Prolonged Field Care Podcast

Dennis
  • 4.9 (65)
  • Education

Become a Paid Subscriber: https://creators.spotify.com/pod/show/dennis3211/subscribe This podcast and website is dedicated to the healthcare professional who needs to provide high quality care in a very austere location. For more content: www.prolongedfieldcare.org Consider supporting us on: patreon.com/ProlongedFieldCareCollective

  1. 2d ago

    291 - Pediatric Burns In Prolonged Field Care Assessment, Resuscitation & Airway Management

    In this essential episode of the Prolonged Field Care Podcast, Dennis sits down with pediatric intensivist Dr. Sara Bibbens to tackle one of the most challenging and anxiety-inducing scenarios in austere medicine: pediatric burns. From initial trauma assessment using MARCH/ABCDE to nuanced airway decisions in small children, burn resuscitation formulas, fluid management pitfalls, hypothermia prevention, wound care, and safe pain/sedation strategies, this conversation delivers practical, downrange-applicable guidance every combat medic, flight medic, and austere provider needs. Key Takeaways: Stick to MARCH/ABCDE — don’t get distracted by dramatic burns; treat life threats first.Pediatric airways swell faster — early intubation considerations (GCS 8, large TBSA, stridor, facial burns, soot).Initial fluid resuscitation rates by age + precise TBSA calculation using the Consensus Formula (3 mL × kg × %TBSA).Add maintenance D5 fluids in kids 30 kg and titrate everything to urine output goals (1 mL/kg/hr under 30 kg; 0.5 mL/kg/hr over 30 kg).Plasma-based resuscitation is preferred when available.Hypothermia prevention is more critical in children due to higher BSA-to-mass ratio.Pain management: Start low with opioids (morphine preferred), ketamine for dissociation/procedural sedation; watch for respiratory depression when combining meds.Avoid routine prophylactic antibiotics; focus on source control and dry dressings.Whether you’re operating in contested environments, remote settings, or supporting pediatric casualties, this episode arms you with the knowledge to avoid common pitfalls like fluid creep and over-resuscitation while delivering life-saving care. Website: ⁠www.prolongedfieldcare.org⁠ Follow @prolonged_field_care on Instagram for carousels, reels, and more austere medicine content. Subscribe and stay on the bleeding edge of combat casualty care. Episode Chapters00:00 - Introduction & Welcome00:46 - Guest Introduction: Dr. Sara Bibbens, Pediatric Intensivist01:04 - Initial Assessment: MARCH/ABCDE in Burned Pediatric Patients02:43 - Prioritizing Life Threats Over Dramatic Burns03:37 - Airway Management in Children: When to Intubate?06:11 - Surgical Airway Limitations & Head Positioning in Pediatrics07:42 - Burn Resuscitation: Initial Fluids & Rule of Tens Limitations08:04 - Pediatric Lund-Browder Chart, TBSA Estimation & Consensus Formula11:46 - Maintenance Fluids (D5) + 4-2-1 Rule in Kids 30 kg13:26 - Glucose Goals & Dextrose Fluid Mixing in Austere Settings14:14 - Urine Output Goals & Endpoints for Resuscitation16:15 - Avoiding Fluid Overload & Fluid Creep in Pediatrics19:00 - Plasma Resuscitation (Vanderbilt Protocol) in Burns20:25 - Titration Strategy: Urine Output Over Fixed Formulas21:52 - Creative Urine Output Measurement (Diaper Weights)22:59 - Hypothermia Prevention in Children (Large Head, High BSA:Mass)24:26 - Wound Care & Why to Avoid Prophylactic Antibiotics25:37 - Pain & Sedation Management: Opioids, Ketamine Dosing & Monitoring28:46 - Common Pitfalls: Fluid Over-Resuscitation29:48 - Managing Fluid Overload & Closing Thoughts

    291 - Pediatric Burns In Prolonged Field Care Assessment, Resuscitation & Airway Management

