Prolonged Field Care Podcast

Dennis
  • 4.9 (63)
  • 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. PFC Podcast: Velocity Kills - Wound Ballistics, Shotguns & Unpredictable Trauma in Prolonged Field Care

    2d ago

    PFC Podcast: Velocity Kills - Wound Ballistics, Shotguns & Unpredictable Trauma in Prolonged Field Care

    In this episode of the Prolonged Field Care Podcast, Dennis sits down with trauma surgeon Mark Shapiro for a no-BS masterclass on wound ballistics. They break down why understanding the physics of penetrating and blast trauma matters in austere and combat environments — even when experience makes you cynical. From high-velocity rifle rounds and their massive temporary cavities to the infectious nightmare of shotgun wounds and the four phases of blast injury, Mark shares hard-won lessons from civilian Level I trauma centers and years training special operations medics and ground surgical teams. They tackle the myths around entry/exit wounds, when (and when not) to explore right upper quadrant gunshot wounds downrange, why you should almost never pack the abdomen or chest from the outside, how to assess neurovascular status in blast-injured extremities, and why bizarre bullet paths and “stable” patients with signs of life can still surprise you. Key Takeaways: Kinetic energy (½mv²) means velocity is king — high-velocity rifle rounds create devastating temporary cavities and fragmentation that can turn one projectile into many.Jacketed rounds still fragment at rifle speeds; never assume a clean through-and-through. Bone fragments act like secondary missiles and can create wounds up to 3x the size of the fragment.For stable patients with right upper quadrant GSWs in resource-limited settings, expectant management can be reasonable — but you must have a plan, know your limits, and be ready to move if things change.Never pack the abdomen or chest from the outside in most cases. It risks pushing debris deeper and worsening injuries. Cover exposed organs if needed, but don’t shove gauze into body cavities.Shotgun wounds (especially buckshot/birdshot) are “mobile IEDs” — massive tissue destruction, heavy debris inoculation, and extremely high risk of infection, fistula, and devascularized tissue requiring serial debridement.In extremity blast trauma, assess vascular status (pulses, Doppler signals, color, warmth, capillary refill) and neurologic function. The ~6-hour window to revascularization is critical, but the decision point comes earlier.Training + common sense + adaptability beat rigid protocols when resources are limited. Sometimes the best move is observation.Chapters 04:15 – Why Wound Ballistics Knowledge Still Matters (even when you’re cynical)08:30 – High-Energy Rifle Wounds: Muzzle Velocity, Kinetic Energy & Spitzer Bullets13:45 – Fragmentation, Tumbling & Secondary Missiles (bone shards & unpredictable paths)18:20 – Clinical Reality: Multiple Injuries & Why “Small Entrance, Big Exit” Is a Myth22:50 – Entry vs. Exit Wounds: When Trajectory Actually Matters (and when it doesn’t)26:40 – Right Upper Quadrant GSWs: Explore, Observe, or Expectant Management Downrange?31:10 – The Dangers of Packing Abdominal & Chest Wounds from the Outside34:55 – Low-Energy Pistol Wounds: How They Differ (or Don’t) from Rifles37:20 – Shotgun Wounds: Close-Range Carnage, Debris & Infectious Nightmares42:40 – IEDs & Modern Explosives: Blast Physics, Ukraine Patterns & Hard-Ground Effects48:15 – Primary, Secondary, Tertiary & Quaternary Blast Injuries Explained52:30 – Neurovascular Assessment in Blast-Injured Extremities (Conscious & Unconscious Patients)56:45 – Lessons from the Trauma Bay: Common Sense, Training & Knowing When to Deviate from ProtocolFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

    58 min
  2. PFC Podcast 282: Blast Lung - Expert Tactics for Blast Lung Injury in Prolonged Field Care

    5d ago

    PFC Podcast 282: Blast Lung - Expert Tactics for Blast Lung Injury in Prolonged Field Care

