Prolonged Field Care Podcast

By Dennis

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The podcast currently has 635 episodes available.

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Number 1: Pack to the Vessel: Hemorrhage Control Is Not a Mind-less Skill
Mike Weisman — 25 years as a Navy Corpsman and SARC, 27 years on a busy Vegas fire department, now clinical education at Celox — does not sell magic dust. He sells a hydraulic problem. A femoral-rate bleed can dump on the order of 500 mL a minute. The clotting cascade is a 14-step masterpiece built for arterioles, not that jet. Early platelet plug gets blown off the vessel wall unless something holds equal pressure against it. Tourniquet, packed gauze, or packed hemostatic gauze: all of them are pressure tools. The chemistry is the advantage on top. Two families, two jobs. Kaolin (Combat Gauze class) is a clay mineral that lights up Factor XII and accelerates your cascade — which means it still needs time and a body that can clot. Chitosan / cellulose dressings work off the cascade. They absorb fluid, grab red cells by charge, and build a viscous mucoadhesive plug. Granules and sprays exist. Mike’s line stays the same: if you do not back them with pressure, you bought a show booth. Then the part schoolhouses skip. The product has to touch the bleeding vessel, not the pool in the hole. Three to six minutes of hold time on a kaolin dressing feels short on the pouch and endless on a screaming casualty. Hemorrhage control is not a monkey skill. Blood programs without packing reps are the cart in front of the horse. Read mechanisms, not company PDFs. Deployed Medicine and independent retrospectives beat the booth. Listen, then pack something that bleeds. prolongedfieldcare.org | @prolonged_field_care | PFC Podcast Top 5 takeawaysIt is a hydraulic problem. Fight pressure with pressure. Chemistry cannot replace a packed tract or a tourniquet.Know the two mechanisms. Kaolin accelerates Factor XII / your cascade. Chitosan-type polysaccharides work independently and form a mucoadhesive plug.Contact the vessel or you wasted the dressing. Clot in a basin of blood is not hemostasis. Anatomy and packing skill are the product.Hold the clock. Kaolin-class products typically need on the order of 3–6 minutes of continuous pressure. The pouch lie is that this is short.Unconscious competence beats the brand. Schoolhouse reps expire. Blood on the truck does not save the casualty if the medic cannot pack. Understand the mechanism, then pick what your system will actually issue.Chapters00:00 Cold open00:19 Dennis + Mike (SARC, Vegas FD, Celox education)01:25 Why not just pressure and plain gauze?02:16 Hydraulic problem: cascade vs femoral-rate bleed03:42 What a hemostatic actually adds03:54 Kaolin: Factor XII, still gauze, still pressure04:54 Chitosan / cellulose: cascade-independent mucoadhesive plug06:03 Charge, RBCs, dual action with the gauze07:07 Granules, sprays, “hummus” pastes — still need pressure08:20 No good hemorrhage control without pressure. Period.08:47 Does it have to touch the vessel? Yes.09:34 Anatomy, packing method, skill — not the brand10:07 Why the 3–5 minute hold feels like an hour10:42 Kaolin activation window (~3–6 min)28:57 Know every item in the bag the way you know a drug29:26 You can spot a professional by the pouch30:11 Hemorrhage control is not a monkey skill31:04 Unconscious competence: pack it blind31:56 Blood programs without packing reps33:04 Schoolhouse months do not last a career34:32 How to read studies that are not the company PDF35:37 Deployed Medicine, JTS workload, mechanisms over marketing37:48 Close: keep getting the reps
September 17, 202639min
Number 2: 296 - Mission Capable Pain Control: The TCCC Analgesia Update Explained
OTFC is gone. That was not a small supply hiccup. It punched a hole in the old TCCC pain plan. George Barbee, a PA and co-author of TCCC Guideline Change 25-03, walks Dennis through why the committee rebuilt battlefield analgesia instead of patching the old triple-option chart. They screened 56 analgesics. They built an objective matrix. They landed on suzetrigine: non-opioid, mentation-sparing, slow onset, long duration — a drug that can keep a still-fighting casualty in the fight and then carry them into prolonged care. The bigger shift is the fork in the road. Not “mild / moderate / severe” as four overlapping options. Can they stay in the fight, or not? Functioning casualties get a non-sedating pack. Non-functioning casualties get a shock-agnostic pathway so you are not stacking drugs blindly down the continuum. Ketamine is still the drug you reach for when you have almost no information. Nystagmus is not the goal. It is the “you gave too much, back off” line. Option 4 sedation is being pulled out of TCCC and written into PCC, where it belongs. If you still teach OTFC, still dose to shaking eyes, or still treat every casualty like they need a narcotic, this episode is the update. Read the change paper @ ⁠www.prolongedfieldcare.org⁠ or ⁠https://jsomonline.org/⁠ Follow @prolonged_field_care Top 5 takeawaysThe change was forced. OTFC disappeared, GWOT safety data said the old plan was too loose, and LSCO needs mission-capable pain control plus a safer path for people who cannot stay in the fight.Suzetrigine is the new stay-in-the-fight drug. Non-opioid. Cognition and blood pressure mostly spared. About a 2-hour onset, long duration. Pair it with meloxicam and acetaminophen for the functioning casualty. Muscle spasm in 1–10% is not a seizure and does not get benzos.Stop using four overlapping “options.” Define pain with the Defense and Veterans Pain Rating Scale. Rough cut: 1–6 can often still function and self-declare. 9–10, polytrauma, multi-amp — they are out of the fight. Medics already know this on sight. The guideline finally says it.Ketamine stays, but the endpoint is not nystagmus. If you have almost no information, ketamine is still the safest narcotic start. Reduction of pain means the casualty and the medic can both manage the situation. Nystagmus means you crossed the line. Fixed-dose ketamine in a bleeding patient can get weird as volume drops — not usually lethal, still a problem.Option 4 is leaving TCCC. Heavy sedation and procedural endpoints are being moved into the PCC update. TCCC keeps the systematic, stack-aware, evidence-based path so the next provider is not surprised by what you already gave.Chapters 00:00 — Disclaimer and open 00:23 — Dennis and George: who wrote the change 02:10 — If it ain’t broke, why touch analgesia? 02:56 — We lost OTFC 03:11 — Safety, LSCO, and early pain vs PTSD 04:27 — Mission-capable control and a shock-agnostic path 05:48 — How suzetrigine beat 56 other drugs 09:38 — Why this non-opioid survived the matrix 11:33 — Spasm vs seizure: do not reach for benzos 13:33 — Stay in the fight vs cannot 14:20 — The old “triple option” was actually four 15:06 — Defining pain with the DVPRS 16:10 — The stay-in-the-fight pack: suzetrigine, meloxicam, Tylenol 17:20 — What “reduction of pain” actually means 18:15 — Esketamine: more analgesia, fewer side effects 27:38 — If you only get one narcotic, start ketamine 28:56 — Esketamine, IN 28 mg, and the 4PANE study 30:15 — IV, IO, IM, IN: why they kept the nose 33:07 — Pain control vs nystagmus 35:26 — Option 4 is moving to PCC 36:41 — Chest tubes, crics, and the sedation gap 37:54 — Next: backing the PCC analgesia update 38:48 — Read JSOM Change 25-03 and close
September 14, 202640min
Number 3: 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 4: 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 5: 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