  2. 6d ago

    SOMA 26 - A History of Mobile Surgical Teams Role 1-3 and Horizon Scan

    In this presentation, we take a deep dive into the 300-year history of mobile surgery supporting land campaigns — from Dominique Larrey’s ambulance volantes through the Letterman system, Arnhem, the Falklands, Mali, and the current Russia-Ukraine war. Drawing on rare surgical memoirs, battle maps, and personal accounts, the discussion extracts the recurring problems that technology has never fully solved: logistics drag, extended timelines, signature management, and the tension between mobility and capability. We then turn to the horizon. In an era of mosaic warfare and large-scale combat operations, medicine cannot remain a drag factor. The talk explores contractile and expandable surgical systems, single-surgeon reach, austere armored resuscitation teams, underground and containerized facilities, emissions control, and how we expand the surgical workforce under resource constraints while still doing the most for the most. Whether you are preparing for LSCO, SOF support, or prolonged field care in denied environments, the hard-won lessons of the past remain the best preparation for the fight ahead. Key Takeaways Mobile surgery is not new — Larrey, Guthrie, Pirogov, and Letterman already solved (and documented) many of the mobility and triage problems we still face.Institutional memory fades fast. Rare single-edition war surgery texts must be digitized and pushed into training pipelines before the lessons are watered down.In mosaic warfare the linear Role 1–4 model is insufficient. Surgical capability must become a mesh: dispersed, diggable, low-signature, and able to expand or contract with the fight.Big fixed facilities and large tented Role 2/3s become high-value targets. Single-surgeon or small polyvalent teams, pre-dug containers, underground sites, and armored austere teams offer greater survivability and shorter wounding-to-surgery times.Blood, sterilizing capacity, anesthetic volume, and outflow remain the greatest logistic constraints. Expectation management and robust triage (including expectant) will be non-negotiable.Capability can be extended by bringing registrars, ODPs/CRNA-equivalents, and well-trained medics further forward earlier — but this requires deliberate peacetime training and wartime derogations.Command and control, decision-making loops, and the ability to cache or hand off casualties must be rehearsed now, not improvised under fire.Chapters 00:00 – Introduction & Scope: 300 Years of Mobile Surgery02:00 – Institutional Memory, Rare Texts & the Risk of Forgetting05:25 – Dominique Larrey & the Birth of the Ambulance Volante07:00 – Guthrie, Napoleonic Lessons & Early British Mobility07:40 – Crimea, Pirogov’s Forward Teams & Brunel’s Prefabs08:15 – The Letterman System & the American Civil War08:50 – World War I: Auto-Chir, Operating Cars & the Limits of Static Warfare11:15 – Spanish Civil War: Civilian Surgeons & Fluid Fronts12:00 – World War II Desert, SAS & the Reality of Extreme Isolation13:40 – Arnhem, Market Garden & Improvised Care Under Fire16:00 – Varsity, Chindits & the Logistics Drag of Jungle Warfare18:00 – Falklands, Gulf War, Mali & Modern Mobility Challenges19:50 – Ukraine: Extended Timelines, Targeting of Medical Assets & Aged Injuries20:50 – Horizon Scan: Mosaic Warfare & Contractile Surgical Systems22:00 – Dispersion, Digging In, Underground Facilities & Signature Management24:00 – Capability Extenders, Team Composition & Decision-Making Under Constraint25:30 – Logistics, Blood, Sterilization & the Middle Ground Between Fixed and Tiny Teams27:00 – Closing Thoughts & Questions Follow @prolonged_field_care and visit prolongedfieldcare.org for more austere and prolonged field care education.