    In this high-signal PFC Podcast episode, Dennis sits down with Dr. John Wightman — former 24th Special Operations Wing Surgeon, emergency physician, and one of the world’s leading experts on blast injuries. Drawing from decades of clinical, combat, and academic experience (including co-authoring a seminal paper on blast injuries just before 9/11 and multiple combat deployments), Dr. Wightman breaks down the unique pathophysiology, recognition, and prolonged field care management of blast lung injury — the often-hidden threat that can kill even when penetrating trauma doesn’t. From the physics of the supersonic pressure wave to practical field decisions on tension pneumothorax, ventilation strategies, fluid management, and avoiding air embolism, this is essential listening for medics, operators, and anyone preparing for large-scale combat operations, urban warfare, or confined-space blasts. Key Takeaways: Primary blast lung injury is caused by the blast wave itself — not fragments or being thrown — and creates unique pulmonary contusions, air leaks, and arterial air emboli risks.Most significant blast lung develops within the first 1–6 hours; subtle dyspnea on exertion can be an early warning.MARCH priorities still rule — aggressively rule out (or treat) tension pneumothorax, even bilaterally, before assuming blast lung.Positive pressure ventilation can worsen outcomes (especially air embolism risk) — use judiciously; CPAP or PEEP may be better bridges when possible.PAO₂/FiO₂ ratio (or SpO₂ on room air) helps stratify severity and predict need for advanced support.Tympanic membrane rupture proves blast exposure but is not required for blast lung.Fluid management must be careful — permissive hypotension may be dangerous in blast lung + shock.Don’t forget occult blast bowel injury — delayed perforation is real (up to 8 days).Whether you're running a team in Ukraine-style trench warfare, preparing for mass casualty events, or just want to stay on the bleeding edge of combat medicine, this episode delivers critical, actionable knowledge. Chapters: 00:43 - John Wightman Introduction: 32 Years as Air Force EM Physician & Blast Injury Expert02:54 - What Is Blast Lung? Defining Primary vs Secondary, Tertiary, Quaternary & Collateral Injuries05:23 - The Physics of the Blast Wave: Overpressure, Stress Waves & Alveolar Damage09:50 - Pathophysiology: Pulmonary Contusion, Pneumothorax, Air Embolism & Traumatic Pseudocysts12:30 - Timelines: When Does Blast Lung Declare Itself? (Israeli & Combat Data)15:56 - Epidemiology: Confined Spaces, Buses, Buildings vs Open-Air Blasts23:12 - Field Diagnosis & MARCH Priorities — Tension Pneumothorax First28:30 - Advanced Assessment: P/F Ratio, Ultrasound Findings, SpO₂ Guidance35:55 - Ventilation Strategies: When to Intubate, CPAP/PEEP, Lung Protective Settings41:18 - Oxygenation Goals, Fluid Management & Permissive Hypotension Risks52:16 - Air Embolism Management & Patient Positioning56:12 - Other Critical Considerations: Blast Bowel Injury, TM Rupture, Resource Triage01:04:36 - Final Thoughts & Key Advice for Deploying MedicsFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

    1h 6m
  3. PFC Podcast: Guerrilla Hospitals - How to Actually Build Medical Systems When Evacuation & Resupply Are Gone

    Jun 4

    PFC Podcast: Guerrilla Hospitals - How to Actually Build Medical Systems When Evacuation & Resupply Are Gone

