Special Operations Medical Association

Telemedicine is a crucial capability that must be planned and practiced. The base of knowledge that a SOF medic's knowledge encompasses includes many areas of medicine but generally lacks

the depth and experience of specialists available to consult. This depth of knowledge is almost universally available when making a simple telephone call to any number of docs willing to take a call at all times of the day and night. Don't let pride or hubris prevent you from seeking advice from someone more experienced than you in taking care of critically injured, complex patients. Telemedical consult is one of the most important core capabilities in a prolonged field care situation.

BOTH the medic making the call as well as the Provider receiving the call must practice and rehearse a telemedical consult placed from a field environment. The medic will gain confidence and be able to relay vital information efficiently in a timely manner. The provider on the other end will have to anticipate problems that the medic may not have thought of and help create a prioritized treatment care plan from incomplete information.

Trust must be built prior to an actual call being made under stressful conditions; trust in the receiving physician and, more importantly, trust in the process. Medics may be apprehensive in calling a complete stranger if they haven't made a test call or even better, a face to face meeting. If you build the rapport before the crisis, this won't be an issue. You may even have the time to prep a draft email who you are and your equipment, training level and usually a region where you will be if you think it will be pertinent.

Rick Hines has spent the last 20+ years in service to his country much of it deployed to combat zones and other unstable, austere environments and is dedicated to improving SOF Medicine. He made it a point to spend a fair amount of time with surgical teams when possible and has gained quite a bit of real world knowledge that we hope to pass on to a wider audience here.

Burns present another wound pattern that can be extremely difficult and time consuming for any level of provider to manage. So much so that there are dedicated burn teams that will often fly to where burn patients are being held in order to get them back to the burn center in San Antonio with the best chance of survival. We have taken the expert guidance of these critical care providers and packaged everything they have learned into a single clinical practice guideline targeted at the medic and other Role 1 Providers who might find themselves sitting on a patient at a Battalion Aid Station or team house before evacuation is available. Initial priorities such as estimating percentage of body surface area burned, starting fluid resuscitation with the rule of 10s, foley placement along with many others may determine the mortality and morbidity of your patient.

We recorded this live from the Joint Special Operations Medical Training Center where Guest Lecturer COL Givens, shares the CBRNe knowledge she has learned working (among many other positions) as a Clinical Toxicologist around the world including as the SOCAFRICA Command Surgeon where she personally helped prepare members of 10th SFG(A) to deal with some of the most venomous snakes in the world.

COL Melissa (Missy) Givens MD, MPH is a graduate of the United States Military Academy and USUHS alumni. She is board certified in Emergency Medicine with subspecialty training in Clinical Toxicology and Sports Medicine and certification as a Strength and Conditioning Specialist. She is the former program director for the Carl R. Darnall Emergency Medicine Residency and EM-PA Fellowship. She has held various academic and operational assignments and completed several combat tours and deployments with both conventional and Special Operations Forces. COL Givens is currently faculty in the Department of Military and Emergency Medicine at USUHS.

Dr. Joe DuBose is an Air Force Trauma Surgeon who recognized early in his career that hemorrhage was the number one killer of potentially survivable patients. This led him to a fellowship in vascular surgery and, as Dennis put it made him a guru in the emerging technology that allows a catheter to be placed in the femoral artery and snaked up past a bleed in the pelvis, abdomen and even chest where a balloon is then inflated cutting off all blood flow below that point. Dr. DuBose was the first to do This in the ED using a newer version that had a small enough diameter that a vascular repair would not be required after use. It is simply placed through a central line and removed as such later on. This is called REBOA or Resuscitative Endovascular Balloon Occlusion of the Aorta. As you can imagine this is not without limits and complications if done improperly.

Jim originally gave this talk at SOMSA2017. Due to popular demand, we were able to convince him to rerecord after the conference concluded. Enjoy...

Version:1.0 StartHTML:000000313 EndHTML:000022696 StartFragment:000021664 EndFragment:000022613 StartSelection:000021664 EndSelection:000022613 SourceURL:https://prolongedfieldcare.org/2017/08/11/podcast-episode-25-advanced-icrc-wound-care-and-the-acute-wound-care-management-clinical-practice-guideline/ Podcast Episode 25: ICRC Style Wound Care and the NEW Acute Wound Care Management Clinical Practice Guideline â€" ProlongedFieldCare.org

This Clinical Practice Guideline was written by a fellow 18D with input from around the surgical community.  It reconciles the differences between wound care done in a role 2 or 3 facility, such as serial debridements, with what is taught in the 18D Special Forces Medical Sergeant Course with regards to delayed primary closure.  One way is not “right” while the other wrong, it has more to do with the amount of time and resources available to the medic or other provider.  The remainder of the blog post and podcast is meant to be a refresher for those who have already been taught these procedures.  It is also meant to be informational for those medical directors who may not be exactly certain of what has been taught as far as wound care and surgery.  If you haven’t been trained to do these procedures before going ahead with them, it is very likely that you may do more harm to the patient than good.