    SOMA 26 - A History of Mobile Surgical Teams Role 1-3 and Horizon Scan

  3. Aug 3

    290 -Manufacturing Medical Gear In A War Zone: Aluminum Splints, Plastic Drag Litters & The Human Side Of War

    In this episode of the Prolonged Field Care Podcast, Dennis sits down with Alex, CEO of Shannon Mechanics, a Ukrainian company that has produced more than 8,000 drag stretchers and over 330,000 immobilization splints for the front line since the full-scale invasion. Alex shares the raw story of how the company started with scrap materials and construction-store aluminum during the early chaos of 2022, scaled production while operating physically underground with independent power and battery-powered equipment, and refined products based on real soldier feedback. They discuss the BM splint (a more rigid, radiolucent alternative designed for Ukrainian conditions), the philosophy behind their rollable plastic drag stretcher optimized for one-person extraction under drone threat and complex terrain, quality control under resource constraints, the transition from pure volunteering to a sustainable business, and the deeper questions of dignity in life and death, PTSD, and long-term rehabilitation. This is practical, unfiltered insight into how medical manufacturing adapts when supply lines collapse, borders close, and every piece of gear has to work in the worst conditions imaginable. Key Takeaways Medical equipment designed for true one-person drag evacuation becomes critical when vehicles and multi-person teams are unavailable under drone threat and destroyed terrain.Starting with simple, locally available materials (construction-store aluminum for splints) allowed rapid production when imports were impossible.Operating underground with independent power, internet, and battery-powered tools enables continuity during blackouts and air raids.Visual quality control plus a “donation pile” for minor cosmetic defects keeps functional gear moving to the front while supporting community needs.Sustainable production requires paying people and covering costs—pure volunteering burns out and collapses.Feedback loops from soldiers drive continuous product improvement (rigidity, size options, packing for NATO pouches).Beyond the gear itself, the conversation highlights the need for dignity in recovery of the wounded and the fallen, plus long-term psychological and prosthetic support for survivors. Chapters 00:00 – Introduction & Disclaimer 00:26 – Meet Alex: CEO of Shannon Mechanics 01:15 – Company origins: Revolution of Dignity to 2014–2022 02:41 – Humble beginnings, scrap materials, and the siege of Kyiv 04:55 – Building supply chains under closed borders 07:18 – Starting with BM splints, then the Utah/drag stretcher 08:06 – Material challenges and community-driven solutions 11:20 – Learning the craft, teaching production, and favoring people over full automation 13:26 – From volunteering to a sustainable business model 16:21 – Quality control process for splints 23:20 – Introducing the drag stretcher design philosophy 24:02 – Why rigid NATO litters fail in modern Ukrainian conditions 25:01 – One-person drag, complex terrain, drones, and secondary injury prevention 28:15 – Limitations (sniper fire) and real-world evacuation stories (8 km drag, quad bike integration) 30:32 – Hypothermia protection, mud/snow durability, and recovery of the fallen 34:40 – PTSD as generational trauma and the need for long-term support 40:00 – Managing supply chain volatility and building Ukrainian supplier capacity 42:39 – What has allowed the company to succeed during war For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠⁠

    290 -Manufacturing Medical Gear In A War Zone: Aluminum Splints, Plastic Drag Litters & The Human Side Of War

  4. Jul 30

    Managing the Combative Patient: Hyperactive Delirium with Severe Agitation, Ketamine & Field Reality