    In this episode, Dennis sits down with Reagan Lyon, an Emergency Medicine physician and 17-year Air Force veteran who spent the majority of her career in special operations, including time on Special Operations Surgical Teams. While at the Naval Postgraduate School, Reagan wrote a thesis on one of the hardest problems in military medicine: how do you actually build and sustain indigenous medical networks in unconventional warfare and denied environments? Drawing from the Yugoslav Partisan guerrilla hospitals of WWII, modern lessons out of Ukraine, and the harsh realities of occupied territory medicine (including Iran’s protest crackdowns), Reagan breaks down why our current Role 1–4 doctrine collapses in these scenarios. She introduces a treatment-goal-based framework instead of capability-based tiers, uses systems dynamics modeling to expose the real chokepoints (training pipelines, blood, patient movement, and capacity), and makes a compelling case for radical cognitive agility and “MacGyver medicine” when the supply chain disappears. Key Takeaways: Why proximity to the fight is both your biggest advantage and fastest way to get compromisedHow to shift from “what gear do we have?” to “what treatment goals can we actually achieve?”The hidden choke points that will kill your casualty care system long before you run out of bulletsWhy forcing the “American way” on partner nations is arrogant and usually counterproductiveThe power (and ethical case) for open-source knowledge to enable a true whole-of-society medical responseWhat needs to change in training, authorities, and interoperability before the next fight If you’re a medic, planner, SOF leader, or anyone thinking seriously about large-scale combat operations or unconventional warfare medicine, this conversation is essential. Reagan doesn’t just diagnose the problem — she gives a clear path forward. Chapters 00:00 – Introduction & Reagan Lyon’s Background (Special Operations Surgical Teams to Naval Postgraduate School)05:15 – Why Tackle an “Unanswerable” Problem? (Avoiding Pat-on-the-Back Academia)09:30 – Historical Context: WWII Guerrilla Hospitals & the Yugoslav Partisans15:45 – The Core Trade-off: Proximity to the Fight vs. Security & Sustainability19:45 – Modern Parallels: Iran Protests, Telemedicine Risks & Ukraine’s Brutal Validation24:00 – Why Traditional Role 1–4 Doctrine Breaks in Denied/Unconventional Environments29:30 – A Better Framework: Treatment Goals Over Capability Tiers (Preventable Death Categories)33:45 – Systems Dynamics Modeling: Finding the Real Chokepoints in Casualty Flow38:45 – Model Validation with Ukraine + Limitations of Current Planning Tools42:45 – The Supply Nightmare: Caches, MacGyvering & Building Cognitive Agility49:30 – Partner Nation Engagement: Humility, Coordination & Avoiding the “American Way” Trap56:00 – Whole of Society Medicine: Empowering Civilians Through Open Source (Without Creating Liability)1:02:15 – Reagan’s “King for a Day” Recommendations (Training, Interoperability & Authorities)1:07:30 – Closing Thoughts & Where This Work Needs to Go Next For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

    1h 2m
  4. PFC Podcast 281: Crisis Standards of Care: The Hardest Conversations Medics and Teams Must Have

    Jun 1

    PFC Podcast 281: Crisis Standards of Care: The Hardest Conversations Medics and Teams Must Have

    In this raw and unflinching episode of the Prolonged Field Care Podcast, Dennis sits down with Thad Snyder (physician, former medic, and brigade surgeon) to tackle one of the most uncomfortable topics in combat medicine: what happens when resources run out, evacuation timelines collapse, and “doing everything” is no longer possible. Drawing from a 72-page crisis standards of care memo (originally written for flu and updated for COVID), Thad explains the shift from standard → contingency → crisis care, the ethical duty to plan for no-win scenarios, and why medics, teams, and leaders must have real conversations about capabilities, limitations, and what “living” actually means after catastrophic injury. They explore palliative/comfort care in austere environments, the emotional weight of those decisions, and practical ways to share the burden so the medic isn’t left carrying it alone. Essential listening for medics, operators, team leaders, and anyone preparing for large-scale combat or prolonged operations where the next casualty might not get a bird out for days or weeks. Key Takeaways There is a duty to plan for crisis standards of care before you’re in the middle of it.Leaders and teams must understand the real capabilities and limitations of their medics—not the 437-task training list.Pre-mission conversations about quality of life, advanced directives, and unacceptable outcomes give medics a moral framework when they have to make the hardest calls.Palliative/comfort care is already happening in modern conflicts (Ukraine, etc.) even if no one wants to talk about it.The emotional and moral burden of end-of-life decisions cannot fall solely on the medic—teams and leaders must share ownership.Staying busy to “do something” can sometimes cause more harm than shifting to dignity-focused comfort care.Chapters 00:00 – Intro & Pulling the Crisis Standards Memo from the Closet 00:56 – Standard, Contingency, and Crisis Care: What Changes When Resources Vanish 02:51 – The Duty to Plan: Preparing for No-Win Scenarios 04:55 – Why Commanders Need Brutally Honest Briefs on Medic Capabilities 06:20 – Surgical Team Limitations, Non-Survivable Injuries, and Realistic Expectations 08:40 – Advanced Directives, Quality of Life, and “Living vs. Being Alive” 11:36 – Palliative Care in Large-Scale Combat (Ukraine, Future Conflicts) 13:15 – How (and When) to Have These Conversations with Your Team 14:38 – The Emotional Reality: Holding Someone’s Hand While They Die Is Harder Than Any Procedure 20:33 – Real Hospital Examples of Hard End-of-Life Discussions 25:58 – What Outcomes Actually Matter to Warriors? (Walking, talking, independence) 32:00 – Using Patient Values as a Moral Framework in Crisis 35:04 – Offloading the Burden: Team Ownership of Comfort Care Decisions 40:43 – Shared Responsibility, Rituals, and Preventing Moral Injury 43:14 – Final Thoughts + Where to Get the Crisis Standards Document This episode is heavy, honest, and desperately needed. Share it with your team. For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

