills in Prolonged Field Care: 4 C’s, Early Debridement & Delayed Primary Closure Lessons from the Field
In this episode of the PFC Podcast, Dennis sits down with missionary surgeon Jason to cut through the noise on real-world wound care in austere and unconventional warfare environments. From the bridge two miles from the front to resource-scarce guerrilla settings, Jason shares hard-won lessons on getting tourniquets off, aggressive debridement, and keeping patients from dying of infection weeks later. You’ll hear why most tourniquets can (and should) come off early, how to use the 4 C’s (Color, Consistency, Contractility, Capillary bleeding) to decide what stays and what goes, why inactivity is harm, and how daily dressing changes plus early cleaning beat the classic “leave it alone for 5 days” approach in many field conditions. Jason also covers practical logistics, antibiotic reality checks, pain management during dressing changes, and when a wound is actually ready for delayed primary closure. Key takeaways:Get the tourniquet completely off and look—most wounds do not need it left on.Dead tissue, dirt, and debris are the real infection risk; antibiotics cannot fix what you leave behind.The 4 C’s give medics a clear, actionable decision tool for debridement.Aggressive early cleaning usually means fewer later trips to the OR, less pain, and better long-term outcomes.In prolonged or definitive field care, the medic who stays with the patient for weeks must own the wound—not just the initial hemorrhage control.Beefy red granulation without cellulitis is the green light for closure decisions; high-tension or complex wounds may still do better left open. Practical, no-nonsense guidance for anyone who may have to manage wounds far beyond the golden hour. Chapters 00:00 – Intro & welcome 00:20 – Guest intro: missionary surgeon in UW environments 01:04 – Tourniquet still on + nasty wound: what actually improves outcome? 01:19 – Get the tourniquet off as soon as possible 01:40 – Data point: ~70% of tourniquets not needed 03:11 – Why taking tourniquets off feels so scary 04:14 – Don’t lower slowly—get past venous pressure fast 05:00 – Simple method: fully loosen, look, reapply only if needed 07:17 – Risk of a brief look is low; most bleeding is manageable 09:07 – Care under fire vs. tactical field care / PFC mindset 12:25 – System solutions for large-scale conflict (push capability forward) 14:46 – Optimizing the patient after hemorrhage control15:03 – Minimal tools needed + goal of removing barriers to healing 16:18 – The 4 C’s of viable tissue (Color, Consistency, Contractility, Capillary bleeding) 17:15 – Lean aggressive: dead tissue + debris kills more than a little extra muscle 19:05 – Fungal/opportunistic infections and why clean tissue matters 22:13 – Early and repeated debridement until only living tissue remains 24:00 – How far to go: check compartments, cut questionable tissue 30:33 – Dressing strategy after initial debridement 30:38 – Copeland method vs. daily (or more frequent) changes 33:12 – Checking the wound the next day in austere settings 34:34 – Pain control and watching the patient’s face during dressing changes 37:01 – What the dressing and wound bed should tell you 37:35 – Antibiotics: best antibiotic is good debridement 40:27 – Logistics in UW: travel light, use partner supplies, stay off the radar 42:47 – When is the wound ready for delayed primary closure? 45:45 – What Jason wishes more medics would internalize For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
August 24, 202650min
Number 5: SOMA 26' - European Medical Preparations for Major Engagements and Large-Scale Combat Operations
Recorded live at SOMA 26 Pierre Pasquier (France) and his German counterpart deliver a clear-eyed assessment of how European military medical systems are preparing for large-scale combat operations and major engagements, drawing heavily on lessons from Ukraine. They examine the scale of expected casualties, the return of mass-casualty and prolonged-care realities, the threat of multi-drug-resistant organisms, the vulnerability of medical treatment facilities to deliberate attacks, and the urgent need for true multinational interoperability. The discussion covers doctrine updates, shared training, data collaboration, civilian-military integration, and the strategic value of medical readiness as a deterrent. Sponsored by the Special Operations Medical Association. Key TakeawaysUkraine has demonstrated casualty rates of several hundred per day—orders of magnitude higher than Iraq/Afghanistan—requiring European medical systems to plan for mass casualties, prolonged field care at scale, and significant disease/non-battle injury burdens, including older soldiers with chronic conditions.Multi-drug-resistant bacteria are already arriving in European hospitals via Ukrainian patients; mass-casualty flows will amplify this biosecurity challenge and demand coordinated infection-control strategies.Systematic attacks on healthcare facilities necessitate a shift to flexible, mobile, low-signature medical treatment facilities that can hide and defend themselves—something current large Role 1–3 structures are not yet optimized for.Lessons from long-evacuation environments (e.g., Sahel) must now be scaled from a handful of patients to dozens or hundreds simultaneously; prolonged care is no longer an exception but a planning assumption.True interoperability requires shared language, clear capability definitions across nations, joint data collection and analysis, and training that moves beyond parallel national exercises to actual patient and team cross-flow.Germany is positioned as a key NATO medical hub for strategic evacuation; France is actively building civilian-military pathways so that civilian systems can absorb returning casualties while military teams remain forward.Medical superiority and demonstrated preparedness function as a strategic deterrent; “stronger together” through SOMA, CMC, shared science, and multinational training is essential. Chapters 00:00 – Introduction and European context01:50 – Ukraine as the current laboratory and weekly French/German learning process03:10 – NATO Eastern Front realities and multinational medical challenges05:00 – Casualty rate comparisons: WWII → Ukraine and implications for doctrine07:00 – Disease, non-battle injury, and the multi-drug-resistant bacteria threat09:50 – Attacks on healthcare facilities and the need for mobile, low-signature MTFs12:20 – Lessons from the Sahel: prolonged care scaled for LSCO14:50 – Interoperability experience and the value of shared data and science17:40 – Changing mindsets, nomenclature, and national doctrines (French Sauvetage au Combat update)21:40 – Training together: Vigorous Warrior and the next steps for joint exercises23:10 – Strategic MEDEVAC, Germany as hub, and civilian-military integration25:10 – Take-home messages: new/old challenges, medical superiority as deterrent, stronger together27:20 – Q&A: hospital capacity concerns and integrating U.S. physician assistants
August 20, 202632min