    In this episode of the Prolonged Field Care Podcast, Dennis sits down with J.R. Pickett — unpack the controversial and high-stakes topic of what used to be called excited delirium. They dig into the history of the syndrome (Bell’s mania, acute exhaustive mania, agitated delirium), why major organizations including ACEP, ACMT, and the National Association of Medical Examiners have rejected the term, and the preferred modern language: hyperactive delirium with severe agitation. The conversation covers real-world presentation, the physiologic cascade that can lead to sudden cardiovascular collapse, the critical differences between a contained hospital environment and the uncontrolled street or austere setting, and the hard lessons from the Elijah McClain case. J.R. walks through practical decision-making for EMS and tactical medics: when de-escalation is possible, when sedation becomes necessary, why intramuscular ketamine remains the most forgiving and rapid option for the violently agitated patient, how to prepare for the predictable risks (brief apnea, loss of airway protection, metabolic derangement), and why continuous medical eyes-on monitoring after sedation is non-negotiable. They also address the dangerous intersection of law enforcement and medical care, the myth of “if they can talk they can breathe,” and the growing criminalization of medical decision-making that threatens providers’ willingness to engage. Key Takeaways The condition is a true medical emergency with historically high mortality, even without restraint or intervention.Engagement ability is a practical field litmus test: if the patient cannot be redirected or answer basic questions, rapid intervention is usually required.Ketamine’s wide therapeutic index and rapid IM onset make it the preferred agent for violent agitation when IV access is impossible — but it is not risk-free.Sedation is a procedure. Have airway equipment, monitors, and a clear team plan ready before the drug is given. Continuous medical provider eyes-on is mandatory in the early phase.“If you can talk, you can breathe” is dangerous teaching. Treat complaints of inability to breathe seriously.Noble intent + thorough preparation is the best defense against both bad outcomes and the growing criminalization of medical care. Chapters 02:45 – What is (or was) excited delirium? History, physiology, and why the term is being abandoned09:30 – Real-world presentation vs. “just being a jerk” and the challenge of the uncontrolled environment15:20 – Elijah McClain case and the broader controversy around restraint, force, and medical justification21:00 – Causes of severe agitation and the difficulty of sorting them in the field26:45 – Clinical clues and the “can I engage?” litmus test32:10 – The physiology of sudden collapse: acidosis, rhabdomyolysis, and the danger of sudden quiet37:40 – “I can’t breathe” and why that teaching is hazardous45:50 – Ketamine deep dive: dosing, therapeutic index, risks, and why it is still the safest rapid option55:20 – Comparison with benzodiazepines and antipsychotics; timing matters01:01:00 – Treating sedation like a procedure: airway readiness, monitoring, team roles, and continuous eyes-on01:10:30 – Police vs. medical roles, the myth of walking away, and the duty to act01:18:00 – Criminalization of medical care and final thoughts on honorable intentFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠⁠

    Managing the Combative Patient: Hyperactive Delirium with Severe Agitation, Ketamine & Field Reality

  5. Jul 27

    289: Guerrilla Surgeon: Life-Saving Surgery in Caves, Dirt Rooms & War Zones

    In this raw and eye-opening episode of the PFC Podcast, Dennis sits down with Jason, a general surgeon who completed nine combat deployments (seven in special operations) and has since operated in caves, dirt-floored schoolhouses, living rooms, and active conflict zones across multiple countries with nothing but a small team and minimal kit. Jason breaks down the hard truths of “guerrilla surgery” — what actually happens when you strip away the three-truck, 21-person forward surgical team and force a four-person element to provide meaningful surgical care far forward in denied or unconventional environments. He explains why the biggest barrier to austere surgery is often the surgeon’s own mindset, how he went from carrying 60 instruments down to the 10 he actually uses, and the critical (and often misunderstood) difference between damage control surgery and definitive field care when follow-on care is not guaranteed. Listeners will hear real-world lessons on space requirements, sterility compromises, anesthesia options with almost nothing, and the courage required to operate when the alternative is certain death for the patient. Key Takeaways: Reduced inventory forces reduced capability — fighting this reality gets people killedThe surgeon is frequently the biggest obstacle to effective austere operationsHow to ruthlessly pare down to the 10 instruments you will actually useWhy damage control surgery can be the wrong choice when you may never see the patient againThe 10 × 8 × 7 foot rule for creating a functional austere operating spaceHow to make sterility decisions when someone is bleeding to death in front of youAnesthesia progression from local blocks to ketamine, spinal, and general in denied environmentsThe mindset shift required to move from “we can do everything” to “what can we actually do here that adds value?” Whether you’re a military surgeon, forward surgical team member, special operations medic, or anyone serious about prolonged field care and austere medicine, this episode will fundamentally change how you think about surgical capability in resource-poor, high-threat environments. Connect with Jason’s work through the Four Winds Professional Guild at ⁠www.4wguild.org⁠. Chapters 00:00 – Podcast Introduction & Guest Welcome00:55 – Jason’s Background: 9 Combat Deployments (7 in Special Operations) & Global Missions02:22 – The Ghost Team Experiment: Why “We Can Do Everything with Less” Is Dangerous04:23 – Why Surgeons Themselves Often Block Effective Austere Operations05:43 – Military Training vs. The Harsh Realities of Austere & Unconventional Warfare08:04 – Paring Down from 60 Instruments to the 10 You Actually Use09:03 – The Hard Realities of War Zones: Doing No Harm When the System Doesn’t Exist11:10 – Small Team Dynamics: You Are the Pre-Op, OR, and PACU13:35 – Damage Control Surgery vs. Definitive Field Care in Denied Environments16:42 – What Actually Drives Your Kit: Terrain, Evacuation Times, Aftercare & Patient Population21:08 – Longer Evacuation Times Change Everything About Your Surgical Approach22:17 – The Critical Decision: Quick & Dirty vs. All-In Definitive Care27:02 – The 10 × 8 × 7 Foot Rule: Minimum Space Requirements for Austere Surgery29:28 – Sterility in Austere Environments: Bare Minimum Standards That Actually Matter32:30 – When Non-Sterile Technique Is the Only Way to Keep Someone Alive35:43 – Anesthesia Options When You Have Almost Nothing (Local → Ketamine → Spinal → General)39:01 – Advice to New Austere Surgeons: Courage, Basic Principles & Trial & Error Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