    59 min
  5. PFC Podcast: Building the Ideal SOF Clinic - Setting Up a World-Class Austere SOF Clinic

    May 28

    PFC Podcast: Building the Ideal SOF Clinic - Setting Up a World-Class Austere SOF Clinic

    In this powerful episode of the Prolonged Field Care Podcast, Special Forces Detachment Commander Nate shares his journey from medical novice to building a highly effective team clinic SOP. With only one 18D on the team, Nate realized that top cover and systems thinking were critical for success in austere environments. He discusses creating, testing, and refining a practical clinic layout, the "Care Chain" concept, realistic PFC training under fatigue, honest medical risk assessment for commanders, and breaking down the mystique of medicine for the entire team. Key Takeaways: Why commanders must dive into medical capabilities and challenge assumptions instead of leaving it solely to the medic.How to design an efficient SOF clinic using systems thinking and proxemics to reduce friction during prolonged care.The critical importance of testing medical plans with full rehearsals and pushing to realistic limits (fatigue, resource constraints).Treating prolonged field care like any other battle drill: train to standard, not convenience.Strategies for communicating medical limitations honestly to higher command and building a culture of openness.Expanding medical knowledge across the entire ODA to increase team resilience.Whether you're a commander, medic, or operator preparing for austere operations, this episode delivers practical, battle-tested insights on turning medical readiness into a true force multiplier. Podcast Chapters: 00:00 - Introduction & Guest WelcomeHost Dennis introduces Nate, SF Detachment Commander, and sets the stage.00:00 - Nate's Medical Journey & First PFC ExerciseHow a failed 24-hour PFC exercise exposed gaps in equipment familiarity, charting, and leadership involvement.03:30 - The Suffolk Experience & Understanding 18D CapabilitiesKey training that gave Nate better appreciation for medics and his own limitations.06:00 - Why Create a Team Clinic SOP?The first overseas deployment, poor rehearsal results, and the lack of existing doctrine for ODA-level clinics.09:00 - Designing the Ideal SOF ClinicSystems-based approach, "Care Chain" concept, layout, storage, vampire kits, proxemics, and reducing friction.13:30 - Testing & Iterating the SOPMoving the entire clinic, rehearsals, learning from failures, and refining based on real feedback.17:00 - Training to Standard vs. Training to ConvenienceComparing medical training to breaching, CQB, and other skills. Why PFC needs to be treated as a battle drill.21:00 - The Power of Realistic, Fatigue-Based TrainingLessons from Suffolk, Rangers' approach, and pushing teams to their actual limits.25:30 - Planning Challenges & Honest Risk AssessmentCommon failures in CONOPs, evac planning, the "death of the golden hour," and testing medical capabilities early.29:00 - Convincing Command & Building a Culture of HonestyCommunicating limitations, resource requirements, and fostering intellectual openness.33:00 - Expanding Medical Knowledge Across the TeamDemystifying medicine, operator-level training, and treating it like ballistics or demolitions.36:30 - Final Thoughts & Call for FeedbackNate's request for community input on the clinic SOP and closing remarks.For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

    25 min
  6. PFC Podcast 280: Hantavirus in the Field: Cruise Ship Outbreak, Deadly Clues & Field-Ready Lessons Every Medic Must Know

    May 26

    PFC Podcast 280: Hantavirus in the Field: Cruise Ship Outbreak, Deadly Clues & Field-Ready Lessons Every Medic Must Know

