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 Post subject: Prolonged Field Care
PostPosted: Mon Nov 28, 2016 11:46 am 
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https://prolongedfieldcare.org/

Check it out guys. I've been reading through the site for about three days, and have picked up a lot of interesting ideas.

Key talking points:

The Ruck, Truck, House, Plane concept is worth consideration in the disaster care model. Specifically the idea of a list of goals or outcomes, and then packing to meet those goals.

The idea of prolonged care, not within the Golden hour or extending the Golden hour, but treating the patient through the critical phases of treatment and effectively meeting their care needs in the field.

Prolonged field care needs to push good medicine into the field, not just expand on existing field concepts and capabilities.

Looking at the latest example case, care providers need to get a solid handle on the idea that quick rescues could turn into camp outs.

Expendable supplies run out quickly, and effective triage and rationing is going to be critical in long term field care.

Long term monitoring, including I's and O's, has a place in field care.

Consults in the field is an interesting idea. While we may not get SOF level support, evaluating your medical resources and thinking about how you could utilize them might be an effective use of time.

I'll be sure to break this down more for future discussion. I know, based on what I've seen, that I've rethought several modules of my larger bags.


Last edited by VXMerlinXV on Thu Jan 12, 2017 12:30 am, edited 1 time in total.

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 Post subject: Re: Prolonged Field Care
PostPosted: Wed Jan 11, 2017 6:52 pm 
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Thanks for sharing.

The area of Prolonged Field Care (PFC) is very exciting. The PFC Group posts a lot of great stuff on their website and youtube channel.

Lots to think about as a prepper as well. My wife and I are in charge on the Medical section of our MAG.

They have tones of cool resources to download for FREE, such as this nice chart to track vital signs and other care provided over time:

https://prolongedfieldcare.org/great-reads-checklists-cheat-sheets-and-other-resources-from-external-sites-that-we-have-found-helpful/

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 Post subject: Re: Prolonged Field Care
PostPosted: Mon Jan 30, 2017 3:19 pm 
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https://prolongedfieldcare.org/great-reads-checklists-cheat-sheets-and-other-resources-from-external-sites-that-we-have-found-helpful/

Ok, so the Ten Essential Capabilities grid. This is what PFC working group has concluded the following capabilities to be essential to treating the sick and injured, especially in a critical care capacity, in the prolonged austere setting (past the initial stabilization period): Monitoring, Resuscitation, Ventilation/Oxygenation, Airway, Sedation/Analgesia, Physical Exam and Diagnostics, Nursing and Hygiene, Surgical Intervention, Telemedical Consult, and Package/Prepare for Flight. For each topic, they give minimum, better, and best reasonable capabilities, as well as a short list of what can be packed in a pack, trunk bag, home, or transport plane.

The good news is this is already tailored for a limited amount of care providers in less than ideal conditions. The bad news is that it assumes the provider is a SF Independent duty provider working with a DoD sized budget. But I still think there's a lot to learn here. Lets go through the headings one by one.

Monitoring: This is a fairly straight forward item, and a no brainer for the most part. But is it? In theory, I would say most people interested in first aid know how to take a pulse. But how many of you regularly check pusles? I work full time in EM and there are many, many times where I have to search for a palpable pulse (especially in an injured limb), and wind up checking with other providers for their opinion. I would suggest anyone interested in administering first aid in a disaster to start taking vital signs when your family members get sick. A full set. Find pulses, if you have a stethoscope and cuff take blood pressures to practice. If you've got an SpO2 probe, use it when someone has a respiratory illness. Learn your machine's limitations, but also what it can do for you (I especially recommend this if you have a CHFer, COPDer, or Asthmatic at home.) Also start charting and trending vitals. Figure out how you like your patient care sheets laid out.

Resuscitation To be honest, never in my life have I thought about giving a buddy transfusion in the field. But I think with the research we've seen from the GWOT, I could see it becoming a remote care provider skill set in the next 10 years. I can not even remotely suggest it for the lay provider, but I can see it becoming a disaster event standard of care sooner rather than later. As far as IV fluids, how much and what to carry has varied a ton in the past 20 years. There's still, absolutely, a place for crystaloid in resuscitation, ESPECIALLY when blood products are not on the table. For the professional care provider, I would listen to the hype and not flood out your patients, but don't assume that you'll never need a 500ml bag or some LR for burn care.

Ventilation/Oxygenation For the lay provider, I would say this is going to be limited to either pocket mask or BVM use I would say to know if anyone immediately local to you has a home use O2 tank, and to see what you'd need to make it work with your O2 supply devices. For the professional provider, throwing a Peep valve in with your ventilation kit adds almost no weight, and there are some serious upsides to patient outcome with some Expiritory pressure.

Airway The 10 point list mostly deals with sedation and surgical crics, but I think the airway concept is worth talking about here on the BLS level. NPA's are a must, OPS's also have their place. LMA/SGA's can be used, but require a sedated or patient without a gag reflex. I also feel suction needs to be discussed in any good airway control piece, so a way to manually clear the airway is going to be important in any field critical care scenario. For the professional provider, ETT and RSI are great, but how much sedation do you carry? What methods do you have of keeping your patient down?

Sedation and Analgesia Again, tricky for the unlicensed provider. You should think about all/any ways you have to treat a casualty for pain.

Exam and Diagnostics In this category, I would suggest further experience/study in a good advanced exam, for example ENT, eye abnormalities, and to be well versed in any point of care diagnostics that may be relevant to your family.