    289: Guerrilla Surgeon: Life-Saving Surgery in Caves, Dirt Rooms & War Zones

  6. Jul 23

    From Tourniquet to Crush: Mastering Hyperkalemia with Calcium in Prolonged Field Care

    In this episode of the Prolonged Field Care Podcast, Dennis sits down with Alex to dissect a controversial claim that calcium is useless for hyperkalemia during cardiac arrest. What started as a social media post that "set his hair on fire" led to a full investigation: reading the primary paper, digging into its references, and uncovering how conclusions can get twisted. They break down the study’s methods, limitations, and real applicability to austere, prehospital, and operational medicine — including crush injuries, medical CPR on base, and why black-and-white social media takes often miss the gray reality of medicine. Topics include cardiac membrane stabilization, physiologic mechanisms, JTS CPGs, confounders in resuscitation research, and why you should always chase the references. Key Takeaways: Calcium doesn’t lower potassium — it stabilizes the cardiac membrane and buys critical time.The referenced paper has significant limitations (small hyperkalemia subgroup, very sick patients, poor outcomes overall) and does not support abandoning calcium.Medicine is gray: knowledge translation lags, and even published papers can overreach conclusions.In austere/prolonged field care, if your teammate is in arrest and it’s safe to act, calcium + bicarb is still worth using while addressing reversible causes (Hs & Ts).Always evaluate studies with PICO, look for confounders, and consider functional outcomes (e.g., Modified Rankin Scale) over simple survival.Peak T-waves are unreliable — treat based on mechanism of injury and clinical suspicion.Whether you’re a tactical medic, flight medic, or austere provider, this episode sharpens your critical thinking and reinforces why calcium remains in the toolkit. Resources & Links: JTS Clinical Practice Guidelines on HyperkalemiaProlonged Field Care website: www.prolongedfieldcare.orgFresh PFC Coffee & free downloads Subscribe, share with your team, and stay on the bleeding edge of austere medicine. Episode Chapters 00:00 – Intro & Welcome00:45 – The Social Media Post That Started It: “Calcium is Useless”02:18 – Knowledge Translation Lag & Gray Areas in Medicine06:05 – Why Dennis Dug Into the References08:21 – Does Medical CPR Apply to Operational Medicine?11:06 – PICO Breakdown of the Study (Taiwan Retrospective Review)15:50 – Better Outcomes Than Just “Dead vs Alive” – Modified Rankin Scale17:39 – Study Results: ROSC, Survival, and Neurologic Outcomes21:08 – Physiology: How Calcium & Sodium Bicarb Actually Work in Hyperkalemia28:52 – Field Recognition of Hyperkalemia (Crush Injury, Relative Bradycardia)31:58 – JTS CPGs, Treatment Thresholds (K+ >6.5), and Why Labs Aren’t Everything35:40 – Very High Potassium Levels & Prognosis in Prolonged Arrest39:20 – Final Thoughts: Don’t Abandon Calcium Based on Weak EvidenceFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