    What happens when a sharp-eyed cruise ship doctor spots a hantavirus amid a sea of hangovers and flu symptoms? In this high-stakes episode of the Prolonged Field Care Podcast, Dennis sits down with Dr. Ryan Maves — combat-experienced infectious disease expert and military medicine veteran — to break down the shocking recent Andes virus outbreak. Far from the next global pandemic, hantaviruses are a real, rodent-borne threat that has hit soldiers before (Korean War, anyone?) and can strike deployed units in austere environments. Ryan delivers hard-hitting insights on rapid diagnosis, the “off-script” decompensation that screams hantavirus, supportive care when there’s no magic antiviral, and — most importantly — prevention strategies that actually work in the field. If you operate in rodent-infested buildings, set up in abandoned structures, or just want to trust your gut when a patient goes south fast, this episode is required listening. Real talk from the A-team who are currently managing these patients stateside. Key Takeaways Classic presentation: Flu-like prodrome (fever, fatigue, myalgias, GI upset) for a few days followed by sudden shock, respiratory failure, and decompensation.Bedside diagnostic gold: Thrombocytopenia (low platelets) + hemoconcentration (elevated hematocrit) in a previously healthy patient = major red flag.Treatment reality: Purely supportive — fluids, pressors, oxygen, renal support. No silver-bullet antiviral; ribavirin has limited data at best.Prevention beats everything: Humans are dead-end hosts. Avoid aerosolizing rodent urine/feces/droppings (no dry sweeping!). Use bleach, N95 (or equivalent), gloves, and gown.Human-to-human spread: Extremely rare except with Andes virus (this outbreak strain). Still, treat unknowns with respect.Military relevance: Endemic in deployment zones worldwide; occupying previously rat-infested buildings is a classic risk. History tied directly to U.S. troops in Korea.Mindset: When things go “off script,” trust your clinical instincts over machines. The best tool in the field is still an experienced medic’s gut. Chapters00:00 – Welcome back to the PFC Podcast00:26 – Introducing Dr. Ryan Maves & the cruise ship outbreak00:55 – Why this isn’t the next pandemic… but still matters03:04 – Military relevance: hantaviruses in deployment zones03:51 – How the cruise ship doc nailed the diagnosis05:27 – Clinical syndrome & the “virus-y” prodrome07:04 – Key labs: thrombocytopenia + hemoconcentration explained09:42 – Disease progression and why young healthy people can still crash10:50 – History of hantaviruses (Korean War → Sin Nombre → Andes)12:21 – Who actually dies and why14:50 – Biocontainment units and the military experts on the case17:35 – Treatment in the field: supportive care only19:35 – Shock management: distributive + capillary leak20:55 – Prevention is king: rodent control & PPE tactics24:22 – Human-to-human transmission (Andes virus exception)27:31 – Infection control, differential diagnosis, and real-world precautions30:08 – Final thoughts: clinical acumen, zoonoses, and trusting your instincts32:32 – Closing & where to find more PFC content Grab your N95 and hit play For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

    33 min
  7. PFC Podcast: Traumatic Cardiac Arrest - Real-World ACLS for Austere & Combat Medicine

    May 21

    PFC Podcast: Traumatic Cardiac Arrest - Real-World ACLS for Austere & Combat Medicine

    In this hard-hitting episode of the PFC Podcast, Dennis sits down with Doug, a cardiothoracic ICU physician, for a no-fluff deep dive into ACLS with a heavy focus on pulseless VT and VFib in austere, military, and prolonged field care environments. From deciding when CPR is worth it under fire or in a mass casualty scenario, to running a lean team code with minimal personnel, nailing high-quality BLS, working the H’s and T’s under chaos, post-ROSC pitfalls, antiarrhythmics, and the gut-wrenching decision of when to call it — this conversation delivers practical, experience-based wisdom you won’t find in standard ACLS class. Whether you’re a medic, PA, physician, or team leader operating far from a hospital, this episode gives you the mental framework and tactical edge to give your teammate the best possible shot at survival. Key Takeaways: Scene safety and triage realities — when not to start CPRHow one knowledgeable person can effectively run an entire code by delegating roles (CPR rotations, timer, airway, meds, defibrillator)Prioritizing actions in resource-limited environments: early high-quality CPR + epi > everything elseWhen and how to practically apply the H’s and T’s (especially hypovolemia, acidosis, hypoxia, and tension pneumo)Post-ROSC critical care: preventing rearrest, airway management, sedation, and treating the “two patients” (heart + brain)Amiodarone vs Lidocaine — when to use whatRealistic termination of resuscitation guidelines, the difference between witnessed vs unwitnessed arrest, and the value of objective outside input (telemedicine)The power of bringing the team in for closure when the fight is overChapters 00:00 – Intro & Welcome00:57 – Can you really do CPR in the field? Safety, triage, and mass casualty realities02:57 – Running a code with minimal trained personnel – how one leader directs chaos06:02 – Essential team roles: CPR rotation, AED/pads, airway, access, and early epi09:08 – Making the H’s and T’s actually useful (hypovolemia, acidosis, hypoxia, tension physiology)16:53 – Post-ROSC care: Preventing rearrest, airway security, sedation, and neuroprotection20:41 – Antiarrhythmics – Amiodarone vs Lidocaine, dosing, and post-arrest infusions22:53 – The hard call: When to terminate resuscitation (witnessed vs unwitnessed, resources, hypothermia exception)28:19 – Emotional reality of coding teammates and giving families/teammates closure33:21 – Final pearls: Telemedicine, ultrasound/video for handoff, STEMI considerations, and medevac prep36:03 – Closing thoughts & resources For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