Nursing Care Do you have a way to keep a patient warm? How about caring for their bathroom needs, or oral care? What do your capacities look like for dressing changes? How much studying have you done regarding long term wound care, or alternative wound closure methods, when antibiotics aren't widely available? Do you have the means to irrigate a wound well? Do you know about RoM exercises, or rotating your patient to prevent pressure based skin breakdown?

Surgical Intervention Now, obviously most of us are not going to be doing cut downs or surgical repairs. But let me ask you this, what is the cleanest you could get your care area if you needed to perform a wound washout or take a look at a traumatic injury? Do you have proper PPE? Disinfectant? Iodine for skin prep? How would you set up for a "clean" procedure if you needed to?

Telemedical consult Critical in this column would be the ability to communicate with care providers far from you. Written, current numbers for local trauma centers, burn centers, etc, as well as an austere telemedicine consult script, will go far in this area. Do not forget to include information as to what capabilities you have at hand.

Package/Prep for Flight As far as this goes, some thought should be put into how you would package and pack a patient for improvised critical care transport in a disaster. What would you bring? Where would you go?

So, that's a good start. Thoughts? Suggestions? Ideas?


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 Post subject: Re: Prolonged Field Care
PostPosted: Mon Jan 30, 2017 5:23 pm 
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Merlin - Since I'll probably never have a cuff/scope in the field - are the pulse points still reliable indicators of BP? radial (>80)/cartoid (>70)/femoral(>50)?
I thought they had been disproved, but was passed along as an anecdote by one of the instructors in a recert I had to do last month?

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 Post subject: Re: Prolonged Field Care
PostPosted: Mon Jan 30, 2017 5:37 pm 
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SCBrian wrote:
Merlin - Since I'll probably never have a cuff/scope in the field - are the pulse points still reliable indicators of BP? radial (>80)/cartoid (>70)/femoral(>50)?
I thought they had been disproved, but was passed along as an anecdote by one of the instructors in a recert I had to do last month?


Yes and no. I usually count Radial, Femoral, and Carotid pulses for perfusion indicators. Radial will drop out first, Femoral second as the limbs shunt towards the core, then Carotid. I do not think it can be assigned to any specific systolic BP(the part that had been disproved), but you can generally count on them to drop out in that order. The way I would use pulse location is by tracking where I can find a pulse at regular intervals, IE if you can't find a radial any more but can find a femoral, the pt is getting sicker, but isn't dead yet. Pressure support measures could be taken at that time.


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 Post subject: Re: Prolonged Field Care
PostPosted: Mon Jan 30, 2017 8:33 pm 
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Makes sense, thanks!

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 Post subject: Re: Prolonged Field Care
PostPosted: Wed Feb 08, 2017 11:01 pm 
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Hello. Been away a long time....that isn't exactly new info. We have been doing most of that and more in the field for the last two or three years. Matter of fact, when I get home, I can explain more. If anything, you guys would do well to learn how to source any medical equipment or improvise any medical equipment in your AO. Talk more when I get back, six weeks. BTW, you need to know LONG BEFORE the decrease in palpable pulses in those areas that your patient is shutting the bed. I very , very rarely ever even have a stethoscope or BP cuff, they aren't in either of my two bags with me at all times. We do buddy transfusions and have for awhile. There's even SOF kits that can be bought for the purpose. I first l earned to do the AT THE VETS OFFICE.....Hespan is what's used with saline. I have four 500cc bags on me right now. Don't count on any telemedicine consult. I'm working with the director of TCCC for basically the U.S. Military right now and having some I interesting conversations. We work with different nations so are comparing notes. I wouldn't count on you getting any orders. Sometimes the French version of the 9 Line MedEvac includes updates and orders instead of our normAl ninth line...ok, gotta go, be safe.


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 Post subject: Re: Prolonged Field Care
PostPosted: Thu Feb 09, 2017 12:28 am 
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 Post subject: Re: Prolonged Field Care
PostPosted: Sun Feb 12, 2017 9:17 pm 
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IANMCDEVITT wrote:
Hello. Been away a long time....that isn't exactly new info. We have been doing most of that and more in the field for the last two or three years. Matter of fact, when I get home, I can explain more. If anything, you guys would do well to learn how to source any medical equipment or improvise any medical equipment in your AO. Talk more when I get back, six weeks. BTW, you need to know LONG BEFORE the decrease in palpable pulses in those areas that your patient is shutting the bed. I very , very rarely ever even have a stethoscope or BP cuff, they aren't in either of my two bags with me at all times. We do buddy transfusions and have for awhile. There's even SOF kits that can be bought for the purpose. I first l earned to do the AT THE VETS OFFICE.....Hespan is what's used with saline. I have four 500cc bags on me right now. Don't count on any telemedicine consult. I'm working with the director of TCCC for basically the U.S. Military right now and having some I interesting conversations. We work with different nations so are comparing notes. I wouldn't count on you getting any orders. Sometimes the French version of the 9 Line MedEvac includes updates and orders instead of our normAl ninth line...ok, gotta go, be safe.


Breaking News, civilian pre-hospital care is a decade behind the military model...Details at 11:00...

Kidding, you make some good points. I think that there are some great takeaways at the PFC website that a lot of EMS and disaster prep enthusiasts just aren't talking about at this point. TCCC is still considered a hot topic, when at this point the SOF groundwork is close to 20 years old.

More than anything, I think the mindset/perspective shift of having to stay in place, and planning to stay in place, with the critically ill and injured to be something that, at least here at ZS, we have not really looked at in the past.


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