    From Tourniquet to Crush: Mastering Hyperkalemia with Calcium in Prolonged Field Care

  7. Jul 20

    288: Blood, Citrate & Cardiac Chaos – Rethinking Calcium in Prolonged Field Care

    In this episode of the Prolonged Field Care Podcast, Dennis sits down with Dr. Andre Cap to unpack the evolving role of calcium in trauma resuscitation. What started as the “new hotness” in forward blood transfusion protocols has become far more nuanced. They discuss the dangers of both hypocalcemia and hypercalcemia, how citrate in all blood products binds ionized calcium, cardiac effects, recent observational data showing worse outcomes with hypercalcemia, and practical guidance for when, how, and how much calcium to give in austere and prolonged field care environments. Whether you’re running a Role 2, working prolonged field care, or just trying to keep your patient alive until definitive care, this episode challenges long-held assumptions and offers field-practical recommendations. Key Takeaways: All blood products contain citrate, which binds ionized calcium — expect hypocalcemia with significant transfusion.Both hypo- and hypercalcemia are bad; recent data shows hypercalcemia is associated with worse mortality than hypocalcemia.Current TCCC guidance (1g calcium after first unit) was written to fix under-use; it may now be too aggressive in some scenarios.Give calcium after blood products, not before. Consider waiting until after 2+ units in most cases.Slow IV push (over ~5 minutes) through a confirmed good peripheral line; calcium chloride is a vesicant — use caution (gluconate is safer).Avoid calcium chloride via IO if possible. Titrate to clinical response when monitoring isn’t available.In refractory shock you can give more, but don’t give calcium as a standalone resuscitation drug — it can be harmful without volume replacement.Ideal future state: Bring i-STAT capability forward when feasible and get better RCT data. Perfect for medics, PAs, physicians, and anyone managing hemorrhagic shock in austere environments. Links:⁠www.prolongedfieldcare.org⁠ | @prolonged_field_care Podcast Chapters (with Timestamps): 00:00 – Intro & Welcome00:39 – Why Calcium Became “The New Hotness” in Trauma Care01:18 – The Joint Trauma System Audit That Started It All03:46 – Citrate in Every Blood Product – The Science Behind the Bind05:44 – Why We Actually Care: Cardiac Repolarization, Contractility & Vascular Tone08:49 – Hypocalcemia vs Hypercalcemia in Trauma Patients10:21 – Shocking New Data: Hypercalcemia Carries Higher Mortality13:14 – TCCC Guidelines – After First Unit? Is This Too Aggressive?14:03 – When Should You Actually Give Calcium in the Field?19:34 – Clinical Triggers Without Monitoring + Dosing Strategy24:56 – Safety First: IV Patency, Calcium Chloride vs Gluconate, IO Concerns28:44 – When to Stop Giving Calcium & Avoiding Over-Correction32:00 – Historical Lessons: When Calcium Alone Made Things Worse33:39 – Practical PFC Recommendations & Final Thoughts38:04 – Closing & Where to Find More For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

    288: Blood, Citrate & Cardiac Chaos – Rethinking Calcium in Prolonged Field Care

  8. Jul 16

    Burn Resuscitation Revelation: Fluid Restriction + Early Plasma Beats Parkland in PFC