    37 min
  8. PFC Podcast 279: Mastering Abdominal Trauma in Prolonged Field Care

    May 18

    PFC Podcast 279: Mastering Abdominal Trauma in Prolonged Field Care

    In this no-fluff, high-stakes episode of the PFC Podcast, Dennis sits down with Patrick Liebel - trauma/ICU surgeon to tackle the injury that makes every medic’s stomach drop: penetrating abdominal trauma. When the golden hour stretches into days, evacuation is delayed, and your patient’s belly is a black box of bleeding, contamination, and impending sepsis, what do you actually do? Patrick delivers hard-earned, practical wisdom on hemorrhage control, evisceration management, permissive hypotension, antibiotics, nutrition, peritonitis, and abdominal compartment syndrome — all tailored for the austere, resource-limited prolonged field care environment. If you carry a medic bag and might one day face a guy with his guts hanging out and no surgeon in sight, this episode is required listening. Real talk, real decisions, real consequences. Key Takeaways (Actionable Gold for Every Medic): Mesenteric torsion = widespread ischemia → never spin the bowel for hemorrhage control. Clamp or ligate targeted vessels instead.Clamping is fine in the heat of the moment — revise to ligation later when safe. Remember: every vessel has two ends.Eviscerated bowel is happier inside the abdomen. Tuck it back if you can (keep it wet, protect it). Only widen the defect if ischemia is imminent and you’re in a controlled setting.Solid organ (liver/spleen) bleeding → permissive hypotension is your only friend. Titrate to mental status + palpable radial pulse. Track trends, not single numbers.Assume hollow viscus injury until proven otherwise. Hit it hard and early with antibiotics (Ceftriaxone + Flagyl is the practical winner most teams actually carry).Nutrition: If they’re hungry, stable, soft abdomen, and no peritonitis after 1–2 days → feed them. Start slow, listen to the patient.Peritonitis = bad news. You’ve done everything possible with antibiotics and resuscitation — now you’re buying time for definitive surgery.Abdominal compartment syndrome is rare with whole blood resuscitation but lethal if it develops. Watch for progressive distension + organ dysfunction (urine output drop + respiratory failure).Document everything. Trends in vitals, urine output, mental status, and abdominal exam are your lifeline in PFC. Chapters: 00:00 – 01:30 Welcome & Patrick Liebel Introduction01:30 – 08:00 Hemorrhage Control: Clamping, Ligating, and Why You Should Never Spin the Bowel08:00 – 14:30 Evisceration Management — Tuck It, Widen It, or Leave It?14:30 – 25:00 Solid Organ Injuries & Permissive Hypotension in PFC25:00 – 35:00 Prolonged Critical Care Monitoring, Urine Output, and Trend Analysis35:00 – 42:00 Contamination Control, Antibiotics, and Hollow Viscus Injuries42:00 – 49:00 Nutrition, Ileus, and When to Feed49:00 – 57:00 Peritonitis, Sepsis, and Abdominal Compartment Syndrome57:00 – End Final Pearls, Nursing Care, and Closing ThoughtsFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

    1 hr
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Ratings & Reviews

4.9
out of 5
63 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

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