    In this episode of the Prolonged Field Care Podcast, Dennis sits down with Alex to break down a hot-off-the-press retrospective study from the Journal of the American College of Surgeons titled “Challenging Legacy Burn Resuscitation Paradigms with Fluid Restriction and Early Plasma.” They dismantle the decades-old “swell to get well” mentality and the classic Parkland formula that has led to dangerous fluid overload, massive edema, and compartment syndromes in burn patients. Instead, they explore a more physiologic approach using lower crystalloid volumes (starting at 2 mL/kg adjusted body weight) plus early fresh frozen plasma (FFP) for patients with larger burns. Key Takeaways: The Parkland formula (4 mL/kg/%TBSA) frequently causes massive over-resuscitation; the new restrictive approach delivered significantly less fluid while maintaining (and often improving) urine output.Capillary leak from glycocalyx damage is the real enemy in burn shock — plasma helps restore oncotic pressure and may reduce third-spacing.Titrate everything to urine output (target 0.3–0.5 mL/kg/hr). Formulas are only a starting point.Use adjusted body weight (ideal body weight + 0.4 × [actual – ideal]) instead of actual body weight for fluid calculations.Early plasma (1–2 units for >30% TBSA) showed a strong signal toward lower mortality, less ventilator days, and reduced renal failure in this study.The Joint Trauma System (JTS) Burn Care CPG still emphasizes early consultation with a burn center — phone a friend early.This approach has direct application for prolonged field care and austere environments, though the study is retrospective and should be implemented thoughtfully.Whether you’re a special operations medic, flight paramedic, or managing burns in a resource-limited setting, this conversation will fundamentally change how you think about burn shock resuscitation. Resources: prolongedfieldcare.org (free downloads, worksheets & more)Follow @prolonged_field_care on InstagramJTS Burn Care CPG (CPG #12) – includes the excellent burn resuscitation worksheet Chapters: 00:00 – Introduction: Why Burn Care Still Terrifies Experienced Medics 03:09 – The Horrifying Reality of Over-Resuscitation (Edema Photos & Leaky Pipe Analogy) 05:30 – Understanding the Glycocalyx and Why Crystalloid Leaks So Fast 09:05 – The One-Third Rule Myth & Why Fluids Disappear in Sick Burn Patients 11:14 – Parkland Formula Breakdown: History, Math & Its Biggest Flaw 13:00 – The New Study: PICO, Methods & the Shift to 2 mL/kg + Early Plasma 16:54 – Elevator Pitch: What This Paper Actually Found 20:06 – Primary Results: Dramatically Less Fluid with the Restrictive Protocol 21:24 – Urine Output Reality Check: Why the “Less Fluid” Group Still Hit Targets 24:23 – Practical Protocol Breakdown: Who Gets 2 mL vs 3 mL + When to Give Plasma 25:30 – Adjusted Body Weight Calculation Explained (and Why It Matters) 27:26 – Titration to Urine Output is King – Stop Chasing Vitals 29:55 – Dennis Rates the Evidence on the PFC Gestalt Scale 30:38 – Why Plasma Makes Physiologic Sense (and Whole Blood May Be Next) 35:30 – Study Limitations & Provider Bias Discussion 37:30 – Can We Implement This in Prolonged Field Care Right Now? 38:38 – JTS Burn Care CPG: The Burn Center Contact You Need to Save 42:53 – Final Advice: Titrate Aggressively, Phone a Friend Early, Close the Gap For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

    Burn Resuscitation Revelation: Fluid Restriction + Early Plasma Beats Parkland in PFC
See All (611)

Ratings & Reviews

4.9
out of 5
65 Ratings

About

Become a Paid Subscriber: https://creators.spotify.com/pod/show/dennis3211/subscribe This podcast and website is dedicated to the healthcare professional who needs to provide high quality care in a very austere location. For more content: www.prolongedfieldcare.org Consider supporting us on: patreon.com/ProlongedFieldCareCollective

Information

You Might Also Like